<a id="pl.1.3"></a><var>1.3</var>plan companies and health care providers;amending Minnesota Statutes 2008, <br/>
<a id="pl.1.4"></a><var>1.4</var>sections 62Q.735, by adding subdivisions; 62Q.75, subdivision 3, by adding a <br/>
<a id="pl.1.5"></a><var>1.5</var>subdivision.<br/>
<a id="pl.1.6"></a><var>1.6</var>BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:<br/>
<br/>
<a id="bill.0.1.0"></a><a id="pl.1.7"></a><var>1.7</var>    Section 1. Minnesota Statutes 2008, section 62Q.735, is amended by adding a <br/>
<a id="pl.1.8"></a><var>1.8</var>subdivision to read:<br/>
<a id="pl.1.9"></a><var>1.9</var>    Subd. 4. <b>Contract amendment and renewal provisions.</b> (a) A health plan <br/>
<a id="pl.1.10"></a><var>1.10</var>company shall not require a provider to provide notice of intention to terminate its contract <br/>
<a id="pl.1.11"></a><var>1.11</var>before communicating with the provider regarding contract renewals. A health plan <br/>
<a id="pl.1.12"></a><var>1.12</var>company shall not communicate with enrollees about the possible termination until final <br/>
<a id="pl.1.13"></a><var>1.13</var>termination notice is received from the provider.<br/>
<a id="pl.1.14"></a><var>1.14</var>(b) A health plan company shall not preclude a nonnetwork provider from <br/>
<a id="pl.1.15"></a><var>1.15</var>subsequent network participation solely as a result of the provider having terminated its <br/>
<a id="pl.1.16"></a><var>1.16</var>participation in accordance with the terms of its contract.<br/>
<a id="pl.1.17"></a><var>1.17</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2011, and applies to <br/>
<a id="pl.1.18"></a><var>1.18</var>contracts entered into, renewed, or amended on or after that date.<br/>
<br/>
<a id="bill.0.2.0"></a><a id="pl.1.19"></a><var>1.19</var>    Sec. 2. Minnesota Statutes 2008, section 62Q.735, is amended by adding a subdivision <br/>
<a id="pl.1.20"></a><var>1.20</var>to read:<br/>
<a id="pl.1.21"></a><var>1.21</var>    Subd. 5. <b>Fee schedules.</b> (a) A health plan company shall provide, upon request, <br/>
<a id="pl.1.22"></a><var>1.22</var>any additional fees or fee schedules relevant to the particular provider's practice beyond <br/>
<a id="pl.1.23"></a><var>1.23</var>those provided with the renewal documents for the next contract year to all participating <br/>
<a id="pl.2.1"></a><var>2.1</var>providers, excluding claims paid under the pharmacy benefit. Health plan companies may <br/>
<a id="pl.2.2"></a><var>2.2</var>fulfill the requirements of this section by making the full fee schedules available through a <br/>
<a id="pl.2.3"></a><var>2.3</var>secure Web portal for contracted providers.<br/>
<a id="pl.2.4"></a><var>2.4</var>(b) A dental organization may satisfy paragraph (a) by complying with section <br/>
<a id="pl.2.5"></a><var>2.5</var>62Q.735, subdivision 1, paragraph (c).<br/>
<a id="pl.2.6"></a><var>2.6</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2011, and applies to <br/>
<a id="pl.2.7"></a><var>2.7</var>contracts entered into, renewed, or amended on or after that date.<br/>
<br/>
<a id="bill.0.3.0"></a><a id="pl.2.8"></a><var>2.8</var>    Sec. 3. Minnesota Statutes 2008, section 62Q.735, is amended by adding a subdivision <br/>
<a id="pl.2.9"></a><var>2.9</var>to read:<br/>
<a id="pl.2.10"></a><var>2.10</var>    Subd. 6. <b>Reimbursement tiering methodologies.</b> Where health plan company <br/>
<a id="pl.2.11"></a><var>2.11</var>reimbursement is related to tiering of providers, the health plan company shall provide to <br/>
<a id="pl.2.12"></a><var>2.12</var>any tiered providers upon request an explanation of the methodology used to calculate tier <br/>
<a id="pl.2.13"></a><var>2.13</var>ranking, including information on cost and quality. This explanation need not allow any <br/>
<a id="pl.2.14"></a><var>2.14</var>provider access to proprietary or trade secret information. When a tiered product is used <br/>
<a id="pl.2.15"></a><var>2.15</var>by a health plan, the health plan company shall provide notification to the provider of the <br/>
<a id="pl.2.16"></a><var>2.16</var>tier in which the provider is included prior to the effective date of the tiered product.<br/>
