1998 Minnesota Statutes

     62D.08 Annual report. 

    Subdivision 1.  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 organization.  

    Subd. 2.  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.  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 4, 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.  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.  Every health maintenance organization shall 
 inform the commissioner of any change in the information 
 described in section 62D.03, subdivision 4, clause (e), 
 including any change in address, any modification of the 
 duration of any contract or agreement, and any addition to the 
 list of participating entities, within ten working days of the 
 notification of the change.  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 three 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.  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 9.  
 Unaudited financial statements for the fourth quarter shall be 
 submitted at the request of the commissioner. 

    HIST: 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