SF 721

as introduced - 87th Legislature (2011 - 2012) Posted on 02/23/2012 09:12am

A bill for an act
relating to human services; providing a right for providers to audit financial
aspects of health plan company contracts with the prepaid medical assistance
program; amending Minnesota Statutes 2010, section 256B.69, by adding a
subdivision.

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

Section 1.

Minnesota Statutes 2010, section 256B.69, is amended by adding a
subdivision to read:

new text begin Subd. 9c. new text end

new text begin Rights to audit related to the loss ratio. new text end

new text begin (a) Within 90 days after the end
of each calendar year during the term of provider participation, each prepaid health plan
used by the commissioner to provide services under this section or section 256B.692 shall
furnish to each provider a statement in reasonable detail setting forth the computation of
the total costs and expenses used in the calculation of the minimum loss ratio as well as
all administrative expenses incurred in the prior calendar year. At the request of any
provider, a prepaid health plan used by the commissioner to provide services under this
section or section 256B.692 shall furnish to the provider all records of payments from
the commissioner to the prepaid plan, all invoices, receipts, and all other data necessary
for the provider to verify the amount of any administrative costs and expenses and the
calculation of the minimum loss ratio.
new text end

new text begin (b) Any provider or group of providers has at its sole expense the right upon 14 days'
written notice to audit and inspect all of the prepaid health plan's records relating to the
costs and expenses which are used in the calculation of the minimum loss ratio; provided,
however, that upon the expiration of 24 months following the end of any calendar year,
the health plan's records shall be deemed to be conclusive, and the providers have no
further rights to audit and inspect them with regard to that calendar year. Appropriate
adjustments shall be made for errors in the amount of the computations revealed by an
audit or inspection. If an audit or inspection by a provider or group of providers indicates
an excess in the amount of administrative costs and expenses by more than two percent,
the cost incurred by the providers for the audit or inspection shall be paid to the providers
by the health plan. If any excess of administrative expense by the plan is discovered by
the audit, the prepaid health plan shall pay the amount of the excess above ten percent to
the health care access fund.
new text end

new text begin (c) Nothing in this subdivision requires the mandatory loss ratio in subdivision
5i to be applied to any prepaid plan's business other than that business awarded by
the commissioner unless the prepaid health plan fails to keep a separate and distinct
accounting for funds received from the commissioner.
new text end

new text begin (d) No prepaid health plan used by the commissioner may require any provider to
waive this right to audit as a condition of participation with the prepaid health plan. No
prepaid health plan may retaliate against any provider for exercising any rights related
to the audit described in this subdivision.
new text end

new text begin (e) If a prepaid health plan and a provider or group of providers do not agree as
to the result of an audit or inspection of records conducted under this subdivision, the
commissioner shall refer the dispute to the attorney general for resolution. Each party
shall pay its own expenses in connection with the process of resolving the dispute.
new text end

new text begin (f) An enrollee or group of enrollees has the right to conduct an audit and inspection
of a prepaid health plan's records in the same basis granted under this subdivision to
health care providers.
new text end

new text begin (g) The commissioner shall reference this subdivision in any request for proposal for
services to which this subdivision applies.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end