Minnesota 2025-2026 Regular Session

Minnesota Senate Bill SF2670 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1.1 A bill for an act
2	2	1.2 relating to human services; requiring individual pricing of phototherapy lights;
3	3	1.3 making technical changes; amending Minnesota Statutes 2024, section 256B.766.
4	4	1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
5	5	1.5 Section 1. Minnesota Statutes 2024, section 256B.766, is amended to read:
6	6	1.6 256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.
7	7	1.7 Subdivision 1.Payment reductions for base care services effective July 1, 2009.(a)
8	8	1.8Effective for services provided on or after July 1, 2009, total payments for basic care services,
9	9	1.9shall be reduced by three percent, except that for the period July 1, 2009, through June 30,
10	10	1.102011, total payments shall be reduced by 4.5 percent for the medical assistance and general
11	11	1.11assistance medical care programs, prior to third-party liability and spenddown calculation.
12	12	1.12 Subd. 2.Classification of therapies as basic care services.Effective July 1, 2010, The
13	13	1.13commissioner shall classify physical therapy services, occupational therapy services, and
14	14	1.14speech-language pathology and related services as basic care services. The reduction in this
15	15	1.15paragraph subdivision 1 shall apply to physical therapy services, occupational therapy
16	16	1.16services, and speech-language pathology and related services provided on or after July 1,
17	17	1.172010.
18	18	1.18 Subd. 3.Payment reductions to managed care plans effective October 1, 2009.(b)
19	19	1.19Payments made to managed care plans and county-based purchasing plans shall be reduced
20	20	1.20for services provided on or after October 1, 2009, to reflect the reduction in subdivision 1
21	21	1.21effective July 1, 2009, and payments made to the plans shall be reduced effective October
22	22	1.221, 2010, to reflect the reduction in subdivision 1 effective July 1, 2010.
23	23	1Section 1.
24	24	25-02749 as introduced02/05/25 REVISOR AGW/HL
25	25	SENATE
26	26	STATE OF MINNESOTA
27	27	S.F. No. 2670NINETY-FOURTH SESSION
28	28	(SENATE AUTHORS: MAYE QUADE, Utke, Boldon, Hoffman and Abeler)
29	29	OFFICIAL STATUSD-PGDATE
30	30	Introduction and first reading03/17/2025
31	31	Referred to Health and Human Services 2.1 Subd. 4.Temporary payment reductions effective September 1, 2011.(c) (a) Effective
32	32	2.2for services provided on or after September 1, 2011, through June 30, 2013, total payments
33	33	2.3for outpatient hospital facility fees shall be reduced by five percent from the rates in effect
34	34	2.4on August 31, 2011.
35	35	2.5 (d) (b) Effective for services provided on or after September 1, 2011, through June 30,
36	36	2.62013, total payments for ambulatory surgery centers facility fees, medical supplies and
37	37	2.7durable medical equipment not subject to a volume purchase contract, prosthetics and
38	38	2.8orthotics, renal dialysis services, laboratory services, public health nursing services, physical
39	39	2.9therapy services, occupational therapy services, speech therapy services, eyeglasses not
40	40	2.10subject to a volume purchase contract, hearing aids not subject to a volume purchase contract,
41	41	2.11and anesthesia services shall be reduced by three percent from the rates in effect on August
42	42	2.1231, 2011.
43	43	2.13 Subd. 5.Payment increases effective September 1, 2014.(e) (a) Effective for services
44	44	2.14provided on or after September 1, 2014, payments for ambulatory surgery centers facility
45	45	2.15fees, hospice services, renal dialysis services, laboratory services, public health nursing
46	46	2.16services, eyeglasses not subject to a volume purchase contract, and hearing aids not subject
47	47	2.17to a volume purchase contract shall be increased by three percent and payments for outpatient
48	48	2.18hospital facility fees shall be increased by three percent.
49	49	2.19 (b) Payments made to managed care plans and county-based purchasing plans shall not
50	50	2.20be adjusted to reflect payments under this paragraph subdivision.
