| 1 | 1 | | 1.1 A bill for an act |
|---|
| 2 | 2 | | 1.2 relating to human services; modifying payment methodologies for certain enteral |
|---|
| 3 | 3 | | 1.3 nutrition equipment and supplies; modifying processes for establishing payment |
|---|
| 4 | 4 | | 1.4 rates for certain medical equipment and supplies; amending Minnesota Statutes |
|---|
| 5 | 5 | | 1.5 2024, section 256B.766. |
|---|
| 6 | 6 | | 1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: |
|---|
| 7 | 7 | | 1.7 Section 1. Minnesota Statutes 2024, section 256B.766, is amended to read: |
|---|
| 8 | 8 | | 1.8 256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES. |
|---|
| 9 | 9 | | 1.9 Subdivision 1.Payment reductions for base care services effective July 1, 2009.(a) |
|---|
| 10 | 10 | | 1.10Effective for services provided on or after July 1, 2009, total payments for basic care services, |
|---|
| 11 | 11 | | 1.11shall be reduced by three percent, except that for the period July 1, 2009, through June 30, |
|---|
| 12 | 12 | | 1.122011, total payments shall be reduced by 4.5 percent for the medical assistance and general |
|---|
| 13 | 13 | | 1.13assistance medical care programs, prior to third-party liability and spenddown calculation. |
|---|
| 14 | 14 | | 1.14 Subd. 2.Classification of therapies as basic care services.Effective July 1, 2010, The |
|---|
| 15 | 15 | | 1.15commissioner shall classify physical therapy services, occupational therapy services, and |
|---|
| 16 | 16 | | 1.16speech-language pathology and related services as basic care services. The reduction in this |
|---|
| 17 | 17 | | 1.17paragraph subdivision 1 shall apply to physical therapy services, occupational therapy |
|---|
| 18 | 18 | | 1.18services, and speech-language pathology and related services provided on or after July 1, |
|---|
| 19 | 19 | | 1.192010. |
|---|
| 20 | 20 | | 1.20 Subd. 3.Payment reductions to managed care plans effective October 1, 2009.(b) |
|---|
| 21 | 21 | | 1.21Payments made to managed care plans and county-based purchasing plans shall be reduced |
|---|
| 22 | 22 | | 1.22for services provided on or after October 1, 2009, to reflect the reduction in subdivision 1 |
|---|
| 23 | 23 | | 1Section 1. |
|---|
| 24 | 24 | | REVISOR AGW/CH 25-0401002/19/25 |
|---|
| 25 | 25 | | State of Minnesota |
|---|
| 26 | 26 | | This Document can be made available |
|---|
| 27 | 27 | | in alternative formats upon request |
|---|
| 28 | 28 | | HOUSE OF REPRESENTATIVES |
|---|
| 29 | 29 | | H. F. No. 2299 |
|---|
| 30 | 30 | | NINETY-FOURTH SESSION |
|---|
| 31 | 31 | | Authored by Bierman and Schomacker03/13/2025 |
|---|
| 32 | 32 | | The bill was read for the first time and referred to the Committee on Human Services Finance and Policy 2.1effective July 1, 2009, and payments made to the plans shall be reduced effective October |
|---|
| 33 | 33 | | 2.21, 2010, to reflect the reduction in subdivision 1 effective July 1, 2010. |
|---|
| 34 | 34 | | 2.3 Subd. 4.Temporary payment reductions effective September 1, 2011.(c) (a) Effective |
|---|
| 35 | 35 | | 2.4for services provided on or after September 1, 2011, through June 30, 2013, total payments |
|---|
| 36 | 36 | | 2.5for outpatient hospital facility fees shall be reduced by five percent from the rates in effect |
|---|
| 37 | 37 | | 2.6on August 31, 2011. |
|---|
| 38 | 38 | | 2.7 (d) (b) Effective for services provided on or after September 1, 2011, through June 30, |
|---|
| 39 | 39 | | 2.82013, total payments for ambulatory surgery centers facility fees, medical supplies and |
|---|
| 40 | 40 | | 2.9durable medical equipment not subject to a volume purchase contract, prosthetics and |
|---|
| 41 | 41 | | 2.10orthotics, renal dialysis services, laboratory services, public health nursing services, physical |
|---|
| 42 | 42 | | 2.11therapy services, occupational therapy services, speech therapy services, eyeglasses not |
|---|
