.................... moves to amend H.F. No. 3042 as follows:
Delete everything after the enacting clause and insert:
"Section 1. Minnesota Statutes 2008, section 62Q.735, is amended by adding a
subdivision to read:
1.5 Subd. 4. Contract amendment and renewal provisions. (a) A health plan company
1.6shall not require a provider to provide notice of intention to terminate its contract before
1.7communicating with the provider regarding contract renewals. A health plan company
1.8shall not communicate with members until final termination notice is received from the
1.9provider, consistent with the requirements described in section 62D.08, subdivision 5.
1.10(b) A health plan company shall not preclude a nonnetwork provider from
1.11subsequent network participation solely as a result of the provider having terminated its
1.12participation in accordance with the terms of its contract.
1.13EFFECTIVE DATE.This section is effective January 1, 2011, and applies to
1.14contracts entered into, renewed, or amended on or after that date.
Sec. 2. Minnesota Statutes 2008, section 62Q.735, is amended by adding a subdivision
1.17 Subd. 5. Fee schedules. A health plan company shall provide, upon request,
1.18any additional fees relevant to the particular provider's practice beyond those provided
1.19with the renewal documents for the next contract year to all participating providers,
1.20excluding claims paid under the pharmacy benefit. Health plan companies may fulfill the
1.21requirements of this section by making the full fee schedules available through a secure
1.22Web portal for contracted providers.
1.23EFFECTIVE DATE.This section is effective January 1, 2011, and applies to
1.24contracts entered into, renewed, or amended on or after that date.
Sec. 3. Minnesota Statutes 2008, section 62Q.735, is amended by adding a subdivision
2.3 Subd. 6. Reimbursement tiering methodologies. Where health plan company
2.4reimbursement is related to tiering of providers, the health plan company shall provide to
2.5any tiered providers upon request an explanation of the methodology used to calculate tier
2.6ranking, including information on cost and quality. This explanation does not allow any
2.7provider access to proprietary or trade secret information. When a tiered product is used
2.8by a health plan, the health plan company shall provide notification to the provider of the
2.9tier in which the provider is included prior to the effective date of the tiered product.
2.10EFFECTIVE DATE.This section is effective January 1, 2011, and applies to
2.11contracts entered into, renewed, or amended on or after that date.
Sec. 4. Minnesota Statutes 2008, section 62Q.75, subdivision 3, is amended to read:
Subd. 3. Claims filing.
Unless otherwise provided by contract, by section
, or by federal law, the health care providers and facilities specified
in subdivision 2 must submit their charges to a health plan company or third-party
administrator within six months from the date of service or the date the health care
provider knew or was informed of the correct name and address of the responsible health
plan company or third-party administrator, whichever is later. A health care provider or
facility that does not make an initial submission of charges within the six-month period
shall not be reimbursed for the charge and may not collect the charge from the recipient of
the service or any other payer. The six-month submission requirement may be extended to
12 months in cases where a health care provider or facility specified in subdivision 2 has
determined and can substantiate that it has experienced a significant disruption to normal
operations that materially affects the ability to conduct business in a normal manner and to
submit claims on a timely basis. Any request by a health care provider or facility specified
2.26in subdivision 2 for an exception to a contractually defined claims submission timeline
2.27must be reviewed and acted upon by the health plan company within the same time frame
2.28as the contractually agreed upon claims filing timeline.
This subdivision also applies to all
health care providers and facilities that submit charges to workers' compensation payers
for treatment of a workers' compensation injury compensable under chapter 176, or to
reparation obligors for treatment of an injury compensable under chapter 65B.
2.32EFFECTIVE DATE.This section is effective January 1, 2011, and applies to
2.33contracts entered into, renewed, or amended on or after that date.
Sec. 5. Minnesota Statutes 2008, section 62Q.75, is amended by adding a subdivision
3.3 Subd. 4. Claims adjustment timeline. (a) Once a clean claim, as defined in section
3.462Q.75, subdivision 1, has been paid, the contract must provide a 12-month deadline on
3.5all adjustments to and recoupments of the payment with the exception of payments related
3.6to coordination of benefits, subrogation, duplicate claims, retroactive terminations, and
3.7cases of fraud and abuse.
3.8(b) Paragraph (a) shall not apply to pharmacy contracts entered into between or on
3.9behalf of health plan companies.
3.10EFFECTIVE DATE.This section is effective January 1, 2011, and applies to
3.11contracts entered into, renewed, or amended on or after that date.
Sec. 6. [62Q.751] COLLECTION OF CO-PAYMENTS, DEDUCTIBLES, AND
3.13ESTIMATED PAYMENTS FROM PATIENTS.
3.14A health plan company shall permit providers to collect co-payments, deductibles,
3.15and coinsurance from patients at or prior to the time of service. Overpayments by patients
3.16to providers must be returned to the patient by the provider in the same form in which
3.17it was collected within 30 days of the date in which the claim adjudication is received
3.18by the provider.
3.19EFFECTIVE DATE.This section is effective August 1, 2010, and applies to
3.20contracts entered into, renewed, or amended on or after that date.