51	51	2.21 Subd. 6.Temporary payment reductions effective July 1, 2014.(f) Payments for
52	52	2.22medical supplies and durable medical equipment not subject to a volume purchase contract,
53	53	2.23and prosthetics and orthotics, provided on or after July 1, 2014, through June 30, 2015, shall
54	54	2.24be decreased by .33 percent.
55	55	2.25 Subd. 7.Payment increases effective July 1, 2015.(a) Payments for medical supplies
56	56	2.26and durable medical equipment not subject to a volume purchase contract, and prosthetics
57	57	2.27and orthotics, provided on or after July 1, 2015, shall be increased by three percent from
58	58	2.28the rates as determined under paragraphs (i) and (j) subdivisions 9 and 10.
59	59	2.29 (g) (b) Effective for services provided on or after July 1, 2015, payments for outpatient
60	60	2.30hospital facility fees, medical supplies and durable medical equipment not subject to a
61	61	2.31volume purchase contract, prosthetics, and orthotics to a hospital meeting the criteria specified
62	62	2.32in section 62Q.19, subdivision 1, paragraph (a), clause (4), shall be increased by 90 percent
63	63	2.33from the rates in effect on June 30, 2015.
64	64	2Section 1.
65	65	25-02749 as introduced02/05/25 REVISOR AGW/HL 3.1 (c) Payments made to managed care plans and county-based purchasing plans shall not
66	66	3.2be adjusted to reflect payments under this paragraph (b).
67	67	3.3 Subd. 8.Exempt services.(h) This section does not apply to physician and professional
68	68	3.4services, inpatient hospital services, family planning services, mental health services, dental
69	69	3.5services, prescription drugs, medical transportation, federally qualified health centers, rural
70	70	3.6health centers, Indian health services, and Medicare cost-sharing.
71	71	3.7 Subd. 9.Individually priced items.(i) (a) Effective for services provided on or after
72	72	3.8July 1, 2015, the following categories of medical supplies and durable medical equipment
73	73	3.9shall be individually priced items: customized and other specialized tracheostomy tubes
74	74	3.10and supplies, electric patient lifts, phototherapy lights, and durable medical equipment repair
75	75	3.11and service.
76	76	3.12 (b) This paragraph subdivision does not apply to medical supplies and durable medical
77	77	3.13equipment subject to a volume purchase contract, products subject to the preferred diabetic
78	78	3.14testing supply program, and items provided to dually eligible recipients when Medicare is
79	79	3.15the primary payer for the item.
80	80	3.16 (c) The commissioner shall not apply any medical assistance rate reductions to durable
81	81	3.17medical equipment as a result of Medicare competitive bidding.
82	82	3.18 Subd. 10.Rate increases effective July 1, 2015.(j) (a) Effective for services provided
83	83	3.19on or after July 1, 2015, medical assistance payment rates for durable medical equipment,
84	84	3.20prosthetics, orthotics, or supplies shall be increased as follows:
85	85	3.21 (1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that
86	86	3.22were subject to the Medicare competitive bid that took effect in January of 2009 shall be
87	87	3.23increased by 9.5 percent; and
88	88	3.24 (2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on
89	89	3.25the medical assistance fee schedule, whether or not subject to the Medicare competitive bid
90	90	3.26that took effect in January of 2009, shall be increased by 2.94 percent, with this increase
91	91	3.27being applied after calculation of any increased payment rate under clause (1).
92	92	3.28 This (b) Paragraph (a) does not apply to medical supplies and durable medical equipment
93	93	3.29subject to a volume purchase contract, products subject to the preferred diabetic testing
94	94	3.30supply program, items provided to dually eligible recipients when Medicare is the primary
95	95	3.31payer for the item, and individually priced items identified in paragraph (i) subdivision 9.
96	96	3.32 (c) Payments made to managed care plans and county-based purchasing plans shall not
97	97	3.33be adjusted to reflect the rate increases in this paragraph subdivision.
98	98	3Section 1.
99	99	25-02749 as introduced02/05/25 REVISOR AGW/HL 4.1 Subd. 11.Rates for ventilators.(k) (a) Effective for nonpressure support ventilators
100	100	4.2provided on or after January 1, 2016, the rate shall be the lower of the submitted charge or
101	101	4.3the Medicare fee schedule rate.
