| 5 | | - | 1.5 imposing an assessment on health plan companies to provide nonfederal funds for |
|---|
| 6 | | - | 1.6 medical assistance; authorizing the commissioner of human services to seek federal |
|---|
| 7 | | - | 1.7 waivers; amending Minnesota Statutes 2024, sections 256.969, subdivision 2b; |
|---|
| 8 | | - | 1.8 256B.0757, subdivision 5, by adding a subdivision; 256B.76, subdivisions 1, 6; |
|---|
| 9 | | - | 1.9 256B.761; proposing coding for new law in Minnesota Statutes, chapters 256B; |
|---|
| 10 | | - | 1.10 295; repealing Minnesota Statutes 2024, section 256B.0625, subdivision 38. |
|---|
| 11 | | - | 1.11BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: |
|---|
| 12 | | - | 1.12 Section 1. Minnesota Statutes 2024, section 256.969, subdivision 2b, is amended to read: |
|---|
| 13 | | - | 1.13 Subd. 2b.Hospital payment rates.(a) For discharges occurring on or after November |
|---|
| 14 | | - | 1.141, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according |
|---|
| 15 | | - | 1.15to the following: |
|---|
| 16 | | - | 1.16 (1) critical access hospitals as defined by Medicare shall be paid using a cost-based |
|---|
| 17 | | - | 1.17methodology; |
|---|
| 18 | | - | 1.18 (2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology |
|---|
| 19 | | - | 1.19under subdivision 25; |
|---|
| 20 | | - | 1.20 (3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation |
|---|
| 21 | | - | 1.21distinct parts as defined by Medicare shall be paid according to the methodology under |
|---|
| 22 | | - | 1.22subdivision 12; and |
|---|
| 23 | | - | 1.23 (4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology. |
|---|
| 5 | + | 1.5 amending Minnesota Statutes 2024, sections 256.969, subdivision 2b; 256B.0757, |
|---|
| 6 | + | 1.6 subdivision 5, by adding a subdivision; 256B.76, subdivisions 1, 6; 256B.761; |
|---|
| 7 | + | 1.7 proposing coding for new law in Minnesota Statutes, chapter 256B; repealing |
|---|
| 8 | + | 1.8 Minnesota Statutes 2024, section 256B.0625, subdivision 38. |
|---|
| 9 | + | 1.9BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: |
|---|
| 10 | + | 1.10 Section 1. Minnesota Statutes 2024, section 256.969, subdivision 2b, is amended to read: |
|---|
| 11 | + | 1.11 Subd. 2b.Hospital payment rates.(a) For discharges occurring on or after November |
|---|
| 12 | + | 1.121, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according |
|---|
| 13 | + | 1.13to the following: |
|---|
| 14 | + | 1.14 (1) critical access hospitals as defined by Medicare shall be paid using a cost-based |
|---|
| 15 | + | 1.15methodology; |
|---|
| 16 | + | 1.16 (2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology |
|---|
| 17 | + | 1.17under subdivision 25; |
|---|
| 18 | + | 1.18 (3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation |
|---|
| 19 | + | 1.19distinct parts as defined by Medicare shall be paid according to the methodology under |
|---|
| 20 | + | 1.20subdivision 12; and |
|---|
| 21 | + | 1.21 (4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology. |
|---|
| 22 | + | 1.22 (b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not |
|---|
| 23 | + | 1.23be rebased, except that a Minnesota long-term hospital shall be rebased effective January |
|---|
| 24 | + | 1.241, 2011, based on its most recent Medicare cost report ending on or before September 1, |
|---|
| 31 | | - | Introduction and first reading38802/13/2025 |
|---|
| 32 | | - | Referred to Health and Human Services |
|---|
| 33 | | - | Authors added Abeler; Boldon57902/27/2025 |
|---|
| 34 | | - | Comm report: To pass as amended and re-refer to Taxes03/03/2025 |
|---|
| 35 | | - | Author stricken Lieske 2.1 (b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not |
|---|
| 36 | | - | 2.2be rebased, except that a Minnesota long-term hospital shall be rebased effective January |
|---|
| 37 | | - | 2.31, 2011, based on its most recent Medicare cost report ending on or before September 1, |
|---|
| 38 | | - | 2.42008, with the provisions under subdivisions 9 and 23, based on the rates in effect on |
|---|
| 39 | | - | 2.5December 31, 2010. For rate setting periods after November 1, 2014, in which the base |
|---|
| 40 | | - | 2.6years are updated, a Minnesota long-term hospital's base year shall remain within the same |
|---|
| 41 | | - | 2.7period as other hospitals. |
|---|
| 42 | | - | 2.8 (c) Effective for discharges occurring on and after November 1, 2014, payment rates |
|---|
| 43 | | - | 2.9for hospital inpatient services provided by hospitals located in Minnesota or the local trade |
|---|
| 44 | | - | 2.10area, except for the hospitals paid under the methodologies described in paragraph (a), |
|---|
| 45 | | - | 2.11clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a |
|---|
| 46 | | - | 2.12manner similar to Medicare. The base year or years for the rates effective November 1, |
|---|
| 47 | | - | 2.132014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral, |
|---|
| 48 | | - | 2.14ensuring that the total aggregate payments under the rebased system are equal to the total |
|---|
| 49 | | - | 2.15aggregate payments that were made for the same number and types of services in the base |
|---|
| 50 | | - | 2.16year. Separate budget neutrality calculations shall be determined for payments made to |
|---|
| 51 | | - | 2.17critical access hospitals and payments made to hospitals paid under the DRG system. Only |
|---|
| 52 | | - | 2.18the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being |
|---|
| 53 | | - | 2.19rebased during the entire base period shall be incorporated into the budget neutrality |
|---|
| 54 | | - | 2.20calculation. |
|---|
| 55 | | - | 2.21 (d) For discharges occurring on or after November 1, 2014, through the next rebasing |
|---|
| 56 | | - | 2.22that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph |
|---|
| 57 | | - | 2.23(a), clause (4), shall include adjustments to the projected rates that result in no greater than |
|---|
| 58 | | - | 2.24a five percent increase or decrease from the base year payments for any hospital. Any |
|---|
| 59 | | - | 2.25adjustments to the rates made by the commissioner under this paragraph and paragraph (e) |
|---|
| 60 | | - | 2.26shall maintain budget neutrality as described in paragraph (c). |
|---|
| 61 | | - | 2.27 (e) For discharges occurring on or after November 1, 2014, the commissioner may make |
|---|
| 62 | | - | 2.28additional adjustments to the rebased rates, and when evaluating whether additional |
|---|
| 63 | | - | 2.29adjustments should be made, the commissioner shall consider the impact of the rates on the |
|---|
| 64 | | - | 2.30following: |
|---|
| 65 | | - | 2.31 (1) pediatric services; |
|---|
| 66 | | - | 2.32 (2) behavioral health services; |
|---|
| 67 | | - | 2.33 (3) trauma services as defined by the National Uniform Billing Committee; |
|---|
| 68 | | - | 2.34 (4) transplant services; |
|---|
| 32 | + | Introduction and first reading02/13/2025 |
|---|
| 33 | + | Referred to Health and Human Services 2.12008, with the provisions under subdivisions 9 and 23, based on the rates in effect on |
|---|
| 34 | + | 2.2December 31, 2010. For rate setting periods after November 1, 2014, in which the base |
|---|
| 35 | + | 2.3years are updated, a Minnesota long-term hospital's base year shall remain within the same |
|---|
| 36 | + | 2.4period as other hospitals. |
|---|
| 37 | + | 2.5 (c) Effective for discharges occurring on and after November 1, 2014, payment rates |
|---|
| 38 | + | 2.6for hospital inpatient services provided by hospitals located in Minnesota or the local trade |
|---|
| 39 | + | 2.7area, except for the hospitals paid under the methodologies described in paragraph (a), |
|---|
| 40 | + | 2.8clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a |
|---|
| 41 | + | 2.9manner similar to Medicare. The base year or years for the rates effective November 1, |
|---|
| 42 | + | 2.102014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral, |
|---|
| 43 | + | 2.11ensuring that the total aggregate payments under the rebased system are equal to the total |
|---|
| 44 | + | 2.12aggregate payments that were made for the same number and types of services in the base |
|---|
| 45 | + | 2.13year. Separate budget neutrality calculations shall be determined for payments made to |
|---|
| 46 | + | 2.14critical access hospitals and payments made to hospitals paid under the DRG system. Only |
|---|
| 47 | + | 2.15the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being |
|---|
| 48 | + | 2.16rebased during the entire base period shall be incorporated into the budget neutrality |
|---|
| 49 | + | 2.17calculation. |
|---|
| 50 | + | 2.18 (d) For discharges occurring on or after November 1, 2014, through the next rebasing |
|---|
| 51 | + | 2.19that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph |
|---|
| 52 | + | 2.20(a), clause (4), shall include adjustments to the projected rates that result in no greater than |
|---|
| 53 | + | 2.21a five percent increase or decrease from the base year payments for any hospital. Any |
|---|
| 54 | + | 2.22adjustments to the rates made by the commissioner under this paragraph and paragraph (e) |
|---|
| 55 | + | 2.23shall maintain budget neutrality as described in paragraph (c). |
|---|
| 56 | + | 2.24 (e) For discharges occurring on or after November 1, 2014, the commissioner may make |
|---|
| 57 | + | 2.25additional adjustments to the rebased rates, and when evaluating whether additional |
