1st Engrossment - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am
Engrossments | ||
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1st Engrossment | Posted on 08/14/1998 |
1.1 A bill for an act 1.2 relating to health; providing cost containment goals 1.3 for health care; extending the repealer of the 1.4 prohibition on exclusive relationships; amending 1.5 Minnesota Statutes 1994, sections 62J.04, subdivision 1.6 1; and 62Q.09, subdivision 5; Minnesota Statutes 1995 1.7 Supplement, sections 62J.04, subdivisions 1a and 3; 1.8 62J.041; and 62J.042, subdivisions 2, 3, and 4. 1.9 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.10 Section 1. Minnesota Statutes 1994, section 62J.04, 1.11 subdivision 1, is amended to read: 1.12 Subdivision 1. [LIMITS ON THE RATE OF GROWTHCOST 1.13 CONTAINMENT GOALS.] (a) The commissioner of health shall set 1.14 annuallimits on the rate of growth ofcost containment goals 1.15 for public and private spending on health care services for 1.16 Minnesota residents, as provided in paragraph (b). Thelimits1.17on growthcost containment goals must be set at levels the 1.18 commissioner determines to be realistic and achievable but that 1.19 will reduce the rate of growth in health care spending by at 1.20 least ten percent per year for the next five years. The 1.21 commissioner shall setlimits on growthcost containment goals 1.22 based on available data on spending and growth trends, including 1.23 data from group purchasers, national data on public and private 1.24 sector health care spending and cost trends, and trend 1.25 information from other states. 1.26 (b) The commissioner shall set the following annuallimits1.27on the rate of growth ofcost containment goals for public and 2.1 private spending on health care services for Minnesota residents: 2.2 (1) for calendar year 1994, therate of growthcost 2.3 containment goal must not exceed the change in the regional 2.4 consumer price index for urban consumers for calendar year 1993 2.5 plus 6.5 percentage points; 2.6 (2) for calendar year 1995, therate of growthcost 2.7 containment goal must not exceed the change in the regional 2.8 consumer price index for urban consumers for calendar year 1994 2.9 plus 5.3 percentage points; 2.10 (3) for calendar year 1996, therate of growthcost 2.11 containment goal must not exceed the change in the regional 2.12 consumer price index for urban consumers for calendar year 1995 2.13 plus 4.3 percentage points; 2.14 (4) for calendar year 1997, therate of growthcost 2.15 containment goal must not exceed the change in the regional 2.16 consumer price index for urban consumers for calendar year 1996 2.17 plus 3.4 percentage points; and 2.18 (5) for calendar year 1998, therate of growthcost 2.19 containment goal must not exceed the change in the regional 2.20 consumer price index for urban consumers for calendar year 1997 2.21 plus 2.6 percentage points. 2.22 The commissioner shall adjust thegrowth limitcost 2.23 containment goal set for calendar year 1995 to recover savings 2.24 in health care spending required for the period July 1, 1993, to 2.25 December 31, 1993. 2.26 (c) The commissioner shall publish: 2.27 (1) the projectedlimitscost containment goal in the State 2.28 Register by April 15 of the year immediately preceding the year 2.29 in which thelimitcost containment goal will be effective 2.30 except for the year 1993, in which thelimitcost containment 2.31 goal shall be published by July 1, 1993; 2.32 (2) the quarterly change in the regional consumer price 2.33 index for urban consumers; and 2.34 (3) the health care financing administration forecast for 2.35 total growth in the national health care expenditures. In 2.36 settingan annual limitthe cost containment goals, the 3.1 commissioner is exempt from the rulemaking requirements of 3.2 chapter 14. The commissioner's decision onan annual limitthe 3.3 cost containment goals is not appealable. 