HF 601

as introduced - 90th Legislature (2017 - 2018) Posted on 02/27/2018 10:22am

A bill for an act
relating to human services; providing commissioner of human services with
additional authority to sanction and terminate state health care program providers;
establishing financial reporting requirements for abortion services; modifying
payment procedures for abortion services; amending Minnesota Statutes 2016,
sections 256B.04, subdivision 21, by adding a subdivision; 256B.0625, by adding
a subdivision; 256B.064, subdivision 1a.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2016, section 256B.04, subdivision 21, is amended to read:

Subd. 21.

Provider enrollment.

(a) If the commissioner or the Centers for Medicare
and Medicaid Services determines that a provider is designated "high-risk," the commissioner
may withhold payment from providers within that category upon initial enrollment for a
90-day period. The withholding for each provider must begin on the date of the first
submission of a claim.

(b) An enrolled provider that is also licensed by the commissioner under chapter 245A,
or is licensed as a home care provider by the Department of Health under chapter 144A and
has a home and community-based services designation on the home care license under
section 144A.484, must designate an individual as the entity's compliance officer. The
compliance officer must:

(1) develop policies and procedures to assure adherence to medical assistance laws and
regulations and to prevent inappropriate claims submissions;

(2) train the employees of the provider entity, and any agents or subcontractors of the
provider entity including billers, on the policies and procedures under clause (1);

(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;

(4) use evaluation techniques to monitor compliance with medical assistance laws and
regulations;

(5) promptly report to the commissioner any identified violations of medical assistance
laws or regulations; and

(6) within 60 days of discovery by the provider of a medical assistance reimbursement
overpayment, report the overpayment to the commissioner and make arrangements with
the commissioner for the commissioner's recovery of the overpayment.

The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.

(c) The commissioner may revoke the enrollment of an ordering or rendering provider
for a period of not more than one year, if the provider fails to maintain and, upon request
from the commissioner, provide access to documentation relating to written orders or requests
for payment for durable medical equipment, certifications for home health services, or
referrals for other items or services written or ordered by such provider, when the
commissioner has identified a pattern of a lack of documentation. A pattern means a failure
to maintain documentation or provide access to documentation on more than one occasion.
Nothing in this paragraph limits the authority of the commissioner to sanction a provider
under the provisions of section 256B.064.

(d) The commissioner shall terminate or deny the enrollment of any individual or entity
if the individual or entity has been terminated from participation in Medicare or under the
Medicaid program or Children's Health Insurance Program of any other state.

new text begin (e) According to federal law, the commissioner shall revoke or deny enrollment of a
provider that has a:
new text end

new text begin (1) criminal conviction related to:
new text end

new text begin (i) patient abuse or neglect;
new text end

new text begin (ii) health care fraud; or
new text end

new text begin (iii) controlled substances; or
new text end

new text begin (2) termination for cause under the State Children's Health Insurance Program under
title XXI of the Social Security Act, title 42, sections 1397aa et seq., or under Health
Insurance for Aged and Disabled under title XVIII of the Social Security Act, title 42,
sections 1395 et seq.
new text end

deleted text begin (e) deleted text end new text begin (f) new text end As a condition of enrollment in medical assistance, the commissioner shall require
that a provider designated "moderate" or "high-risk" by the Centers for Medicare and
Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.

deleted text begin (f) deleted text end new text begin (g) new text end As a condition of enrollment in medical assistance, the commissioner shall require
that a high-risk provider, or a person with a direct or indirect ownership interest in the
provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is designated
high-risk for fraud, waste, or abuse.

deleted text begin (g) deleted text end new text begin (h) new text end (1) Upon initial enrollment, reenrollment, and notification of revalidation, all
durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers
meeting the durable medical equipment provider and supplier definition in clause (3),
operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is
annually renewed and designates the Minnesota Department of Human Services as the
obligee, and must be submitted in a form approved by the commissioner. For purposes of
this clause, the following medical suppliers are not required to obtain a surety bond: a
federally qualified health center, a home health agency, the Indian Health Service, a
pharmacy, and a rural health clinic.

(2) At the time of initial enrollment or reenrollment, durable medical equipment providers
and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating
provider's Medicaid revenue in the previous calendar year is up to and including $300,000,
the provider agency must purchase a surety bond of $50,000. If a revalidating provider's
Medicaid revenue in the previous calendar year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and
fees in pursuing a claim on the bond.