|---|
| 58 | + | 2.26adjustments should be made, the commissioner shall consider the impact of the rates on the |
|---|
| 59 | + | 2.27following: |
|---|
| 60 | + | 2.28 (1) pediatric services; |
|---|
| 61 | + | 2.29 (2) behavioral health services; |
|---|
| 62 | + | 2.30 (3) trauma services as defined by the National Uniform Billing Committee; |
|---|
| 63 | + | 2.31 (4) transplant services; |
|---|
| 64 | + | 2.32 (5) obstetric services, newborn services, and behavioral health services provided by |
|---|
| 65 | + | 2.33hospitals outside the seven-county metropolitan area; |
|---|
| 70 | | - | S1402-1 1st EngrossmentSF1402 REVISOR AGW 3.1 (5) obstetric services, newborn services, and behavioral health services provided by |
|---|
| 71 | | - | 3.2hospitals outside the seven-county metropolitan area; |
|---|
| 72 | | - | 3.3 (6) outlier admissions; |
|---|
| 73 | | - | 3.4 (7) low-volume providers; and |
|---|
| 74 | | - | 3.5 (8) services provided by small rural hospitals that are not critical access hospitals. |
|---|
| 75 | | - | 3.6 (f) Hospital payment rates established under paragraph (c) must incorporate the following: |
|---|
| 76 | | - | 3.7 (1) for hospitals paid under the DRG methodology, the base year payment rate per |
|---|
| 77 | | - | 3.8admission is standardized by the applicable Medicare wage index and adjusted by the |
|---|
| 78 | | - | 3.9hospital's disproportionate population adjustment; |
|---|
| 79 | | - | 3.10 (2) for critical access hospitals, payment rates for discharges between November 1, 2014, |
|---|
| 80 | | - | 3.11and June 30, 2015, shall be set to the same rate of payment that applied for discharges on |
|---|
| 81 | | - | 3.12October 31, 2014; |
|---|
| 82 | | - | 3.13 (3) the cost and charge data used to establish hospital payment rates must only reflect |
|---|
| 83 | | - | 3.14inpatient services covered by medical assistance; and |
|---|
| 84 | | - | 3.15 (4) in determining hospital payment rates for discharges occurring on or after the rate |
|---|
| 85 | | - | 3.16year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per |
|---|
| 86 | | - | 3.17discharge shall be based on the cost-finding methods and allowable costs of the Medicare |
|---|
| 87 | | - | 3.18program in effect during the base year or years. In determining hospital payment rates for |
|---|
| 88 | | - | 3.19discharges in subsequent base years, the per discharge rates shall be based on the cost-finding |
|---|
| 89 | | - | 3.20methods and allowable costs of the Medicare program in effect during the base year or |
|---|
| 90 | | - | 3.21years. |
|---|
| 91 | | - | 3.22 (g) The commissioner shall validate the rates effective November 1, 2014, by applying |
|---|
| 92 | | - | 3.23the rates established under paragraph (c), and any adjustments made to the rates under |
|---|
| 93 | | - | 3.24paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the |
|---|
| 94 | | - | 3.25total aggregate payments for the same number and types of services under the rebased rates |
|---|
| 95 | | - | 3.26are equal to the total aggregate payments made during calendar year 2013. |
|---|
| 96 | | - | 3.27 (h) Effective for discharges occurring on or after July 1, 2017, and every two years |
|---|
| 97 | | - | 3.28thereafter, payment rates under this section shall be rebased to reflect only those changes |
|---|
| 98 | | - | 3.29in hospital costs between the existing base year or years and the next base year or years. In |
|---|
| 99 | | - | 3.30any year that inpatient claims volume falls below the threshold required to ensure a |
|---|
| 100 | | - | 3.31statistically valid sample of claims, the commissioner may combine claims data from two |
|---|
| 101 | | - | 3.32consecutive years to serve as the base year. Years in which inpatient claims volume is |
|---|
| 102 | | - | 3.33reduced or altered due to a pandemic or other public health emergency shall not be used as |
|---|
| 67 | + | 25-02460 as introduced02/07/25 REVISOR AGW/VJ 3.1 (6) outlier admissions; |
|---|
| 68 | + | 3.2 (7) low-volume providers; and |
|---|
| 69 | + | 3.3 (8) services provided by small rural hospitals that are not critical access hospitals. |
|---|
| 70 | + | 3.4 (f) Hospital payment rates established under paragraph (c) must incorporate the following: |
|---|
| 71 | + | 3.5 (1) for hospitals paid under the DRG methodology, the base year payment rate per |
|---|
| 72 | + | 3.6admission is standardized by the applicable Medicare wage index and adjusted by the |
|---|
| 73 | + | 3.7hospital's disproportionate population adjustment; |
|---|
| 74 | + | 3.8 (2) for critical access hospitals, payment rates for discharges between November 1, 2014, |
|---|
| 75 | + | 3.9and June 30, 2015, shall be set to the same rate of payment that applied for discharges on |
|---|
| 76 | + | 3.10October 31, 2014; |
|---|
| 77 | + | 3.11 (3) the cost and charge data used to establish hospital payment rates must only reflect |
|---|
| 78 | + | 3.12inpatient services covered by medical assistance; and |
|---|
| 79 | + | 3.13 (4) in determining hospital payment rates for discharges occurring on or after the rate |
|---|
| 80 | + | 3.14year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per |
|---|
| 81 | + | 3.15discharge shall be based on the cost-finding methods and allowable costs of the Medicare |
|---|
| 82 | + | 3.16program in effect during the base year or years. In determining hospital payment rates for |
|---|
| 83 | + | 3.17discharges in subsequent base years, the per discharge rates shall be based on the cost-finding |
|---|
| 84 | + | 3.18methods and allowable costs of the Medicare program in effect during the base year or |
|---|
| 85 | + | 3.19years. |
|---|
| 86 | + | 3.20 (g) The commissioner shall validate the rates effective November 1, 2014, by applying |
|---|
| 87 | + | 3.21the rates established under paragraph (c), and any adjustments made to the rates under |
|---|
| 88 | + | 3.22paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the |
|---|
| 89 | + | 3.23total aggregate payments for the same number and types of services under the rebased rates |
|---|
| 90 | + | 3.24are equal to the total aggregate payments made during calendar year 2013. |
|---|
| 91 | + | 3.25 (h) Effective for discharges occurring on or after July 1, 2017, and every two years |
|---|
| 92 | + | 3.26thereafter, payment rates under this section shall be rebased to reflect only those changes |
|---|
| 93 | + | 3.27in hospital costs between the existing base year or years and the next base year or years. In |
|---|
| 94 | + | 3.28any year that inpatient claims volume falls below the threshold required to ensure a |
|---|
| 95 | + | 3.29statistically valid sample of claims, the commissioner may combine claims data from two |
|---|
| 96 | + | 3.30consecutive years to serve as the base year. Years in which inpatient claims volume is |
|---|
| 97 | + | 3.31reduced or altered due to a pandemic or other public health emergency shall not be used as |
|---|
| 98 | + | 3.32a base year or part of a base year if the base year includes more than one year. Changes in |
|---|
| 99 | + | 3.33costs between base years shall be measured using the lower of the hospital cost index defined |
|---|
| 104 | | - | S1402-1 1st EngrossmentSF1402 REVISOR AGW 4.1a base year or part of a base year if the base year includes more than one year. Changes in |
|---|
| 105 | | - | 4.2costs between base years shall be measured using the lower of the hospital cost index defined |
|---|
| 106 | | - | 4.3in subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per |
|---|
| 107 | | - | 4.4claim. The commissioner shall establish the base year for each rebasing period considering |
|---|
| 108 | | - | 4.5the most recent year or years for which filed Medicare cost reports are available, except |
|---|
| 109 | | - | 4.6that the base years for the rebasing effective July 1, 2023, are calendar years 2018 and 2019. |
|---|
| 110 | | - | 4.7The estimated change in the average payment per hospital discharge resulting from a |
|---|
| 111 | | - | 4.8scheduled rebasing must be calculated and made available to the legislature by January 15 |
|---|
| 112 | | - | 4.9of each year in which rebasing is scheduled to occur, and must include by hospital the |
|---|
| 113 | | - | 4.10differential in payment rates compared to the individual hospital's costs. |
|---|
| 114 | | - | 4.11 (i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates |
|---|
| 115 | | - | 4.12for critical access hospitals located in Minnesota or the local trade area shall be determined |
|---|
| 116 | | - | 4.13using a new cost-based methodology. The commissioner shall establish within the |
|---|
| 117 | | - | 4.14methodology tiers of payment designed to promote efficiency and cost-effectiveness. |
|---|
| 118 | | - | 4.15Payment rates for hospitals under this paragraph shall be set at a level that does not exceed |
|---|
| 119 | | - | 4.16the total cost for critical access hospitals as reflected in base year cost reports. Until the |
|---|
| 120 | | - | 4.17next rebasing that occurs, the new methodology shall result in no greater than a five percent |
|---|
| 121 | | - | 4.18decrease from the base year payments for any hospital, except a hospital that had payments |
|---|
| 122 | | - | 4.19that were greater than 100 percent of the hospital's costs in the base year shall have their |
|---|
| 123 | | - | 4.20rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and |
