2005 Minnesota Statutes

     62Q.735 Provider contracting procedures. 

    Subdivision 1.    Contract disclosure.  (a) Before 
 requiring a health care provider to sign a contract, a health 
 plan company shall give to the provider a complete copy of the 
 proposed contract, including:  

    (1) all attachments and exhibits; 

    (2) operating manuals; 

    (3) a general description of the health plan company's 
 health service coding guidelines and requirement for procedures 
 and diagnoses with modifiers, and multiple procedures; and 

    (4) all guidelines and treatment parameters incorporated or 
 referenced in the contract.  

    (b) The health plan company shall make available to the 
 provider the fee schedule or a method or process that allows the 
 provider to determine the fee schedule for each health care 
 service to be provided under the contract.  

    (c) Notwithstanding paragraph (b), a health plan company 
 that is a dental plan organization, as defined in section 
 62Q.76, shall disclose information related to the individual 
 contracted provider's expected reimbursement from the dental 
 plan organization.  Nothing in this section requires a dental 
 plan organization to disclose the plan's aggregate maximum 
 allowable fee table used to determine other providers' fees.  
 The contracted provider must not release this information in any 
 way that would violate any state or federal antitrust law.  

    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 45 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.  

    Subd. 3.    Hospital contract amendment disclosure.  (a) 
 Any amendment or change in the terms of an existing contract 
 between a network organization and a hospital, ambulatory 
 surgical center, or freestanding emergency room must be 
 disclosed to that provider. 

    (b) Any amendment or change in the contract that alters the 
 financial reimbursement or alters the written contractual 
 policies and procedures governing the relationship between the 
 hospital, ambulatory surgical center, or freestanding emergency 
 room and the network organization must be disclosed to that 
 provider before the amendment or change is deemed to be in 
 effect. 

    (c) For purposes of this subdivision, "network organization"
 means a preferred provider organization, as defined in section 
 145.61, subdivision 4c; a managed care organization, as defined 
 in section 62Q.01, subdivision 5; or other entity that uses or 
 consists of a network of health care providers. 

    HIST: 2004 c 246 s 5 

*   NOTE:  This section, as added by Laws 2004, chapter 246, 
*section 5, is effective for provider contracts issued, renewed, 
*or amended on or after July 1, 2006.  Laws 2004, chapter 246, 
*section 12.