Minnesota Session Laws - 1999, Regular Session

                            CHAPTER 146-S.F.No. 1268 
                  An act relating to health; requiring prompt payments 
                  by health maintenance organizations of certain claims 
                  made by home care providers; requiring health 
                  maintenance organizations to pay interest on late 
                  payments; establishing penalties; proposing coding for 
                  new law in Minnesota Statutes, chapter 62D. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  [62D.108] [PROMPT PAYMENTS TO HOME CARE 
        PROVIDERS.] 
           Subdivision 1.  [APPLICABILITY.] This section applies to 
        health maintenance organizations regulated under this chapter. 
           Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
        following terms have the meanings given them: 
           (1) "clean claim" means an original paper or electronic 
        claim with correct data elements, prepared in accordance with 
        the health maintenance organization's published specifications 
        for claims preparation, that does not require an attachment or 
        text information to pay or deny the claim; 
           (2) "home care provider" has the meaning given in section 
        144A.43, subdivision 4; and 
           (3) "valid home care provider claim" means a clean claim 
        submitted directly to the health maintenance organization by an 
        eligible home care provider for home care services provided to 
        an eligible enrollee. 
           Subd. 3.  [CLAIMS PAYMENTS TO HOME CARE PROVIDERS.] A 
        health maintenance organization must pay or deny a valid home 
        care provider claim for home care services within 30 days of 
        receiving the claim and all other information from third parties 
        required to process the claim in accordance with the health 
        maintenance organization's specifications for claims processing. 
        A health maintenance organization must notify a home care 
        provider of an incorrect, defective, or improper claim within 30 
        days of receipt of the original claim.  If the health 
        maintenance organization is unable to pay or deny the claim 
        within 30 days because additional information, other than 
        information from the home care provider, is required to complete 
        the processing of the claim, the health maintenance organization 
        shall disclose to the home care provider the nature of the 
        additional information needed to process the claim.  The 
        disclosure shall be made consistent with state and federal law.  
        Where evidence of suspected fraud is present, the requirement to 
        disclose additional information need not be specific. 
           Subd. 4.  [PAYMENT OF INTEREST ON LATE PAYMENTS.] (a) If a 
        health maintenance organization fails to pay or deny a valid 
        home care provider claim within 30 days as specified in 
        subdivision 3, the health maintenance organization must pay 
        interest to the home care provider on the claim with interest 
        accruing from the 30th day.  If a negotiated contract or 
        agreement between a home care provider and a health maintenance 
        organization requires an audit by the health maintenance 
        organization before acceptance and payment of the claim, 
        interest payments do not apply until 30 days after the timely 
        completion of the audit by the health maintenance organization.  
        Before any interest payment is made, the home care provider must 
        bill the health maintenance organization for the interest.  
           (b) The rate of interest paid by a health maintenance 
        organization under this subdivision shall be 1.5 percent per 
        month or any part of the month. 
           (c) A home care provider who prevails in a civil action to 
        collect interest payments from a health maintenance organization 
        shall be awarded the costs and disbursements, including attorney 
        fees, incurred in bringing the action. 
           (d) The minimum monthly interest payment that a health 
        maintenance organization must pay to a home care provider for 
        the unpaid balance for any single overdue claim equal to or 
        exceeding $100 is $10.  For unpaid balances of less than $100, 
        the health maintenance organization must pay the actual interest 
        payment due to the home care provider. 
           (e) A health maintenance organization 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. 
           Sec. 2.  [EFFECTIVE DATE.] 
           Section 1 is effective July 1, 1999, and applies to claims 
        made under health maintenance organization contracts with home 
        care providers entered into or renewed on or after that date. 
           Presented to the governor May 7, 1999 
           Signed by the governor May 11, 1999, 1:50 p.m.