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HF 1139

as introduced - 92nd Legislature (2021 - 2022) Posted on 02/15/2021 02:37pm

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

Bill Text Versions

Introduction Posted on 02/15/2021

Current Version - as introduced

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A bill for an act
relating to health care; requiring the commissioner of human services to determine
payback amounts from managed care plans and county-based purchasing plans.


Section 1. new text beginCAPITATION PAYMENT PAYBACK.
new text end

new text begin (a) The commissioner of human services shall determine the total amount paid by the
Department of Human Services for fee-for-service claims for services covered under
Minnesota Statutes, section 256B.0625, provided in calendar year 2019 and the amount
paid for claims for services provided in calendar year 2020. After adjusting for factors other
than utilization, the commissioner shall determine the difference in spending as a percentage
between the total amount paid in 2019 and 2020.
new text end

new text begin (b) If the difference in the amount paid out in calendar year 2020 was less than calendar
year 2019 as determined in paragraph (a), the commissioner shall require each managed
care plan and county-based purchasing plan that was under contract with the commissioner
to provide services under Minnesota Statutes, section 256B.69, in calendar year 2020 to
pay to the commissioner an amount equal to the percentage decrease from calendar year
2019 to calendar year 2020, if that amount is greater than the amount the managed care plan
or county-based purchasing plan is already required to pay based on the medical loss ratio
requirement as specified in the plan's contract with the commissioner.
new text end

new text begin (c) The commissioner shall inform each managed care plan and county-based purchasing
plan of the amount that the plan is required to pay to the commissioner under paragraph (b)
by July 1, 2021. The amount owed must be paid to the commissioner by October 1, 2021.
If the plan disputes the amount specified by the commissioner, the plan must notify the
commissioner by August 1, 2021, in the manner and using forms specified by the
commissioner. The plan must submit data satisfactory to the commissioner that demonstrates
that the amount assessed to the plan by the commissioner is incorrect. The commissioner
shall make a decision concerning the dispute within 60 days. If the commissioner determines
that the plan has satisfactorily demonstrated that the amount specified by the commissioner
to be paid by the plan is incorrect, the commissioner shall adjust the amount accordingly.
new text end

new text begin (d) Any amount collected by the commissioner shall be deposited to the general fund.
new text end