Minnesota Legislature
HF 4519
as introduced - 93rd Legislature (2023 - 2024) Posted on 03/04/2024 02:29pm
1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21
5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 5.33 5.34 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10
A bill for an act
relating to human services; requiring individual pricing of phototherapy lights;
modifying payment methodologies for certain enteral nutrition equipment and
supplies; modifying processes for establishing payment rates for certain medical
equipment and supplies; making technical changes; amending Minnesota Statutes
2022, section 256B.767; Minnesota Statutes 2023 Supplement, section 256B.766.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2023 Supplement, section 256B.766, is amended to read:
256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.
new text begin Subdivision 1. new text end
new text begin Payment reductions for basic care services effective July 1, 2009. new text end
deleted text begin (a)deleted text end
Effective for services provided on or after July 1, 2009, total payments for basic care services,
shall be reduced by three percent, except that for the period July 1, 2009, through June 30,
2011, total payments shall be reduced by 4.5 percent for the medical assistance and general
assistance medical care programs, prior to third-party liability and spenddown calculation.
new text begin Subd. 2. new text end
new text begin Classification of therapies as basic care services. new text end
deleted text begin Effective July 1, 2010,deleted text end The
commissioner shall classify physical therapy services, occupational therapy services, and
speech-language pathology and related services as basic care services. The reduction in deleted text begin this
paragraphdeleted text end new text begin subdivision 1new text end shall apply to physical therapy services, occupational therapy
services, and speech-language pathology and related services deleted text begin provided on or after July 1,
2010deleted text end .
new text begin Subd. 3. new text end
new text begin Payment reductions to managed care plans effective October 1, 2009. new text end
deleted text begin (b)deleted text end
Payments made to managed care plans and county-based purchasing plans shall be reduced
for services provided on or after October 1, 2009, to reflect the reduction new text begin in subdivision 1
new text end effective July 1, 2009, and payments made to the plans shall be reduced effective October
1, 2010, to reflect the reduction new text begin in subdivision 1 new text end effective July 1, 2010.
new text begin Subd. 4. new text end
new text begin Temporary payment reductions effective September 1, 2011. new text end
deleted text begin (c)deleted text end new text begin (a)new text end Effective
for services provided on or after September 1, 2011, through June 30, 2013, total payments
for outpatient hospital facility fees shall be reduced by five percent from the rates in effect
on August 31, 2011.
deleted text begin (d)deleted text end new text begin (b)new text end Effective for services provided on or after September 1, 2011, through June 30,
2013, total payments for ambulatory surgery centers facility fees, medical supplies and
durable medical equipment not subject to a volume purchase contract, prosthetics and
orthotics, renal dialysis services, laboratory services, public health nursing services, physical
therapy services, occupational therapy services, speech therapy services, eyeglasses not
subject to a volume purchase contract, hearing aids not subject to a volume purchase contract,
and anesthesia services shall be reduced by three percent from the rates in effect on August
31, 2011.
new text begin Subd. 5. new text end
new text begin Payment increases effective September 1, 2014. new text end
deleted text begin (e)deleted text end new text begin (a)new text end Effective for services
provided on or after September 1, 2014, payments for ambulatory surgery centers facility
fees, hospice services, renal dialysis services, laboratory services, public health nursing
services, eyeglasses not subject to a volume purchase contract, and hearing aids not subject
to a volume purchase contract shall be increased by three percent and payments for outpatient
hospital facility fees shall be increased by three percent.
new text begin (b) new text end Payments made to managed care plans and county-based purchasing plans shall not
be adjusted to reflect payments under this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end .
new text begin Subd. 6. new text end
new text begin Temporary payment reductions effective July 1, 2014. new text end
deleted text begin (f)deleted text end Payments for
medical supplies and durable medical equipment not subject to a volume purchase contract,
and prosthetics and orthotics, provided on or after July 1, 2014, through June 30, 2015, shall
be decreased by .33 percent.
new text begin Subd. 7. new text end
new text begin Payment increases effective July 1, 2015. new text end
new text begin (a) new text end Payments for medical supplies
and durable medical equipment not subject to a volume purchase contract, and prosthetics
and orthotics, provided on or after July 1, 2015, shall be increased by three percent from
the rates new text begin for durable medical equipment, prosthetics, orthotics, or supplies new text end as determined
under deleted text begin paragraphs (i) and (j)deleted text end new text begin subdivisions 9 and 10new text end .
