Bill Text: MN HF2412 | 2011-2012 | 87th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Managed care plan financial reporting changes made, an annual independent third-party audit required, and reporting requirements eliminated and modified.
Spectrum: Slight Partisan Bill (Republican 10-4)
Status: (Introduced - Dead) 2012-04-16 - Author added Fabian [HF2412 Detail]
Download: Minnesota-2011-HF2412-Introduced.html
Bill Title: Managed care plan financial reporting changes made, an annual independent third-party audit required, and reporting requirements eliminated and modified.
Spectrum: Slight Partisan Bill (Republican 10-4)
Status: (Introduced - Dead) 2012-04-16 - Author added Fabian [HF2412 Detail]
Download: Minnesota-2011-HF2412-Introduced.html
1.2relating to health; requiring certain changes in managed care plan financial
1.3reporting; requiring an annual independent third-party audit;amending
1.4Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 9c.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 9c,
1.7is amended to read:
1.8 Subd. 9c. Managed care financial reporting. (a) The commissioner shall collect
1.9detailed data regarding financials, provider payments, provider rate methodologies, and
1.10other data as determined by the commissioner and managed care and county-based
1.11purchasing plans that are required to be submitted under this section. The commissioner,
1.12in consultation with the commissioners of health and commerce, and in consultation
1.13with managed care plans and county-based purchasing plans, shall set uniform criteria,
1.14definitions, and standards for the data to be submitted, and shall require managed care and
1.15county-based purchasing plans to comply with these criteria, definitions, and standards
1.16when submitting data under this section. In carrying out the responsibilities of this
1.17subdivision, the commissioner shall ensure that the data collection is implemented in an
1.18integrated and coordinated manner that avoids unnecessary duplication of effort. To the
1.19extent possible, the commissioner shall use existing data sources and streamline data
1.20collection in order to reduce public and private sector administrative costs. Nothing in
1.21this subdivision shall allow release of information that is nonpublic data pursuant to
1.22section13.02 .
1.23(b) Each managed care and county-based purchasing plan must annually provide
1.24to the commissioner the following information on state public programs, in the form
2.1and manner specified by the commissioner, according to guidelines developed by the
2.2commissioner in consultation with managed care plans and county-based purchasing
2.3plans under contract:
2.4(1) administrative expenses by category and subcategory consistent with
2.5administrative expense reporting to other state and federal regulatory agencies, by
2.6program;
2.7(2) revenues by program, including investment income;
2.8(3) nonadministrative service payments, provider payments, and reimbursement
2.9rates by provider type or service category, by program, paid by the managed care plan
2.10under this section or the county-based purchasing plan under section256B.692 to
2.11providers and vendors for administrative services under contract with the plan, including
2.12but not limited to:
2.13(i) individual-level provider payment and reimbursement rate data;
2.14(ii) provider reimbursement rate methodologies by provider type, by program,
2.15including a description of alternative payment arrangements and payments outside the
2.16claims process;
2.17(iii) data on implementation of legislatively mandated provider rate changes; and
2.18(iv) individual-level provider payment and reimbursement rate data and plan-specific
2.19provider reimbursement rate methodologies by provider type, by program, including
2.20alternative payment arrangements and payments outside the claims process, provided to
2.21the commissioner under this subdivision are nonpublic data as defined in section13.02 ;
2.22(4) data on the amount of reinsurance or transfer of risk by program; and
2.23(5) contribution to reserve, by program.
2.24(c) In the event a report is published or released based on data provided under
2.25this subdivision, the commissioner shall provide the report to managed care plans and
2.26county-based purchasing plans 30 days prior to the publication or release of the report.
2.27Managed care plans and county-based purchasing plans shall have 30 days to review the
2.28report and provide comment to the commissioner.