|---|
| 124 | | - | 4.21after July 1, 2016, covered under this paragraph shall be increased by the inflation factor |
|---|
| 125 | | - | 4.22in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not |
|---|
| 126 | | - | 4.23be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the |
|---|
| 127 | | - | 4.24following criteria: |
|---|
| 128 | | - | 4.25 (1) hospitals that had payments at or below 80 percent of their costs in the base year |
|---|
| 129 | | - | 4.26shall have a rate set that equals 85 percent of their base year costs; |
|---|
| 130 | | - | 4.27 (2) hospitals that had payments that were above 80 percent, up to and including 90 |
|---|
| 131 | | - | 4.28percent of their costs in the base year shall have a rate set that equals 95 percent of their |
|---|
| 132 | | - | 4.29base year costs; and |
|---|
| 133 | | - | 4.30 (3) hospitals that had payments that were above 90 percent of their costs in the base year |
|---|
| 134 | | - | 4.31shall have a rate set that equals 100 percent of their base year costs. |
|---|
| 135 | | - | 4.32 (j) The commissioner may refine the payment tiers and criteria for critical access hospitals |
|---|
| 136 | | - | 4.33to coincide with the next rebasing under paragraph (h). The factors used to develop the new |
|---|
| 137 | | - | 4.34methodology may include, but are not limited to: |
|---|
| 101 | + | 25-02460 as introduced02/07/25 REVISOR AGW/VJ 4.1in subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per |
|---|
| 102 | + | 4.2claim. The commissioner shall establish the base year for each rebasing period considering |
|---|
| 103 | + | 4.3the most recent year or years for which filed Medicare cost reports are available, except |
|---|
| 104 | + | 4.4that the base years for the rebasing effective July 1, 2023, are calendar years 2018 and 2019. |
|---|
| 105 | + | 4.5The estimated change in the average payment per hospital discharge resulting from a |
|---|
| 106 | + | 4.6scheduled rebasing must be calculated and made available to the legislature by January 15 |
|---|
| 107 | + | 4.7of each year in which rebasing is scheduled to occur, and must include by hospital the |
|---|
| 108 | + | 4.8differential in payment rates compared to the individual hospital's costs. |
|---|
| 109 | + | 4.9 (i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates |
|---|
| 110 | + | 4.10for critical access hospitals located in Minnesota or the local trade area shall be determined |
|---|
| 111 | + | 4.11using a new cost-based methodology. The commissioner shall establish within the |
|---|
| 112 | + | 4.12methodology tiers of payment designed to promote efficiency and cost-effectiveness. |
|---|
| 113 | + | 4.13Payment rates for hospitals under this paragraph shall be set at a level that does not exceed |
|---|
| 114 | + | 4.14the total cost for critical access hospitals as reflected in base year cost reports. Until the |
|---|
| 115 | + | 4.15next rebasing that occurs, the new methodology shall result in no greater than a five percent |
|---|
| 116 | + | 4.16decrease from the base year payments for any hospital, except a hospital that had payments |
|---|
| 117 | + | 4.17that were greater than 100 percent of the hospital's costs in the base year shall have their |
|---|
| 118 | + | 4.18rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and |
|---|
| 119 | + | 4.19after July 1, 2016, covered under this paragraph shall be increased by the inflation factor |
|---|
| 120 | + | 4.20in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not |
|---|
| 121 | + | 4.21be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the |
|---|
| 122 | + | 4.22following criteria: |
|---|
| 123 | + | 4.23 (1) hospitals that had payments at or below 80 percent of their costs in the base year |
|---|
| 124 | + | 4.24shall have a rate set that equals 85 percent of their base year costs; |
|---|
| 125 | + | 4.25 (2) hospitals that had payments that were above 80 percent, up to and including 90 |
|---|
| 126 | + | 4.26percent of their costs in the base year shall have a rate set that equals 95 percent of their |
|---|
| 127 | + | 4.27base year costs; and |
|---|
| 128 | + | 4.28 (3) hospitals that had payments that were above 90 percent of their costs in the base year |
|---|
| 129 | + | 4.29shall have a rate set that equals 100 percent of their base year costs. |
|---|
| 130 | + | 4.30 (j) The commissioner may refine the payment tiers and criteria for critical access hospitals |
|---|
| 131 | + | 4.31to coincide with the next rebasing under paragraph (h). The factors used to develop the new |
|---|
| 132 | + | 4.32methodology may include, but are not limited to: |
|---|
| 133 | + | 4.33 (1) the ratio between the hospital's costs for treating medical assistance patients and the |
|---|
| 134 | + | 4.34hospital's charges to the medical assistance program; |
|---|
| 139 | | - | S1402-1 1st EngrossmentSF1402 REVISOR AGW 5.1 (1) the ratio between the hospital's costs for treating medical assistance patients and the |
|---|
| 140 | | - | 5.2hospital's charges to the medical assistance program; |
|---|
| 141 | | - | 5.3 (2) the ratio between the hospital's costs for treating medical assistance patients and the |
|---|
| 142 | | - | 5.4hospital's payments received from the medical assistance program for the care of medical |
|---|
| 143 | | - | 5.5assistance patients; |
|---|
| 144 | | - | 5.6 (3) the ratio between the hospital's charges to the medical assistance program and the |
|---|
| 145 | | - | 5.7hospital's payments received from the medical assistance program for the care of medical |
|---|
| 146 | | - | 5.8assistance patients; |
|---|
| 147 | | - | 5.9 (4) the statewide average increases in the ratios identified in clauses (1), (2), and (3); |
|---|
| 148 | | - | 5.10 (5) the proportion of that hospital's costs that are administrative and trends in |
|---|
| 149 | | - | 5.11administrative costs; and |
|---|
| 150 | | - | 5.12 (6) geographic location. |
|---|
| 151 | | - | 5.13 (k) Subject to subdivision 2g, effective for discharges occurring on or after January 1, |
|---|
| 152 | | - | 5.142024, the rates paid to hospitals described in paragraph (a), clauses (2) to (4), must include |
|---|
| 153 | | - | 5.15a rate factor specific to each hospital that qualifies for a medical education and research |
|---|
| 154 | | - | 5.16cost distribution under section 62J.692, subdivision 4, paragraph (a). |
|---|
| 155 | | - | 5.17 (l) Effective for discharges occurring on or after January 1, 2028, the commissioner |
|---|
| 156 | | - | 5.18must increase: |
|---|
| 157 | | - | 5.19 (1) payments for inpatient behavioral health services provided by hospitals paid under |
|---|
| 158 | | - | 5.20the DRG methodology by increasing the adjustment for behavioral health services under |
|---|
| 159 | | - | 5.21section 256.969, subdivision 2b, paragraph (e); and |
|---|
| 160 | | - | 5.22 (2) capitation payments made to managed care plans and county-based purchasing plans |
|---|
| 161 | | - | 5.23to reflect the rate increase provided under this paragraph. Managed care and county-based |
|---|
| 162 | | - | 5.24purchasing plans must use the capitation rate increase provided under this clause to increase |
|---|
| 163 | | - | 5.25payment rates for inpatient behavioral health services provided by hospitals paid under the |
|---|
| 164 | | - | 5.26DRG methodology. The commissioner must monitor the effect of this rate increase on |
|---|
| 165 | | - | 5.27enrollee access to behavioral health services. If for any contract year federal approval is not |
|---|
| 166 | | - | 5.28received for this clause, the commissioner must adjust the capitation rates paid to managed |
|---|
| 167 | | - | 5.29care plans and county-based purchasing plans for that contract year to reflect the removal |
|---|
| 168 | | - | 5.30of this clause. Contracts between managed care plans and county-based purchasing plans |
|---|
| 169 | | - | 5.31and providers to whom this paragraph applies must allow recovery of payments from those |
|---|
| 170 | | - | 5.32providers if capitation rates are adjusted in accordance with this clause. Payment recoveries |
|---|
| 171 | | - | 5.33must not exceed the amount equal to any increase in rates that results from this paragraph. |
|---|
| 136 | + | 25-02460 as introduced02/07/25 REVISOR AGW/VJ 5.1 (2) the ratio between the hospital's costs for treating medical assistance patients and the |
|---|
| 137 | + | 5.2hospital's payments received from the medical assistance program for the care of medical |
|---|
| 138 | + | 5.3assistance patients; |
|---|
| 139 | + | 5.4 (3) the ratio between the hospital's charges to the medical assistance program and the |
|---|
| 140 | + | 5.5hospital's payments received from the medical assistance program for the care of medical |
|---|
| 141 | + | 5.6assistance patients; |
|---|
| 142 | + | 5.7 (4) the statewide average increases in the ratios identified in clauses (1), (2), and (3); |
|---|
| 143 | + | 5.8 (5) the proportion of that hospital's costs that are administrative and trends in |
|---|
| 144 | + | 5.9administrative costs; and |
|---|
| 145 | + | 5.10 (6) geographic location. |
|---|
| 146 | + | 5.11 (k) Subject to subdivision 2g, effective for discharges occurring on or after January 1, |
|---|
| 147 | + | 5.122024, the rates paid to hospitals described in paragraph (a), clauses (2) to (4), must include |
|---|
| 148 | + | 5.13a rate factor specific to each hospital that qualifies for a medical education and research |
