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SF 3943

as introduced - 91st Legislature (2019 - 2020) Posted on 03/05/2020 08:41am

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

Current Version - as introduced

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A bill for an act
relating to health care; modifying prompt payment requirements to health care
providers; prohibiting discrimination against providers based on geographic
location; modifying managed care organization's claims and payments to health
care providers; amending Minnesota Statutes 2018, sections 62Q.735, subdivision
2; 62Q.736; 62Q.75, subdivisions 2, 3, 4; 256B.0625, subdivision 31; 256B.69,
by adding a subdivision; proposing coding for new law in Minnesota Statutes,
chapter 62K.

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

Section 1.

new text begin [62K.106] NONDISCRIMINATION AGAINST PROVIDERS WITHIN
A GEOGRAPHIC AREA.
new text end

new text begin (a) Notwithstanding any law to the contrary, no health carrier shall deny a health care
provider the right to contract with the health carrier as an in-network provider in any health
plan offered and actively marketed by the health carrier within the same geographic area
in which the provider's primary practice is located. For purposes of this section, "geographic
area" means the Minnesota specific geographic rating areas established for purposes of
insurance rate pricing within the state.
new text end

new text begin (b) The health carrier may require the provider to meet reasonable referral, utilization
review, and quality assurance requirements on the same basis as other in-network providers.
new text end

new text begin (c) This section applies to health plans offered by managed care organizations and
county-based purchasing plans under a public health care program under chapter 256B or
256L.
new text end

new text begin (d) Nothing in this section shall be construed to waive any exclusions of coverage under
the terms and conditions of an enrollee's health plan or require a health carrier to provide
coverage for a health care service that is not covered under an enrollee's health plan.
new text end

Sec. 2.

Minnesota Statutes 2018, section 62Q.735, subdivision 2, is amended to read:


Subd. 2.

Proposed amendments.

(a) Any amendment or change in the terms of an
existing contract between a health plan company and a provider must be disclosed to the
provider at least 45 days prior to the effective date of the proposed change, with the exception
of amendments required of the health plan company by law or governmental regulatory
authority, when notice shall be given to the provider when the requirement is made known
to the health plan company.

(b) Any amendment or change in the contract that alters the fee schedule or materially
alters the written contractual policies and procedures governing the relationship between
the provider and the health plan company must be disclosed to the provider not less than
deleted text begin 45deleted text endnew text begin 90new text end days before the effective date of the proposed change and the provider must have the
opportunity to terminate the contract before the amendment or change is deemed to be in
effect.

(c) By mutual consent, evidenced in writing in amendments separate from the base
contract and not contingent on participation, the parties may waive the disclosure
requirements under paragraphs (a) and (b).

(d) Notwithstanding paragraphs (a) and (b), the effective date of contract termination
shall comply with the terms of the contract when a provider terminates a contract.

Sec. 3.

Minnesota Statutes 2018, section 62Q.736, is amended to read:


62Q.736 PAYMENT RATES.

new text begin (a) new text endA contract between a health plan company and a provider shall comply with section
62A.64.

new text begin (b) No health plan company or third-party administrator shall refuse to negotiate with
a provider because the provider has a designated contract negotiator or refuse to negotiate
with a provider's designated contract negotiator. No health plan company or third-party
administrator shall refuse to negotiate with a provider because the provider's designated
contract negotiator is working for or on behalf of one or more providers.
new text end

Sec. 4.

Minnesota Statutes 2018, 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, but does not include 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.

new text begin (d) If a health plan company or third-party administrator makes a partial payment on a
clean claim, 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 the health plan company or third-party administrator
makes full payment on the claim.
new text end

deleted text begin (d)deleted text end new text begin(e) new text endThe 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.new text begin If a health plan
company or third-party administrator fails to pay interest to a provider as required under
this subdivision, the health plan company or third-party administrator shall be liable for all
costs, including legal fees, incurred by the provider to collect the unpaid interest.
new text end

deleted text begin (e)deleted text endnew text begin (f)new text end 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 practicesnew text begin, if the review is based on a reasonable,
good faith basis that the provider has engaged in fraudulent or abusive billing practices
new text end.

deleted text begin (f)deleted text endnew text begin (g)new text end 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.