3.4 Sec. 2. Minnesota Statutes 1995 Supplement, section 3.5 62J.04, subdivision 1a, is amended to read: 3.6 Subd. 1a. [ADJUSTED GROWTH LIMITS AND ENFORCEMENTCOST 3.7 CONTAINMENT GOALS.](a)The commissioner shall publish the final 3.8 adjustedgrowth limitcost containment goal in the State 3.9 Register by January 31 of the year that theexpenditure limit3.10 cost containment goal is to be in effect. The adjustedlimit3.11 cost containment goal must reflect the actual regional consumer 3.12 price index for urban consumers for the previous calendar year, 3.13 and may deviate from the previously published projectedgrowth3.14limitscost containment goal to reflect differences between the 3.15 actual regional consumer price index for urban consumers and the 3.16 projected Consumer Price Index for urban consumers. The 3.17 commissioner shall report to the legislature by February 15 of 3.18 each year on the implementation of thegrowth limitscost 3.19 containment goal. This annual report shall describe the 3.20 differences between the projected increase in health care 3.21 expenditures, the actual expenditures based on data collected, 3.22 and the impact and validity ofgrowth limitscost containment 3.23 goals within the overall health care reform strategy. 3.24(b) The commissioner, in consultation with the Minnesota3.25health care commission, shall research and include in the annual3.26report required in paragraph (a) for 1996, recommendations3.27regarding the implementation of growth limits for health plan3.28companies and providers. The commissioner shall:3.29(1) consider both spending and revenue approaches and3.30report on the implementation of the interim limits as defined in3.31sections 62J.041 and 62J.042;3.32(2) make recommendations regarding the enforcement3.33mechanism and consider mechanisms to adjust future growth limits3.34as well as mechanisms to establish financial penalties for3.35noncompliance;3.36(3) address the feasibility of systemwide limits imposed on4.1all integrated service networks; and4.2(4) make recommendations on the most effective way to4.3implement growth limits on the fee-for-service system in the4.4absence of a regulated all-payer system.4.5(c) The commissioner shall enforce limits on growth in4.6spending for health plan companies and revenues for providers.4.7If the commissioner determines that artificial inflation or4.8padding of costs or prices has occurred in anticipation of the4.9implementation of growth limits, the commissioner may adjust the4.10base year spending totals or growth limits or take other action4.11to reverse the effect of the artificial inflation or padding.4.12(d) The commissioner shall impose and enforce overall4.13limits on growth in spending for health plan companies, with4.14adjustments for changes in enrollment, benefits, severity, and4.15risks. If a health plan company exceeds the growth limits, the4.16commissioner may impose financial penalties up to the amount4.17exceeding the applicable growth limit.4.18 Sec. 3. Minnesota Statutes 1995 Supplement, section 4.19 62J.04, subdivision 3, is amended to read: 4.20 Subd. 3. [COST CONTAINMENT DUTIES.] After obtaining the 4.21 advice and recommendations of the Minnesota health care 4.22 commission, the commissioner shall: 4.23 (1) establish statewide and regionallimits on growth in4.24 cost containment goals for total health care spending under this 4.25 section,and collect data as described in sections 62J.37 to 4.26 62J.41 to monitor statewidecompliance with the spending limits,4.27and take action to achieve compliance to the extent authorized4.28by the legislatureachievement of the cost containment goals; 4.29 (2) divide the state into no fewer than four regions, with 4.30 one of those regions being the Minneapolis/St. Paul metropolitan 4.31 statistical area but excluding Chisago, Isanti, Wright, and 4.32 Sherburne counties, for purposes of fostering the development of 4.33 regional health planning and coordination of health care 4.34 delivery among regional health care systems and working to 4.35 achievespending limitsthe cost containment goals; 4.36 (3) provide technical assistance to regional coordinating 5.1 boards; 5.2 (4) monitor the quality of health care throughout the state 5.3 and take action as necessary to ensure an appropriate level of 5.4 quality; 5.5 (5) issue recommendations regarding uniform billing forms, 5.6 uniform electronic billing procedures and data interchanges, 5.7 patient identification cards, and other uniform claims and 5.8 administrative procedures for health care providers and private 5.9 and public sector payers. In developing the recommendations, 5.10 the commissioner shall review the work of the work group on 5.11 electronic data interchange (WEDI) and the American National 5.12 Standards Institute (ANSI) at the national level, and the work 5.13 being done at the state