|---|
| 149 | + | 5.14cost distribution under section 62J.692, subdivision 4, paragraph (a). |
|---|
| 150 | + | 5.15 (l) Effective for discharges occurring on or after January 1, 2028, the commissioner |
|---|
| 151 | + | 5.16must increase: |
|---|
| 152 | + | 5.17 (1) payments for inpatient behavioral health services provided by hospitals paid under |
|---|
| 153 | + | 5.18the DRG methodology by increasing the adjustment for behavioral health services under |
|---|
| 154 | + | 5.19section 256.969, subdivision 2b, paragraph (e); and |
|---|
| 155 | + | 5.20 (2) capitation payments made to managed care plans and county-based purchasing plans |
|---|
| 156 | + | 5.21to reflect the rate increase provided under this paragraph. Managed care and county-based |
|---|
| 157 | + | 5.22purchasing plans must use the capitation rate increase provided under this clause to increase |
|---|
| 158 | + | 5.23payment rates for inpatient behavioral health services provided by hospitals paid under the |
|---|
| 159 | + | 5.24DRG methodology. The commissioner must monitor the effect of this rate increase on |
|---|
| 160 | + | 5.25enrollee access to behavioral health services. If for any contract year federal approval is not |
|---|
| 161 | + | 5.26received for this clause, the commissioner must adjust the capitation rates paid to managed |
|---|
| 162 | + | 5.27care plans and county-based purchasing plans for that contract year to reflect the removal |
|---|
| 163 | + | 5.28of this clause. Contracts between managed care plans and county-based purchasing plans |
|---|
| 164 | + | 5.29and providers to whom this paragraph applies must allow recovery of payments from those |
|---|
| 165 | + | 5.30providers if capitation rates are adjusted in accordance with this clause. Payment recoveries |
|---|
| 166 | + | 5.31must not exceed the amount equal to any increase in rates that results from this paragraph. |
|---|
| 174 | 169 | | 6.2 Subd. 5.Payments.(a) The commissioner shall make payments to each designated |
|---|
| 175 | 170 | | 6.3provider for the provision of health home services described in subdivision 3 to each eligible |
|---|
| 176 | 171 | | 6.4individual under subdivision 2 that selects the health home as a provider. This paragraph |
|---|
| 177 | 172 | | 6.5expires on the date that paragraph (b) becomes effective. |
|---|
| 178 | 173 | | 6.6 (b) Effective January 1, 2028, or upon federal approval, whichever is later, the |
|---|
| 179 | 174 | | 6.7commissioner shall make payments to each designated provider for the provision of health |
|---|
| 180 | 175 | | 6.8home services described in subdivision 3, except for behavioral health services, to each |
|---|
| 181 | 176 | | 6.9eligible individual under subdivision 2 who selects the health home as a provider. |
|---|
| 182 | 177 | | 6.10 Sec. 3. Minnesota Statutes 2024, section 256B.0757, is amended by adding a subdivision |
|---|
| 183 | 178 | | 6.11to read: |
|---|
| 184 | 179 | | 6.12 Subd. 5a.Payments for behavioral health home services.(a) Notwithstanding |
|---|
| 185 | 180 | | 6.13subdivision 5, the commissioner must implement a single statewide reimbursement rate for |
|---|
| 186 | 181 | | 6.14behavioral health home services under this section. The rate must be no less than $425 per |
|---|
| 187 | 182 | | 6.15member per month. The commissioner must adjust the statewide reimbursement rate annually |
|---|
| 188 | 183 | | 6.16according to the change from the midpoint of the previous rate year to the midpoint of the |
|---|
| 189 | 184 | | 6.17rate year for which the rate is being determined using the Centers for Medicare and Medicaid |
|---|
| 190 | 185 | | 6.18Services Medicare Economic Index as forecasted in the fourth quarter of the calendar year |
|---|
| 191 | 186 | | 6.19before the rate year. |
|---|
| 192 | 187 | | 6.20 (b) The commissioner must review and update the behavioral health home services rate |
|---|
| 193 | 188 | | 6.21under paragraph (a) at least every four years. The updated rate must account for the average |
|---|
| 194 | 189 | | 6.22hours required for behavioral health home team members spent providing services and the |
|---|
| 195 | 190 | | 6.23Department of Labor prevailing wage for required behavioral health home team members. |
|---|
| 196 | 191 | | 6.24The updated rate must ensure that behavioral health home services rates are sufficient to |
|---|
| 197 | 192 | | 6.25allow providers to meet required certifications, training, and practice transformation |
|---|
| 198 | 193 | | 6.26standards; staff qualification requirements; and service delivery standards. |
|---|
| 199 | 194 | | 6.27 (c) This section is effective January 1, 2028, or upon federal approval, whichever is |
|---|
| 200 | 195 | | 6.28later. |
|---|
| 201 | 196 | | 6.29 Sec. 4. [256B.757] REIMBURSEMENT RATES FOR OBSTETRIC AND |
|---|
| 202 | 197 | | 6.30GYNECOLOGIC SERVICES. |
|---|
| 203 | 198 | | 6.31 Subdivision 1.Obstetric and gynecologic minimum rate.Effective for services rendered |
|---|
| 204 | 199 | | 6.32on or after January 1, 2026, or the date of federal approval, whichever is later, rates for |
|---|
| 205 | 200 | | 6Sec. 4. |
|---|
| 207 | 202 | | 7.2must be at least equal to 100 percent of the Medicare Physician Fee Schedule. |
|---|
| 208 | 203 | | 7.3 Subd. 2.Capitation payments.Effective for services rendered on or after January 1, |
|---|
| 209 | 204 | | 7.42026, or the date of federal approval, whichever is later, the commissioner shall increase |
|---|
| 210 | 205 | | 7.5capitation payments made to managed care plans and county-based purchasing plans to |
|---|
| 211 | 206 | | 7.6reflect the rate increases provided under this section. Managed care plans and county-based |
|---|
| 212 | 207 | | 7.7purchasing plans must use the capitation rate increase provided under this subdivision to |
|---|
| 213 | 208 | | 7.8increase payment rates to the providers corresponding to the rate increases. The commissioner |
|---|
| 214 | 209 | | 7.9must monitor the effect of this rate increase on enrollee access to services under this section. |
|---|
| 215 | 210 | | 7.10If for any contract year federal approval is not received for this subdivision, the commissioner |
|---|
| 216 | 211 | | 7.11must adjust the capitation rates paid to managed care plans and county-based purchasing |
|---|
| 217 | 212 | | 7.12plans for that contract year to reflect the removal of this subdivision. Contracts between |
|---|
| 218 | 213 | | 7.13managed care plans and county-based purchasing plans and providers to whom this |
|---|
| 219 | 214 | | 7.14subdivision applies must allow recovery of payments from those providers if capitation |
|---|
| 220 | 215 | | 7.15rates are adjusted in accordance with this subdivision. Payment recoveries must not exceed |
|---|
| 221 | 216 | | 7.16the amount equal to any increase in rates that results from this subdivision. |
|---|
| 222 | 217 | | 7.17 Subd. 3.Medicare physician fee schedule.For purposes of this section, the applicable |
|---|
| 223 | 218 | | 7.18Medicare Physician Fee Schedule is the most recent Medicare Physician Fee Schedule Final |
|---|
| 224 | 219 | | 7.19Rule issued by the Centers for Medicare and Medicaid Services in effect at the time the |
|---|
| 225 | 220 | | 7.20service was rendered. |
|---|
| 226 | 221 | | 7.21 EFFECTIVE DATE.Subdivision 3 is effective January 1, 2026, or upon federal |
|---|
| 227 | 222 | | 7.22approval, whichever is later. The commissioner shall notify the revisor of statutes when |
|---|
| 228 | 223 | | 7.23federal approval is obtained. |
|---|
| 229 | 224 | | 7.24 Sec. 5. Minnesota Statutes 2024, section 256B.76, subdivision 1, is amended to read: |
|---|
| 230 | 225 | | 7.25 Subdivision 1.Physician and professional services reimbursement.(a) Effective for |
|---|
| 231 | 226 | | 7.26services rendered on or after October 1, 1992, the commissioner shall make payments for |
|---|
| 232 | 227 | | 7.27physician services as follows: |
|---|
| 233 | 228 | | 7.28 (1) payment for level one Centers for Medicare and Medicaid Services' common |
|---|
| 234 | 229 | | 7.29procedural coding system codes titled "office and other outpatient services," "preventive |
|---|
| 235 | 230 | | 7.30medicine new and established patient," "delivery, antepartum, and postpartum care," "critical |
|---|
| 236 | 231 | | 7.31care," cesarean delivery and pharmacologic management provided to psychiatric patients, |
|---|
| 237 | 232 | | 7.32and level three codes for enhanced services for prenatal high risk, shall be paid at the lower |
|---|
| 238 | 233 | | 7.33of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992; |
|---|
| 239 | 234 | | 7Sec. 5. |
|---|
| 241 | 236 | | 8.2or (ii) 15.4 percent above the rate in effect on June 30, 1992; and |
|---|
| 242 | 237 | | 8.3 (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th |
|---|
| 243 | 238 | | 8.4percentile of 1989, less the percent in aggregate necessary to equal the above increases |
|---|
| 244 | 239 | | 8.5except that payment rates for home health agency services shall be the rates in effect on |
|---|
| 245 | 240 | | 8.6September 30, 1992. |
|---|
| 246 | 241 | | 8.7 (b) Effective for services rendered on or after January 1, 2000, payment rates for physician |
|---|
| 247 | 242 | | 8.8and professional services shall be increased by three percent over the rates in effect on |
|---|
| 248 | 243 | | 8.9December 31, 1999, except for home health agency and family planning agency services. |
|---|
