Bill Text: MN SF721 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Prepaid health plans provider right to audit financial aspects of health plan company contracts
Sponsorship: Partisan Bill (Republican 1)
Status: (Introduced - Dead) 2011-03-10 - Referred to Health and Human Services [SF721 Detail]
Download: Minnesota-2011-SF721-Introduced.html
1.2relating to human services; providing a right for providers to audit financial
1.3aspects of health plan company contracts with the prepaid medical assistance
1.4program;amending Minnesota Statutes 2010, section 256B.69, by adding a
1.5subdivision.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2010, section 256B.69, is amended by adding a
1.8subdivision to read:
1.9 Subd. 9c. Rights to audit related to the loss ratio. (a) Within 90 days after the end
1.10of each calendar year during the term of provider participation, each prepaid health plan
1.11used by the commissioner to provide services under this section or section 256B.692 shall
1.12furnish to each provider a statement in reasonable detail setting forth the computation of
1.13the total costs and expenses used in the calculation of the minimum loss ratio as well as
1.14all administrative expenses incurred in the prior calendar year. At the request of any
1.15provider, a prepaid health plan used by the commissioner to provide services under this
1.16section or section 256B.692 shall furnish to the provider all records of payments from
1.17the commissioner to the prepaid plan, all invoices, receipts, and all other data necessary
1.18for the provider to verify the amount of any administrative costs and expenses and the
1.19calculation of the minimum loss ratio.
1.20(b) Any provider or group of providers has at its sole expense the right upon 14 days'
1.21written notice to audit and inspect all of the prepaid health plan's records relating to the
1.22costs and expenses which are used in the calculation of the minimum loss ratio; provided,
1.23however, that upon the expiration of 24 months following the end of any calendar year,
1.24the health plan's records shall be deemed to be conclusive, and the providers have no
1.25further rights to audit and inspect them with regard to that calendar year. Appropriate
2.1adjustments shall be made for errors in the amount of the computations revealed by an
2.2audit or inspection. If an audit or inspection by a provider or group of providers indicates
2.3an excess in the amount of administrative costs and expenses by more than two percent,
2.4the cost incurred by the providers for the audit or inspection shall be paid to the providers
2.5by the health plan. If any excess of administrative expense by the plan is discovered by
2.6the audit, the prepaid health plan shall pay the amount of the excess above ten percent to
2.7the health care access fund.
2.8(c) Nothing in this subdivision requires the mandatory loss ratio in subdivision
2.95i to be applied to any prepaid plan's business other than that business awarded by
2.10the commissioner unless the prepaid health plan fails to keep a separate and distinct
2.11accounting for funds received from the commissioner.
2.12(d) No prepaid health plan used by the commissioner may require any provider to
2.13waive this right to audit as a condition of participation with the prepaid health plan. No
2.14prepaid health plan may retaliate against any provider for exercising any rights related
2.15to the audit described in this subdivision.
2.16(e) If a prepaid health plan and a provider or group of providers do not agree as
2.17to the result of an audit or inspection of records conducted under this subdivision, the
2.18commissioner shall refer the dispute to the attorney general for resolution. Each party
2.19shall pay its own expenses in connection with the process of resolving the dispute.
2.20(f) An enrollee or group of enrollees has the right to conduct an audit and inspection
2.21of a prepaid health plan's records in the same basis granted under this subdivision to
2.22health care providers.
2.23(g) The commissioner shall reference this subdivision in any request for proposal for
2.24services to which this subdivision applies.
2.25EFFECTIVE DATE.This section is effective January 1, 2012.
1.3aspects of health plan company contracts with the prepaid medical assistance
1.4program;amending Minnesota Statutes 2010, section 256B.69, by adding a
1.5subdivision.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2010, section 256B.69, is amended by adding a
1.8subdivision to read:
1.9 Subd. 9c. Rights to audit related to the loss ratio. (a) Within 90 days after the end
1.10of each calendar year during the term of provider participation, each prepaid health plan
1.11used by the commissioner to provide services under this section or section 256B.692 shall
1.12furnish to each provider a statement in reasonable detail setting forth the computation of
1.13the total costs and expenses used in the calculation of the minimum loss ratio as well as
1.14all administrative expenses incurred in the prior calendar year. At the request of any
1.15provider, a prepaid health plan used by the commissioner to provide services under this
1.16section or section 256B.692 shall furnish to the provider all records of payments from
1.17the commissioner to the prepaid plan, all invoices, receipts, and all other data necessary
1.18for the provider to verify the amount of any administrative costs and expenses and the
1.19calculation of the minimum loss ratio.
1.20(b) Any provider or group of providers has at its sole expense the right upon 14 days'
1.21written notice to audit and inspect all of the prepaid health plan's records relating to the
1.22costs and expenses which are used in the calculation of the minimum loss ratio; provided,
1.23however, that upon the expiration of 24 months following the end of any calendar year,
1.24the health plan's records shall be deemed to be conclusive, and the providers have no
1.25further rights to audit and inspect them with regard to that calendar year. Appropriate
2.1adjustments shall be made for errors in the amount of the computations revealed by an
2.2audit or inspection. If an audit or inspection by a provider or group of providers indicates
2.3an excess in the amount of administrative costs and expenses by more than two percent,
2.4the cost incurred by the providers for the audit or inspection shall be paid to the providers
2.5by the health plan. If any excess of administrative expense by the plan is discovered by
2.6the audit, the prepaid health plan shall pay the amount of the excess above ten percent to
2.7the health care access fund.
2.8(c) Nothing in this subdivision requires the mandatory loss ratio in subdivision
2.95i to be applied to any prepaid plan's business other than that business awarded by
2.10the commissioner unless the prepaid health plan fails to keep a separate and distinct
2.11accounting for funds received from the commissioner.
2.12(d) No prepaid health plan used by the commissioner may require any provider to
2.13waive this right to audit as a condition of participation with the prepaid health plan. No
2.14prepaid health plan may retaliate against any provider for exercising any rights related
2.15to the audit described in this subdivision.
2.16(e) If a prepaid health plan and a provider or group of providers do not agree as
2.17to the result of an audit or inspection of records conducted under this subdivision, the
2.18commissioner shall refer the dispute to the attorney general for resolution. Each party
2.19shall pay its own expenses in connection with the process of resolving the dispute.
2.20(f) An enrollee or group of enrollees has the right to conduct an audit and inspection
2.21of a prepaid health plan's records in the same basis granted under this subdivision to
2.22health care providers.
2.23(g) The commissioner shall reference this subdivision in any request for proposal for
2.24services to which this subdivision applies.
2.25EFFECTIVE DATE.This section is effective January 1, 2012.