and local level. The commissioner may 5.14 adopt rules requiring the use of the Uniform Bill 82/92 form, 5.15 the National Council of Prescription Drug Providers (NCPDP) 3.2 5.16 electronic version, the Health Care Financing Administration 5.17 1500 form, or other standardized forms or procedures; 5.18 (6) undertake health planning responsibilities as provided 5.19 in section 62J.15; 5.20 (7) authorize, fund, or promote research and 5.21 experimentation on new technologies and health care procedures; 5.22 (8) within the limits of appropriations for these purposes, 5.23 administer or contract for statewide consumer education and 5.24 wellness programs that will improve the health of Minnesotans 5.25 and increase individual responsibility relating to personal 5.26 health and the delivery of health care services, undertake 5.27 prevention programs including initiatives to improve birth 5.28 outcomes, expand childhood immunization efforts, and provide 5.29 start-up grants for worksite wellness programs;and5.30 (9) undertake other activities to monitor and oversee the 5.31 delivery of health care services in Minnesota with the goal of 5.32 improving affordability, quality, and accessibility of health 5.33 care for all Minnesotans; and 5.34 (10) make the cost containment goal data available to the 5.35 public in a consumer-oriented manner. 5.36 Sec. 4. Minnesota Statutes 1995 Supplement, section 6.1 62J.041, is amended to read: 6.2 62J.041 [INTERIM HEALTH PLAN COMPANYEXPENDITURE LIMITS6.3 COST CONTAINMENT GOALS.] 6.4 Subdivision 1. [DEFINITIONS.] (a) For purposes of this 6.5 section, the following definitions apply. 6.6 (b) "Health plan company" has the definition provided in 6.7 section 62Q.01. 6.8 (c) "Total expenditures" means incurred claims or 6.9 expenditures on health care services, administrative expenses, 6.10 charitable contributions, and all other payments made by health 6.11 plan companies out of premium revenues. 6.12 (d) "Net expenditures" means total expenditures minus 6.13 exempted taxes and assessments and payments or allocations made 6.14 to establish or maintain reserves. 6.15 (e) "Exempted taxes and assessments" means direct payments 6.16 for taxes to government agencies, contributions to the Minnesota 6.17 comprehensive health association, the medical assistance 6.18 provider's surcharge under section 256.9657, the MinnesotaCare 6.19 provider tax under section 295.52, assessments by the health 6.20 coverage reinsurance association, assessments by the Minnesota 6.21 life and health insurance guaranty association, assessments by 6.22 the Minnesota risk adjustment association, and any new 6.23 assessments imposed by federal or state law. 6.24 (f) "Consumer cost-sharing or subscriber liability" means 6.25 enrollee coinsurance, copayment, deductible payments, and 6.26 amounts in excess of benefit plan maximums. 6.27 Subd. 2. [ESTABLISHMENT.] The commissioner of health shall 6.28 establishlimits oncost containment goals for the increase in 6.29 net expenditures by each healthcarrierplan company for 6.30 calendar years 1994, 1995, 1996, and 1997. Thelimitscost 6.31 containment goals must be the same as the annualrate of growth6.32incost containment goals for health care spending established 6.33 under section 62J.04, subdivision 1, paragraph (b). Health plan 6.34 companies that are affiliates may elect to meet one 6.35 combinedexpenditure limitcost containment goal. 6.36 Subd. 3. [DETERMINATION OF EXPENDITURES.] Health plan 7.1 companies shall submit to the commissioner of health, by April 7.2 1, 1994, for calendar year 1993; April 1, 1995, for calendar 7.3 year 1994; April 1, 1996, for calendar year 1995; April 1, 1997, 7.4 for calendar year 1996; and April 1, 1998, for calendar year 7.5 1997 all information the commissioner determines to be necessary 7.6 to implementand enforcethis section. The information must be 7.7 submitted in the form specified by the commissioner. The 7.8 information must include, but is not limited to, expenditures 7.9 per member per month or cost per employee per month, and 7.10 detailed information on revenues and reserves. The 7.11 commissioner, to the extent possible, shall coordinate the 7.12 submittal of the information required under this section with 7.13 the submittal of the financial data required under chapter 62J, 7.14 to minimize the administrative burden on health plan companies. 