| 249 | 244 | | 8.10The increases in this paragraph shall be implemented January 1, 2000, for managed care. |
|---|
| 250 | 245 | | 8.11 (c) Effective for services rendered on or after July 1, 2009, payment rates for physician |
|---|
| 251 | 246 | | 8.12and professional services shall be reduced by five percent, except that for the period July |
|---|
| 252 | 247 | | 8.131, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent for the medical |
|---|
| 253 | 248 | | 8.14assistance and general assistance medical care programs, over the rates in effect on June |
|---|
| 254 | 249 | | 8.1530, 2009. This reduction and the reductions in paragraph (d) do not apply to office or other |
|---|
| 255 | 250 | | 8.16outpatient visits, preventive medicine visits and family planning visits billed by physicians, |
|---|
| 256 | 251 | | 8.17advanced practice registered nurses, or physician assistants in a family planning agency or |
|---|
| 257 | 252 | | 8.18in one of the following primary care practices: general practice, general internal medicine, |
|---|
| 258 | 253 | | 8.19general pediatrics, general geriatrics, and family medicine. This reduction and the reductions |
|---|
| 259 | 254 | | 8.20in paragraph (d) do not apply to federally qualified health centers, rural health centers, and |
|---|
| 260 | 255 | | 8.21Indian health services. Effective October 1, 2009, payments made to managed care plans |
|---|
| 261 | 256 | | 8.22and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall |
|---|
| 262 | 257 | | 8.23reflect the payment reduction described in this paragraph. |
|---|
| 263 | 258 | | 8.24 (d) Effective for services rendered on or after July 1, 2010, payment rates for physician |
|---|
| 264 | 259 | | 8.25and professional services shall be reduced an additional seven percent over the five percent |
|---|
| 265 | 260 | | 8.26reduction in rates described in paragraph (c). This additional reduction does not apply to |
|---|
| 266 | 261 | | 8.27physical therapy services, occupational therapy services, and speech pathology and related |
|---|
| 267 | 262 | | 8.28services provided on or after July 1, 2010. This additional reduction does not apply to |
|---|
| 268 | 263 | | 8.29physician services billed by a psychiatrist or an advanced practice registered nurse with a |
|---|
| 269 | 264 | | 8.30specialty in mental health. Effective October 1, 2010, payments made to managed care plans |
|---|
| 270 | 265 | | 8.31and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall |
|---|
| 271 | 266 | | 8.32reflect the payment reduction described in this paragraph. |
|---|
| 272 | 267 | | 8.33 (e) Effective for services rendered on or after September 1, 2011, through June 30, 2013, |
|---|
| 273 | 268 | | 8.34payment rates for physician and professional services shall be reduced three percent from |
|---|
| 274 | 269 | | 8Sec. 5. |
|---|
| 276 | 271 | | 9.2services, occupational therapy services, and speech pathology and related services. |
|---|
| 277 | 272 | | 9.3 (f) Effective for services rendered on or after September 1, 2014, payment rates for |
|---|
| 278 | 273 | | 9.4physician and professional services, including physical therapy, occupational therapy, speech |
|---|
| 279 | 274 | | 9.5pathology, and mental health services shall be increased by five percent from the rates in |
|---|
| 280 | 275 | | 9.6effect on August 31, 2014. In calculating this rate increase, the commissioner shall not |
|---|
| 281 | 276 | | 9.7include in the base rate for August 31, 2014, the rate increase provided under section |
|---|
| 282 | 277 | | 9.8256B.76, subdivision 7. This increase does not apply to federally qualified health centers, |
|---|
| 283 | 278 | | 9.9rural health centers, and Indian health services. Payments made to managed care plans and |
|---|
| 284 | 279 | | 9.10county-based purchasing plans shall not be adjusted to reflect payments under this paragraph. |
|---|
| 285 | 280 | | 9.11 (g) (a) Effective for services rendered on or after July 1, 2015, payment rates for physical |
|---|
| 286 | 281 | | 9.12therapy, occupational therapy, and speech pathology and related services provided by a |
|---|
| 287 | 282 | | 9.13hospital meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause |
|---|
| 288 | 283 | | 9.14(4), shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments |
|---|
| 289 | 284 | | 9.15made to managed care plans and county-based purchasing plans shall not be adjusted to |
|---|
| 290 | 285 | | 9.16reflect payments under this paragraph. |
|---|
| 291 | 286 | | 9.17 (h) (b) Any ratables effective before July 1, 2015, do not apply to early intensive |
|---|
| 292 | 287 | | 9.18developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949. |
|---|
| 293 | 288 | | 9.19 (i) (c) The commissioner may reimburse physicians and other licensed professionals for |
|---|
| 294 | 289 | | 9.20costs incurred to pay the fee for testing newborns who are medical assistance enrollees for |
|---|
| 295 | 290 | | 9.21heritable and congenital disorders under section 144.125, subdivision 1, paragraph (c), when |
|---|
| 296 | 291 | | 9.22the sample is collected outside of an inpatient hospital or freestanding birth center and the |
|---|
| 297 | 292 | | 9.23cost is not recognized by another payment source. |
|---|
| 298 | 293 | | 9.24 EFFECTIVE DATE.This section is effective January 1, 2026, or upon federal approval |
|---|
| 299 | 294 | | 9.25of the amendments in this act to section 256B.76, subdivision 6, whichever is later. The |
|---|
| 300 | 295 | | 9.26commissioner of human services shall notify the revisor of statutes when federal approval |
|---|
| 301 | 296 | | 9.27is obtained. |
|---|
| 302 | 297 | | 9.28 Sec. 6. Minnesota Statutes 2024, section 256B.76, subdivision 6, is amended to read: |
|---|
| 303 | 298 | | 9.29 Subd. 6.Medicare relative value units.(a) Effective for services rendered on or after |
|---|
| 304 | 299 | | 9.30January 1, 2007, the commissioner shall make payments for physician and professional |
|---|
| 305 | 300 | | 9.31services based on the Medicare relative value units (RVUs). This change shall be budget |
|---|
| 306 | 301 | | 9.32neutral and the cost of implementing RVUs will be incorporated in the established conversion |
|---|
| 307 | 302 | | 9.33factor. This paragraph expires on the date that paragraph (b) becomes effective. |
|---|
| 308 | 303 | | 9Sec. 6. |
|---|
| 310 | 305 | | 10.2for services rendered on or after January 1, 2007, the commissioner shall make payments |
|---|
| 311 | 306 | | 10.3for physician and professional services based on the Medicare relative value units (RVUs). |
|---|
| 312 | 307 | | 10.4 (b) (c) Effective for services rendered on or after January 1, 2025, rates for mental health |
|---|
| 313 | 308 | | 10.5services reimbursed under the resource-based relative value scale (RBRVS) must be equal |
|---|
| 314 | 309 | | 10.6to 83 percent of the Medicare Physician Fee Schedule. This paragraph expires on the date |
|---|
| 315 | 310 | | 10.7that paragraph (d) becomes effective. |
|---|
| 316 | 311 | | 10.8 (d) Effective January 1, 2026, or upon federal approval, whichever is later, and effective |
|---|
| 317 | 312 | | 10.9for services rendered on or after January 1, 2026, or the date of federal approval, whichever |
|---|
| 318 | 313 | | 10.10is later, rates for all physician and professional services must be at least equal to 100 percent |
|---|
| 319 | 314 | | 10.11of the Medicare Physician Fee Schedule. |
|---|
| 320 | 315 | | 10.12 (c) (e) Effective for services rendered on or after January 1, 2025, the commissioner |
|---|
| 321 | 316 | | 10.13shall increase capitation payments made to managed care plans and county-based purchasing |
|---|
| 322 | 317 | | 10.14plans to reflect the rate increases provided under this subdivision. Managed care plans and |
|---|
| 323 | 318 | | 10.15county-based purchasing plans must use the capitation rate increase provided under this |
|---|
| 324 | 319 | | 10.16paragraph to increase payment rates to the providers corresponding to the rate increases. |
|---|
| 325 | 320 | | 10.17The commissioner must monitor the effect of this rate increase on enrollee access to services |
|---|
| 326 | 321 | | 10.18under this subdivision. If for any contract year federal approval is not received for this |
|---|
| 327 | 322 | | 10.19paragraph, the commissioner must adjust the capitation rates paid to managed care plans |
|---|
| 328 | 323 | | 10.20and county-based purchasing plans for that contract year to reflect the removal of this |
|---|
| 329 | 324 | | 10.21paragraph. Contracts between managed care plans and county-based purchasing plans and |
|---|
| 330 | 325 | | 10.22providers to whom this paragraph applies must allow recovery of payments from those |
|---|
| 331 | 326 | | 10.23providers if capitation rates are adjusted in accordance with this paragraph. Payment |
|---|
| 332 | 327 | | 10.24recoveries must not exceed the amount equal to any increase in rates that results from this |
|---|
| 333 | 328 | | 10.25paragraph. |
|---|
| 334 | 329 | | 10.26 (f) For purposes of this subdivision, the applicable Medicare Physician Fee Schedule is |
|---|
| 335 | 330 | | 10.27the most recent Medicare Physician Fee Schedule Final Rule issued by the Centers for |
|---|
| 336 | 331 | | 10.28Medicare and Medicaid Services in effect at the time the service was rendered. |
|---|
| 337 | 332 | | 10.29 EFFECTIVE DATE.Paragraph (f) is effective January 1, 2026, or upon federal |
|---|
