<a id="pl.1.3"></a><var>1.3</var>claim filing; establishing compliance procedures for electronic transactions;<br/>
<a id="pl.1.4"></a><var>1.4</var>amending Minnesota Statutes 2006, sections 62J.51, subdivisions 17, 18; <br/>
<a id="pl.1.5"></a><var>1.5</var>62J.52, subdivision 4; 62J.59; 72A.201, subdivision 4; Minnesota Statutes <br/>
<a id="pl.1.6"></a><var>1.6</var>2007 Supplement, sections 62J.52, subdivisions 1, 2; 62J.536, subdivision 1, <br/>
<a id="pl.1.7"></a><var>1.7</var>by adding subdivisions; repealing Minnesota Statutes 2006, sections 62J.52, <br/>
<a id="pl.1.8"></a><var>1.8</var>subdivision 5; 62J.58.<br/>
<a id="pl.1.9"></a><var>1.9</var>BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:<br/>
<br/>
<a id="bill.0.1.0"></a><a id="pl.1.10"></a><var>1.10</var>    Section 1. Minnesota Statutes 2006, section 62J.51, subdivision 17, is amended to read:<br/>
<a id="pl.1.11"></a><var>1.11</var>    Subd. 17. <b>Uniform billing form CMS 1450.</b> "Uniform billing form CMS 1450" <br/>
<a id="pl.1.12"></a><var>1.12</var>means the most current version of the uniform billing form known as the CMS 1450 or <br/>
<a id="pl.1.13"></a><var>1.13</var>UB92, developed by the National Uniform Billing Committee in 1992 and approved for <br/>
<a id="pl.1.14"></a><var>1.14</var>implementation in October 1993, and any subsequent amendments to the form.<br/>
<br/>
<a id="bill.0.2.0"></a><a id="pl.1.15"></a><var>1.15</var>    Sec. 2. Minnesota Statutes 2006, section 62J.51, subdivision 18, is amended to read:<br/>
<a id="pl.1.16"></a><var>1.16</var>    Subd. 18. <b>Uniform billing form CMS 1500.</b> "Uniform billing form CMS 1500" <br/>
<a id="pl.1.17"></a><var>1.17</var>means the 1990 most current version of the health insurance claim form, CMS 1500, <br/>
<a id="pl.1.18"></a><var>1.18</var>developed by the National Uniform Claim Committee and any subsequent amendments to <br/>
<a id="pl.1.19"></a><var>1.19</var>the form.<br/>
<br/>
<a id="bill.0.3.0"></a><a id="pl.1.20"></a><var>1.20</var>    Sec. 3. Minnesota Statutes 2007 Supplement, section 62J.52, subdivision 1, is amended <br/>
<a id="pl.1.21"></a><var>1.21</var>to read:<br/>
<a id="pl.1.22"></a><var>1.22</var>    Subdivision 1. <b>Uniform billing form CMS 1450.</b> (a) On and after January 1, <br/>
<a id="pl.1.23"></a><var>1.23</var>1996, all institutional inpatient hospital services, ancillary services, institutionally owned <br/>
<a id="pl.1.24"></a><var>1.24</var>or operated outpatient services rendered by providers in Minnesota, and institutional <br/>
<a id="pl.2.1"></a><var>2.1</var>or noninstitutional home health services that are not being billed using an equivalent <br/>
<a id="pl.2.2"></a><var>2.2</var>electronic billing format, must be billed using the uniform billing form CMS 1450, except <br/>
<a id="pl.2.3"></a><var>2.3</var>as provided in subdivision 5.<br/>
<a id="pl.2.4"></a><var>2.4</var>    (b) The instructions and definitions for the use of the uniform billing form CMS <br/>
<a id="pl.2.5"></a><var>2.5</var>1450 shall be in accordance with the uniform billing form manual specified by the <br/>
<a id="pl.2.6"></a><var>2.6</var>commissioner. In promulgating these instructions, the commissioner may utilize the <br/>
<a id="pl.2.7"></a><var>2.7</var>manual developed by the National Uniform Billing Committee, as adopted and finalized <br/>
<a id="pl.2.8"></a><var>2.8</var>by the Minnesota Uniform Billing Committee.<br/>
<a id="pl.2.9"></a><var>2.9</var>    (c) Services to be billed using the uniform billing form CMS 1450 include: <br/>
<a id="pl.2.10"></a><var>2.10</var>institutional inpatient hospital services and distinct units in the hospital such as psychiatric <br/>
<a id="pl.2.11"></a><var>2.11</var>unit services, physical therapy unit services, swing bed (SNF) services, inpatient state <br/>
<a id="pl.2.12"></a><var>2.12</var>psychiatric hospital services, inpatient skilled nursing facility services, home health <br/>
<a id="pl.2.13"></a><var>2.13</var>services (Medicare part A), and hospice services; ancillary services, where benefits are <br/>
<a id="pl.2.14"></a><var>2.14</var>exhausted or patient has no Medicare part A, from hospitals, state psychiatric hospitals, <br/>
<a id="pl.2.15"></a><var>2.15</var>skilled nursing facilities, ICF/MR's, and home health (Medicare part B); institutional <br/>
<a id="pl.2.16"></a><var>2.16</var>owned or operated outpatient services such as waivered services, hospital outpatient <br/>
<a id="pl.2.17"></a><var>2.17</var>services, including ambulatory surgical center services, hospital referred laboratory <br/>
<a id="pl.2.18"></a><var>2.18</var>services, hospital-based ambulance services, and other hospital outpatient services, <br/>
<a id="pl.2.19"></a><var>2.19</var>skilled nursing facilities, home health, freestanding renal dialysis centers, comprehensive <br/>
<a id="pl.2.20"></a><var>2.20</var>outpatient rehabilitation facilities (CORF), outpatient rehabilitation facilities (ORF), rural <br/>
<a id="pl.2.21"></a><var>2.21</var>health clinics, federally qualified health centers, and community mental health centers; <br/>
<a id="pl.2.22"></a><var>2.22</var>home health services such as home health intravenous therapy providers, waivered <br/>
<a id="pl.2.23"></a><var>2.23</var>services, personal care attendants, and hospice; and any other health care provider certified <br/>
<a id="pl.2.24"></a><var>2.24</var>by the Medicare program to use this form.<br/>
<a id="pl.2.25"></a><var>2.25</var>    (d) On and after January 1, 1996, a mother and newborn child must be billed <br/>
<a id="pl.2.26"></a><var>2.26</var>separately, and must not be combined on one claim form.<br/>