Sec. 5.

Minnesota Statutes 2018, section 62Q.75, subdivision 3, is amended to read:


Subd. 3.

Claims filing.

new text begin(a) new text endUnless 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 deleted text beginsixdeleted text endnew text begin 12new text end 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 deleted text beginsix-monthdeleted text endnew text begin 12-monthnew text end 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 deleted text beginsix-monthdeleted text endnew text begin 12-monthnew text end submission requirement may be extended to
deleted text begin 12deleted text endnew text begin 18new text end 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. Any 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 begin (b) 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.

Sec. 6.

Minnesota Statutes 2018, section 62Q.75, subdivision 4, is amended to read:


Subd. 4.

Claims adjustment timeline.

(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 begin (b) No health plan company or third-party administrator shall negatively adjust or recoup
a payment based on a fee schedule that was not in effect on the date of service for which
the claim was submitted.
new text end

new text begin (c) No health plan company or third-party administrator shall audit claims older than 12
months.
new text end

deleted text begin (b) Paragraph (a) shall notdeleted text endnew text begin (d) This subdivision does notnew text end apply to pharmacy contracts
entered into between or on behalf of health plan companies.

Sec. 7.

Minnesota Statutes 2018, section 256B.0625, subdivision 31, is amended to read:


Subd. 31.

Medical supplies and equipment.

(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall be
made for wheelchairs and wheelchair accessories for recipients who are residents of
intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs
and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions
and limitations as coverage for recipients who do not reside in institutions. A wheelchair
purchased outside of the facility's payment rate is the property of the recipient.

(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.

(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics,
or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment
requirement if:

(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic,
or medical supply;

(2) the vendor serves ten or fewer medical assistance recipients per year;

(3) the commissioner finds that other vendors are not available to provide same or similar
durable medical equipment, prosthetics, orthotics, or medical supplies; and

(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with the
Medicare program's supplier and quality standards and the vendor serves primarily pediatric
patients.

(d) Durable medical equipment means a device or equipment that:

(1) can withstand repeated use;

(2) is generally not useful in the absence of an illness, injury, or disability; and

(3) is provided to correct or accommodate a physiological disorder or physical condition
or is generally used primarily for a medical purpose.

(e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must
be locked in order to prevent use not related to communication.

(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be
locked to prevent use not as an augmentative communication device, a recipient of waiver
services may use an electronic tablet for a use not related to communication when the
recipient has been authorized under the waiver to receive one or more additional applications
that can be loaded onto the electronic tablet, such that allowing the additional use prevents
the purchase of a separate electronic tablet with waiver funds.

(g) An order or prescription for medical supplies, equipment, or appliances must meet
the requirements in Code of Federal Regulations, title 42, part 440.70.

new text begin (h) A managed care plan or county-based purchasing plan must follow the same periodic
and quantity limits that are in place and required for durable medical equipment and supplies
under the fee-for-service system administered by the commissioner.
new text end

Sec. 8.

Minnesota Statutes 2018, section 256B.69, is amended by adding a subdivision to
read:


new text begin Subd. 6e. new text end

new text begin Provider payments. new text end

new text begin (a) Effective January 1, 2021, any managed care plan or
county-based purchasing plan that contracts with the commissioner to provide covered
services pursuant to this section must follow the same requirements for the submission and
payment of provider claims as are required by the commissioner under the fee-for-service
system.
new text end

new text begin (b) Effective January 1, 2021, any managed care plan or county-based purchasing plan
that contracts with the commissioner to provide covered services pursuant to this section
must reimburse providers who are employed by or under contract with the plan an amount
that is at least as much as the fee-for-service payment for the same covered service. Quality
measures that must be tracked in conjunction with this paragraph include the rate of access
to these services.
new text end