| 338 | 333 | | 10.30approval, whichever is later. The commissioner of human services shall notify the revisor |
|---|
| 339 | 334 | | 10.31of statutes when federal approval is obtained. |
|---|
| 340 | 335 | | 10Sec. 6. |
|---|
| 342 | 337 | | 11.2 256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES. |
|---|
| 343 | 338 | | 11.3 (a) Effective for services rendered on or after July 1, 2001, payment for medication |
|---|
| 344 | 339 | | 11.4management provided to psychiatric patients, outpatient mental health services, day treatment |
|---|
| 345 | 340 | | 11.5services, home-based mental health services, and family community support services shall |
|---|
| 346 | 341 | | 11.6be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of |
|---|
| 347 | 342 | | 11.71999 charges. |
|---|
| 348 | 343 | | 11.8 (b) Effective July 1, 2001, the medical assistance rates for outpatient mental health |
|---|
| 349 | 344 | | 11.9services provided by an entity that operates: (1) a Medicare-certified comprehensive |
|---|
| 350 | 345 | | 11.10outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993, |
|---|
| 351 | 346 | | 11.11with at least 33 percent of the clients receiving rehabilitation services in the most recent |
|---|
| 352 | 347 | | 11.12calendar year who are medical assistance recipients, will be increased by 38 percent, when |
|---|
| 353 | 348 | | 11.13those services are provided within the comprehensive outpatient rehabilitation facility and |
|---|
| 354 | 349 | | 11.14provided to residents of nursing facilities owned by the entity. |
|---|
| 355 | 350 | | 11.15 (c) In addition to rate increases otherwise provided, the commissioner may restructure |
|---|
| 356 | 351 | | 11.16coverage policy and rates to improve access to adult rehabilitative mental health services |
|---|
| 357 | 352 | | 11.17under section 256B.0623 and related mental health support services under section 256B.021, |
|---|
| 358 | 353 | | 11.18subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected |
|---|
| 359 | 354 | | 11.19state share of increased costs due to this paragraph is transferred from adult mental health |
|---|
| 360 | 355 | | 11.20grants under sections 245.4661 and 256K.10. The transfer for fiscal year 2016 is a permanent |
|---|
| 361 | 356 | | 11.21base adjustment for subsequent fiscal years. Payments made to managed care plans and |
|---|
| 362 | 357 | | 11.22county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect |
|---|
| 363 | 358 | | 11.23the rate changes described in this paragraph. |
|---|
| 364 | 359 | | 11.24 (d) Any ratables effective before July 1, 2015, do not apply to early intensive |
|---|
| 365 | 360 | | 11.25developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949. |
|---|
| 366 | 361 | | 11.26 (e) Effective for services rendered on or after January 1, 2024, payment rates for |
|---|
| 367 | 362 | | 11.27behavioral health services included in the rate analysis required by Laws 2021, First Special |
|---|
| 368 | 363 | | 11.28Session chapter 7, article 17, section 18, except for adult day treatment services under section |
|---|
| 369 | 364 | | 11.29256B.0671, subdivision 3; early intensive developmental and behavioral intervention services |
|---|
| 370 | 365 | | 11.30under section 256B.0949; and substance use disorder services under chapter 254B, must be |
|---|
| 371 | 366 | | 11.31increased by three percent from the rates in effect on December 31, 2023. Effective for |
|---|
| 372 | 367 | | 11.32services rendered on or after January 1, 2025, payment rates for behavioral health services |
|---|
| 373 | 368 | | 11.33included in the rate analysis required by Laws 2021, First Special Session chapter 7, article |
|---|
| 374 | 369 | | 11.3417, section 18; early intensive developmental behavioral intervention services under section |
|---|
| 375 | 370 | | 11Sec. 7. |
|---|
| 377 | 372 | | 12.2adjusted according to the change from the midpoint of the previous rate year to the midpoint |
|---|
| 378 | 373 | | 12.3of the rate year for which the rate is being determined using the Centers for Medicare and |
|---|
| 379 | 374 | | 12.4Medicaid Services Medicare Economic Index as forecasted in the fourth quarter of the |
|---|
| 380 | 375 | | 12.5calendar year before the rate year. For payments made in accordance with this paragraph, |
|---|
| 381 | 376 | | 12.6if and to the extent that the commissioner identifies that the state has received federal |
|---|
| 382 | 377 | | 12.7financial participation for behavioral health services in excess of the amount allowed under |
|---|
| 383 | 378 | | 12.8United States Code, title 42, section 447.321, the state shall repay the excess amount to the |
|---|
| 384 | 379 | | 12.9Centers for Medicare and Medicaid Services with state money and maintain the full payment |
|---|
| 385 | 380 | | 12.10rate under this paragraph. This paragraph does not apply to federally qualified health centers, |
|---|
| 386 | 381 | | 12.11rural health centers, Indian health services, certified community behavioral health clinics, |
|---|
| 387 | 382 | | 12.12cost-based rates, and rates that are negotiated with the county. This paragraph expires upon |
|---|
| 388 | 383 | | 12.13legislative implementation of the new rate methodology resulting from the rate analysis |
|---|
| 389 | 384 | | 12.14required by Laws 2021, First Special Session chapter 7, article 17, section 18. |
|---|
| 390 | 385 | | 12.15 (f) Effective January 1, 2024, the commissioner shall increase capitation payments made |
|---|
| 391 | 386 | | 12.16to managed care plans and county-based purchasing plans to reflect the behavioral health |
|---|
| 392 | 387 | | 12.17service rate increase provided in paragraph (e). Managed care and county-based purchasing |
|---|
| 393 | 388 | | 12.18plans must use the capitation rate increase provided under this paragraph to increase payment |
|---|
| 394 | 389 | | 12.19rates to behavioral health services providers. The commissioner must monitor the effect of |
|---|
| 395 | 390 | | 12.20this rate increase on enrollee access to behavioral health services. If for any contract year |
|---|
| 396 | 391 | | 12.21federal approval is not received for this paragraph, the commissioner must adjust the |
|---|
| 397 | 392 | | 12.22capitation rates paid to managed care plans and county-based purchasing plans for that |
|---|
| 398 | 393 | | 12.23contract year to reflect the removal of this provision. Contracts between managed care plans |
|---|
| 399 | 394 | | 12.24and county-based purchasing plans and providers to whom this paragraph applies must |
|---|
| 400 | 395 | | 12.25allow recovery of payments from those providers if capitation rates are adjusted in accordance |
|---|
| 401 | 396 | | 12.26with this paragraph. Payment recoveries must not exceed the amount equal to any increase |
|---|
| 402 | 397 | | 12.27in rates that results from this provision. |
|---|
| 403 | 398 | | 12.28 (g) Effective for services rendered on or after January 1, 2026, or the date of federal |
|---|
| 404 | 399 | | 12.29approval, whichever is later: |
|---|
| 405 | 400 | | 12.30 (1) rates for mental health services reimbursed under the resource-based relative value |
|---|
| 406 | 401 | | 12.31scale must be at least equal to 100 percent of the Medicare Physician Fee Schedule; and |
|---|
| 407 | 402 | | 12.32 (2) the commissioner must increase capitation payments made to managed care plans |
|---|
| 408 | 403 | | 12.33and county-based purchasing plans to reflect the rate increases provided under this paragraph. |
|---|
| 409 | 404 | | 12.34Managed care plans and county-based purchasing plans must use the capitation rate increase |
|---|
| 410 | 405 | | 12.35provided under this clause to increase payment rates to the providers corresponding to the |
|---|
| 411 | 406 | | 12Sec. 7. |
|---|
| 413 | 408 | | 13.2access to services under this paragraph. If for any contract year federal approval is not |
|---|
| 414 | 409 | | 13.3received for this clause, the commissioner must adjust the capitation rates paid to managed |
|---|
| 415 | 410 | | 13.4care plans and county-based purchasing plans for that contract year to reflect the removal |
|---|
| 416 | 411 | | 13.5of this clause. Contracts between managed care plans and county-based purchasing plans |
|---|
| 417 | 412 | | 13.6and providers to whom this clause applies must allow recovery of payments from those |
|---|
| 418 | 413 | | 13.7providers if capitation rates are adjusted in accordance with this clause. Payment recoveries |
|---|
| 419 | 414 | | 13.8must not exceed the amount equal to any increase in rates that results from this clause. |
|---|
| 420 | 415 | | 13.9 (h) Effective for services under this section billed and coded under Healthcare Common |
|---|
| 421 | 416 | | 13.10Procedure Coding System H, T, and S, and rendered on or after January 1, 2027, or the date |
|---|
| 422 | 417 | | 13.11of federal approval, whichever is later, the commissioner must increase reimbursement rates |
|---|
| 423 | 418 | | 13.12as necessary to align with the Medicare Physician Fee Schedule. |
|---|
| 424 | 419 | | 13.13 (i) Effective for children's therapeutic supports and services under section 256B.0943, |
|---|
| 425 | 420 | | 13.14subdivision 2, and services under section 245.488, rendered on or after January 1, 2026, or |
|---|
| 426 | 421 | | 13.15the date of federal approval, whichever is later, the commissioner must increase: |
|---|
| 427 | 422 | | 13.16 (1) reimbursement rates as necessary to align with the Medicare Physician Fee Schedule; |
