SF 896

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; extending prompt payment requirements to pharmacy benefit
managers and pharmacies; amending Minnesota Statutes 2006, section 62Q.75,
subdivisions 1, 2.

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

Section 1.

Minnesota Statutes 2006, section 62Q.75, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For purposes of this section, the following terms
have the meanings given to them.

(b) "Clean claim" means a claim that has no defect or impropriety, including any lack
of any required substantiating documentation, including, but not limited to, coordination
of benefits information, or particular circumstance requiring special treatment that
prevents timely payment from being made on a claim under this section. Nothing in this
section alters an enrollee's obligation to disclose information as required by law.

(c) "Third-party administrator" means a third-party administrator or other entity
subject to section 60A.23, subdivision 8, and Minnesota Rules, chapter 2767. new text begin For
purposes of this section, third-party administrator includes a pharmacy benefit manager.
new text end

Sec. 2.

Minnesota Statutes 2006, section 62Q.75, subdivision 2, is amended to read:

Subd. 2.

Claims payments.

(a) This section applies to clean claims submitted to a
health plan company or third-party administrator for services provided by any:

(1) health care provider, as defined in section 62Q.74, deleted text begin but does not include deleted text end new text begin including
new text end a provider licensed under chapter 151;

(2) home health care provider, as defined in section 144A.43, subdivision 4; or

(3) health care facility.

All health plan companies and third-party administrators must pay or deny claims that are
clean claims within 30 calendar days after the date upon which the health plan company or
third-party administrator received the claim.

(b) The health plan company or third-party administrator shall, upon request, make
available to the provider information about the status of a claim submitted by the provider
consistent with section 62J.581.

(c) If a health plan company or third-party administrator does not pay or deny a
clean claim within the period provided in paragraph (a), the health plan company or
third-party administrator must pay interest on the claim for the period beginning on the
day after the required payment date specified in paragraph (a) and ending on the date on
which the health plan company or third-party administrator makes the payment or denies
the claim. In any payment, the health plan company or third-party administrator must
itemize any interest payment being made separately from other payments being made for
services provided. The health plan company or third-party administrator shall not require
the health care provider to bill the health plan company or third-party administrator for the
interest required under this section before any interest payment is made. Interest payments
must be made to the health care provider no less frequently than quarterly.

(d) The rate of interest paid by a health plan company or third-party administrator
under this subdivision shall be 1.5 percent per month or any part of a month.

(e) A health plan company or third-party administrator is not required to make
an interest payment on a claim for which payment has been delayed for purposes of
reviewing potentially fraudulent or abusive billing practices.

(f) The commissioner may assess a financial administrative penalty against a
health plan company for violation of this subdivision when there is a pattern of abuse
that demonstrates a lack of good faith effort and a systematic failure of the health plan
company to comply with this subdivision.