deleted text begin (g)deleted text end new text begin (b)new text end Effective for services provided on or after July 1, 2015, payments for outpatient
hospital facility fees, medical supplies and durable medical equipment not subject to a
volume purchase contract, prosthetics, and orthotics to a hospital meeting the criteria specified
in section 62Q.19, subdivision 1, paragraph (a), clause (4), shall be increased by 90 percent
from the rates in effect on June 30, 2015.
new text begin (c) new text end Payments made to managed care plans and county-based purchasing plans shall not
be adjusted to reflect payments under deleted text begin thisdeleted text end paragraphnew text begin (b)new text end .
new text begin Subd. 8. new text end
new text begin Exempt services. new text end
deleted text begin (h)deleted text end This section does not apply to physician and professional
services, inpatient hospital services, family planning services, mental health services, dental
services, prescription drugs, medical transportation, federally qualified health centers, rural
health centers, Indian health services, and Medicare cost-sharing.
new text begin Subd. 9. new text end
new text begin Individually priced items. new text end
deleted text begin (i)deleted text end new text begin (a)new text end Effective for services provided on or after
July 1, 2015, the following categories of medical supplies and durable medical equipment
shall be individually priced items: customized and other specialized tracheostomy tubes
and supplies, electric patient lifts, new text begin phototherapy lights, new text end and durable medical equipment repair
and service.
new text begin (b) new text end This deleted text begin paragraphdeleted text end new text begin subdivisionnew text end does not apply to medical supplies and durable medical
equipment subject to a volume purchase contract, products subject to the preferred diabetic
testing supply program, and items provided to dually eligible recipients when Medicare is
the primary payer for the item.
new text begin (c) new text end The commissioner shall not apply any medical assistance rate reductions to durable
medical equipment as a result of Medicare competitive bidding.
new text begin Subd. 10. new text end
new text begin Rate increases effective July 1, 2015. new text end
deleted text begin (j)deleted text end new text begin (a)new text end Effective for services provided
on or after July 1, 2015, medical assistance payment rates for durable medical equipment,
prosthetics, orthotics, or supplies shall be increased as follows:
(1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that
were subject to the Medicare competitive bid that took effect in January of 2009 shall be
increased by 9.5 percent; and
(2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on
the medical assistance fee schedule, whether or not subject to the Medicare competitive bid
that took effect in January of 2009, shall be increased by 2.94 percent, with this increase
being applied after calculation of any increased payment rate under clause (1).
deleted text begin Thisdeleted text end new text begin (b)new text end Paragraphnew text begin (a)new text end does not apply to medical supplies and durable medical equipment
subject to a volume purchase contract, products subject to the preferred diabetic testing
supply program, items provided to dually eligible recipients when Medicare is the primary
payer for the item, and individually priced items identified in deleted text begin paragraph (i)deleted text end new text begin subdivision 9new text end .
new text begin (c) new text end Payments made to managed care plans and county-based purchasing plans shall not
be adjusted to reflect the rate increases in deleted text begin thisdeleted text end paragraphnew text begin (a)new text end .
new text begin Subd. 11. new text end
new text begin Rates for ventilators. new text end
deleted text begin (k)deleted text end new text begin (a)new text end Effective for nonpressure support ventilators
provided on or after January 1, 2016, the rate shall be the lower of the new text begin provider's new text end submitted
charge or the Medicare fee schedule rate.
new text begin (b) new text end Effective for pressure support ventilators provided on or after January 1, 2016, the
rate shall be the lower of the new text begin provider's new text end submitted charge or 47 percent above the Medicare
fee schedule rate.
new text begin (c) new text end For payments made in accordance with this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end , if, and to the
extent that, the commissioner identifies that the state has received federal financial
participation for ventilators in excess of the amount allowed effective January 1, 2018,
under United States Code, title 42, section 1396b(i)(27), the state shall repay the excess
amount to the Centers for Medicare and Medicaid Services with state funds and maintain
the full payment rate under this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end .
new text begin Subd. 12. new text end
new text begin Rates subject to the upper payment limit. new text end
deleted text begin (l)deleted text end Payment rates for durable
medical equipment, prosthetics, orthotics or supplies, that are subject to the upper payment
limit in accordance with section 1903(i)(27) of the Social Security Act, shall be paid the
Medicare rate. Rate increases provided in this chapter shall not be applied to the items listed
in this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end .
new text begin Subd. 13. new text end
new text begin Temporary rates for enteral nutrition and supplies. new text end
deleted text begin (m)deleted text end new text begin (a)new text end For dates of
service on or after July 1, 2023, through June 30, 2024, enteral nutrition and supplies must
be paid according to this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end . If sufficient data exists for a product or
supply, payment must be based upon the 50th percentile of the usual and customary charges
per product code submitted to the commissioner, using only charges submitted per unit.