7.15 The commissioner may adjust final expenditure figures for 7.16 demographic changes, risk selection, changes in basic benefits, 7.17 and legislative initiatives that materially change health care 7.18 costs, as long as these adjustments are consistent with the 7.19 methodology submitted by the health plan company to the 7.20 commissioner, and approved by the commissioner as actuarially 7.21 justified. The methodology to be used for adjustments and the 7.22 election to meet oneexpenditure limitcost containment goal for 7.23 affiliated health plan companies must be submitted to the 7.24 commissioner by September 1, 1994. Community integrated service 7.25 networks may submit the information with their application for 7.26 licensure. The commissioner shall also accept changes to 7.27 methodologies already submitted. The adjustment methodology 7.28 submitted and approved by the commissioner must apply to the 7.29 data submitted for calendar years 1994 and 1995. The 7.30 commissioner may allow changes to accepted adjustment 7.31 methodologies for data submitted for calendar years 1996 and 7.32 1997. Changes to the adjustment methodology must be received by 7.33 September 1, 1996, and must be approved by the commissioner. 7.34 Subd. 4. [MONITORING OF RESERVES.] (a) The commissioners 7.35 of health and commerce shall monitor health plan company 7.36 reserves and net worth as established under chapters 60A, 62C, 8.1 62D, 62H, and 64B, with respect to the health plan companies 8.2 that each commissioner respectively regulates toensure8.3thatassess the degree to which savings resulting from the 8.4 establishment ofexpenditure limitscost containment goals are 8.5 passed on to consumers in the form of lower premium rates. 8.6 (b) Health plan companies shall fully reflect in the 8.7 premium rates the savings generated by theexpenditure limits8.8 cost containment goals. No premium rate, currently reviewed by 8.9 the departments of health or commerce, may be approved for those 8.10 health plan companies unless the health plan company establishes 8.11 to the satisfaction of the commissioner of commerce or the 8.12 commissioner of health, as appropriate, that the proposed new 8.13 rate would comply with this paragraph. 8.14 (c) Health plan companies, except those licensed under 8.15 chapter 60A to sell accident and sickness insurance under 8.16 chapter 62A, shall annually before the end of the fourth fiscal 8.17 quarter provide to the commissioner of health or commerce, as 8.18 applicable, a projection of the level of reserves the company 8.19 expects to attain during each quarter of the following fiscal 8.20 year. These health plan companies shall submit with required 8.21 quarterly financial statements a calculation of the actual 8.22 reserve level attained by the company at the end of each quarter 8.23 including identification of the sources of any significant 8.24 changes in the reserve level and an updated projection of the 8.25 level of reserves the health plan company expects to attain by 8.26 the end of the fiscal year. In cases where the health plan 8.27 company has been given a certificate to operate a new health 8.28 maintenance organization under chapter 62D, or been licensed as 8.29 an integrated service network or community integrated service 8.30 network under chapter 62N, or formed an affiliation with one of 8.31 these organizations, the health plan company shall also submit 8.32 with its quarterly financial statement, total enrollment at the 8.33 beginning and end of the quarter and enrollment changes within 8.34 each service area of the new organization. The reserve 8.35 calculations shall be maintained by the commissioners as trade 8.36 secret information, except to the extent that such information 9.1 is also required to be filed by another provision of state law 9.2 and is not treated as trade secret information under such other 9.3 provisions. 9.4 (d) Health plan companies in paragraph (c) whose reserves 9.5 are less than the required minimum or more than the required 9.6 maximum at the end of the fiscal year shall submit a plan of 9.7 corrective action to the commissioner of health or commerce 9.8 under subdivision 7. 