1.1A bill for an act1.2relating 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    Subd. 4.Contract amendment and renewal provisions.(a) A health plan 1.10company shall not require a provider to provide notice of intention to terminate its contract 1.11before communicating with the provider regarding contract renewals. A health plan 1.12company shall not communicate with enrollees about the possible termination until final 1.13termination notice is received from the provider.1.14(b) A health plan company shall not preclude a nonnetwork provider from 1.15subsequent network participation solely as a result of the provider having terminated its 1.16participation in accordance with the terms of its contract.1.17EFFECTIVE DATE.This section is effective January 1, 2011, and applies to 1.18contracts entered into, renewed, or amended on or after that date.1.19    Sec. 2. Minnesota Statutes 2008, section 62Q.735, is amended by adding a subdivision 1.20to read:1.21    Subd. 5.Fee schedules.(a) A health plan company shall provide, upon request, 1.22any additional fees or fee schedules relevant to the particular provider's practice beyond 1.23those provided with the renewal documents for the next contract year to all participating 2.1providers, excluding claims paid under the pharmacy benefit. Health plan companies may 2.2fulfill the requirements of this section by making the full fee schedules available through a 2.3secure Web portal for contracted providers.2.4(b) A dental organization may satisfy paragraph (a) by complying with section 2.562Q.735, subdivision 1, paragraph (c).2.6EFFECTIVE DATE.This section is effective January 1, 2011, and applies to 2.7contracts entered into, renewed, or amended on or after that date.2.8    Sec. 3. Minnesota Statutes 2008, section 62Q.735, is amended by adding a subdivision 2.9to read:2.10    Subd. 6.Reimbursement tiering methodologies.Where health plan company 2.11reimbursement is related to tiering of providers, the health plan company shall provide to 2.12any tiered providers upon request an explanation of the methodology used to calculate tier 2.13ranking, including information on cost and quality. This explanation need not allow any 2.14provider access to proprietary or trade secret information. When a tiered product is used 2.15by a health plan, the health plan company shall provide notification to the provider of the 2.16tier in which the provider is included prior to the effective date of the tiered product.2.17EFFECTIVE DATE.This section is effective January 1, 2011, and applies to 2.18contracts entered into, renewed, or amended on or after that date.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. Any request by a health care provider or facility specified 2.33in subdivision 2 for an exception to a contractually defined claims submission timeline 3.1must be reviewed and acted upon by the health plan company within the same time frame 3.2as the contractually agreed upon claims filing timeline. 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.3.6EFFECTIVE DATE.This section is effective January 1, 2011, and applies to 3.7contracts entered into, renewed, or amended on or after that date.3.8    Sec. 5. Minnesota Statutes 2008, section 62Q.75, is amended by adding a subdivision 3.9to read:3.10    Subd. 4.Claims adjustment timeline.(a) Once a clean claim, as defined in section 3.1162Q.75, subdivision 1, has been paid, the contract must provide a 12-month deadline on 3.12all adjustments to and recoupments of the payment with the exception of payments related 3.13to coordination of benefits, subrogation, duplicate claims, retroactive terminations, and 3.14cases of fraud and abuse.3.15(b) Paragraph (a) shall not apply to pharmacy contracts entered into between or on 3.16behalf of health plan companies.3.17EFFECTIVE DATE.This section is effective January 1, 2011, and applies to 3.18contracts entered into, renewed, or amended on or after that date.