SF2441

Purpose of the Bill

The bill aims to reform various aspects of health care contracts, payments, and provisions in Minnesota, ensuring fair practices in managed care organizations and health care provider interactions. It seeks to improve transparency, timeliness, and equity in payment and contract negotiations between health care providers and health plan companies.

Main Provisions

• Non-Discrimination Against Providers: The bill prohibits health carriers from denying contracts with providers based on geographic location if the health plans are actively marketed in that area. Providers may need to meet standard quality assurance and utilization review criteria.
• Contract Amendments: Health plan companies must disclose amendments or changes to existing contracts with providers at least 45-90 days before the changes take effect, with the possibility for providers to terminate contracts prior to amendments.
• Prompt Payment and Interest on Claims: Health plan companies are required to process clean claims within 30 days, paying interest on delayed payments. Interest must be paid separately and regularly without providers needing to request it.
• Claims Filing Timeline: The bill extends the time period for submitting claims from six to twelve months from the service date, with exceptions for disruptions that can extend this period further.
• Durable Medical Equipment (DME) and Supplies: Expands coverage under medical assistance, adjusting rules for enrolling DME vendors and clarifying the definition and conditions for covering certain medical equipment.

Significant Changes to Existing Law

• The bill amends several sections of Minnesota Statutes concerning health care, such as clarifying the claims process, enforcement of timely payment, provider contract negotiations, and geographic discrimination.
• Introduces obligations on health carriers to maintain non-discriminative provider networks across geographic areas and mandates timely communication and negotiation with providers.
• Implements structured timelines and interest rates for claims payments to promote accountability and efficiency.
• Adjusts the rules for equipment vendors involving Medicare enrollment to ensure broader access to necessary medical equipment.

Relevant Terms

• Health carriers, health care providers, geographic discrimination, managed care organizations, clean claims, durable medical equipment, Medicare enrollment, prompt payment, contract amendments, and fee-for-service.