102	102	4.4 (b) Effective for pressure support ventilators provided on or after January 1, 2016, the
103	103	4.5rate shall be the lower of the submitted charge or 47 percent above the Medicare fee schedule
104	104	4.6rate.
105	105	4.7 (c) For payments made in accordance with this paragraph subdivision, if, and to the
106	106	4.8extent that, the commissioner identifies that the state has received federal financial
107	107	4.9participation for ventilators in excess of the amount allowed effective January 1, 2018,
108	108	4.10under United States Code, title 42, section 1396b(i)(27), the state shall repay the excess
109	109	4.11amount to the Centers for Medicare and Medicaid Services with state funds and maintain
110	110	4.12the full payment rate under this paragraph subdivision.
111	111	4.13 Subd. 12.Rates subject to the upper payment limit.(l) Payment rates for durable
112	112	4.14medical equipment, prosthetics, orthotics or supplies, that are subject to the upper payment
113	113	4.15limit in accordance with section 1903(i)(27) of the Social Security Act, shall be paid the
114	114	4.16Medicare rate. Rate increases provided in this chapter shall not be applied to the items listed
115	115	4.17in this paragraph subdivision.
116	116	4.18 Subd. 13.Temporary rates for enteral nutrition and supplies.(m) (a) For dates of
117	117	4.19service on or after July 1, 2023, through June 30, 2025, enteral nutrition and supplies must
118	118	4.20be paid according to this paragraph subdivision. If sufficient data exists for a product or
119	119	4.21supply, payment must be based upon the 50th percentile of the usual and customary charges
120	120	4.22per product code submitted to the commissioner, using only charges submitted per unit.
121	121	4.23Increases in rates resulting from the 50th percentile payment method must not exceed 150
122	122	4.24percent of the previous fiscal year's rate per code and product combination. Data are sufficient
123	123	4.25if: (1) the commissioner has at least 100 paid claim lines by at least ten different providers
124	124	4.26for a given product or supply; or (2) in the absence of the data in clause (1), the commissioner
125	125	4.27has at least 20 claim lines by at least five different providers for a product or supply that
126	126	4.28does not meet the requirements of clause (1). If sufficient data are not available to calculate
127	127	4.29the 50th percentile for enteral products or supplies, the payment rate must be the payment
128	128	4.30rate in effect on June 30, 2023.
129	129	4.31 (b) This subdivision expires June 30, 2024.
130	130	4.32 Subd. 14.Rates for enteral nutrition and supplies.(n) For dates of service on or after
131	131	4.33July 1, 2025, enteral nutrition and supplies must be paid according to this paragraph
132	132	4.34subdivision and updated annually each January 1. If sufficient data exists for a product or
133	133	4Section 1.
134	134	25-02749 as introduced02/05/25 REVISOR AGW/HL 5.1supply, payment must be based upon the 50th percentile of the usual and customary charges
135	135	5.2per product code submitted to the commissioner for the previous calendar year, using only
136	136	5.3charges submitted per unit. Increases in rates resulting from the 50th percentile payment
137	137	5.4method must not exceed 150 percent of the previous year's rate per code and product
138	138	5.5combination. Data are sufficient if: (1) the commissioner has at least 100 paid claim lines
139	139	5.6by at least ten different providers for a given product or supply; or (2) in the absence of the
140	140	5.7data in clause (1), the commissioner has at least 20 claim lines by at least five different
141	141	5.8providers for a product or supply that does not meet the requirements of clause (1). If
142	142	5.9sufficient data are not available to calculate the 50th percentile for enteral products or
143	143	5.10supplies, the payment must be the manufacturer's suggested retail price of that product or
144	144	5.11supply minus 20 percent. If the manufacturer's suggested retail price is not available, payment
145	145	5.12must be the actual acquisition cost of that product or supply plus 20 percent.
146	146	5Section 1.
147	147	25-02749 as introduced02/05/25 REVISOR AGW/HL