| 43 | 43 | | 2.12subject to a volume purchase contract, hearing aids not subject to a volume purchase contract, |
|---|
| 44 | 44 | | 2.13and anesthesia services shall be reduced by three percent from the rates in effect on August |
|---|
| 45 | 45 | | 2.1431, 2011. |
|---|
| 46 | 46 | | 2.15 Subd. 5.Payment increases effective September 1, 2014.(e) (a) Effective for services |
|---|
| 47 | 47 | | 2.16provided on or after September 1, 2014, payments for ambulatory surgery centers facility |
|---|
| 48 | 48 | | 2.17fees, hospice services, renal dialysis services, laboratory services, public health nursing |
|---|
| 49 | 49 | | 2.18services, eyeglasses not subject to a volume purchase contract, and hearing aids not subject |
|---|
| 50 | 50 | | 2.19to a volume purchase contract shall be increased by three percent and payments for outpatient |
|---|
| 51 | 51 | | 2.20hospital facility fees shall be increased by three percent. |
|---|
| 52 | 52 | | 2.21 (b) Payments made to managed care plans and county-based purchasing plans shall not |
|---|
| 53 | 53 | | 2.22be adjusted to reflect payments under this paragraph subdivision. |
|---|
| 54 | 54 | | 2.23 Subd. 6.Temporary payment reductions effective July 1, 2014.(f) Payments for |
|---|
| 55 | 55 | | 2.24medical supplies and durable medical equipment not subject to a volume purchase contract, |
|---|
| 56 | 56 | | 2.25and prosthetics and orthotics, provided on or after July 1, 2014, through June 30, 2015, shall |
|---|
| 57 | 57 | | 2.26be decreased by .33 percent. |
|---|
| 58 | 58 | | 2.27 Subd. 7.Payment increases effective July 1, 2015.(a) Payments for medical supplies |
|---|
| 59 | 59 | | 2.28and durable medical equipment not subject to a volume purchase contract, and prosthetics |
|---|
| 60 | 60 | | 2.29and orthotics, provided on or after July 1, 2015, shall be increased by three percent from |
|---|
| 61 | 61 | | 2.30the rates as determined under paragraphs (i) and (j) subdivisions 9 and 10. |
|---|
| 62 | 62 | | 2.31 (g) (b) Effective for services provided on or after July 1, 2015, payments for outpatient |
|---|
| 63 | 63 | | 2.32hospital facility fees, medical supplies and durable medical equipment not subject to a |
|---|
| 64 | 64 | | 2.33volume purchase contract, prosthetics, and orthotics to a hospital meeting the criteria specified |
|---|
| 65 | 65 | | 2Section 1. |
|---|
| 66 | 66 | | REVISOR AGW/CH 25-0401002/19/25 3.1in section 62Q.19, subdivision 1, paragraph (a), clause (4), shall be increased by 90 percent |
|---|
| 67 | 67 | | 3.2from the rates in effect on June 30, 2015. |
|---|
| 68 | 68 | | 3.3 (c) Payments made to managed care plans and county-based purchasing plans shall not |
|---|
| 69 | 69 | | 3.4be adjusted to reflect payments under this paragraph (b). |
|---|
| 70 | 70 | | 3.5 Subd. 8.Exempt services.(h) This section does not apply to physician and professional |
|---|
| 71 | 71 | | 3.6services, inpatient hospital services, family planning services, mental health services, dental |
|---|
| 72 | 72 | | 3.7services, prescription drugs, medical transportation, federally qualified health centers, rural |
|---|
| 73 | 73 | | 3.8health centers, Indian health services, and Medicare cost-sharing. |
|---|
| 74 | 74 | | 3.9 Subd. 9.Individually priced items.(i) (a) Effective for services provided on or after |
|---|
| 75 | 75 | | 3.10July 1, 2015, the following categories of medical supplies and durable medical equipment |
|---|
| 76 | 76 | | 3.11shall be individually priced items: customized and other specialized tracheostomy tubes |
|---|
| 77 | 77 | | 3.12and supplies, electric patient lifts, and durable medical equipment repair and service. |
|---|
| 78 | 78 | | 3.13 (b) This paragraph subdivision does not apply to medical supplies and durable medical |
|---|
| 79 | 79 | | 3.14equipment subject to a volume purchase contract, products subject to the preferred diabetic |
|---|
