Reporting Provider Payment Rates. (1) According to guidelines developed by the State, in consultation with health care providers and MCOs, each MCO must annually provide to the State information on reimbursement rates paid by the MCO to providers and vendors for administrative services under contract with the MCO, pursuant to Minnesota Statutes, § 256B.69, subd. 9b. In addition, each MCO must provide to the State in the form and manner specified by the State:
(a) The amount of the payment made to the MCO under this section that is paid to health care providers for patient care;
(b) Aggregate provider payment data, categorized by inpatient payments and outpatient payments, with the outpatient payments categorized by payments to primary care providers and non-primary care providers;
(c) The process by which increases or decreases in payments made to the MCO under this section, that are based on actuarial analysis related to provider cost increases or decreases, or that are required by legislative action, are passed through to health care providers, categorized by payments to primary care providers and non-primary care providers; and
(d) Specific information on the methodology used to establish provider reimbursement rates paid by the MCO.
(2) The MCO agrees to participate in a workgroup with the STATE to provide input on the data collection format and parameters for the reporting requirements under 3.5.2.T (1). The scope of the data collection will include detailed provider reimbursement data, aggregate expenditure data based on service groupings, and narrative information. The MCO will submit the first phase of the provider payment data reporting beginning no later than July 1, 2010 and will include information on aggregate provider payment data, information on legislatively-mandated provider rate changes, and information and data on provider reimbursement rates and rate methodologies.
Reporting Provider Payment Rates. (1) According to guidelines developed by the State, in consultation with health care providers and MCOs, each MCO must annually provide to the State information on reimbursement rates paid by the MCO to provider and vendors for administrative services under contract with the plan, pursuant to Minnesota Statutes, § 256B.69, subd. 9b (b). In addition, each MCO must provide to the State in the form and manner specified by the State:
(2) The amount of the payment received from the STATE under this contract that is paid to health care providers for patient care;
(3) Aggregate provider payment data, categorized by inpatient payments and outpatient payments, with the outpatient payments categorized by payments to primary care providers and nonprimary care providers;
(4) The process by which increases or decreases in payments made to the plan under this section, that are based on actuarial analysis related to provider cost increases or decreases, or that are required by legislative action, are passed through to health care providers, categorized by payments to primary care providers and nonprimary care providers; and
(5) Specific information on the methodology used to establish provider reimbursement rates paid by the MCO.
(6) The MCO will submit the provider payment data report on August 15 of the Contract Year. This report will include aggregate provider payment data, information on legislatively mandated provider rate changes, and information and data on provider reimbursement rates and rate methodologies. (U) Dental CHIPRA Data Files Submission. In accordance with section 501(e) of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) to promote and improve access to dental services for children, the MCO shall submit quarterly data files to the STATE that include information about dental providers in the MCO’s network. The MCO must provide certification of the quarterly data at the same time that it submits the data or by the 5th day of the month following the month of submission. If for any reason the data needs to be corrected, a new data certification will be required. The data files shall comply with the specifications and submission guide outlined in the document entitled, “Insure Kids Now (IKN) Provider Data Submission Technical Information” modified by the STATE and posted on the DHS managed care website.
Reporting Provider Payment Rates. According to guidelines developed by the State, in consultation with health care providers and MCOs, each MCO must annually provide to the State information on reimbursement rates paid by the MCO to provider types and vendors for administrative services under contract with the plan, pursuant to Minnesota Statutes, § 256B.69, subd. 9b. In addition, each MCO must provide to the State in the form and manner specified by the State:
(A) The amount of the payment made to the plan under this section that is paid to health care providers for patient care;
(B) Aggregate provider payment data, categorized by inpatient payments and outpatient payments, with the outpatient payments categorized by payments to primary care providers and non-primary care providers;
(C) The process by which increases or decreases in payments made to the plan under this section, that are based on actuarial analysis related to provider cost increases or decreases, or that are required by legislative action, are passed through to health care providers, categorized by payments to primary care providers and non-primary care providers; and
(D) Specific information on the methodology used to establish provider reimbursement rates paid by the MCO.
Reporting Provider Payment Rates. According to guidelines developed by the STATE, in consultation with health care providers and MCOs, each MCO must annually provide to the STATE the following information:
(1) Administrative expenses by category and subcategory consistent with administrative expense reporting to other state and federal regulatory agencies, by program;
(2) Revenues by program, including investment income;
(3) Non-administrative service payments, provider payments, and reimbursement rates by provider type or service category, by program, paid by the managed care plan under this section or the county-based purchasing plan under Minnesota Statutes, § 256B.692 to providers and vendors for administrative services under contract with the plan, including but not limited to:
(a) Individual-level provider payment and reimbursement rate data;
(b) Provider reimbursement rate methodologies by provider type, by program, including a description of alternative payment arrangements and payments outside the claims process;
(c) Data on implementation of legislatively mandated provider rate changes; and
(d) Individual-level provider payment and reimbursement rate data and plan- specific provider reimbursement rate methodologies by provider type, by program, including alternative payment arrangements and payments outside the claims process, provided to the STATE under this subdivision are nonpublic data as defined in Minnesota Statutes, § 13.02;
(4) Data on the amount of reinsurance or transfer of risk by program; and
(5) Contribution to reserve, by program.
(6) The MCO will submit the provider payment data report by August 15 of the Contract Year in a form and manner determined by the STATE in accordance with Minnesota Statutes, § 256B.69, subd. 9c.
(7) In the event a report is published or released based on data provided under this subdivision, the STATE shall provide the report to the MCO thirty (30) days prior to the publication or release of the report. The MCO shall have thirty (30) days to review the report and provide comment to the STATE.