<a id="pl.2.27"></a><var>2.27</var>    (e) Services provided by Medicare Critical Access Hospitals electing Method <br/>
<a id="pl.2.28"></a><var>2.28</var>II billing will be allowed an exception to this provision to allow the inclusion of the <br/>
<a id="pl.2.29"></a><var>2.29</var>professional fees on the CMS 1450.<br/>
<br/>
<a id="bill.0.4.0"></a><a id="pl.2.30"></a><var>2.30</var>    Sec. 4. Minnesota Statutes 2007 Supplement, section 62J.52, subdivision 2, is amended <br/>
<a id="pl.2.31"></a><var>2.31</var>to read:<br/>
<a id="pl.2.32"></a><var>2.32</var>    Subd. 2. <b>Uniform billing form CMS 1500.</b> (a) On and after January 1, 1996, all <br/>
<a id="pl.2.33"></a><var>2.33</var>noninstitutional health care services rendered by providers in Minnesota except dental <br/>
<a id="pl.2.34"></a><var>2.34</var>or pharmacy providers, that are not currently being billed using an equivalent electronic <br/>
<a id="pl.3.1"></a><var>3.1</var>billing format, must be billed using the health insurance claim form CMS 1500, except as <br/>
<a id="pl.3.2"></a><var>3.2</var>provided in subdivision 5.<br/>
<a id="pl.3.3"></a><var>3.3</var>    (b) The instructions and definitions for the use of the uniform billing form CMS <br/>
<a id="pl.3.4"></a><var>3.4</var>1500 shall be in accordance with the manual developed by the Administrative Uniformity <br/>
<a id="pl.3.5"></a><var>3.5</var>Committee entitled standards for the use of the CMS 1500 form, dated February 1994, <br/>
<a id="pl.3.6"></a><var>3.6</var>as further defined by the commissioner.<br/>
<a id="pl.3.7"></a><var>3.7</var>    (c) Services to be billed using the uniform billing form CMS 1500 include physician <br/>
<a id="pl.3.8"></a><var>3.8</var>services and supplies, durable medical equipment, noninstitutional ambulance services, <br/>
<a id="pl.3.9"></a><var>3.9</var>independent ancillary services including occupational therapy, physical therapy, speech <br/>
<a id="pl.3.10"></a><var>3.10</var>therapy and audiology, home infusion therapy, podiatry services, optometry services, <br/>
<a id="pl.3.11"></a><var>3.11</var>mental health licensed professional services, substance abuse licensed professional <br/>
<a id="pl.3.12"></a><var>3.12</var>services, nursing practitioner professional services, certified registered nurse anesthetists, <br/>
<a id="pl.3.13"></a><var>3.13</var>chiropractors, physician assistants, laboratories, medical suppliers, waivered services, <br/>
<a id="pl.3.14"></a><var>3.14</var>personal care attendants, and other health care providers such as day activity centers and <br/>
<a id="pl.3.15"></a><var>3.15</var>freestanding ambulatory surgical centers.<br/>
<a id="pl.3.16"></a><var>3.16</var>    (d) Services provided by Medicare Critical Access Hospitals electing Method <br/>
<a id="pl.3.17"></a><var>3.17</var>II billing will be allowed an exception to this provision to allow the inclusion of the <br/>
<a id="pl.3.18"></a><var>3.18</var>professional fees on the CMS 1450.<br/>
<br/>
<a id="bill.0.5.0"></a><a id="pl.3.19"></a><var>3.19</var>    Sec. 5. Minnesota Statutes 2006, section 62J.52, subdivision 4, is amended to read:<br/>
<a id="pl.3.20"></a><var>3.20</var>    Subd. 4. <b>Uniform pharmacy billing form.</b> (a) On and after January 1, 1996, <br/>
<a id="pl.3.21"></a><var>3.21</var>all pharmacy services provided by pharmacists in Minnesota that are not currently <br/>
<a id="pl.3.22"></a><var>3.22</var>being billed using an equivalent electronic billing format shall be billed using the <br/>
<a id="pl.3.23"></a><var>3.23</var>NCPDP/universal claim form, except as provided in subdivision 5.<br/>
<a id="pl.3.24"></a><var>3.24</var>(b) The instructions and definitions for the use of the uniform claim form shall <br/>
<a id="pl.3.25"></a><var>3.25</var>be in accordance with instructions specified by the commissioner of health, except as <br/>
<a id="pl.3.26"></a><var>3.26</var>provided in subdivision 5.<br/>
<br/>
<a id="bill.0.6.0"></a><a id="pl.3.27"></a><var>3.27</var>    Sec. 6. Minnesota Statutes 2007 Supplement, section 62J.536, subdivision 1, is <br/>
<a id="pl.3.28"></a><var>3.28</var>amended to read:<br/>
<a id="pl.3.29"></a><var>3.29</var>    Subdivision 1. <b>Electronic claims and eligibility transactions required.</b> (a) <br/>
<a id="pl.3.30"></a><var>3.30</var>Beginning January 15, 2009, all group purchasers must accept from health care providers <br/>
<a id="pl.3.31"></a><var>3.31</var>the eligibility for a health plan transaction described under Code of Federal Regulations, <br/>
<a id="pl.3.32"></a><var>3.32</var>title 45, part 162, subpart L. Beginning July 15, 2009, all group purchasers must accept <br/>
<a id="pl.3.33"></a><var>3.33</var>from health care providers the health care claims or equivalent encounter information <br/>
<a id="pl.3.34"></a><var>3.34</var>transaction described under Code of Federal Regulations, title 45, part 162, subpart K.<br/>
<a id="pl.4.1"></a><var>4.1</var>    (b) Beginning January 15, 2009, all group purchasers must transmit to providers <br/>
<a id="pl.4.2"></a><var>4.2</var>the eligibility for a health plan transaction described under Code of Federal Regulations, <br/>
<a id="pl.4.3"></a><var>4.3</var>title 45, part 162, subpart L. Beginning December 1 15, 2009, all group purchasers must <br/>
<a id="pl.4.4"></a><var>4.4</var>transmit to providers the health care payment and remittance advice transaction described <br/>
<a id="pl.4.5"></a><var>4.5</var>under Code of Federal Regulations, title 45, part 162, subpart P.<br/>
<a id="pl.4.6"></a><var>4.6</var>    (c) Beginning January 15, 2009, all health care providers must submit to group <br/>
