SF 1268

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act
  1.2             relating to health; requiring prompt payments by 
  1.3             health maintenance organizations and nonprofit health 
  1.4             service plan corporations of certain claims made by 
  1.5             home care providers; requiring claim errors to be 
  1.6             reported within a certain time; establishing 
  1.7             penalties; proposing coding for new law in Minnesota 
  1.8             Statutes, chapter 62Q. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  [62Q.68] [PROMPT PAYMENTS TO HOME CARE 
  1.11  PROVIDERS.] 
  1.12     Subdivision 1.  [APPLICABILITY.] This section applies to 
  1.13  health maintenance organizations regulated under chapter 62D and 
  1.14  nonprofit health service plan corporations regulated under 
  1.15  chapter 62C. 
  1.16     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
  1.17  following terms have the meanings given them: 
  1.18     (1) "clean claim" means an original paper or electronic 
  1.19  claim with correct data elements, prepared in accordance with 
  1.20  the health maintenance organization's or nonprofit health 
  1.21  service plan corporation's published specifications for claims 
  1.22  preparation, that does not require an attachment or text 
  1.23  information to pay or deny the claim; 
  1.24     (2) "home care provider" has the meaning given in section 
  1.25  144A.43, subdivision 4; and 
  1.26     (3) "valid home care provider claim" means a clean claim 
  1.27  submitted directly to the health maintenance organization or 
  2.1   nonprofit health service plan corporation by an eligible home 
  2.2   care provider for home care services provided to an eligible 
  2.3   enrollee. 
  2.4      Subd. 3.  [CLAIMS PAYMENTS TO HOME CARE PROVIDERS.] A 
  2.5   health maintenance organization or nonprofit health service plan 
  2.6   corporation must pay or deny a valid home care provider claim 
  2.7   for home care services within 30 days of receiving the claim.  
  2.8   Adjustment claims, claims with attachments and text information, 
  2.9   and claims submitted to the health maintenance organization or 
  2.10  nonprofit health service plan corporation as a secondary or 
  2.11  tertiary payer, which have been prepared in accordance with the 
  2.12  published specifications of the health maintenance organization 
  2.13  or nonprofit health service plan corporation, must be 
  2.14  adjudicated within 60 days after receiving the claim. 
  2.15     Subd. 4.  [PAYMENT OF INTEREST ON LATE PAYMENTS.] (a) If a 
  2.16  health maintenance organization or nonprofit health service plan 
  2.17  corporation fails to pay or deny a valid home care provider 
  2.18  claim within 30 days as specified in subdivision 3, the health 
  2.19  maintenance organization or nonprofit health service plan 
  2.20  corporation must pay interest to the home care provider on the 
  2.21  claim.  If a negotiated contract or agreement between a home 
  2.22  care provider and a health maintenance organization or nonprofit 
  2.23  health service plan corporation requires an audit by the health 
  2.24  maintenance organization or nonprofit health service plan 
  2.25  corporation before acceptance and payment of the claim, interest 
  2.26  payments do not apply until 30 days after the timely completion 
  2.27  of the audit by the health maintenance organization or nonprofit 
  2.28  health service plan corporation.  Before any interest payment is 
  2.29  made, the home care provider must bill the health maintenance 
  2.30  organization or nonprofit health service plan corporation for 
  2.31  the interest. 
  2.32     (b) The rate of interest paid by a health maintenance 
  2.33  organization or nonprofit health service plan corporation under 
  2.34  this subdivision shall be 1-1/2 percent per month or any part of 
  2.35  the month. 
  2.36     (c) All interest payments and collection costs must be paid 
  3.1   from the current operating budget of the health maintenance 
  3.2   organization or nonprofit health service plan corporation.  No 
  3.3   health maintenance organization or nonprofit health service plan 
  3.4   corporation may seek to increase its premium rates for the 
  3.5   purpose of obtaining funds to pay interest payments or 
  3.6   collection costs. 
  3.7      (d) A home care provider who prevails in a civil action to 
  3.8   collect interest payments from a health maintenance organization 
  3.9   or nonprofit health service plan corporation shall be awarded 
  3.10  the costs and disbursements, including attorneys' fees, incurred 
  3.11  in bringing the action. 
  3.12     (e) No interest costs may accrue against a health 
  3.13  maintenance organization or nonprofit health service plan 
  3.14  corporation that delays payment of a claim due to a disagreement 
  3.15  with the home care provider; provided, that the dispute must be 
  3.16  settled within 30 days after the claim becomes overdue.  Upon 
  3.17  resolution of the dispute, the health maintenance organization 
  3.18  or nonprofit health service plan corporation must pay the home 
  3.19  care provider accrued interest on all proper claims for which 
  3.20  payment was not received within the applicable time limits 
  3.21  specified in subdivision 3. 
  3.22     (f) The minimum monthly interest payment that a health 
  3.23  maintenance organization or nonprofit health service plan 
  3.24  corporation must pay to a home care provider for the unpaid 
  3.25  balance for any single overdue claim equal to or exceeding $100 
  3.26  is $10.  For unpaid balances of less than $100, the health 
  3.27  maintenance organization or nonprofit health service plan 
  3.28  corporation must pay the actual interest payment due to the home 
  3.29  care provider. 
  3.30     (g) A health maintenance organization or nonprofit health 
  3.31  service plan corporation is not required to make an interest 
  3.32  payment on a claim for which payment has been delayed for 
  3.33  purposes of reviewing potentially fraudulent or abusive billing 
  3.34  practices, if there is an eventual finding of fraud or abuse in 
  3.35  any judicial or administrative agency proceeding. 
  3.36     Subd. 5.  [CLAIMS ERRORS.] For purposes of payments made to 
  4.1   home care providers receiving reimbursement from a health 
  4.2   maintenance organization or nonprofit health service plan 
  4.3   corporation, a health maintenance organization or nonprofit 
  4.4   health service plan corporation that receives a claim that is 
  4.5   incorrect, defective, or otherwise improper must notify the home 
  4.6   care provider of any error within 30 days of discovery of the 
  4.7   error. 
  4.8      Sec. 2.  [EFFECTIVE DATE.] 
  4.9      Section 1 is effective July 1, 1999, and applies to claims 
  4.10  made under health maintenance organization or nonprofit health 
  4.11  service plan corporation contracts with home care providers 
  4.12  entered into or renewed on or after that date.