Subpart 1.
Contracts;
modifications.
A managed care plan shall provide the commissioner with a copy
of the following contracts.
A.
Contracts between the managed care plan and any insurer or self-insured
employer, signed by the parties, within 30 days of execution of the contracts.
Standard contracts may be submitted instead of individual contracts if no
modifications are made. Standard contracts must include a list of signatories
and a listing of all employers covered by each contract including the
employer's names, unemployment benefits identification number, and estimated
number of employees governed by the managed care plan contract. Amendments and
addendums to the contracts must be submitted to the commissioner within 30 days
of execution. Contract provisions must be consistent with parts 5218.0010 to
5218.0900 and Minnesota Statutes, section
176.1351. The
contract must specify the billing and payment procedures and how the medical
case management and return to work functions will be coordinated.
B. New types of agreements between
participating health care providers and the managed care plan that are not
identical to the agreements previously submitted to the department under part
5218.0100, subpart 1, item E, subitem (1), which shall not be effective until
approved by the commissioner.
C.
Contracts between the managed care plan and any entity, other than individual
participating providers, that performs some of the functions of the managed
care plan.
Subp. 2.
Annual reporting.
In order to maintain certification, each managed care plan
shall provide on the first working day following each anniversary of
certification the following information in items A to D. The annual report must
be accompanied by a nonrefundable fee of $400:
A. a current listing of participating health
care providers, including provider names, types of license, specialty, business
address, telephone number, and a statement that all licenses are current and in
good standing;
B. a summary of any
sanctions or punitive actions taken by the managed care plan against its
participating providers;
C. a
report that summarizes peer review, utilization review, reported complaints and
dispute resolution proceedings showing cases reviewed, issued involved, and any
action taken; and
D. a report of
educational opportunities offered to participating providers and a summary of
attendance.
Subp. 3.
Plan amendments.
Any of the proposed changes to the certified managed care plan
in items A to C, other than changes to the health care provider list, must be
reported and may not be implemented under the plan until approved by the
commissioner. Submitted changes must be accompanied by a nonrefundable fee of
$150:
A. amendments to any contract
with participating health care providers;
B. amendments to contracts between the
managed care plan and another entity performing functions of the managed care
plan; and
C. any other amendments
to the managed care plan as certified.
Subp. 4.
Insurers; data.
The managed care plan must report to the insurer any data
regarding medical services and supplies related to the workers' compensation
claim required by the insurer to determine compensability in accordance with
Minnesota Statutes, sections
176.135,
subdivision 7, and 176.138, and any other data required by rule.
Subp. 5.
Monitoring.
The commissioner shall require additional information from the
managed care plan if the information is relevant to determining the managed
care plan's compliance with parts 5218.0100 to 5218.0900 and Minnesota
Statutes, section
176.1351.