<a id="pl.4.7"></a><var>4.7</var>purchasers the eligibility for a health plan transaction described under Code of Federal <br/>
<a id="pl.4.8"></a><var>4.8</var>Regulations, title 45, part 162, subpart L. Beginning July 15, 2009, all health care <br/>
<a id="pl.4.9"></a><var>4.9</var>providers must submit to group purchasers the health care claims or equivalent encounter <br/>
<a id="pl.4.10"></a><var>4.10</var>information transaction described under Code of Federal Regulations, title 45, part 162, <br/>
<a id="pl.4.11"></a><var>4.11</var>subpart K.<br/>
<a id="pl.4.12"></a><var>4.12</var>    (d) Beginning January 15, 2009, all health care providers must accept from group <br/>
<a id="pl.4.13"></a><var>4.13</var>purchasers the eligibility for a health plan transaction described under Code of Federal <br/>
<a id="pl.4.14"></a><var>4.14</var>Regulations, title 45, part 162, subpart L. Beginning December 15, 2009, all health care <br/>
<a id="pl.4.15"></a><var>4.15</var>providers must accept from group purchasers the health care payment and remittance <br/>
<a id="pl.4.16"></a><var>4.16</var>advice transaction described under Code of Federal Regulations, title 45, part 162, subpart <br/>
<a id="pl.4.17"></a><var>4.17</var>P.<br/>
<a id="pl.4.18"></a><var>4.18</var>    (e) Each of the transactions described in paragraphs (a) to (d) shall require the use <br/>
<a id="pl.4.19"></a><var>4.19</var>of a single, uniform companion guide to the implementation guides described under <br/>
<a id="pl.4.20"></a><var>4.20</var>Code of Federal Regulations, title 45, part 162. The companion guides will be developed <br/>
<a id="pl.4.21"></a><var>4.21</var>pursuant to subdivision 2.<br/>
<a id="pl.4.22"></a><var>4.22</var>    (f) Notwithstanding any other provisions in sections 
         <statute_ref>62J.50</statute_ref> to 
         <statute_ref>62J.61</statute_ref>, all group <br/>
<a id="pl.4.23"></a><var>4.23</var>purchasers and health care providers must exchange claims and eligibility information <br/>
<a id="pl.4.24"></a><var>4.24</var>electronically using the transactions, companion guides, implementation guides, and <br/>
<a id="pl.4.25"></a><var>4.25</var>timelines required under this subdivision. Group purchasers may not impose any fee on <br/>
<a id="pl.4.26"></a><var>4.26</var>providers for the use of the transactions prescribed in this subdivision.<br/>
<a id="pl.4.27"></a><var>4.27</var>    (g) Nothing in this subdivision shall prohibit group purchasers and health care <br/>
<a id="pl.4.28"></a><var>4.28</var>providers from using a direct data entry, Web-based methodology for complying with <br/>
<a id="pl.4.29"></a><var>4.29</var>the requirements of this subdivision. Any direct data entry method for conducting <br/>
<a id="pl.4.30"></a><var>4.30</var>the transactions specified in this subdivision must be consistent with the data content <br/>
<a id="pl.4.31"></a><var>4.31</var>component of the single, uniform companion guides required in paragraph (e) and the <br/>
<a id="pl.4.32"></a><var>4.32</var>implementation guides described under Code of Federal Regulations, title 45, part 162.<br/>
<br/>
<a id="bill.0.7.0"></a><a id="pl.4.33"></a><var>4.33</var>    Sec. 7. Minnesota Statutes 2007 Supplement, section 62J.536, is amended by adding a <br/>
<a id="pl.4.34"></a><var>4.34</var>subdivision to read:<br/>
<a id="pl.5.1"></a><var>5.1</var>    Subd. 4. <b>Group purchasers not covered by HIPAA.</b> (a) For transactions with <br/>
<a id="pl.5.2"></a><var>5.2</var>group purchasers defined in section 62J.03, subdivision 6, that are not covered under <br/>
<a id="pl.5.3"></a><var>5.3</var>United States Code, title 42, sections 1320d to 1320d-8, the requirements of this section <br/>
<a id="pl.5.4"></a><var>5.4</var>are modified as follows:<br/>
<a id="pl.5.5"></a><var>5.5</var>(1) The group purchasers may be exempt from one or more of the requirements <br/>
<a id="pl.5.6"></a><var>5.6</var>to exchange claims and eligibility information electronically using the transactions, <br/>
<a id="pl.5.7"></a><var>5.7</var>companion guides, implementation guides, and timelines in subdivision 1 if the <br/>
<a id="pl.5.8"></a><var>5.8</var>commissioner of health determines that:<br/>
<a id="pl.5.9"></a><var>5.9</var>(i) a transaction is incapable of exchanging data that are currently being exchanged <br/>
<a id="pl.5.10"></a><var>5.10</var>on paper and is necessary to accomplish the purpose of the transaction; or<br/>
<a id="pl.5.11"></a><var>5.11</var>(ii) another national electronic transaction standard would be more appropriate and <br/>
<a id="pl.5.12"></a><var>5.12</var>effective to accomplish the purpose of the transaction.<br/>
<a id="pl.5.13"></a><var>5.13</var>(2) If group purchasers are exempt from one or more of the requirements to exchange <br/>
<a id="pl.5.14"></a><var>5.14</var>claims and eligibility information electronically using the transactions, companion guides, <br/>
<a id="pl.5.15"></a><var>5.15</var>implementation guides, and timelines in subdivision 1, providers shall also be exempt <br/>
<a id="pl.5.16"></a><var>5.16</var>from exchanging those transactions with the group purchaser.<br/>
<a id="pl.5.17"></a><var>5.17</var>(3) If the commissioner of health exempts a group purchaser from one or more of <br/>
<a id="pl.5.18"></a><var>5.18</var>the requirements because a transaction is incapable of exchanging data that are currently <br/>
<a id="pl.5.19"></a><var>5.19</var>being exchanged on paper and are necessary to accomplish the purpose of the transaction, <br/>
<a id="pl.5.20"></a><var>5.20</var>the commissioner shall review that exemption annually. If the commissioner determines <br/>
