Skip to main content Skip to office menu Skip to footer
Capital IconMinnesota Legislature

Office of the Revisor of Statutes

62J.38 COST CONTAINMENT DATA FROM GROUP PURCHASERS.
(a) The commissioner shall require group purchasers to submit detailed data on total health
care spending for each calendar year. Group purchasers shall submit data for the 1993 calendar
year by April 1, 1994, and each April 1 thereafter shall submit data for the preceding calendar year.
(b) The commissioner shall require each group purchaser to submit data on revenue,
expenses, and member months, as applicable. Revenue data must distinguish between premium
revenue and revenue from other sources and must also include information on the amount of
revenue in reserves and changes in reserves. Expenditure data must distinguish between costs
incurred for patient care and administrative costs. Patient care and administrative costs must
include only expenses incurred on behalf of health plan members and must not include the cost
of providing health care services for nonmembers at facilities owned by the group purchaser or
affiliate. Expenditure data must be provided separately for the following categories and for other
categories required by the commissioner: physician services, dental services, other professional
services, inpatient hospital services, outpatient hospital services, emergency, pharmacy services
and other nondurable medical goods, mental health, and chemical dependency services, other
expenditures, subscriber liability, and administrative costs. Administrative costs must include
costs for marketing; advertising; overhead; salaries and benefits of central office staff who do
not provide direct patient care; underwriting; lobbying; claims processing; provider contracting
and credentialing; detection and prevention of payment for fraudulent or unjustified requests for
reimbursement or services; clinical quality assurance and other types of medical care quality
improvement efforts; concurrent or prospective utilization review as defined in section 62M.02;
costs incurred to acquire a hospital, clinic, or health care facility, or the assets thereof; capital
costs incurred on behalf of a hospital or clinic; lease payments; or any other costs incurred
pursuant to a partnership, joint venture, integration, or affiliation agreement with a hospital, clinic,
or other health care provider. Capital costs and costs incurred must be recorded according to
standard accounting principles. The reports of this data must also separately identify expenses
for local, state, and federal taxes, fees, and assessments. The commissioner may require each
group purchaser to submit any other data, including data in unaggregated form, for the purposes
of developing spending estimates, setting spending limits, and monitoring actual spending and
costs. In addition to reporting administrative costs incurred to acquire a hospital, clinic, or health
care facility, or the assets thereof; or any other costs incurred pursuant to a partnership, joint
venture, integration, or affiliation agreement with a hospital, clinic, or other health care provider;
reports submitted under this section also must include the payments made during the calendar
year for these purposes. The commissioner shall make public, by group purchaser data collected
under this paragraph in accordance with section 62J.321, subdivision 5. Workers' compensation
insurance plans and automobile insurance plans are exempt from complying with this paragraph
as it relates to the submission of administrative costs.
(c) The commissioner may collect information on:
(1) premiums, benefit levels, managed care procedures, and other features of health plan
companies;
(2) prices, provider experience, and other information for services less commonly covered
by insurance or for which patients commonly face significant out-of-pocket expenses; and
(3) information on health care services not provided through health plan companies,
including information on prices, costs, expenditures, and utilization.
(d) All group purchasers shall provide the required data using a uniform format and uniform
definitions, as prescribed by the commissioner.
History: 1993 c 345 art 3 s 10; 1994 c 625 art 8 s 28; 1995 c 234 art 5 s 11; 1Sp2001 c 9
art 16 s 4; 2002 c 379 art 1 s 113

Official Publication of the State of Minnesota
Revisor of Statutes