SF 2700

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 03/09/2010 11:53am

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 or renewals. A health plan company
shall not communicate with members until final termination notice is received from the
provider, consistent with the requirements described in section 62D.08, subdivision 5.
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 health plan company shall provide, upon request,
any additional fees 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 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
all providers with prior communications explaining in detail the methodology used to
calculate tier ranking including, but not limited to, cost and quality measurements and
constructive feedback processes.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2010, 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 deleted text begin , deleted text end new text begin for a longer period new text end
by section 16A.124, subdivision 4a deleted text begin , deleted text end 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. This 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 August 1, 2010, 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; by mutual agreement only; deadline on
adjustments. new text end

new text begin (a) A health plan company may implement a claims adjustment, elimination
of a pending claim, settlement, and payment recoupment only with the mutual agreement
of the health plan company and the provider. No contract or other agreement between a
health plan company and a provider shall include any provision waiving or avoiding this
mutual agreement requirement.
new text end

new text begin (b) Once a clean claim, as defined in subdivision 1 has been paid, the contract must
provide a six-month deadline on all adjustments to and recoupments of the payment.
new text end

new text begin (c) Paragraphs (a) and (b) 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 August 1, 2010, and applies to
contracts entered into, renewed, or amended on or after that date.
new text end

Sec. 6.

new text begin [62Q.751] COLLECTION OF CO-PAYMENTS, DEDUCTIBLES, AND
ESTIMATED PAYMENTS FROM PATIENTS.
new text end

new text begin A health plan company shall permit providers to collect co-payments, deductibles,
and coinsurance from patients at or prior to the time of service. Overpayments by patients
to providers must be returned to the patient by the provider in the same form in which
it was collected within 30 days of the date in which the claim adjudication is received
by the provider.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2010, and applies to
contracts entered into, renewed, or amended on or after that date.
new text end