HF 3372

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; changing provisions for uniform billing forms and electronic
claim filing; amending Minnesota Statutes 2006, sections 62J.51, subdivisions
17, 18; 62J.52, subdivisions 4, 5; 62J.59; Minnesota Statutes 2007 Supplement,
sections 62J.52, subdivisions 1, 2; 62J.536, subdivision 1, by adding a
subdivision; repealing Minnesota Statutes 2006, section 62J.58.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2006, section 62J.51, subdivision 17, is amended to read:

Subd. 17.

Uniform billing form CMS 1450.

"Uniform billing form CMS 1450"
means the new text begin most current version of the new text end uniform billing form known as the CMS 1450 deleted text begin or
UB92, deleted text end developed by the National Uniform Billing Committee deleted text begin in 1992 and approved for
implementation in October 1993, and any subsequent amendments to the form deleted text end .

Sec. 2.

Minnesota Statutes 2006, section 62J.51, subdivision 18, is amended to read:

Subd. 18.

Uniform billing form CMS 1500.

"Uniform billing form CMS 1500"
means the deleted text begin 1990 deleted text end new text begin most current new text end version of the health insurance claim form, CMS 1500,
developed by the National Uniform Claim Committee deleted text begin and any subsequent amendments to
the form deleted text end .

Sec. 3.

Minnesota Statutes 2007 Supplement, section 62J.52, subdivision 1, is amended
to read:

Subdivision 1.

Uniform billing form CMS 1450.

(a) On and after January 1,
1996, all institutional inpatient hospital services, ancillary services, institutionally owned
or operated outpatient services rendered by providers in Minnesota, and institutional
or noninstitutional home health services that are not being billed using an equivalent
electronic billing format, must be billed using the uniform billing form CMS 1450, except
as provided in subdivision 5.

(b) The instructions and definitions for the use of the uniform billing form CMS
1450 shall be in accordance with the uniform billing form manual specified by the
commissioner. In promulgating these instructions, the commissioner may utilize the
manual developed by the National Uniform Billing Committee deleted text begin , as adopted and finalized
by the Minnesota Uniform Billing Committee deleted text end .

(c) Services to be billed using the uniform billing form CMS 1450 include:
institutional inpatient hospital services and distinct units in the hospital such as psychiatric
unit services, physical therapy unit services, swing bed (SNF) services, inpatient state
psychiatric hospital services, inpatient skilled nursing facility services, home health
services (Medicare part A), and hospice services; ancillary services, where benefits are
exhausted or patient has no Medicare part A, from hospitals, state psychiatric hospitals,
skilled nursing facilities, and home health (Medicare part B); institutional owned or
operated outpatient services such as waivered services, hospital outpatient services,
including ambulatory surgical center services, hospital referred laboratory services,
hospital-based ambulance services, and other hospital outpatient services, skilled nursing
facilities, home health, freestanding renal dialysis centers, comprehensive outpatient
rehabilitation facilities (CORF), outpatient rehabilitation facilities (ORF), rural health
clinics, new text begin federally qualified health centers, new text end and community mental health centers; home
health services such as home health intravenous therapy providers, deleted text begin waivered services,
personal care attendants, deleted text end and hospice; and any other health care provider certified by the
Medicare program to use this form.

(d) On and after January 1, 1996, a mother and newborn child must be billed
separately, and must not be combined on one claim form.

(e) Services provided by Medicare Critical Access Hospitals electing Method
II billing will be allowed an exception to this provision to allow the inclusion of the
professional fees on the CMS 1450.

Sec. 4.

Minnesota Statutes 2007 Supplement, section 62J.52, subdivision 2, is amended
to read:

Subd. 2.

Uniform billing form CMS 1500.

(a) On and after January 1, 1996, all
noninstitutional health care services rendered by providers in Minnesota except dental
or pharmacy providers, that are not currently being billed using an equivalent electronic
billing format, must be billed using the health insurance claim form CMS 1500, except as
provided in subdivision 5.

(b) The instructions and definitions for the use of the uniform billing form CMS
1500 shall be in accordance with the manual developed by the Administrative Uniformity
Committee entitled standards for the use of the CMS 1500 form, dated February 1994,
as further defined by the commissioner.