| 80 | 80 | | 3.15testing supply program, and items provided to dually eligible recipients when Medicare is |
|---|
| 81 | 81 | | 3.16the primary payer for the item. |
|---|
| 82 | 82 | | 3.17 (c) The commissioner shall not apply any medical assistance rate reductions to durable |
|---|
| 83 | 83 | | 3.18medical equipment as a result of Medicare competitive bidding. |
|---|
| 84 | 84 | | 3.19 Subd. 10.Rate increases effective July 1, 2015.(j) (a) Effective for services provided |
|---|
| 85 | 85 | | 3.20on or after July 1, 2015, medical assistance payment rates for durable medical equipment, |
|---|
| 86 | 86 | | 3.21prosthetics, orthotics, or supplies shall be increased as follows: |
|---|
| 87 | 87 | | 3.22 (1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that |
|---|
| 88 | 88 | | 3.23were subject to the Medicare competitive bid that took effect in January of 2009 shall be |
|---|
| 89 | 89 | | 3.24increased by 9.5 percent; and |
|---|
| 90 | 90 | | 3.25 (2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on |
|---|
| 91 | 91 | | 3.26the medical assistance fee schedule, whether or not subject to the Medicare competitive bid |
|---|
| 92 | 92 | | 3.27that took effect in January of 2009, shall be increased by 2.94 percent, with this increase |
|---|
| 93 | 93 | | 3.28being applied after calculation of any increased payment rate under clause (1). |
|---|
| 94 | 94 | | 3.29 This (b) Paragraph (a) does not apply to medical supplies and durable medical equipment |
|---|
| 95 | 95 | | 3.30subject to a volume purchase contract, products subject to the preferred diabetic testing |
|---|
| 96 | 96 | | 3.31supply program, items provided to dually eligible recipients when Medicare is the primary |
|---|
| 97 | 97 | | 3.32payer for the item, and individually priced items identified in paragraph (i) subdivision 9. |
|---|
| 98 | 98 | | 3Section 1. |
|---|
| 99 | 99 | | REVISOR AGW/CH 25-0401002/19/25 4.1 (c) Payments made to managed care plans and county-based purchasing plans shall not |
|---|
| 100 | 100 | | 4.2be adjusted to reflect the rate increases in this paragraph subdivision. |
|---|
| 101 | 101 | | 4.3 Subd. 11.Rates for ventilators.(k) (a) Effective for nonpressure support ventilators |
|---|
| 102 | 102 | | 4.4provided on or after January 1, 2016, the rate shall be the lower of the submitted charge or |
|---|
| 103 | 103 | | 4.5the Medicare fee schedule rate. |
|---|
| 104 | 104 | | 4.6 (b) Effective for pressure support ventilators provided on or after January 1, 2016, the |
|---|
| 105 | 105 | | 4.7rate shall be the lower of the submitted charge or 47 percent above the Medicare fee schedule |
|---|
| 106 | 106 | | 4.8rate. |
|---|
| 107 | 107 | | 4.9 (c) For payments made in accordance with this paragraph subdivision, if, and to the |
|---|
| 108 | 108 | | 4.10extent that, the commissioner identifies that the state has received federal financial |
|---|
| 109 | 109 | | 4.11participation for ventilators in excess of the amount allowed effective January 1, 2018, |
|---|
| 110 | 110 | | 4.12under United States Code, title 42, section 1396b(i)(27), the state shall repay the excess |
|---|
| 111 | 111 | | 4.13amount to the Centers for Medicare and Medicaid Services with state funds and maintain |
|---|
| 112 | 112 | | 4.14the full payment rate under this paragraph subdivision. |
|---|
| 113 | 113 | | 4.15 Subd. 12.Rates subject to the upper payment limit.(l) Payment rates for durable |
|---|
| 114 | 114 | | 4.16medical equipment, prosthetics, orthotics or supplies, that are subject to the upper payment |
|---|
| 115 | 115 | | 4.17limit in accordance with section 1903(i)(27) of the Social Security Act, shall be paid the |
|---|
| 116 | 116 | | 4.18Medicare rate. Rate increases provided in this chapter shall not be applied to the items listed |
|---|
| 117 | 117 | | 4.19in this paragraph subdivision. |
|---|
| 118 | 118 | | 4.20 Subd. 13.Temporary rates for enteral nutrition and supplies.(m) (a) For dates of |
