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SF 2700

3rd Engrossment - 86th Legislature (2009 - 2010) Posted on 05/10/2010 07:50am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - 3rd Engrossment

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A bill for an act
relating to health; regulating participating provider agreements between health
plan companies and health care providers; amending Minnesota Statutes 2008,
sections 62Q.735, by adding subdivisions; 62Q.75, subdivision 3, by adding a
subdivision; proposing coding for new law in Minnesota Statutes, chapter 62Q.

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

Section 1.

Minnesota Statutes 2008, section 62Q.735, is amended by adding a
subdivision to read:


new text begin Subd. 4. new text end

new text begin Contract amendment and renewal provisions. new text end

new text begin (a) A health plan
company shall not require a provider to provide notice of intention to terminate its contract
before communicating with the provider regarding contract renewals. A health plan
company shall not communicate with enrollees about the possible termination until final
termination notice is received from the provider.
new text end

new text begin (b) A health plan company shall not preclude a nonnetwork provider from
subsequent network participation solely as a result of the provider having terminated its
participation in accordance with the terms of its contract.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, and applies to
contracts entered into, renewed, or amended on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2008, section 62Q.735, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Fee schedules. new text end

new text begin (a) A health plan company shall provide, upon request,
any additional fees or fee schedules relevant to the particular provider's practice beyond
those provided with the renewal documents for the next contract year to all participating
providers, excluding claims paid under the pharmacy benefit. Health plan companies may
fulfill the requirements of this section by making the full fee schedules available through a
secure Web portal for contracted providers.
new text end

new text begin (b) A dental organization may satisfy paragraph (a) by complying with section
62Q.735, subdivision 1, paragraph (c).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, and applies to
contracts entered into, renewed, or amended on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2008, section 62Q.735, is amended by adding a subdivision
to read:


new text begin Subd. 6. new text end

new text begin Reimbursement tiering methodologies. new text end

new text begin Where health plan company
reimbursement is related to tiering of providers, the health plan company shall provide to
any tiered providers upon request an explanation of the methodology used to calculate tier
ranking, including information on cost and quality. This explanation need not allow any
provider access to proprietary or trade secret information. When a tiered product is used
by a health plan, the health plan company shall provide notification to the provider of the
tier in which the provider is included prior to the effective date of the tiered product.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, and applies to
contracts entered into, renewed, or amended on or after that date.
new text end

Sec. 4.

Minnesota Statutes 2008, section 62Q.75, subdivision 3, is amended to read:


Subd. 3.

Claims filing.

Unless otherwise provided by contract, by section 16A.124,
subdivision 4a
, or by federal law, the health care providers and facilities specified
in subdivision 2 must submit their charges to a health plan company or third-party
administrator within six months from the date of service or the date the health care
provider knew or was informed of the correct name and address of the responsible health
plan company or third-party administrator, whichever is later. A health care provider or
facility that does not make an initial submission of charges within the six-month period
shall not be reimbursed for the charge and may not collect the charge from the recipient of
the service or any other payer. The six-month submission requirement may be extended to
12 months in cases where a health care provider or facility specified in subdivision 2 has
determined and can substantiate that it has experienced a significant disruption to normal
operations that materially affects the ability to conduct business in a normal manner and to
submit claims on a timely basis. new text beginAny request by a health care provider or facility specified
in subdivision 2 for an exception to a contractually defined claims submission timeline
must be reviewed and acted upon by the health plan company within the same time frame
as the contractually agreed upon claims filing timeline.
new text endThis subdivision also applies to all
health care providers and facilities that submit charges to workers' compensation payers
for treatment of a workers' compensation injury compensable under chapter 176, or to
reparation obligors for treatment of an injury compensable under chapter 65B.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, and applies to
contracts entered into, renewed, or amended on or after that date.
new text end

Sec. 5.

Minnesota Statutes 2008, section 62Q.75, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Claims adjustment timeline. new text end

new text begin (a) Once a clean claim, as defined in section
62Q.75, subdivision 1, has been paid, the contract must provide a 12-month deadline on
all adjustments to and recoupments of the payment with the exception of payments related
to coordination of benefits, subrogation, duplicate claims, retroactive terminations, and
cases of fraud and abuse.
new text end

new text begin (b) Paragraph (a) shall not apply to pharmacy contracts entered into between or on
behalf of health plan companies.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, and applies to
contracts entered into, renewed, or amended on or after that date.
new text end

Sec. 6.

new text begin [62Q.751] COLLECTING DEDUCTIBLES AND COINSURANCE.
new text end

new text begin A health plan company shall not prohibit providers from collecting deductibles and
coinsurance from patients at or prior to the time of service. Providers may not withhold a
service to a health plan company enrollee based on a patient's failure to pay a deductible
or coinsurance at or prior to the time of service. Overpayments by patients to providers
must be returned to the patient by the provider by check or electronic payment within 30
days of the date in which the claim adjudication is received by the provider.
new text end