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2007 Minnesota Statutes

This is an historical version of this statute chapter. Also view the most recent published version.

    Subdivision 1. Notice of changes. A health maintenance organization shall, unless otherwise
provided for by rules adopted by the commissioner of health, file notice with the commissioner
of health prior to any modification of the operations or documents described in the information
submitted under clauses (a), (b), (e), (f), (g), (i), (j), (l), (m), (n), (o), (p), (q), (r), (s), and (t) of
section 62D.03, subdivision 4. If the commissioner of health does not disapprove of the filing
within 60 days, it shall be deemed approved and may be implemented by the health maintenance
    Subd. 2. Annual report required. Every health maintenance organization shall annually, on
or before April 1, file a verified report with the commissioner of health covering the preceding
calendar year. However, utilization data required under subdivision 3, clause (c), shall be filed
on or before July 1.
    Subd. 3. Report requirements. Such report shall be on forms prescribed by the
commissioner of health, and shall include:
(a) a financial statement of the organization, including its balance sheet and receipts and
disbursements for the preceding year certified by an independent certified public accountant,
reflecting at least (1) all prepayment and other payments received for health care services rendered,
(2) expenditures to all providers, by classes or groups of providers, and insurance companies or
nonprofit health service plan corporations engaged to fulfill obligations arising out of the health
maintenance contract, (3) expenditures for capital improvements, or additions thereto, including
but not limited to construction, renovation or purchase of facilities and capital equipment, and
(4) a supplementary statement of assets, liabilities, premium revenue, and expenditures for risk
sharing business under section 62D.04, subdivision 1, on forms prescribed by the commissioner;
(b) the number of new enrollees enrolled during the year, the number of group enrollees
and the number of individual enrollees as of the end of the year and the number of enrollees
terminated during the year;
(c) a summary of information compiled pursuant to section 62D.04, subdivision 1, clause (c),
in such form as may be required by the commissioner of health;
(d) a report of the names and addresses of all persons set forth in section 62D.03, subdivision
, clause (c), who were associated with the health maintenance organization or the major
participating entity during the preceding year, and the amount of wages, expense reimbursements,
or other payments to such individuals for services to the health maintenance organization or
the major participating entity, as those services relate to the health maintenance organization,
including a full disclosure of all financial arrangements during the preceding year required to be
disclosed pursuant to section 62D.03, subdivision 4, clause (d);
(e) a separate report addressing health maintenance contracts sold to individuals covered by
Medicare, title XVIII of the Social Security Act, as amended, including the information required
under section 62D.30, subdivision 6; and
(f) such other information relating to the performance of the health maintenance organization
as is reasonably necessary to enable the commissioner of health to carry out the duties under
sections 62D.01 to 62D.30.
    Subd. 4. Penalty; extension for good cause. Any health maintenance organization which
fails to file a verified report with the commissioner on or before April 1 of the year due shall be
subject to the levy of a fine up to $500 for each day the report is past due. This failure will serve as
a basis for other disciplinary action against the organization, including suspension or revocation,
in accordance with sections 62D.15 to 62D.17. The commissioner may grant an extension of the
reporting deadline upon good cause shown by the health maintenance organization. Any fine
levied or disciplinary action taken against the organization under this subdivision is subject to the
contested case and judicial review provisions of sections 14.57 to 14.69.
    Subd. 5. Changes in participating entities; penalty. Any cancellation or discontinuance
of any contract or agreement listed in section 62D.03, subdivision 4, clause (e), or listed
subsequently in accordance with this subdivision, shall be reported to the commissioner 120 days
before the effective date. When the health maintenance organization terminates a provider for
cause, death, disability, or loss of license, the health maintenance organization must notify the
commissioner within ten working days of the date the health maintenance organization sends out
or receives the notice of cancellation, discontinuance, or termination. Any health maintenance
organization which fails to notify the commissioner within the time periods prescribed in this
subdivision shall be subject to the levy of a fine up to $200 per contract for each day the notice is
past due, accruing up to the date the organization notifies the commissioner of the cancellation or
discontinuance. Any fine levied under this subdivision is subject to the contested case and judicial
review provisions of chapter 14. The levy of a fine does not preclude the commissioner from
using other penalties described in sections 62D.15 to 62D.17.
    Subd. 6. Financial statements. A health maintenance organization shall submit to the
commissioner unaudited financial statements of the organization for the first three quarters of the
year on forms prescribed by the commissioner. The statements are due 30 days after the end of
the quarter and shall be maintained as nonpublic data, as defined by section 13.02, subdivision
. Unaudited financial statements for the fourth quarter shall be submitted at the request of the
History: 1973 c 670 s 8; 1974 c 284 s 2; 1977 c 305 s 45; 1983 c 289 s 114 subd 1; 1984 c
464 s 20-23; 1984 c 655 art 1 s 92; 1985 c 248 s 70; 1986 c 444; 1987 c 130 s 2; 1987 c 329 s 21;
1987 c 384 art 2 s 1; 1988 c 434 s 4,5; 1988 c 612 s 18; 1990 c 538 s 19-21; 2001 c 170 s 1

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