(c) Services to be billed using the uniform billing form CMS 1500 include physician
services and supplies, durable medical equipment, noninstitutional ambulance services,
independent ancillary services including occupational therapy, physical therapy, speech
therapy and audiology, home infusion therapy, podiatry services, optometry services,
mental health licensed professional services, substance abuse licensed professional
services, nursing practitioner professional services, certified registered nurse anesthetists,
chiropractors, physician assistants, laboratories, medical suppliers, new text begin waivered services,
personal care attendants, new text end and other health care providers such as day activity centers and
freestanding ambulatory surgical centers.

(d) Services provided by Medicare Critical Access Hospitals electing Method
II billing will be allowed an exception to this provision to allow the inclusion of the
professional fees on the CMS 1450.

Sec. 5.

Minnesota Statutes 2006, section 62J.52, subdivision 4, is amended to read:

Subd. 4.

Uniform pharmacy billing form.

(a) On and after January 1, 1996,
all pharmacy services provided by pharmacists in Minnesota that are not currently
being billed using an equivalent electronic billing format shall be billed using the
NCPDP/universal claim form deleted text begin , except as provided in subdivision 5 deleted text end .

(b) The instructions and definitions for the use of the uniform claim form shall
be in accordance with instructions specified by the commissioner of health deleted text begin , except as
provided in subdivision 5 deleted text end .

Sec. 6.

Minnesota Statutes 2006, section 62J.52, subdivision 5, is amended to read:

Subd. 5.

State and federal health care programs.

(a) Skilled nursing facilities
and ICF/MR services billed to state and federal health care programs administered by
the Department of Human Services shall use the new text begin CMS 1450 new text end form deleted text begin designated by the
Department of Human Services deleted text end .

(b) On and after July 1, 1996, state and federal health care programs administered by
the Department of Human Services shall accept the CMS 1450 for community mental
health center services and shall accept the CMS 1500 for freestanding ambulatory surgical
center services.

deleted text begin (c) State and federal health care programs administered by the Department of
Human Services shall be authorized to use the forms designated by the Department of
Human Services for pharmacy services.
deleted text end

deleted text begin (d) State and federal health care programs administered by the Department of
Human Services shall accept the form designated by the Department of Human Services,
and the CMS 1500 for supplies, medical supplies, or durable medical equipment. Health
care providers may choose which form to submit.
deleted text end

deleted text begin (e) deleted text end new text begin (c) new text end Personal care attendant and waivered services billed on a fee-for-service basis
directly to state and federal health care programs administered by the Department of
Human Services shall use deleted text begin either the CMS 1450 or deleted text end the CMS 1500 form, as designated by
the Department of Human Services.

Sec. 7.

Minnesota Statutes 2007 Supplement, section 62J.536, subdivision 1, is
amended to read:

Subdivision 1.

Electronic claims and eligibility transactions required.

(a)
Beginning January 15, 2009, all group purchasers must accept from health care providers
the eligibility for a health plan transaction described under Code of Federal Regulations,
title 45, part 162, subpart L. Beginning July 15, 2009, all group purchasers must accept
from health care providers the health care claims or equivalent encounter information
transaction described under Code of Federal Regulations, title 45, part 162, subpart K.

(b) Beginning January 15, 2009, all group purchasers must transmit to providers
the eligibility for a health plan transaction described under Code of Federal Regulations,
title 45, part 162, subpart L. Beginning December deleted text begin 1 deleted text end new text begin 15 new text end , 2009, all group purchasers must
transmit to providers the health care payment and remittance advice transaction described
under Code of Federal Regulations, title 45, part 162, subpart P.

(c) Beginning January 15, 2009, all health care providers must submit to group
purchasers the eligibility for a health plan transaction described under Code of Federal
Regulations, title 45, part 162, subpart L. Beginning July 15, 2009, all health care
providers must submit to group purchasers the health care claims or equivalent encounter
information transaction described under Code of Federal Regulations, title 45, part 162,
subpart K.

(d) Beginning January 15, 2009, all health care providers must accept from group
purchasers the eligibility for a health plan transaction described under Code of Federal
Regulations, title 45, part 162, subpart L. Beginning December 15, 2009, all health care
providers must accept from group purchasers the health care payment and remittance
advice transaction described under Code of Federal Regulations, title 45, part 162, subpart
P.

(e) Each of the transactions described in paragraphs (a) to (d) shall require the use
of a single, uniform companion guide to the implementation guides described under
Code of Federal Regulations, title 45, part 162. The companion guides will be developed
pursuant to subdivision 2.