2.29(d) The commissioner shall require, in the request for bids and the resulting
2.30contracts for coverage to be provided under this section, that each managed care and
2.31county-based purchasing plan submit to and fully cooperate with an annual independent
2.32third-party financial audit of the information required under paragraph (b). For purposes
2.33of this paragraph, "independent third party" means that the audit must be conducted
2.34by a firm that performs audits only for governmental entities and does not provide or
2.35receive, and has not provided or received, payment for actuarial, auditing, accounting,
2.36or other services provided by the firm, or by any affiliate of the firm, to a managed care
3.1or county-based purchasing plan, or to any affiliate of either, that is awarded a contract
3.2with the commissioner under this section.
3.3(e) The commissioner shall not contract, for purposes of this section, with a firm
3.4that provides consulting or other services to a participating managed care or county-based
3.5purchasing plan, regardless of whether the consulting services are related to health care
3.6provided under this section.
3.7(f) A managed care plan or county-based purchasing plan that provides services
3.8under this section shall provide complete real-time encounter and claims data at the
3.9granular or source level regarding those services to the commissioner and shall, upon
3.10request of the commissioner, promptly provide the commissioner and the independent
3.11third-party auditing firm with auditable proof that the encounters and claims are occurring
3.12as reported.
3.13(g) Contracts awarded under this section to a managed care or county-based
3.14purchasing plan must provide that the commissioner and the contracted auditor shall have
3.15unlimited access to any and all data required to complete the audit and that this access
3.16shall be enforceable in a court of competent jurisdiction through the process of injunctive
3.17or other appropriate relief.
3.18(h) No actuary or actuarial firm providing actuarial services to the commissioner
3.19in connection with this subdivision shall provide services to any managed care or
3.20county-based purchasing plan participating in this subdivision during the term of the
3.21actuary's work for the commissioner under this subdivision.
3.22(i) The actuary or actuarial firm referenced in paragraph (h) shall certify and attest
3.23to the rates paid to managed care plans and county-based purchasing plans under this
3.24section, and the certification and attestation must be auditable.
3.25(j) The independent third-party audit shall include a determination of compliance
3.26with the federal Medicaid rate certification process.
3.27(k) The commissioner's contract with the independent third-party auditing firm shall
3.28be designed and administered so as to render the independent third-party audit eligible for
3.29a federal subsidy if available for that purpose.
3.30(l) Upon completion of the audit, and its receipt by the commissioner, the
3.31commissioner shall provide copies of the audit report to the legislative auditor, the attorney
3.32general, and the chairs of the health finance committees of the legislature.
3.33EFFECTIVE DATE.This section is effective the day following final enactment
3.34and applies to contracts, and the contracting process, for contracts that are effective
3.35January 1, 2013, and thereafter.
1.3reporting; requiring an annual independent third-party audit;amending
1.4Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 9c.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 9c,
1.7is amended to read:
1.8 Subd. 9c. Managed care financial reporting. (a) The commissioner shall collect
1.9detailed data regarding financials, provider payments, provider rate methodologies, and
1.10other data as determined by the commissioner and managed care and county-based
1.11purchasing plans that are required to be submitted under this section. The commissioner,
1.12in consultation with the commissioners of health and commerce, and in consultation
1.13with managed care plans and county-based purchasing plans, shall set uniform criteria,
1.14definitions, and standards for the data to be submitted, and shall require managed care and
1.15county-based purchasing plans to comply with these criteria, definitions, and standards
1.16when submitting data under this section. In carrying out the responsibilities of this
1.17subdivision, the commissioner shall ensure that the data collection is implemented in an
1.18integrated and coordinated manner that avoids unnecessary duplication of effort. To the
1.19extent possible, the commissioner shall use existing data sources and streamline data
1.20collection in order to reduce public and private sector administrative costs. Nothing in
1.21this subdivision shall allow release of information that is nonpublic data pursuant to
1.22section
1.23(b) Each managed care and county-based purchasing plan must annually provide
1.24to the commissioner the following information on state public programs, in the form
2.1and manner specified by the commissioner, according to guidelines developed by the
2.2commissioner in consultation with managed care plans and county-based purchasing
2.3plans under contract:
2.4(1) administrative expenses by category and subcategory consistent with
2.5administrative expense reporting to other state and federal regulatory agencies, by
2.6program;
2.7(2) revenues by program, including investment income;
2.8(3) nonadministrative service payments, provider payments, and reimbursement
2.9rates by provider type or service category, by program, paid by the managed care plan
2.10under this section or the county-based purchasing plan under section
2.11providers and vendors for administrative services under contract with the plan, including
2.12but not limited to:
2.13(i) individual-level provider payment and reimbursement rate data;
2.14(ii) provider reimbursement rate methodologies by provider type, by program,
2.15including a description of alternative payment arrangements and payments outside the
2.16claims process;
2.17(iii) data on implementation of legislatively mandated provider rate changes; and
2.18(iv) individual-level provider payment and reimbursement rate data and plan-specific
2.19provider reimbursement rate methodologies by provider type, by program, including
2.20alternative payment arrangements and payments outside the claims process, provided to
2.21the commissioner under this subdivision are nonpublic data as defined in section
2.22(4) data on the amount of reinsurance or transfer of risk by program; and
2.23(5) contribution to reserve, by program.