Increases in rates resulting from the 50th percentile payment method must not exceed 150
percent of the previous fiscal year's rate per code and product combination. Data are sufficient
if: (1) the commissioner has at least 100 paid claim lines by at least ten different providers
for a given product or supply; or (2) in the absence of the data in clause (1), the commissioner
has at least 20 claim lines by at least five different providers for a product or supply that
does not meet the requirements of clause (1). If sufficient data are not available to calculate
the 50th percentile for enteral products or supplies, the payment rate must be the payment
rate in effect on June 30, 2023.
new text begin
(b) This subdivision expires June 30, 2024.
new text end
new text begin Subd. 14. new text end
new text begin Rates for enteral nutrition and supplies. new text end
deleted text begin (n)deleted text end For dates of service on or after
July 1, 2024, enteral nutrition and supplies must be paid according to this deleted text begin paragraphdeleted text end new text begin
subdivisionnew text end and updated annually each January 1. If sufficient data exists for a product or
supply, payment must be based upon the 50th percentile of the usual and customary charges
per product code submitted to the commissioner for the previous calendar year, using only
charges submitted per unit. Increases in rates resulting from the 50th percentile payment
method must not exceed 150 percent of the previous year's rate per code and product
combination. Data are sufficient if: (1) the commissioner has at least 100 paid claim lines
by at least ten different providers for a given product or supply; or (2) in the absence of the
data in clause (1), the commissioner has at least 20 claim lines by at least five different
providers for a product or supply that does not meet the requirements of clause (1). If
sufficient data are not available to calculate the 50th percentile for enteral products or
supplies, the payment must be the manufacturer's suggested retail price of that product or
supply deleted text begin minus 20deleted text end new text begin plus ...new text end percent. If the manufacturer's suggested retail price is not available,
payment must be the deleted text begin actual acquisition cost of that product or supply plus 20 percentdeleted text end new text begin
provider's submitted charge minus 50 percentnew text end .
new text begin Subd. 15. new text end
new text begin Payments based on manufacturer's suggested retail price. new text end
new text begin
For medical
supplies and equipment payments based on the manufacturer's suggested retail price
methodology set forth in Minnesota Rules, part 9505.0445, item S, the commissioner shall
establish the payment amount on an annual basis for each product code with an annual
volume of at least 100 paid claim lines.
new text end
Sec. 2.
Minnesota Statutes 2022, section 256B.767, is amended to read:
256B.767 MEDICARE PAYMENT LIMIT.
new text begin Subdivision 1. new text end
new text begin Services subject to a payment limit based on Medicare rates. new text end
deleted text begin (a)deleted text end
Effective for services rendered on or after July 1, 2010, fee-for-service payment rates for
physician and professional services under section 256B.76, subdivision 1, and basic care
services subject to the rate reduction specified in section 256B.766, shall not exceed the
Medicare payment rate for the applicable service, as adjusted for any changes in Medicare
payment rates after July 1, 2010. The commissioner shall deleted text begin implement this section after any
other rate adjustment that is effective July 1, 2010, and shalldeleted text end reduce rates under this section
by first reducing or eliminating provider rate add-ons.
new text begin Subd. 2. new text end
new text begin Services exempt from the payment limit. new text end
deleted text begin (b)deleted text end new text begin (a)new text end This section does not apply
to services provided by advanced practice certified nurse midwives licensed under chapter
148 or traditional midwives licensed under chapter 147D. Notwithstanding this exemption,
medical assistance fee-for-service payment rates for advanced practice certified nurse
midwives and licensed traditional midwives shall equal and shall not exceed the medical
assistance payment rate to physicians for the applicable service.
deleted text begin (c)deleted text end new text begin (b)new text end This section does not apply to mental health services or physician services billed
by a psychiatrist or an advanced practice registered nurse with a specialty in mental health.
deleted text begin (d) Effective July 1, 2015,deleted text end new text begin (c)new text end This section shall not apply to durable medical equipment,
prosthetics, orthotics, or supplies.
deleted text begin (e)deleted text end new text begin (d)new text end This section does not apply to physical therapy, occupational therapy, speech
pathology and related services, and basic care services provided by a hospital meeting the
criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause (4).