SF 811

as introduced - 87th Legislature (2011 - 2012) Posted on 02/23/2012 09:18am

A bill for an act
relating to state government; requiring the commissioner of management and
budget to issue a request for proposals and enter into a contract for dependent
audit verification for state employee health plans.

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

Section 1. new text begin STATE EMPLOYEE GROUP INSURANCE PLAN DEPENDENT
ELIGIBILITY VERIFICATION AUDIT SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Request for proposals. new text end

new text begin By ......., 2011, the commissioner of
management and budget shall issue a request for proposals for a contract to provide
dependent eligibility verification audit services for state-paid hospital, medical, and dental
benefits provided to state employees and their dependents. The request for proposals
must require that the vendor will:
new text end

new text begin (1) conduct a document-model dependent eligibility verification audit of all plans
offered under Minnesota Statutes, sections 43A.22 to 43A.31;
new text end

new text begin (2) identify ineligible dependents covered by the plans and report those findings to
the commissioner and third-party administrators of the state's employee health plans, as
directed by the commissioner; and
new text end

new text begin (3) implement a process for ongoing eligibility verification following the conclusion
of the dependent eligibility verification audit required by this section.
new text end

new text begin Subd. 2. new text end

new text begin Additional vendor criteria. new text end

new text begin The request for proposals required by
subdivision 1 must require the vendor to provide the following minimum capabilities and
experience in performing the services described in subdivision 1:
new text end

new text begin (1) a rules-based platform employing auto-adjudication for making objective
eligibility determinations;
new text end

new text begin (2) assigned eligibility advocates to assist employees through the verification
process;
new text end

new text begin (3) a formal claims and appeals process; and
new text end

new text begin (4) experience in the performance of dependent eligibility verification audits for
other states.
new text end

new text begin Subd. 3. new text end

new text begin Contract required. new text end

new text begin By ......., 2011, the commissioner must enter into
a contract for the services specified in subdivision 1. The contract must incorporate a
performance-based vendor financing option that compensates the vendor based on the
amount of savings generated by the work performed under the contract.
new text end