Minnesota Session Laws - 2011, Regular Session

CHAPTER 64--S.F.No. 302

An act

relating to insurance; regulating dental provider contracts and provider audits;

amending Minnesota Statutes 2010, sections 62Q.76, by adding a subdivision; 62Q.78, by adding subdivisions.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2010, section 62Q.76, is amended by adding a subdivision to read:

new text begin Subd. 8. new text end

new text begin Dental provider contract. new text end

new text begin "Dental provider contract" means a written agreement between a dentist or dental clinic and dental organization to provide dental care services. new text end

Sec. 2.

Minnesota Statutes 2010, section 62Q.78, is amended by adding a subdivision to read:

new text begin Subd. 4. new text end

new text begin Contract amendment. new text end

new text begin An amendment or change in terms of an existing contract between a dental organization and a dentist must be disclosed to the dentist at least 90 days before the effective date of the proposed change. new text end

Sec. 3.

Minnesota Statutes 2010, section 62Q.78, is amended by adding a subdivision to read:

new text begin Subd. 5. new text end

new text begin Provider audits. new text end

new text begin (a) A dental organization that conducts audits of dental providers shall: new text end

new text begin (1) provide a written explanation to the dental provider of the reason for the audit and the process the dental organization intends to use to audit patient charts, as well as a written explanation of the processes available to the provider once the dental organization completes its review of the audited patient records; and new text end

new text begin (2) allow the provider a reasonable period of time from the date that the provider receives the verified audit or investigation findings to review, meet, and negotiate a resolution to the audit or investigation. new text end

new text begin (b) If a dental organization conducts a provider audit, the dental organization must use a licensed dentist whose license is in good standing to review patient charts. new text end

Sec. 4.

Minnesota Statutes 2010, section 62Q.78, is amended by adding a subdivision to read:

new text begin Subd. 6. new text end

new text begin Payment for covered services. new text end

new text begin (a) No contract of any dental plan or dental organization that covers any dental services or dental provider agreement with a dentist may require, directly or indirectly, that a dentist provide services to an enrolled participant at a fee set by, or at a fee subject to the approval of, the dental plan or dental organization unless the dental services are covered services. new text end

new text begin (b) A dental plan or dental organization or other person providing third-party administrator services shall not make available any providers in its dentist network to a plan that sets dental fees for any services except covered services. new text end

new text begin (c) "Covered services" means dental care services for which a reimbursement is available under an enrollee's plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, co-payments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation. new text end

Sec. 5.

new text begin EFFECTIVE DATE. new text end

new text begin Sections 1 to 4 are effective August 1, 2011, and apply to dental plans and provider agreements entered into or renewed on or after that date. new text end

Presented to the governor May 23, 2011

Signed by the governor May 24, 2011, 2:28 p.m.