(f) Notwithstanding any other provisions in sections 62J.50 to 62J.61, all group
purchasers and health care providers must exchange claims and eligibility information
electronically using the transactions, companion guides, implementation guides, and
timelines required under this subdivision. Group purchasers may not impose any fee on
providers for the use of the transactions prescribed in this subdivision.

(g) Nothing in this subdivision shall prohibit group purchasers and health care
providers from using a direct data entry, Web-based methodology for complying with
the requirements of this subdivision. Any direct data entry method for conducting
the transactions specified in this subdivision must be consistent with the data content
component of the single, uniform companion guides required in paragraph (e) and the
implementation guides described under Code of Federal Regulations, title 45, part 162.

Sec. 8.

Minnesota Statutes 2007 Supplement, section 62J.536, is amended by adding a
subdivision to read:

new text begin Subd. 4. new text end

new text begin Group purchasers not covered by HIPAA. new text end

new text begin (a) For transactions with
group purchasers defined in section 62J.03, subdivision 8, that are not covered under
United States Code, title 42, sections 1320d to 1320d-8, the requirements of this section
are modified as follows:
new text end

new text begin (1) The group purchasers may be exempt from one or more of the requirements
to exchange claims and eligibility information electronically using the transactions,
companion guides, implementation guides, and timelines in subdivision 1 if the
commissioner of health determines that:
new text end

new text begin (i) a transaction is incapable of exchanging data that are currently being exchanged
on paper and is necessary to accomplish the purpose of the transaction; or
new text end

new text begin (ii) another national electronic transaction standard would be more appropriate and
effective to accomplish the purpose of the transaction.
new text end

new text begin (2) If group purchasers are exempt from one or more of the requirements to exchange
claims and eligibility information electronically using the transactions, companion guides,
implementation guides, and timelines in subdivision 1, providers shall also be exempt
from exchanging those transactions with the group purchaser.
new text end

new text begin (3) If the commissioner of health exempts a group purchaser from one or more of
the requirements because a transaction is incapable of exchanging data that are currently
being exchanged on paper and are necessary to accomplish the purpose of the transaction,
the commissioner shall review that exemption annually. If the commissioner determines
that the exemption is no longer necessary or appropriate, the commissioner of health shall
promulgate rules pursuant to section 62J.61 establishing and requiring group purchasers
and health care providers to use the transactions and the uniform, standard companion
guides required under subdivision 1, paragraph (e). Group purchasers and providers shall
have 12 months to implement any rules promulgated.
new text end

new text begin (4) If the commissioner of health exempts a group purchaser from one or more of
the requirements because another national electronic transaction standard would be more
appropriate and effective to accomplish the purpose of the transaction, the commissioner
shall promulgate rules pursuant to section 62J.61 establishing and requiring group
purchasers and health care providers to use the national electronic transaction standard.
Group purchasers and providers shall have 12 months to implement any rules promulgated.
new text end

new text begin (5) The requirement of paper claims attachments shall not indicate that a health
care claims or equivalent encounter information transaction described under Code of
Federal Regulations, title 45, part 162, subpart K, is incapable of exchanging data that
are currently being exchanged on paper provided that the electronic health care claims
transaction has a mechanism to link the paper attachments to the electronic claim.
new text end

Sec. 9.

Minnesota Statutes 2006, section 62J.59, is amended to read:

62J.59 IMPLEMENTATION OF NCPDP TELECOMMUNICATIONS
STANDARD FOR PHARMACY CLAIMS.

(a) Beginning January 1, 1996, all category I and II pharmacists licensed in this state
shall accept the new text begin most recent version of the new text end NCPDP telecommunication standard deleted text begin format 3.2 deleted text end
or the new text begin most recent version of the new text end NCPDP tape billing and payment deleted text begin format 2.0 deleted text end new text begin standard new text end for
the electronic submission of claims as appropriate.

(b) Beginning January 1, 1996, all category I and category II group purchasers in this
state shall use the new text begin most recent version of the new text end NCPDP telecommunication standard deleted text begin format
3.2 deleted text end or NCPDP tape billing and payment deleted text begin format 2.0 deleted text end new text begin standard new text end for electronic submission
of payment information to pharmacists.

Sec. 10. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, section 62J.58, new text end new text begin is repealed.
new text end