<a id="pl.5.21"></a><var>5.21</var>that the exemption is no longer necessary or appropriate, the commissioner of health shall <br/>
<a id="pl.5.22"></a><var>5.22</var>adopt rules pursuant to section 62J.61 establishing and requiring group purchasers and <br/>
<a id="pl.5.23"></a><var>5.23</var>health care providers to use the transactions and the uniform, standard companion guides <br/>
<a id="pl.5.24"></a><var>5.24</var>required under subdivision 1, paragraph (e). Group purchasers and providers shall have 12 <br/>
<a id="pl.5.25"></a><var>5.25</var>months to implement any rules adopted.<br/>
<a id="pl.5.26"></a><var>5.26</var>(4) If the commissioner of health exempts a group purchaser from one or more of <br/>
<a id="pl.5.27"></a><var>5.27</var>the requirements because another national electronic transaction standard would be more <br/>
<a id="pl.5.28"></a><var>5.28</var>appropriate and effective to accomplish the purpose of the transaction, the commissioner <br/>
<a id="pl.5.29"></a><var>5.29</var>shall adopt rules pursuant to section 62J.61 establishing and requiring group purchasers <br/>
<a id="pl.5.30"></a><var>5.30</var>and health care providers to use the national electronic transaction standard. Group <br/>
<a id="pl.5.31"></a><var>5.31</var>purchasers and providers shall have 12 months to implement any rules adopted.<br/>
<a id="pl.5.32"></a><var>5.32</var>(5) The requirement of paper claims attachments shall not indicate that a health <br/>
<a id="pl.5.33"></a><var>5.33</var>care claims or equivalent encounter information transaction described under Code of <br/>
<a id="pl.5.34"></a><var>5.34</var>Federal Regulations, title 45, part 162, subpart K, is incapable of exchanging data that <br/>
<a id="pl.5.35"></a><var>5.35</var>are currently being exchanged on paper provided that the electronic health care claims <br/>
<a id="pl.5.36"></a><var>5.36</var>transaction has a mechanism to link the paper attachments to the electronic claim.<br/>
<br/>
<a id="bill.0.8.0"></a><a id="pl.6.1"></a><var>6.1</var>    Sec. 8. Minnesota Statutes 2007 Supplement, section 62J.536, is amended by adding a <br/>
<a id="pl.6.2"></a><var>6.2</var>subdivision to read:<br/>
<a id="pl.6.3"></a><var>6.3</var>    Subd. 5. <b>Compliance and investigations.</b> (a) The commissioner of health shall, to <br/>
<a id="pl.6.4"></a><var>6.4</var>the extent practicable, seek the cooperation of health care providers and group purchasers <br/>
<a id="pl.6.5"></a><var>6.5</var>in obtaining compliance with this section and may provide technical assistance to health <br/>
<a id="pl.6.6"></a><var>6.6</var>care providers and group purchasers.<br/>
<a id="pl.6.7"></a><var>6.7</var>    (b) A person who believes a health care provider or group purchaser is not complying <br/>
<a id="pl.6.8"></a><var>6.8</var>with the requirements of this section may file a complaint with the commissioner of health. <br/>
<a id="pl.6.9"></a><var>6.9</var>Complaints filed under this section must meet the following requirements:<br/>
<a id="pl.6.10"></a><var>6.10</var>    (1) A complaint must be filed in writing, either on paper or electronically.<br/>
<a id="pl.6.11"></a><var>6.11</var>    (2) A complaint must name the person that is the subject of the complaint and <br/>
<a id="pl.6.12"></a><var>6.12</var>describe the acts or omissions believed to be in violation of this section.<br/>
<a id="pl.6.13"></a><var>6.13</var>    (3) A complaint must be filed within 180 days of when the complainant knew or <br/>
<a id="pl.6.14"></a><var>6.14</var>should have known that the act or omission complained of occurred.<br/>
<a id="pl.6.15"></a><var>6.15</var>    (4) The commissioner may prescribe additional procedures for the filing of <br/>
<a id="pl.6.16"></a><var>6.16</var>complaints as required to satisfy the requirements of this section.<br/>
<a id="pl.6.17"></a><var>6.17</var>    (c) The commissioner of health may investigate complaints filed under this section. <br/>
<a id="pl.6.18"></a><var>6.18</var>The investigation may include a review of the pertinent policies, procedures, or practices <br/>
<a id="pl.6.19"></a><var>6.19</var>of the health care provider or group purchaser and of the circumstances regarding any <br/>
<a id="pl.6.20"></a><var>6.20</var>alleged violation. At the time of initial written communication with the health care <br/>
<a id="pl.6.21"></a><var>6.21</var>provider or group purchaser about the complaint, the commissioner of health shall <br/>
<a id="pl.6.22"></a><var>6.22</var>describe the acts or omissions that are the basis of the complaint. The commissioner <br/>
<a id="pl.6.23"></a><var>6.23</var>may conduct compliance reviews to determine whether health care providers and group <br/>
<a id="pl.6.24"></a><var>6.24</var>purchasers are complying with this section.<br/>
<a id="pl.6.25"></a><var>6.25</var>    (d) Health care providers and group purchasers must cooperate with the <br/>
<a id="pl.6.26"></a><var>6.26</var>commissioner of health if the commissioner undertakes an investigation or compliance <br/>
<a id="pl.6.27"></a><var>6.27</var>review of the policies, procedures, or practices of the health care provider or group <br/>
<a id="pl.6.28"></a><var>6.28</var>purchaser to determine compliance with this section. This cooperation includes, but is <br/>
<a id="pl.6.29"></a><var>6.29</var>not limited to:<br/>
<a id="pl.6.30"></a><var>6.30</var>    (1) A health care provider or group purchaser must permit access by the <br/>
<a id="pl.6.31"></a><var>6.31</var>commissioner of health during normal business hours to its facilities, books, records, <br/>
<a id="pl.6.32"></a><var>6.32</var>accounts, and other sources of information that are pertinent to ascertaining compliance <br/>
