SF 1824 requires a third-party financial audit of managed care and county-based purchasing plans that contract with the Commissioner of Human Services under section 256B.69.

Section 1 (256B.69, subdivision 9c), paragraph (d), states that the Commissioner of Human Services, as part of the request for bids and the resulting contracts with managed care plans and county-based purchasing plans, shall require the plans to submit to and fully cooperate with an annual independent third-party financial audit of the information the plans are required to submit under section 256B.69, subdivision 9c.

Paragraph (e) prohibits the commissioner from contracting with a firm that provides consulting or other services to a participating managed care or county-based purchasing plan.

Paragraph (f) requires the plans to provide complete real-time encounter and claims data at the granular or source level regarding the services provided under section 256B.69 and requires the plans, upon request by the commissioner, to promptly provide the commissioner and the auditing firm with auditable proof that the encounters and claims are occurring as reported.

Paragraph (g) states that contracts awarded under section 256B.69 must provide that the commissioner and the auditor have unlimited access to any and all data required to complete the audit.  This paragraph also states that this access shall be enforceable through injunctive or other appropriate relief.

Paragraph (h) prohibits an actuary or actuarial firm providing actuarial services to the commissioner in connection with this subdivision from providing services to any managed care or county-based purchasing plan participating in this subdivision during the term of the firm's actuarial work under this subdivision.

Paragraph (i) states that the actuary or actuarial firm providing actuarial services to the commissioner under this subdivision shall certify and attest to the rates paid to the managed care and county-based purchasing plans and that the certification and attestation must be auditable.

Paragraph (j) requires the independent audit to include a determination of compliance with the federal Medicaid rate certification process.

Paragraph (k) requires the contract with the auditing firm to be designed and administered so that the independent audit will be eligible for a federal subsidy if available for that purpose.

Paragraph (l) requires the commissioner to provide copies of the audit report to the legislative auditor, the attorney general, and the legislature.

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