|---|
| 119 | 119 | | 4.21service on or after July 1, 2023, through June 30, 2025 2027, enteral nutrition and supplies |
|---|
| 120 | 120 | | 4.22must be paid according to this paragraph subdivision. If sufficient data exists for a product |
|---|
| 121 | 121 | | 4.23or supply, payment must be based upon the 50th percentile of the usual and customary |
|---|
| 122 | 122 | | 4.24charges per product code submitted to the commissioner, using only charges submitted per |
|---|
| 123 | 123 | | 4.25unit. Increases in rates resulting from the 50th percentile payment method must not exceed |
|---|
| 124 | 124 | | 4.26150 percent of the previous fiscal year's rate per code and product combination. Data are |
|---|
| 125 | 125 | | 4.27sufficient if: (1) the commissioner has at least 100 paid claim lines by at least ten different |
|---|
| 126 | 126 | | 4.28providers for a given product or supply; or (2) in the absence of the data in clause (1), the |
|---|
| 127 | 127 | | 4.29commissioner has at least 20 claim lines by at least five different providers for a product or |
|---|
| 128 | 128 | | 4.30supply that does not meet the requirements of clause (1). If sufficient data are not available |
|---|
| 129 | 129 | | 4.31to calculate the 50th percentile for enteral products or supplies, the payment rate must be |
|---|
| 130 | 130 | | 4.32the payment rate in effect on June 30, 2023. |
|---|
| 131 | 131 | | 4.33 (b) This subdivision expires June 30, 2027. |
|---|
| 132 | 132 | | 4Section 1. |
|---|
| 133 | 133 | | REVISOR AGW/CH 25-0401002/19/25 5.1 Subd. 14.Rates for enteral nutrition and supplies.(n) For dates of service on or after |
|---|
| 134 | 134 | | 5.2July 1, 2025 2027, enteral nutrition and supplies must be paid according to this paragraph |
|---|
| 135 | 135 | | 5.3subdivision and updated annually each January 1. If sufficient data exists for a product or |
|---|
| 136 | 136 | | 5.4supply, payment must be based upon the 50th percentile of the usual and customary charges |
|---|
| 137 | 137 | | 5.5per product code submitted to the commissioner for the previous calendar year, using only |
|---|
| 138 | 138 | | 5.6charges submitted per unit. Increases in rates resulting from the 50th percentile payment |
|---|
| 139 | 139 | | 5.7method must not exceed 150 percent of the previous year's rate per code and product |
|---|
| 140 | 140 | | 5.8combination. Data are sufficient if: (1) the commissioner has at least 100 paid claim lines |
|---|
| 141 | 141 | | 5.9by at least ten different providers for a given product or supply; or (2) in the absence of the |
|---|
| 142 | 142 | | 5.10data in clause (1), the commissioner has at least 20 claim lines by at least five different |
|---|
| 143 | 143 | | 5.11providers for a product or supply that does not meet the requirements of clause (1). If |
|---|
| 144 | 144 | | 5.12sufficient data are not available to calculate the 50th percentile for enteral products or |
|---|
| 145 | 145 | | 5.13supplies, the payment must be the manufacturer's suggested retail price of that product or |
|---|
| 146 | 146 | | 5.14supply minus 20 percent. If the manufacturer's suggested retail price is not available, payment |
|---|
| 147 | 147 | | 5.15must be the actual acquisition cost of that product or supply plus 20 percent. |
|---|
| 148 | 148 | | 5.16 Subd. 15.Payments based on manufacturer's suggested retail price.For medical |
|---|
| 149 | 149 | | 5.17supplies and equipment payments based on the manufacturer's suggested retail price |
|---|
| 150 | 150 | | 5.18methodology set forth in Minnesota Rules, part 9505.0445, item S, the commissioner shall |
|---|
| 151 | 151 | | 5.19establish the payment amount on an annual basis for enteral formula, low profile feeding |
|---|
| 152 | 152 | | 5.20tubes, and feeding tube extension sets. |
|---|
| 153 | 153 | | 5Section 1. |
|---|
| 154 | 154 | | REVISOR AGW/CH 25-0401002/19/25 |
|---|