<a id="pl.6.33"></a><var>6.33</var>with this section.<br/>
<a id="pl.6.34"></a><var>6.34</var>    (2) If any information required of a health care provider or group purchaser under <br/>
<a id="pl.6.35"></a><var>6.35</var>this section is in the exclusive possession of any other agency, institution, or person and <br/>
<a id="pl.6.36"></a><var>6.36</var>the other agency, institution, or person fails or refuses to furnish the information, the <br/>
<a id="pl.7.1"></a><var>7.1</var>health care provider or group purchaser must so certify and set forth what efforts it has <br/>
<a id="pl.7.2"></a><var>7.2</var>made to obtain the information.<br/>
<a id="pl.7.3"></a><var>7.3</var>    (3) Any individually identifiable health information obtained by the commissioner <br/>
<a id="pl.7.4"></a><var>7.4</var>of health in connection with an investigation or compliance review under this section <br/>
<a id="pl.7.5"></a><var>7.5</var>may not be used or disclosed by the commissioner of health, except as necessary for <br/>
<a id="pl.7.6"></a><var>7.6</var>ascertaining or enforcing compliance with this section.<br/>
<a id="pl.7.7"></a><var>7.7</var>    (e) If an investigation of a complaint indicates noncompliance, the commissioner <br/>
<a id="pl.7.8"></a><var>7.8</var>of health shall attempt to reach a resolution of the matter by informal means. Informal <br/>
<a id="pl.7.9"></a><var>7.9</var>means may include demonstrated compliance or a completed corrective action plan or <br/>
<a id="pl.7.10"></a><var>7.10</var>other agreement. If the matter is resolved by informal means, the commissioner of health <br/>
<a id="pl.7.11"></a><var>7.11</var>shall so inform the health care provider or group purchaser and, if the matter arose from a <br/>
<a id="pl.7.12"></a><var>7.12</var>complaint, the complainant, in writing. If the matter is not resolved by informal means, <br/>
<a id="pl.7.13"></a><var>7.13</var>the commissioner of health shall:<br/>
<a id="pl.7.14"></a><var>7.14</var>    (1) inform the health care provider or group purchaser and provide an opportunity <br/>
<a id="pl.7.15"></a><var>7.15</var>for the health care provider or group purchaser to submit written evidence of any <br/>
<a id="pl.7.16"></a><var>7.16</var>mitigating factors or other considerations. The health care provider or group purchaser <br/>
<a id="pl.7.17"></a><var>7.17</var>must submit any such evidence to the commissioner of health within 30 calendar days <br/>
<a id="pl.7.18"></a><var>7.18</var>of receipt of the notification; and<br/>
<a id="pl.7.19"></a><var>7.19</var>    (2) inform the health care provider or group purchaser, through a notice of proposed <br/>
<a id="pl.7.20"></a><var>7.20</var>determination according to paragraph (i), that the commissioner of health finds that a <br/>
<a id="pl.7.21"></a><var>7.21</var>civil money penalty should be imposed.<br/>
<a id="pl.7.22"></a><var>7.22</var>    (f) If, after an investigation or a compliance review, the commissioner of health <br/>
<a id="pl.7.23"></a><var>7.23</var>determines that further action is not warranted, the commissioner of health shall so inform <br/>
<a id="pl.7.24"></a><var>7.24</var>the health care provider or group purchaser and, if the matter arose from a complaint, the <br/>
<a id="pl.7.25"></a><var>7.25</var>complainant, in writing.<br/>
<a id="pl.7.26"></a><var>7.26</var>    (g) A health care provider or group purchaser may not threaten, intimidate, coerce, <br/>
<a id="pl.7.27"></a><var>7.27</var>harass, discriminate against, or take any other retaliatory action against any individual <br/>
<a id="pl.7.28"></a><var>7.28</var>or other person for:<br/>
<a id="pl.7.29"></a><var>7.29</var>    (1) filing of a complaint under this section;<br/>
<a id="pl.7.30"></a><var>7.30</var>    (2) testifying, assisting, or participating in an investigation, compliance review, <br/>
<a id="pl.7.31"></a><var>7.31</var>proceeding, or contested case proceeding under this section; or<br/>
<a id="pl.7.32"></a><var>7.32</var>    (3) opposing any act or practice made unlawful by this section, provided the <br/>
<a id="pl.7.33"></a><var>7.33</var>individual or person has a good faith belief that the practice opposed is unlawful, and <br/>
<a id="pl.7.34"></a><var>7.34</var>the manner of opposition is reasonable and does not involve an unauthorized disclosure <br/>
<a id="pl.7.35"></a><var>7.35</var>of a patient's health information.<br/>
<a id="pl.8.1"></a><var>8.1</var>    (h) The commissioner of health may impose a civil money penalty on a health care <br/>
<a id="pl.8.2"></a><var>8.2</var>provider or group purchaser if the commissioner of health determines that the health <br/>
<a id="pl.8.3"></a><var>8.3</var>care provider or group purchaser has violated this section. If the commissioner of health <br/>
<a id="pl.8.4"></a><var>8.4</var>determines that more than one health care provider or group purchaser was responsible <br/>
<a id="pl.8.5"></a><var>8.5</var>for a violation, the commissioner of health may impose a civil money penalty against <br/>
<a id="pl.8.6"></a><var>8.6</var>each health care provider or group purchaser. The amount of a civil money penalty shall <br/>
<a id="pl.8.7"></a><var>8.7</var>be determined as follows:<br/>
<a id="pl.8.8"></a><var>8.8</var>    (1) The amount of a civil money penalty shall be up to $100 for each violation, but <br/>
<a id="pl.8.9"></a><var>8.9</var>not exceed $25,000 for identical violations during a calendar year.<br/>
<a id="pl.8.10"></a><var>8.10</var>    (2) In the case of continuing violation of this section, a separate violation occurs each <br/>