9.9 (e) The commissioner of commerce, in consultation with the 9.10 commissioner of health, shall report to the legislature no later 9.11 than January 15, 1995, as to whether the concept of a reserve 9.12 corridor or other mechanism for purposes of monitoring reserves 9.13 is adaptable for use with indemnity health insurers that do 9.14 business in multiple states and that must comply with their 9.15 domiciliary state's reserves requirements. 9.16 Subd. 5. [NOTICE.] The commissioner of health shall 9.17 publish in the State Register and make available to the public 9.18 by July 1, 1995, a list of all health plan companies that 9.19 exceeded theirexpenditure limitcost containment goal for the 9.20 1994 calendar year. The commissioner shall publish in the State 9.21 Register and make available to the public by July 1, 1996, a 9.22 list of all health plan companies that exceeded their 9.23 combinedexpenditure limitcost containment goal for calendar 9.24 years 1994 and 1995. The commissioner shall notify each health 9.25 plan company that the commissioner has determined that the 9.26 health plan company exceeded itsexpenditure limitcost 9.27 containment goal, at least 30 days before publishing the list, 9.28 and shall provide each health plan company with ten days to 9.29 provide an explanation for exceeding theexpenditure limitcost 9.30 containment goal. The commissioner shall review the explanation 9.31 and may change a determination if the commissioner determines 9.32 the explanation to be valid. 9.33 Subd. 6. [ASSISTANCE BY THE COMMISSIONER OF COMMERCE.] The 9.34 commissioner of commerce shall provide assistance to the 9.35 commissioner of health in monitoring health plan companies 9.36 regulated by the commissioner of commerce.The commissioner of10.1commerce, in consultation with the commissioner of health, shall10.2enforce compliance with expenditure limits for those health plan10.3companies.10.4Subd. 7. [ENFORCEMENT.] (a) The commissioners of health10.5and commerce shall enforce the reserve limits referenced in10.6subdivision 4, with respect to the health plan companies that10.7each commissioner respectively regulates. Each commissioner10.8shall require health plan companies under the commissioner's10.9jurisdiction to submit plans of corrective action when the10.10reserve requirement is not met. The plan of correction must10.11address the following:10.12(1) actuarial assumptions used in forecasting future10.13financial results;10.14(2) trend assumptions used in setting future premiums;10.15(3) demographic, geographic, and private and public sector10.16mix of the population covered by the health plan company;10.17(4) proposed rate increases or decreases;10.18(5) growth limits applied under section 62J.04, subdivision10.191, paragraph (b); and10.20(6) other factors deemed appropriate by the health plan10.21company or commissioner.10.22If the health plan company's reserves exceed the required10.23maximum, the plan of correction shall address how the health10.24plan company will come into compliance and set forth a timetable10.25within which compliance would be achieved. The plan of10.26correction may propose premium refunds, credits for prior10.27premiums paid, policyholder dividends, or any combination of10.28these or other methods which will benefit enrollees and/or10.29Minnesota residents and are such that the reserve requirements10.30can reasonably be expected to be met. The commissioner's10.31evaluation of the plan of correction must consider:10.32(1) whether implementation of the plan would provide the10.33company with an unfair advantage in the market;10.34(2) the extent to which the reserve excess was created by10.35any movement of enrolled persons to another organization formed10.36by the company;11.1(3) whether any proposed premium refund, credit, and/or11.2dividend represents an equitable allocation to policyholders11.3covered in prior periods as determined using sound actuarial11.4practice; and11.5(4) any other factors deemed appropriate by the applicable11.6commissioner.11.7(b) The plan of correction is subject to approval by the11.8commissioner of health or commerce, as applicable. If such a11.9plan is not approved by the applicable commissioner, the11.10applicable commissioner shall enter an order stating the steps11.11that the health plan company must take to come into compliance.11.12Within 30 days of the date of such order, the health plan11.13company must file a notice of appeal with the applicable11.14commissioner or comply with the commissioner's order. If an11.15appeal is filed, such appeal is governed by chapter 