|---|
| 428 | 423 | | 13.17and |
|---|
| 429 | 424 | | 13.18 (2) capitation payments made to managed care plans and county-based purchasing plans |
|---|
| 430 | 425 | | 13.19to reflect the rate increases provided under this paragraph. Managed care plans and |
|---|
| 431 | 426 | | 13.20county-based purchasing plans must use the capitation rate increase provided under this |
|---|
| 432 | 427 | | 13.21clause to increase payment rates to the providers corresponding to the rate increases. The |
|---|
| 433 | 428 | | 13.22commissioner must monitor the effect of this rate increase on enrollee access to services |
|---|
| 434 | 429 | | 13.23under this paragraph. If for any contract year federal approval is not received for this clause, |
|---|
| 435 | 430 | | 13.24the commissioner must adjust the capitation rates paid to managed care plans and |
|---|
| 436 | 431 | | 13.25county-based purchasing plans for that contract year to reflect the removal of this clause. |
|---|
| 437 | 432 | | 13.26Contracts between managed care plans and county-based purchasing plans and providers |
|---|
| 438 | 433 | | 13.27to whom this clause applies must allow recovery of payments from those providers if |
|---|
| 439 | 434 | | 13.28capitation rates are adjusted in accordance with this clause. Payment recoveries must not |
|---|
| 440 | 435 | | 13.29exceed the amount equal to any increase in rates that results from this clause. |
|---|
| 441 | 436 | | 13.30 (j) Paragraph (i) does not apply to federally qualified health centers, rural health centers, |
|---|
| 442 | 437 | | 13.31Indian health services, certified community behavioral health clinics, cost-based rates, |
|---|
| 443 | 438 | | 13.32psychiatric residential treatment facilities, and children's residential services and rates that |
|---|
| 444 | 439 | | 13.33are negotiated with the county. |
|---|
| 445 | 440 | | 13Sec. 7. |
|---|
| 447 | 442 | | 14.2First Special Session chapter 7, article 17, section 18, except for adult day treatment services |
|---|
| 448 | 443 | | 14.3under section 256B.0671, subdivision 3; early intensive developmental and behavioral |
|---|
| 449 | 444 | | 14.4intervention services under section 256B.0949; and substance use disorder services under |
|---|
| 450 | 445 | | 14.5chapter 254B, managed care plans and county-based purchasing plans must reimburse the |
|---|
| 451 | 446 | | 14.6providers at a rate that is at least equal to the fee-for-service payment rate. The commissioner |
|---|
| 452 | 447 | | 14.7must monitor the effect of this requirement on the rate of access to the services delivered |
|---|
| 453 | 448 | | 14.8by providers of behavioral health services. |
|---|
| 454 | 449 | | 14.9 (l) For purposes of this section, the applicable Medicare Physician Fee Schedule is the |
|---|
| 455 | 450 | | 14.10most recent Medicare Physician Fee Schedule Final Rule issued by the Centers for Medicare |
|---|
| 456 | 451 | | 14.11and Medicaid Services in effect at the time the service was rendered. |
|---|
| 457 | 452 | | 14.12 EFFECTIVE DATE.Paragraphs (j) to (l) are effective January 1, 2026, or upon federal |
|---|
| 458 | 453 | | 14.13approval, whichever is later. The commissioner shall notify the revisor of statutes when |
|---|
| 459 | 454 | | 14.14federal approval is obtained. |
|---|
| 460 | 455 | | 14.15Sec. 8. [256B.7662] REIMBURSEMENT RATES FOR PRIMARY CARE SERVICES. |
|---|
| 461 | 456 | | 14.16 Subdivision 1.Primary care minimum rate.Effective for services rendered on or after |
|---|
| 462 | 457 | | 14.17January 1, 2026, or the date of federal approval, whichever is later, rates for primary care |
|---|
| 463 | 458 | | 14.18services reimbursed under the resource-based relative value scale must be at least equal to |
|---|
| 464 | 459 | | 14.19100 percent of the Medicare Physician Fee Schedule. |
|---|
| 465 | 460 | | 14.20 Subd. 2.Capitation payments.Effective for services rendered on or after January 1, |
|---|
| 466 | 461 | | 14.212026, or the date of federal approval, whichever is later, the commissioner shall increase |
|---|
| 467 | 462 | | 14.22capitation payments made to managed care plans and county-based purchasing plans to |
|---|
| 468 | 463 | | 14.23reflect the rate increases provided under this section. Managed care plans and county-based |
|---|
| 469 | 464 | | 14.24purchasing plans must use the capitation rate increase provided under this subdivision to |
|---|
| 470 | 465 | | 14.25increase payment rates to the providers corresponding to the rate increases. The commissioner |
|---|
| 471 | 466 | | 14.26must monitor the effect of this rate increase on enrollee access to services under this section. |
|---|
| 472 | 467 | | 14.27If for any contract year federal approval is not received for this subdivision, the commissioner |
|---|
| 473 | 468 | | 14.28must adjust the capitation rates paid to managed care plans and county-based purchasing |
|---|
| 474 | 469 | | 14.29plans for that contract year to reflect the removal of this subdivision. Contracts between |
|---|
| 475 | 470 | | 14.30managed care plans and county-based purchasing plans and providers to whom this |
|---|
| 476 | 471 | | 14.31subdivision applies must allow recovery of payments from those providers if capitation |
|---|
| 477 | 472 | | 14.32rates are adjusted in accordance with this subdivision. Payment recoveries must not exceed |
|---|
| 478 | 473 | | 14.33the amount equal to any increase in rates that results from this subdivision. |
|---|
| 479 | 474 | | 14Sec. 8. |
|---|
| 487 | | - | 15.8 Sec. 9. [295.525] MCO ASSESSMENT ON HEALTH PLAN COMPANIES. |
|---|
| 488 | | - | 15.9 Subdivision 1.Definitions.(a) For purposes of this section, the definitions have the |
|---|
| 489 | | - | 15.10meanings given. |
|---|
| 490 | | - | 15.11 (b) "Base year" means January 1, 2025, to December 31, 2025. |
|---|
| 491 | | - | 15.12 (c) "Commissioner" means the commissioner of human services. |
|---|
| 492 | | - | 15.13 (d) "Enrollee" has the meaning given in section 62Q.01, except that enrollee does not |
|---|
| 493 | | - | 15.14include: |
|---|
| 494 | | - | 15.15 (1) an individual enrolled in a Medicare plan; |
|---|
| 495 | | - | 15.16 (2) a plan-to-plan enrollee; or |
|---|
| 496 | | - | 15.17 (3) an individual enrolled in a health plan pursuant to the Federal Employees Health |
|---|
| 497 | | - | 15.18Benefits Act of 1959, Public Law 86-382, as amended, to the extent the imposition of the |
|---|
| 498 | | - | 15.19assessment under this section is preempted pursuant to United States Code, title 5, section |
|---|
| 499 | | - | 15.208909, subsection (f). |
|---|
| 500 | | - | 15.21 (e) "Health plan" has the meaning given in section 62Q.01. |
|---|
| 501 | | - | 15.22 (f) "Health plan company" has the meaning given in section 62Q.01. |
|---|
| 502 | | - | 15.23 (g) "Medical assistance" means the medical assistance program established under chapter |
|---|
| 503 | | - | 15.24256B. |
|---|
| 504 | | - | 15.25 (h) "Medical assistance enrollee" means an enrollee in medical assistance for whom the |
|---|
| 505 | | - | 15.26department of human services directly pays the health plan company a capitated payment. |
|---|
| 506 | | - | 15.27 (i) "Plan-to-plan enrollee" means an individual who receives coverage for health care |
|---|
| 507 | | - | 15.28services through a health plan pursuant to a subcontract from another health plan. |
|---|
| 508 | | - | 15.29 Subd. 2.MCO assessment.(a) An annual assessment is imposed on health plan |
|---|
| 509 | | - | 15.30companies for calendar years 2026 to 2029. The total annual assessment amount is equal |
|---|
| 482 | + | 15.8 Sec. 9. REPEALER. |
|---|
| 483 | + | 15.9 Minnesota Statutes 2024, section 256B.0625, subdivision 38, is repealed. |
|---|
| 484 | + | 15.10 EFFECTIVE DATE.This section is effective January 1, 2027, or upon federal approval, |
|---|
| 485 | + | 15.11whichever is later. The commissioner of human services shall notify the revisor of statutes |
|---|
| 486 | + | 15.12when federal approval is obtained. |
|---|
| 511 | | - | S1402-1 1st EngrossmentSF1402 REVISOR AGW 16.1to the sum of the amounts assessed for medical assistance enrollees under paragraph (b) |
|---|
| 512 | | - | 16.2and for nonmedical assistance enrollees under paragraph (c). |
|---|
| 513 | | - | 16.3 (b) The amount assessed for medical assistance enrollees is equal to the sum of the |
|---|
| 514 | | - | 16.4following: |
|---|
| 515 | | - | 16.5 (1) for medical assistance enrollees 0 to 60,000, $0 per enrollee; |
|---|
| 516 | | - | 16.6 (2) for medical assistance enrollees 60,001 to 100,000, $340 per enrollee; |
|---|
| 517 | | - | 16.7 (3) for medical assistance enrollees 100,001 to 200,000, $365 per enrollee; and |
|---|
| 518 | | - | 16.8 (4) for medical assistance enrollees 200,001 to 350,000, $380 per enrollee. |
|---|
| 519 | | - | 16.9 (c) The amount assessed for nonmedical assistance enrollees is equal to the sum of the |
|---|
| 520 | | - | 16.10following: |
|---|
| 521 | | - | 16.11 (1) for nonmedical assistance enrollees 0 to 60,000, $0 per enrollee; |
|---|
| 522 | | - | 16.12 (2) for nonmedical assistance enrollees 60,001 to 100,000, 50 cents per enrollee; |
|---|
| 523 | | - | 16.13 (3) for nonmedical assistance enrollees 100,001 to 200,000, 75 cents per enrollee; and |
|---|
| 524 | | - | 16.14 (4) for nonmedical assistance enrollees 200,001 to 350,000, $1 per enrollee. |
|---|