<a id="pl.8.11"></a><var>8.11</var>business day that the health care provider or group purchaser is in violation of this section.<br/>
<a id="pl.8.12"></a><var>8.12</var>    (3) In determining the amount of any civil money penalty, the commissioner of health <br/>
<a id="pl.8.13"></a><var>8.13</var>may consider as aggravating or mitigating factors, as appropriate, any of the following:<br/>
<a id="pl.8.14"></a><var>8.14</var>    (i) the nature of the violation, in light of the purpose of the goals of this section;<br/>
<a id="pl.8.15"></a><var>8.15</var>    (ii) the time period during which the violation occurred;<br/>
<a id="pl.8.16"></a><var>8.16</var>    (iii) whether the violation hindered or facilitated an individual's ability to obtain <br/>
<a id="pl.8.17"></a><var>8.17</var>health care;<br/>
<a id="pl.8.18"></a><var>8.18</var>    (iv) whether the violation resulted in financial harm;<br/>
<a id="pl.8.19"></a><var>8.19</var>    (v) whether the violation was intentional;<br/>
<a id="pl.8.20"></a><var>8.20</var>    (vi) whether the violation was beyond the direct control of the health care provider <br/>
<a id="pl.8.21"></a><var>8.21</var>or group purchaser;<br/>
<a id="pl.8.22"></a><var>8.22</var>    (vii) any history of prior compliance with the provisions of this section, including <br/>
<a id="pl.8.23"></a><var>8.23</var>violations;<br/>
<a id="pl.8.24"></a><var>8.24</var>    (viii) whether and to what extent the provider or group purchaser has attempted to <br/>
<a id="pl.8.25"></a><var>8.25</var>correct previous violations;<br/>
<a id="pl.8.26"></a><var>8.26</var>    (ix) how the health care provider or group purchaser has responded to technical <br/>
<a id="pl.8.27"></a><var>8.27</var>assistance from the commissioner of health provided in the context of a compliance <br/>
<a id="pl.8.28"></a><var>8.28</var>effort; or<br/>
<a id="pl.8.29"></a><var>8.29</var>    (x) the financial condition of the health care provider or group purchaser including, <br/>
<a id="pl.8.30"></a><var>8.30</var>but not limited to, whether the healthcare provider or group purchaser had financial <br/>
<a id="pl.8.31"></a><var>8.31</var>difficulties that affected its ability to comply or whether the imposition of a civil money <br/>
<a id="pl.8.32"></a><var>8.32</var>penalty would jeopardize the ability of the health care provider or group purchaser to <br/>
<a id="pl.8.33"></a><var>8.33</var>continue to provide, or to pay for, health care.<br/>
<a id="pl.8.34"></a><var>8.34</var>    (i) If a penalty is proposed according to this section, the commissioner of health <br/>
<a id="pl.8.35"></a><var>8.35</var>must deliver, or send by certified mail with return receipt requested, to the respondent <br/>
<a id="pl.9.1"></a><var>9.1</var>written notice of the commissioner of health's intent to impose a penalty. This notice <br/>
<a id="pl.9.2"></a><var>9.2</var>of proposed determination must include:<br/>
<a id="pl.9.3"></a><var>9.3</var>    (1) a reference to the statutory basis for the penalty;<br/>
<a id="pl.9.4"></a><var>9.4</var>    (2) a description of the findings of fact regarding the violations with respect to <br/>
<a id="pl.9.5"></a><var>9.5</var>which the penalty is proposed;<br/>
<a id="pl.9.6"></a><var>9.6</var>    (3) the amount of the proposed penalty;<br/>
<a id="pl.9.7"></a><var>9.7</var>    (4) any circumstances described in paragraph (i) that were considered in determining <br/>
<a id="pl.9.8"></a><var>9.8</var>the amount of the proposed penalty;<br/>
<a id="pl.9.9"></a><var>9.9</var>    (5) instructions for responding to the notice, including a statement of the respondent's <br/>
<a id="pl.9.10"></a><var>9.10</var>right to a contested case proceeding and a statement that failure to request a contested case <br/>
<a id="pl.9.11"></a><var>9.11</var>proceeding within 30 calendar days permits the imposition of the proposed penalty; and <br/>
<a id="pl.9.12"></a><var>9.12</var>    (6) the address to which the contested case proceeding request must be sent.<br/>
<a id="pl.9.13"></a><var>9.13</var>    (j) A health care provider or group purchaser may contest whether the finding of <br/>
<a id="pl.9.14"></a><var>9.14</var>facts constitute a violation of this section, according to a contested case proceeding as set <br/>
<a id="pl.9.15"></a><var>9.15</var>forth in sections 14.57 to 14.62, subject to appeal according to sections 14.63 to 14.68.<br/>
<a id="pl.9.16"></a><var>9.16</var>    (k) Any data collected by the commissioner of health as part of an active <br/>
<a id="pl.9.17"></a><var>9.17</var>investigation or active compliance review under this section are classified as protected <br/>
<a id="pl.9.18"></a><var>9.18</var>nonpublic data pursuant to section 13.02, subdivision 13, in the case of data not on <br/>
<a id="pl.9.19"></a><var>9.19</var>individuals and confidential pursuant to section 13.02, subdivision 3, in the case of data <br/>
<a id="pl.9.20"></a><var>9.20</var>on individuals. Data describing the final disposition of an investigation or compliance <br/>
<a id="pl.9.21"></a><var>9.21</var>review are classified as public.<br/>
<a id="pl.9.22"></a><var>9.22</var>    (l) Civil money penalties imposed and collected under this subdivision shall be <br/>
<a id="pl.9.23"></a><var>9.23</var>deposited into a revolving fund and are appropriated to the commissioner of health for the <br/>
<a id="pl.9.24"></a><var>9.24</var>purposes of this subdivision, including the provision of technical assistance.<br/>
<br/>
<a id="bill.0.9.0"></a><a id="pl.9.25"></a><var>9.25</var>    Sec. 9. Minnesota Statutes 2006, section 62J.59, is amended to read:<br/>
<a id="pl.9.26"></a><var>9.26</var><b>62J.59 IMPLEMENTATION OF NCPDP TELECOMMUNICATIONS </b><br/>
