SF 2700

1st Unofficial Engrossment - 86th Legislature (2009 - 2010)

Posted on 12/26/2012 11:17 p.m.

1.1A bill for an act 1.2relating to health; regulating participating provider agreements between health 1.3plan companies and health care providers;amending Minnesota Statutes 2008, 1.4sections 62Q.735, by adding subdivisions; 62Q.75, subdivision 3, by adding a 1.5subdivision. 1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.7    Section 1. Minnesota Statutes 2008, section 62Q.735, is amended by adding a 1.8subdivision to read: 1.9     new text begin Subd. 4. new text end new text begin Contract amendment and renewal provisions. new text end new text begin (a) A health plan new text end 1.10 new text begin company shall not require a provider to provide notice of intention to terminate its contract new text end 1.11 new text begin before communicating with the provider regarding contract renewals. A health plan new text end 1.12 new text begin company shall not communicate with enrollees about the possible termination until final new text end 1.13 new text begin termination notice is received from the provider. new text end 1.14 new text begin (b) A health plan company shall not preclude a nonnetwork provider from new text end 1.15 new text begin subsequent network participation solely as a result of the provider having terminated its new text end 1.16 new text begin participation in accordance with the terms of its contract. new text end 1.17 new text begin EFFECTIVE DATE. new text end new text begin This section is effective January 1, 2011, and applies to new text end 1.18 new text begin contracts entered into, renewed, or amended on or after that date. new text end 1.19    Sec. 2. Minnesota Statutes 2008, section 62Q.735, is amended by adding a subdivision 1.20to read: 1.21     new text begin Subd. 5. new text end new text begin Fee schedules. new text end new text begin (a) A health plan company shall provide, upon request, new text end 1.22 new text begin any additional fees or fee schedules relevant to the particular provider's practice beyond new text end 1.23 new text begin those provided with the renewal documents for the next contract year to all participating new text end 2.1 new text begin providers, excluding claims paid under the pharmacy benefit. Health plan companies may new text end 2.2 new text begin fulfill the requirements of this section by making the full fee schedules available through a new text end 2.3 new text begin secure Web portal for contracted providers. new text end 2.4 new text begin (b) A dental organization may satisfy paragraph (a) by complying with section new text end 2.5 new text begin 62Q.735, subdivision 1, paragraph (c). new text end 2.6 new text begin EFFECTIVE DATE. new text end new text begin This section is effective January 1, 2011, and applies to new text end 2.7 new text begin contracts entered into, renewed, or amended on or after that date. new text end 2.8    Sec. 3. Minnesota Statutes 2008, section 62Q.735, is amended by adding a subdivision 2.9to read: 2.10     new text begin Subd. 6. new text end new text begin Reimbursement tiering methodologies. new text end new text begin Where health plan company new text end 2.11 new text begin reimbursement is related to tiering of providers, the health plan company shall provide to new text end 2.12 new text begin any tiered providers upon request an explanation of the methodology used to calculate tier new text end 2.13 new text begin ranking, including information on cost and quality. This explanation need not allow any new text end 2.14 new text begin provider access to proprietary or trade secret information. When a tiered product is used new text end 2.15 new text begin by a health plan, the health plan company shall provide notification to the provider of the new text end 2.16 new text begin tier in which the provider is included prior to the effective date of the tiered product. new text end 2.17 new text begin EFFECTIVE DATE. new text end new text begin This section is effective January 1, 2011, and applies to new text end 2.18 new text begin contracts entered into, renewed, or amended on or after that date. new text end 2.19    Sec. 4. Minnesota Statutes 2008, section 62Q.75, subdivision 3, is amended to read: 2.20    Subd. 3. Claims filing. Unless otherwise provided by contract, by section 16A.124, 2.21subdivision 4a , or by federal law, the health care providers and facilities specified 2.22in subdivision 2 must submit their charges to a health plan company or third-party 2.23administrator within six months from the date of service or the date the health care 2.24provider knew or was informed of the correct name and address of the responsible health 2.25plan company or third-party administrator, whichever is later. A health care provider or 2.26facility that does not make an initial submission of charges within the six-month period 2.27shall not be reimbursed for the charge and may not collect the charge from the recipient of 2.28the service or any other payer. The six-month submission requirement may be extended to 2.2912 months in cases where a health care provider or facility specified in subdivision 2 has 2.30determined and can substantiate that it has experienced a significant disruption to normal 2.31operations that materially affects the ability to conduct business in a normal manner and to 2.32submit claims on a timely basis. new text begin Any request by a health care provider or facility specified new text end 2.33 new text begin in subdivision 2 for an exception to a contractually defined claims submission timeline new text end 3.1 new text begin must be reviewed and acted upon by the health plan company within the same time frame new text end 3.2 new text begin as the contractually agreed upon claims filing timeline. new text end This subdivision also applies to all 3.3health care providers and facilities that submit charges to workers' compensation payers 3.4for treatment of a workers' compensation injury compensable under chapter 176, or to 3.5reparation obligors for treatment of an injury compensable under chapter 65B. 3.6 new text begin EFFECTIVE DATE. new text end new text begin This section is effective January 1, 2011, and applies to new text end 3.7 new text begin contracts entered into, renewed, or amended on or after that date. new text end 3.8    Sec. 5. Minnesota Statutes 2008, section 62Q.75, is amended by adding a subdivision 3.9to read: 3.10     new text begin Subd. 4. new text end new text begin Claims adjustment timeline. new text end new text begin (a) Once a clean claim, as defined in section new text end 3.11 new text begin 62Q.75, subdivision 1, has been paid, the contract must provide a 12-month deadline on new text end 3.12 new text begin all adjustments to and recoupments of the payment with the exception of payments related new text end 3.13 new text begin to coordination of benefits, subrogation, duplicate claims, retroactive terminations, and new text end 3.14 new text begin cases of fraud and abuse. new text end 3.15 new text begin (b) Paragraph (a) shall not apply to pharmacy contracts entered into between or on new text end 3.16 new text begin behalf of health plan companies. new text end 3.17 new text begin EFFECTIVE DATE. new text end new text begin This section is effective January 1, 2011, and applies to new text end 3.18 new text begin contracts entered into, renewed, or amended on or after that date. new text end