14.11.16(c) Health plan companies that exceed the expenditure11.17limits based on two-year average expenditure data (1994 and11.181995, 1996 and 1997) shall be required by the appropriate11.19commissioner to pay back the amount exceeding the expenditure11.20limit through an assessment on the health plan company. A11.21health plan company may appeal the commissioner's order to pay11.22back the amount exceeding the expenditure limit by mailing to11.23the commissioner a written notice of appeal within 30 days from11.24the date the commissioner's order was mailed. The contested11.25case and judicial review provisions of chapter 14 apply to the11.26appeal. The health plan company shall pay the amount specified11.27by the commissioner either to the commissioner or into an escrow11.28account until final resolution of the appeal. Notwithstanding11.29sections 3.762 to 3.765, each party is responsible for its own11.30fees and expenses, including attorneys fees, for the appeal.11.31Any amount required to be paid back under this section shall be11.32deposited in the health care access fund. The appropriate11.33commissioner may approve a different repayment method to take11.34into account the health plan company's financial condition.11.35Health plan companies shall comply with the limits but shall11.36also guarantee that their contractual obligations are met.12.1Health plan companies are prohibited from meeting spending12.2obligations by increasing subscriber liability, including12.3copayments and deductibles and amounts in excess of benefit plan12.4maximums.12.5 Sec. 5. Minnesota Statutes 1995 Supplement, section 12.6 62J.042, subdivision 2, is amended to read: 12.7 Subd. 2. [ESTABLISHMENT.] The commissioner of health shall 12.8 establishlimits oncost containment goals for the increase in 12.9 revenue for each health care provider, for calendar years 1994, 12.10 1995, 1996, and 1997. Thelimitsgoals must be the same as the 12.11annual rate ofgoals for growth in health care spending 12.12 established under section 62J.04, subdivision 1, paragraph (b). 12.13 The commissioner may adjust final revenue figures for case mix 12.14 complexity, payer mix, out-of-period settlements, certain taxes 12.15 and assessments including the MinnesotaCare provider tax and 12.16 provider surcharge, any new assessments imposed by federal or 12.17 state law, research and education costs, donations, grants, and 12.18 legislative initiatives that materially change health care 12.19 revenues, as long as these adjustments are consistent with the 12.20 methodology submitted by the health care provider to the 12.21 commissioner, and approved by the commissioner as actuarially 12.22 justified. The methodology to be used for adjustments must be 12.23 submitted to the commissioner by September 1, 1994. The 12.24 commissioner shall also accept changes to methodologies already 12.25 submitted. The adjustment methodology submitted and approved by 12.26 the commissioner must apply to the data submitted for calendar 12.27 years 1994 and 1995. The commissioner may allow changes to 12.28 accepted adjustment methodologies for data submitted for 12.29 calendar years 1996 and 1997. Changes to the adjustment 12.30 methodology must be received by September 1, 1996, and must be 12.31 approved by the commissioner. 12.32 Sec. 6. Minnesota Statutes 1995 Supplement, section 12.33 62J.042, subdivision 3, is amended to read: 12.34 Subd. 3. [MONITORING OF REVENUE.] The commissioner of 12.35 health shall monitor health care provider revenue, toensure12.36thatassess the degree to which savings resulting from the 13.1 establishment ofrevenue limitscost containment goals are 13.2 passed on to consumers in the form of lower charges. The 13.3 commissioner shall monitor hospital revenue by examining net 13.4 inpatient revenue per adjusted admission and net outpatient 13.5 revenue per outpatient visit. The commissioner shall monitor 13.6 the revenue of physicians and other health care providers by 13.7 examining revenue per patient per year or revenue per 13.8 encounter. For purposes of this section, definitions related to 13.9 the implementation oflimitscost containment goals for 13.10 providers other than hospitals are included in Minnesota Rules, 13.11 chapter 4650, and definitions related to the implementation 13.12 oflimitscost containment goals for hospitals are included in 13.13 Minnesota