<a id="pl.9.27"></a><var>9.27</var><b>STANDARD FOR PHARMACY CLAIMS.</b><br/>
<a id="pl.9.28"></a><var>9.28</var>    (a) Beginning January 1, 1996, All category I and II pharmacists pharmacies licensed <br/>
<a id="pl.9.29"></a><var>9.29</var>in this state shall accept use the most recent HIPAA-mandated version of the NCPDP <br/>
<a id="pl.9.30"></a><var>9.30</var>telecommunication standard format 3.2 or the NCPDP tape billing and payment format 2.0 <br/>
<a id="pl.9.31"></a><var>9.31</var>batch standard for the electronic submission of claims to group purchasers as appropriate.<br/>
<a id="pl.9.32"></a><var>9.32</var>    (b) Beginning January 1, 1996, All category I and category II group purchasers <br/>
<a id="pl.9.33"></a><var>9.33</var>in this state shall use the most recent HIPAA-mandated version of the NCPDP <br/>
<a id="pl.9.34"></a><var>9.34</var>telecommunication standard format 3.2 or NCPDP tape billing and payment format 2.0 <br/>
<a id="pl.10.1"></a><var>10.1</var>batch standard for the electronic submission of payment information NCPDP response <br/>
<a id="pl.10.2"></a><var>10.2</var>transaction to pharmacists pharmacies as appropriate.<br/>
<br/>
<a id="bill.0.10.0"></a><a id="pl.10.3"></a><var>10.3</var>    Sec. 10. Minnesota Statutes 2006, section 72A.201, subdivision 4, is amended to read:<br/>
<a id="pl.10.4"></a><var>10.4</var>    Subd. 4. <b>Standards for claim filing and handling.</b> The following acts by an <br/>
<a id="pl.10.5"></a><var>10.5</var>insurer, an adjuster, a self-insured, or a self-insurance administrator constitute unfair <br/>
<a id="pl.10.6"></a><var>10.6</var>settlement practices:<br/>
<a id="pl.10.7"></a><var>10.7</var>    (1) except for claims made under a health insurance policy, after receiving <br/>
<a id="pl.10.8"></a><var>10.8</var>notification of claim from an insured or a claimant, failing to acknowledge receipt of the <br/>
<a id="pl.10.9"></a><var>10.9</var>notification of the claim within ten business days, and failing to promptly provide all <br/>
<a id="pl.10.10"></a><var>10.10</var>necessary claim forms and instructions to process the claim, unless the claim is settled <br/>
<a id="pl.10.11"></a><var>10.11</var>within ten business days. The acknowledgment must include the telephone number of the <br/>
<a id="pl.10.12"></a><var>10.12</var>company representative who can assist the insured or the claimant in providing information <br/>
<a id="pl.10.13"></a><var>10.13</var>and assistance that is reasonable so that the insured or claimant can comply with the policy <br/>
<a id="pl.10.14"></a><var>10.14</var>conditions and the insurer's reasonable requirements. If an acknowledgment is made by <br/>
<a id="pl.10.15"></a><var>10.15</var>means other than writing, an appropriate notation of the acknowledgment must be made in <br/>
<a id="pl.10.16"></a><var>10.16</var>the claim file of the insurer and dated. An appropriate notation must include at least the <br/>
<a id="pl.10.17"></a><var>10.17</var>following information where the acknowledgment is by telephone or oral contact:<br/>
<a id="pl.10.18"></a><var>10.18</var>    (i) the telephone number called, if any;<br/>
<a id="pl.10.19"></a><var>10.19</var>    (ii) the name of the person making the telephone call or oral contact;<br/>
<a id="pl.10.20"></a><var>10.20</var>    (iii) the name of the person who actually received the telephone call or oral contact;<br/>
<a id="pl.10.21"></a><var>10.21</var>    (iv) the time of the telephone call or oral contact; and<br/>
<a id="pl.10.22"></a><var>10.22</var>    (v) the date of the telephone call or oral contact;<br/>
<a id="pl.10.23"></a><var>10.23</var>    (2) failing to reply, within ten business days of receipt, to all other communications <br/>
<a id="pl.10.24"></a><var>10.24</var>about a claim from an insured or a claimant that reasonably indicate a response is <br/>
<a id="pl.10.25"></a><var>10.25</var>requested or needed;<br/>
<a id="pl.10.26"></a><var>10.26</var>    (3)(i) unless provided otherwise by clause (ii) or (iii), other law, or in the policy, <br/>
<a id="pl.10.27"></a><var>10.27</var>failing to complete its investigation and inform the insured or claimant of acceptance or <br/>
<a id="pl.10.28"></a><var>10.28</var>denial of a claim within 30 business days after receipt of notification of claim unless <br/>
<a id="pl.10.29"></a><var>10.29</var>the investigation cannot be reasonably completed within that time. In the event that the <br/>
<a id="pl.10.30"></a><var>10.30</var>investigation cannot reasonably be completed within that time, the insurer shall notify <br/>
<a id="pl.10.31"></a><var>10.31</var>the insured or claimant within the time period of the reasons why the investigation is not <br/>
<a id="pl.10.32"></a><var>10.32</var>complete and the expected date the investigation will be complete. For claims made under <br/>
<a id="pl.10.33"></a><var>10.33</var>a health policy the notification of claim must be in writing;<br/>
<a id="pl.10.34"></a><var>10.34</var>    (ii) for claims submitted under a health policy, the insurer must comply with all of <br/>
<a id="pl.10.35"></a><var>10.35</var>the requirements of section 
         <statute_ref>62Q.75</statute_ref>;<br/>
<a id="pl.11.1"></a><var>11.1</var>    (iii) for claims submitted under a health policy that are accepted, the insurer must <br/>
<a id="pl.11.2"></a><var>11.2</var>notify the insured or claimant no less than semiannually of the disposition of claims of the <br/>
<a id="pl.11.3"></a><var>11.3</var>insured or claimant. Notwithstanding the requirements of section 72A.20, subdivision <br/>