2.24(c) In the event a report is published or released based on data provided under
2.25this subdivision, the commissioner shall provide the report to managed care plans and
2.26county-based purchasing plans 30 days prior to the publication or release of the report.
2.27Managed care plans and county-based purchasing plans shall have 30 days to review the
2.28report and provide comment to the commissioner.
2.29(d) The commissioner shall require, in the request for bids and the resulting
2.30contracts for coverage to be provided under this section, that each managed care and
2.31county-based purchasing plan submit to and fully cooperate with an annual independent
2.32third-party financial audit of the information required under paragraph (b). For purposes
2.33of this paragraph, "independent third party" means that the audit must be conducted
2.34by a firm that performs audits only for governmental entities and does not provide or
2.35receive, and has not provided or received, payment for actuarial, auditing, accounting,
2.36or other services provided by the firm, or by any affiliate of the firm, to a managed care
3.1or county-based purchasing plan, or to any affiliate of either, that is awarded a contract
3.2with the commissioner under this section.
3.3(e) The commissioner shall not contract, for purposes of this section, with a firm
3.4that provides consulting or other services to a participating managed care or county-based
3.5purchasing plan, regardless of whether the consulting services are related to health care
3.6provided under this section.
3.7(f) A managed care plan or county-based purchasing plan that provides services
3.8under this section shall provide complete real-time encounter and claims data at the
3.9granular or source level regarding those services to the commissioner and shall, upon
3.10request of the commissioner, promptly provide the commissioner and the independent
3.11third-party auditing firm with auditable proof that the encounters and claims are occurring
3.12as reported.
3.13(g) Contracts awarded under this section to a managed care or county-based
3.14purchasing plan must provide that the commissioner and the contracted auditor shall have
3.15unlimited access to any and all data required to complete the audit and that this access
3.16shall be enforceable in a court of competent jurisdiction through the process of injunctive
3.17or other appropriate relief.
3.18(h) No actuary or actuarial firm providing actuarial services to the commissioner
3.19in connection with this subdivision shall provide services to any managed care or
3.20county-based purchasing plan participating in this subdivision during the term of the
3.21actuary's work for the commissioner under this subdivision.
3.22(i) The actuary or actuarial firm referenced in paragraph (h) shall certify and attest
3.23to the rates paid to managed care plans and county-based purchasing plans under this
3.24section, and the certification and attestation must be auditable.
3.25(j) The independent third-party audit shall include a determination of compliance
3.26with the federal Medicaid rate certification process.
3.27(k) The commissioner's contract with the independent third-party auditing firm shall
3.28be designed and administered so as to render the independent third-party audit eligible for
3.29a federal subsidy if available for that purpose.
3.30(l) Upon completion of the audit, and its receipt by the commissioner, the
3.31commissioner shall provide copies of the audit report to the legislative auditor, the attorney
3.32general, and the chairs of the health finance committees of the legislature.
3.33EFFECTIVE DATE.This section is effective the day following final enactment
3.34and applies to contracts, and the contracting process, for contracts that are effective
3.35January 1, 2013, and thereafter.
