(a) The commissioner shall require group purchasers to submit detailed data on total health care spending for each calendar year. Group purchasers shall submit data for the 1993 calendar year by April 1, 1994, and each April 1 thereafter shall submit data for the preceding calendar year.
(b) The commissioner shall require each group purchaser to submit data on revenue, expenses, and member months, as applicable. Revenue data must distinguish between premium revenue and revenue from other sources and must also include information on the amount of revenue in reserves and changes in reserves. Expenditure data must distinguish between costs incurred for patient care and administrative costs. Patient care and administrative costs must include only expenses incurred on behalf of health plan members and must not include the cost of providing health care services for nonmembers at facilities owned by the group purchaser or affiliate. Expenditure data must be provided separately for the following categories and for other categories required by the commissioner: physician services, dental services, other professional services, inpatient hospital services, outpatient hospital services, emergency, pharmacy services and other nondurable medical goods, mental health, and substance use disorder services, other expenditures, subscriber liability, and administrative costs. Administrative costs must include costs for marketing; advertising; overhead; salaries and benefits of central office staff who do not provide direct patient care; underwriting; lobbying; claims processing; provider contracting and credentialing; detection and prevention of payment for fraudulent or unjustified requests for reimbursement or services; clinical quality assurance and other types of medical care quality improvement efforts; concurrent or prospective utilization review as defined in section 62M.02; costs incurred to acquire a hospital, clinic, or health care facility, or the assets thereof; capital costs incurred on behalf of a hospital or clinic; lease payments; or any other costs incurred pursuant to a partnership, joint venture, integration, or affiliation agreement with a hospital, clinic, or other health care provider. Capital costs and costs incurred must be recorded according to standard accounting principles. The reports of this data must also separately identify expenses for local, state, and federal taxes, fees, and assessments. The commissioner may require each group purchaser to submit any other data, including data in unaggregated form, for the purposes of developing spending estimates, setting spending limits, and monitoring actual spending and costs. In addition to reporting administrative costs incurred to acquire a hospital, clinic, or health care facility, or the assets thereof; or any other costs incurred pursuant to a partnership, joint venture, integration, or affiliation agreement with a hospital, clinic, or other health care provider; reports submitted under this section also must include the payments made during the calendar year for these purposes. The commissioner shall make public, by group purchaser data collected under this paragraph in accordance with section 62J.321, subdivision 5. Workers' compensation insurance plans and automobile insurance plans are exempt from complying with this paragraph as it relates to the submission of administrative costs.
(c) The commissioner may collect information on:
(1) premiums, benefit levels, managed care procedures, and other features of health plan companies;
(2) prices, provider experience, and other information for services less commonly covered by insurance or for which patients commonly face significant out-of-pocket expenses; and
(3) information on health care services not provided through health plan companies, including information on prices, costs, expenditures, and utilization.
(d) All group purchasers shall provide the required data using a uniform format and uniform definitions, as prescribed by the commissioner.
1993 c 345 art 3 s 10; 1994 c 625 art 8 s 28; 1995 c 234 art 5 s 11; 1Sp2001 c 9 art 16 s 4; 2002 c 379 art 1 s 113; 2022 c 98 art 4 s 51
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 62J — Health Care Cost Containment
Section 62J.016 — Goals Of Restructuring.
Section 62J.017 — Implementation Timetable.
Section 62J.04 — Monitoring The Rate Of Growth Of Health Care Spending.
Section 62J.041 — Interim Health Plan Company Cost Containment Goals.
Section 62J.052 — Provider Cost Disclosure.
Section 62J.06 — Immunity From Liability.
Section 62J.156 — Closed Committee Hearings.
Section 62J.17 — Expenditure Reporting.
Section 62J.212 — Public Health Goals.
Section 62J.22 — Participation Of Federal Programs.
Section 62J.23 — Provider Conflicts Of Interest.
Section 62J.25 — Mandatory Medicare Assignment.
Section 62J.26 — Evaluation Of Proposed Health Coverage Mandates.
Section 62J.2930 — Information Clearinghouse.
Section 62J.301 — Research And Data Initiatives.
Section 62J.311 — Analysis And Use Of Data.
Section 62J.321 — Data Collection And Processing Procedures.
Section 62J.38 — Cost Containment Data From Group Purchasers.
Section 62J.40 — Cost Containment Data From State Agencies And Other Governmental Units.
Section 62J.42 — Quality, Utilization, And Outcome Data.
Section 62J.431 — Evidence-based Health Care Guidelines.
Section 62J.46 — Monitoring And Reports.
Section 62J.48 — Criteria For Ambulance Services Reimbursement.
Section 62J.49 — Ambulance Services Financial Data.
Section 62J.495 — Electronic Health Record Technology.
Section 62J.496 — Electronic Health Record System Revolving Account And Loan Program.
Section 62J.497 — Electronic Prescription Drug Program.
Section 62J.498 — Health Information Exchange.
Section 62J.4981 — Certificate Of Authority To Provide Health Information Exchange Services.
Section 62J.4982 — Enforcement Authority; Compliance.
Section 62J.50 — Citation And Purpose.
Section 62J.52 — Establishment Of Uniform Billing Forms.
Section 62J.53 — Acceptance Of Uniform Billing Forms By Group Purchasers.
Section 62J.535 — Uniform Billing Requirements For Claim Transactions.
Section 62J.536 — Uniform Electronic Transactions And Implementation Guide Standards.
Section 62J.54 — Identification And Implementation Of Unique Identifiers.
Section 62J.55 — Privacy Of Unique Identifiers.
Section 62J.56 — Implementation Of Electronic Data Interchange Standards.
Section 62J.57 — Minnesota Center For Health Care Electronic Data Interchange.
Section 62J.581 — Standards For Minnesota Uniform Health Care Reimbursement Documents.
Section 62J.60 — Minnesota Uniform Health Care Identification Card.
Section 62J.61 — Rulemaking; Implementation.
Section 62J.62 — Electronic Billing Assistance.
Section 62J.63 — Center For Health Care Purchasing Improvement.
Section 62J.692 — Medical Education.
Section 62J.701 — Governmental Programs.
Section 62J.71 — Prohibited Provider Contracts.
Section 62J.72 — Disclosure Of Health Care Provider Information.
Section 62J.73 — Prohibition On Exclusive Arrangements.
Section 62J.76 — Nonpreemption.
Section 62J.81 — Disclosure Of Payments For Health Care Services.
Section 62J.812 — Primary Care Price Transparency.
Section 62J.82 — Hospital Information Reporting Disclosure.
Section 62J.823 — Hospital Pricing Transparency.
Section 62J.824 — Facility Fee Disclosure.