<a id="pl.2.17"></a><var>2.17</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2011, and applies to <br/>
<a id="pl.2.18"></a><var>2.18</var>contracts entered into, renewed, or amended on or after that date.<br/>
<br/>
<a id="bill.0.4.0"></a><a id="pl.2.19"></a><var>2.19</var>    Sec. 4. Minnesota Statutes 2008, section 62Q.75, subdivision 3, is amended to read:<br/>
<a id="pl.2.20"></a><var>2.20</var>    Subd. 3. <b>Claims filing.</b> Unless otherwise provided by contract, by section 
         <statute_ref>16A.124, <br/>
<a id="pl.2.21"></a><var>2.21</var>subdivision 4a
         </statute_ref>, or by federal law, the health care providers and facilities specified <br/>
<a id="pl.2.22"></a><var>2.22</var>in subdivision 2 must submit their charges to a health plan company or third-party <br/>
<a id="pl.2.23"></a><var>2.23</var>administrator within six months from the date of service or the date the health care <br/>
<a id="pl.2.24"></a><var>2.24</var>provider knew or was informed of the correct name and address of the responsible health <br/>
<a id="pl.2.25"></a><var>2.25</var>plan company or third-party administrator, whichever is later. A health care provider or <br/>
<a id="pl.2.26"></a><var>2.26</var>facility that does not make an initial submission of charges within the six-month period <br/>
<a id="pl.2.27"></a><var>2.27</var>shall not be reimbursed for the charge and may not collect the charge from the recipient of <br/>
<a id="pl.2.28"></a><var>2.28</var>the service or any other payer. The six-month submission requirement may be extended to <br/>
<a id="pl.2.29"></a><var>2.29</var>12 months in cases where a health care provider or facility specified in subdivision 2 has <br/>
<a id="pl.2.30"></a><var>2.30</var>determined and can substantiate that it has experienced a significant disruption to normal <br/>
<a id="pl.2.31"></a><var>2.31</var>operations that materially affects the ability to conduct business in a normal manner and to <br/>
<a id="pl.2.32"></a><var>2.32</var>submit claims on a timely basis. Any request by a health care provider or facility specified <br/>
<a id="pl.2.33"></a><var>2.33</var>in subdivision 2 for an exception to a contractually defined claims submission timeline <br/>
<a id="pl.3.1"></a><var>3.1</var>must be reviewed and acted upon by the health plan company within the same time frame <br/>
<a id="pl.3.2"></a><var>3.2</var>as the contractually agreed upon claims filing timeline. This subdivision also applies to all <br/>
<a id="pl.3.3"></a><var>3.3</var>health care providers and facilities that submit charges to workers' compensation payers <br/>
<a id="pl.3.4"></a><var>3.4</var>for treatment of a workers' compensation injury compensable under chapter 176, or to <br/>
<a id="pl.3.5"></a><var>3.5</var>reparation obligors for treatment of an injury compensable under chapter 65B.<br/>
<a id="pl.3.6"></a><var>3.6</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2011, and applies to <br/>
<a id="pl.3.7"></a><var>3.7</var>contracts entered into, renewed, or amended on or after that date.<br/>
<br/>
<a id="bill.0.5.0"></a><a id="pl.3.8"></a><var>3.8</var>    Sec. 5. Minnesota Statutes 2008, section 62Q.75, is amended by adding a subdivision <br/>
<a id="pl.3.9"></a><var>3.9</var>to read:<br/>
<a id="pl.3.10"></a><var>3.10</var>    Subd. 4. <b>Claims adjustment timeline.</b> (a) Once a clean claim, as defined in section <br/>
<a id="pl.3.11"></a><var>3.11</var>62Q.75, subdivision 1, has been paid, the contract must provide a 12-month deadline on <br/>
<a id="pl.3.12"></a><var>3.12</var>all adjustments to and recoupments of the payment with the exception of payments related <br/>
<a id="pl.3.13"></a><var>3.13</var>to coordination of benefits, subrogation, duplicate claims, retroactive terminations, and <br/>
<a id="pl.3.14"></a><var>3.14</var>cases of fraud and abuse.<br/>
<a id="pl.3.15"></a><var>3.15</var>(b) Paragraph (a) shall not apply to pharmacy contracts entered into between or on <br/>
<a id="pl.3.16"></a><var>3.16</var>behalf of health plan companies.<br/>
<a id="pl.3.17"></a><var>3.17</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2011, and applies to <br/>
<a id="pl.3.18"></a><var>3.18</var>contracts entered into, renewed, or amended on or after that date.<br/>