| 525 | | - | 16.15 (d) The commissioner may, after consultation with health plan companies likely to be |
|---|
| 526 | | - | 16.16affected, modify the rate of assessment, as set forth in paragraphs (a) to (c), as necessary to |
|---|
| 527 | | - | 16.17comply with federal law, obtain or maintain a waiver under Code of Federal Regulations, |
|---|
| 528 | | - | 16.18title 42, section 433.72, or to otherwise maximize under this section federal financial |
|---|
| 529 | | - | 16.19participation for medical assistance. |
|---|
| 530 | | - | 16.20 (e) Unpaid assessment amounts accrue interest at a rate of ten percent per annum, |
|---|
| 531 | | - | 16.21beginning the day following the assessment payment's due date. A penalty, equal to the |
|---|
| 532 | | - | 16.22total accrued interest charge, is imposed monthly on payments 60 days or more overdue |
|---|
| 533 | | - | 16.23until the payment, penalty, and interest are paid in full. |
|---|
| 534 | | - | 16.24 Subd. 3.Assessment computation; collection.(a) The commissioner must determine |
|---|
| 535 | | - | 16.25the following for each health plan company: |
|---|
| 536 | | - | 16.26 (1) total cumulative enrollment for the base year; |
|---|
| 537 | | - | 16.27 (2) total Medicare cumulative enrollment for the base year; |
|---|
| 538 | | - | 16.28 (3) total medical assistance cumulative enrollment for the base year; |
|---|
| 539 | | - | 16.29 (4) total plan-to-plan cumulative enrollment for the base year; |
|---|
| 540 | | - | 16Sec. 9. |
|---|
| 541 | | - | S1402-1 1st EngrossmentSF1402 REVISOR AGW 17.1 (5) total cumulative enrollment through the Federal Employees Health Benefits Act of |
|---|
| 542 | | - | 17.21959, Public Law 86-382, as amended, for the base year; and |
|---|
| 543 | | - | 17.3 (6) total other cumulative enrollment for the base year that is not otherwise counted in |
|---|
| 544 | | - | 17.4clauses (2) to (5). |
|---|
| 545 | | - | 17.5 (b) Health plan companies must provide any information requested by the commissioner |
|---|
| 546 | | - | 17.6for the purpose of this subdivision, provided that the commissioner determines such |
|---|
| 547 | | - | 17.7information is necessary to accurately determine the information in paragraph (a). |
|---|
| 548 | | - | 17.8 (c) The commissioner may correct errors in data provided to the commissioner by a |
|---|
| 549 | | - | 17.9health plan company to the extent necessary to accurately determine the information in |
|---|
| 550 | | - | 17.10paragraph (a). |
|---|
| 551 | | - | 17.11 (d) For purposes of calculating the information in paragraph (a) for a health plan company, |
|---|
| 552 | | - | 17.12the commissioner must count any individual that was an enrollee of a health plan at any |
|---|
| 553 | | - | 17.13point of the base year, regardless of the enrollee's duration as an enrollee of the health plan. |
|---|
| 554 | | - | 17.14 (e) The commissioner must use the information in paragraph (a) to compute the |
|---|
| 555 | | - | 17.15assessment for each health plan company. |
|---|
| 556 | | - | 17.16 (f) The commissioner must collect the annual assessment for each health plan company |
|---|
| 557 | | - | 17.17in four equal installments, in the manner and on the schedule determined by the |
|---|
| 558 | | - | 17.18commissioner. The commissioner is prohibited from collecting any amount under this section |
|---|
| 559 | | - | 17.19until 20 days after the commissioner has notified the health plan company of: |
|---|
| 560 | | - | 17.20 (1) the effective date of this section; |
|---|
| 561 | | - | 17.21 (2) the assessment due dates for the applicable calendar year; and |
|---|
| 562 | | - | 17.22 (3) the annual assessment amount. |
|---|
| 563 | | - | 17.23 (g) The commissioner may waive all or part of the interest or penalty imposed on a |
|---|
| 564 | | - | 17.24health plan company under subdivision 2, paragraph (e), if the commissioner determines |
|---|
| 565 | | - | 17.25the interest or penalty is likely to create an undue financial hardship on the health plan |
|---|
| 566 | | - | 17.26company or a significant financial difficulty in providing necessary services to medical |
|---|
| 567 | | - | 17.27assistance enrollees. A waiver under this paragraph must be contingent on the health plan |
|---|
| 568 | | - | 17.28company's agreement to make assessment payments on an alternative schedule, determined |
|---|
| 569 | | - | 17.29by the commissioner, that accounts for the health plan company's finances and the potential |
|---|
| 570 | | - | 17.30impact on the delivery of services to medical assistance enrollees. |
|---|
| 571 | | - | 17.31 (h) In the event of a merger, acquisition, or other transaction that results in the transfer |
|---|
| 572 | | - | 17.32of health plan responsibility to another health plan company or similar entity during calendar |
|---|
| 573 | | - | 17Sec. 9. |
|---|
| 574 | | - | S1402-1 1st EngrossmentSF1402 REVISOR AGW 18.1years 2026 to 2029, the surviving, acquiring, or controlling health plan company or similar |
|---|
| 575 | | - | 18.2entity shall be responsible for paying the full assessment amount as provided in this section |
|---|
| 576 | | - | 18.3that would have been the responsibility of the health plan company to which that full |
|---|
| 577 | | - | 18.4assessment amount was assessed upon the effective date of the transaction. If a transaction |
|---|
| 578 | | - | 18.5results in the transfer of health plan responsibility for only some of a health plan's enrollees |
|---|
| 579 | | - | 18.6under this section but not all enrollees, the full assessment amount as provided in this section |
|---|
| 580 | | - | 18.7remains the responsibility of that health plan company to which that full assessment amount |
|---|
| 581 | | - | 18.8was assessed. |
|---|
| 582 | | - | 18.9 Subd. 4.MCO assessment expenditures.(a) All amounts collected by the commissioner |
|---|
| 583 | | - | 18.10under this section must be deposited in the health care access fund. |
|---|
| 584 | | - | 18.11 (b) All amounts collected by the commissioner under this section are annually |
|---|
| 585 | | - | 18.12appropriated to the commissioner to provide nonfederal funds for medical assistance. The |
|---|
| 586 | | - | 18.13assessment funds must be used to supplement funds for medical assistance from the general |
|---|
| 587 | | - | 18.14fund. |
|---|
| 588 | | - | 18.15 (c) The commissioner must provide an annual report to all health plan companies, in a |
|---|
| 589 | | - | 18.16time and manner determined by the commissioner. The report must identify the assessments |
|---|
| 590 | | - | 18.17imposed on each health plan company pursuant to this section, account for all funds raised |
|---|
| 591 | | - | 18.18by the MCO assessment, and provide an itemized accounting of expenditures from the fund. |
|---|
| 592 | | - | 18.19 Subd. 5.Expiration.This section expires June 30, 2030. |
|---|
| 593 | | - | 18.20 EFFECTIVE DATE.This section is effective January 1, 2026, or upon federal approval |
|---|
| 594 | | - | 18.21for the assessment established in this section to be considered a permissible health |
|---|
| 595 | | - | 18.22care-related tax under Code of Federal Regulations, title 42, section 433.68, eligible for |
|---|
| 596 | | - | 18.23federal financial participation, including but not limited to federal approval of a waiver |
|---|
| 597 | | - | 18.24under Code of Federal Regulations, title 42, section 433.72, if such waiver is necessary to |
|---|
| 598 | | - | 18.25receive health care-related taxes without a reduction in federal financial participation, |
|---|
| 599 | | - | 18.26whichever is later. The commissioner of human services shall notify the revisor of statutes |
|---|
| 600 | | - | 18.27when federal approval is obtained. |
|---|
| 601 | | - | 18.28Sec. 10. FEDERAL APPROVAL; WAIVERS. |
|---|
| 602 | | - | 18.29 (a) The commissioner must request, as the commissioner determines necessary, federal |
|---|
| 603 | | - | 18.30approval for the MCO assessment on health plan companies established in this act to be |
|---|
| 604 | | - | 18.31considered a permissible health care-related tax under Code of Federal Regulations, title |
|---|
| 605 | | - | 18.3242, section 433.68, eligible for federal financial participation. |
|---|
| 606 | | - | 18Sec. 10. |
|---|
| 607 | | - | S1402-1 1st EngrossmentSF1402 REVISOR AGW 19.1 (b) To obtain the federal approval under paragraph (a), the commissioner may apply for |
|---|
| 608 | | - | 19.2a waiver of the federal broad-based requirement for health care-related taxes, uniform |
|---|
| 609 | | - | 19.3requirement for health care-related taxes, and any other provision of federal law necessary |
|---|
| 610 | | - | 19.4to implement Minnesota Statutes, section 295.525. |
|---|
| 611 | | - | 19.5 EFFECTIVE DATE.This section is effective the day following final enactment. |
|---|
| 612 | | - | 19.6 Sec. 11. REPEALER. |
|---|
| 613 | | - | 19.7 Minnesota Statutes 2024, section 256B.0625, subdivision 38, is repealed. |
|---|
| 614 | | - | 19.8 EFFECTIVE DATE.This section is effective January 1, 2027, or upon federal approval, |
|---|
| 615 | | - | 19.9whichever is later. The commissioner of human services shall notify the revisor of statutes |
|---|
| 616 | | - | 19.10when federal approval is obtained. |
|---|
| 617 | | - | 19Sec. 11. |
|---|
| 618 | | - | S1402-1 1st EngrossmentSF1402 REVISOR AGW 256B.0625 COVERED SERVICES. |
|---|
| 488 | + | 25-02460 as introduced02/07/25 REVISOR AGW/VJ 256B.0625 COVERED SERVICES. |
|---|