Rules, chapter 4651.If this information is not13.14available, the commissioner may enforce an annual limit on the13.15rate of growth of the provider's current fees.13.16 Sec. 7. Minnesota Statutes 1995 Supplement, section 13.17 62J.042, subdivision 4, is amended to read: 13.18 Subd. 4. [MONITORINGAND ENFORCEMENT.] Health care 13.19 providers shall submit to the commissioner of health, in the 13.20 form and at the times required by the commissioner, all 13.21 information the commissioner determines to be necessary to 13.22 implementand enforcethis section.The commissioner shall13.23regularly audit all health clinics employing or contracting with13.24over 100 physicians. The commissioner shall also audit, at13.25times and in a manner that does not interfere with delivery of13.26patient care, a sample of smaller clinics and other health care13.27providers. Providers that exceed revenue limits based on13.28two-year average revenue data shall be required by the13.29commissioner to pay back the amount exceeding the revenue limits13.30during the following calendar year.13.31 Pharmacists may adjust their revenue figures for increases 13.32 in drug product costs that are set by the manufacturer. The 13.33 commissioner shall consult with pharmacy groups, including 13.34 pharmacies, wholesalers, drug manufacturers, health plans, and 13.35 other interested parties, to determine the methodology for 13.36 measuring and implementing the interimgrowth limitscost 14.1 containment goals while taking into account the adjustments for 14.2 drug product costs. 14.3 The commissioner shall monitor providers meeting thegrowth14.4limitscost containment goals based on their current fees on an 14.5 annual basis. The fee charged for each service must be based on 14.6 a weighted average across 12 months and compared to the weighted 14.7 average for the previous 12-month period. The percentage 14.8 increase in the average fee from 1993 to 1994, and from 1994 to 14.9 1995 is subject to thegrowth limitscost containment goals 14.10 established under section 62J.04, subdivision 1, paragraph (b). 14.11 The percentage increase in the average fee from 1995 to 1996, 14.12 and from 1996 to 1997 is subject to the change in the regional 14.13 consumer price index for urban consumers for the previous year 14.14 published in the State Register in January of the year that 14.15 thegrowth limitcost containment goal is in effect. The 14.16auditmonitoring process may include a review of the provider's 14.17 monthly fee schedule, and a random claims analysis for the 14.18 provider during different parts of the year to monitor 14.19 variations in fees.The commissioner shall require providers14.20that exceed growth limits, based on annual fees, to pay back14.21during the following calendar year the amount of fees received14.22exceeding the limit.14.23The commissioner shall notify each provider that has14.24exceeded its revenue or fee limit, at least 30 days before14.25taking action, and shall provide each provider with ten days to14.26provide an explanation for exceeding the revenue or fee limit.14.27The commissioner shall review the explanation and may change a14.28determination if the commissioner determines the explanation to14.29be valid.14.30The commissioner may approve a different repayment schedule14.31for a health care provider that takes into account the14.32provider's financial condition.14.33A provider may appeal the commissioner's order to pay back14.34the amount exceeding the revenue or fee limit by mailing a14.35written notice of appeal to the commissioner within 30 days14.36after the commissioner's order was mailed. The contested case15.1and judicial review provisions of chapter 14 apply to the15.2appeal. The provider shall pay the amount specified by the15.3commissioner either to the commissioner or into an escrow15.4account until final resolution of the appeal. Notwithstanding15.5sections 3.762 to 3.765, each party is responsible for its own15.6fees and expenses, including attorneys fees, for the appeal.15.7Any amount required to be paid back under this section shall be15.8deposited in the health care access fund.15.9 Sec. 8. Minnesota Statutes 1994, section 62Q.09, 15.10 subdivision 5, is amended to read: 15.11 Subd. 5. [SUNSET.] This section expires January 1, 15.1219972000. 15.13 Sec. 9. [EFFECTIVE DATE.] 15.14 Section 8 is effective the day following final enactment.