<a id="pl.11.4"></a><var>11.4</var>37, this notification requirement is satisfied if the information related to the acceptance of <br/>
<a id="pl.11.5"></a><var>11.5</var>the claim is made accessible to the insured or claimant on a secured Web site maintained <br/>
<a id="pl.11.6"></a><var>11.6</var>by the insurer. For purposes of this clause, acceptance of a claim means that there is no <br/>
<a id="pl.11.7"></a><var>11.7</var>additional financial liability for the insured or claimant, either because there is a flat <br/>
<a id="pl.11.8"></a><var>11.8</var>co-payment amount specified in the health plan or because there is no co-payment, <br/>
<a id="pl.11.9"></a><var>11.9</var>deductible, or coinsurance owed;<br/>
<a id="pl.11.10"></a><var>11.10</var>    (4) where evidence of suspected fraud is present, the requirement to disclose their <br/>
<a id="pl.11.11"></a><var>11.11</var>reasons for failure to complete the investigation within the time period set forth in clause <br/>
<a id="pl.11.12"></a><var>11.12</var>(3) need not be specific. The insurer must make this evidence available to the Department <br/>
<a id="pl.11.13"></a><var>11.13</var>of Commerce if requested;<br/>
<a id="pl.11.14"></a><var>11.14</var>    (5) failing to notify an insured who has made a notification of claim of all available <br/>
<a id="pl.11.15"></a><var>11.15</var>benefits or coverages which the insured may be eligible to receive under the terms of a <br/>
<a id="pl.11.16"></a><var>11.16</var>policy and of the documentation which the insured must supply in order to ascertain <br/>
<a id="pl.11.17"></a><var>11.17</var>eligibility;<br/>
<a id="pl.11.18"></a><var>11.18</var>    (6) unless otherwise provided by law or in the policy, requiring an insured to give <br/>
<a id="pl.11.19"></a><var>11.19</var>written notice of loss or proof of loss within a specified time, and thereafter seeking to <br/>
<a id="pl.11.20"></a><var>11.20</var>relieve the insurer of its obligations if the time limit is not complied with, unless the <br/>
<a id="pl.11.21"></a><var>11.21</var>failure to comply with the time limit prejudices the insurer's rights and then only if the <br/>
<a id="pl.11.22"></a><var>11.22</var>insurer gave prior notice to the insured of the potential prejudice;<br/>
<a id="pl.11.23"></a><var>11.23</var>    (7) advising an insured or a claimant not to obtain the services of an attorney or <br/>
<a id="pl.11.24"></a><var>11.24</var>an adjuster, or representing that payment will be delayed if an attorney or an adjuster <br/>
<a id="pl.11.25"></a><var>11.25</var>is retained by the insured or the claimant;<br/>
<a id="pl.11.26"></a><var>11.26</var>    (8) failing to advise in writing an insured or claimant who has filed a notification of <br/>
<a id="pl.11.27"></a><var>11.27</var>claim known to be unresolved, and who has not retained an attorney, of the expiration of <br/>
<a id="pl.11.28"></a><var>11.28</var>a statute of limitations at least 60 days prior to that expiration. For the purposes of this <br/>
<a id="pl.11.29"></a><var>11.29</var>clause, any claim on which the insurer has received no communication from the insured <br/>
<a id="pl.11.30"></a><var>11.30</var>or claimant for a period of two years preceding the expiration of the applicable statute <br/>
<a id="pl.11.31"></a><var>11.31</var>of limitations shall not be considered to be known to be unresolved and notice need not <br/>
<a id="pl.11.32"></a><var>11.32</var>be sent pursuant to this clause;<br/>
<a id="pl.11.33"></a><var>11.33</var>    (9) demanding information which would not affect the settlement of the claim;<br/>
<a id="pl.11.34"></a><var>11.34</var>    (10) unless expressly permitted by law or the policy, refusing to settle a claim of an <br/>
<a id="pl.11.35"></a><var>11.35</var>insured on the basis that the responsibility should be assumed by others;<br/>
<a id="pl.12.1"></a><var>12.1</var>    (11) failing, within 60 business days after receipt of a properly executed proof of loss, <br/>
<a id="pl.12.2"></a><var>12.2</var>to advise the insured of the acceptance or denial of the claim by the insurer. No insurer <br/>
<a id="pl.12.3"></a><var>12.3</var>shall deny a claim on the grounds of a specific policy provision, condition, or exclusion <br/>
<a id="pl.12.4"></a><var>12.4</var>unless reference to the provision, condition, or exclusion is included in the denial. The <br/>
<a id="pl.12.5"></a><var>12.5</var>denial must be given to the insured in writing with a copy filed in the claim file;<br/>
<a id="pl.12.6"></a><var>12.6</var>    (12) denying or reducing a claim on the basis of an application which was altered or <br/>
<a id="pl.12.7"></a><var>12.7</var>falsified by the agent or insurer without the knowledge of the insured;<br/>
<a id="pl.12.8"></a><var>12.8</var>    (13) failing to notify the insured of the existence of the additional living expense <br/>
<a id="pl.12.9"></a><var>12.9</var>coverage when an insured under a homeowners policy sustains a loss by reason of a <br/>
<a id="pl.12.10"></a><var>12.10</var>covered occurrence and the damage to the dwelling is such that it is not habitable;<br/>
<a id="pl.12.11"></a><var>12.11</var>    (14) failing to inform an insured or a claimant that the insurer will pay for an <br/>
<a id="pl.12.12"></a><var>12.12</var>estimate of repair if the insurer requested the estimate and the insured or claimant had <br/>
<a id="pl.12.13"></a><var>12.13</var>previously submitted two estimates of repair.<br/>
<br/>
<a id="bill.0.11.0"></a><a id="pl.12.14"></a><var>12.14</var>    Sec. 11. <b> REPEALER.</b><br/>
<a id="pl.12.15"></a><var>12.15</var>Minnesota Statutes 2006, sections 62J.52, subdivision 5; and 62J.58, are repealed.<br/>