(3) "Durable medical equipment provider or supplier" means a medical supplier that can
purchase medical equipment or supplies for sale or rental to the general public and is able
to perform or arrange for necessary repairs to and maintenance of equipment offered for
sale or rental.

deleted text begin (h) deleted text end new text begin (i) new text end The Department of Human Services may require a provider to purchase a surety
bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment
if: (1) the provider fails to demonstrate financial viability, (2) the department determines
there is significant evidence of or potential for fraud and abuse by the provider, or (3) the
provider or category of providers is designated high-risk pursuant to paragraph (a) and as
per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in an
amount of $100,000 or ten percent of the provider's payments from Medicaid during the
immediately preceding 12 months, whichever is greater. The surety bond must name the
Department of Human Services as an obligee and must allow for recovery of costs and fees
in pursuing a claim on the bond. This paragraph does not apply if the provider currently
maintains a surety bond under the requirements in section 256B.0659 or 256B.85.

Sec. 2.

Minnesota Statutes 2016, section 256B.04, is amended by adding a subdivision to
read:

new text begin Subd. 25. new text end

new text begin Provider reporting requirement. new text end

new text begin (a) The commissioner shall require vendors
of medical care to document, for each abortion service provided to each patient, the portion
of the total vendor cost related to:
new text end

new text begin (1) professional services related to performance of the abortion;
new text end

new text begin (2) professional services for preprocedure and postprocedure visits related to the
performance of the abortion; and
new text end

new text begin (3) facility, administrative, and overhead costs related to performance of the abortion,
reported separately for the services described in clauses (1) and (2).
new text end

new text begin (b) Vendors shall submit the documentation identified in paragraph (a) to the
commissioner, for each abortion service provided to each patient, in the manner specified
by the commissioner.
new text end

Sec. 3.

Minnesota Statutes 2016, section 256B.0625, is amended by adding a subdivision
to read:

new text begin Subd. 16a. new text end

new text begin Payment for abortion services. new text end

new text begin (a) Medical assistance payment for abortion
services is limited to payment for:
new text end

new text begin (1) professional services related to performance of the abortion; and
new text end

new text begin (2) professional services for preprocedure and postprocedure visits related to the
performance of the abortion.
new text end

new text begin (b) Medical assistance payment shall not be provided for facility, administrative, and
overhead costs related to performance of the abortion.
new text end

Sec. 4.

Minnesota Statutes 2016, section 256B.064, subdivision 1a, is amended to read:

Subd. 1a.

Grounds for sanctions against vendors.

The commissioner may impose
sanctions against a vendor of medical care for any of the following:

(1) fraud, theft, or abuse in connection with the provision of medical care to recipients
of public assistance;

(2) a pattern of presentment of false or duplicate claims or claims for services not
medically necessary new text begin or that fail to meet professionally recognized standards of care new text end ;

(3) a pattern of making false statements of material facts for the purpose of obtaining
greater compensation than that to which the vendor is legally entitled;

(4) suspension or termination as a Medicare vendor;

(5) refusal to grant the state agency access during regular business hours to examine all
records necessary to disclose the extent of services provided to program recipients and
appropriateness of claims for payment;

(6) failure to repay an overpayment or a fine finally established under this section;

(7) failure to correct errors in the maintenance of health service or financial records for
which a fine was imposed or after issuance of a warning by the commissioner; deleted text begin and
deleted text end

(8) any reason for which a vendor could be excluded from participation in the Medicare
program under section 1128, 1128A, or 1866(b)(2) of the Social Security Act new text begin ;
new text end

new text begin (9) accepting a payment kickback or engaging in another activity prohibited under federal
law;
new text end

new text begin (10) submitting a claim for services furnished by a provider under sanction by federal
or state government;
new text end

new text begin (11) failure to supply payment and other information required or requested by the
commissioner;
new text end

new text begin (12) making a false statement or misrepresenting a material fact relating to the provision
of services and billing for those services;
new text end

new text begin (13) failure to ensure that services or items are provided economically and only when,
and to the extent, medically necessary;
new text end

new text begin (14) failure to ensure that a service or item is of a quality that meets professionally
recognized standards of health care that are supported by evidence of necessity and quality;
new text end

new text begin (15) being found liable for patient neglect that results in the death of, or injury to, the
patient;
new text end

new text begin (16) submittal of a claim for an abortion or related services when claim submittal would
violate federal or state law;
new text end

new text begin (17) failure to comply with the provider reporting requirements specified in section
256B.04, subdivision 25; and
new text end

new text begin (18) failure to comply with a federal or state law requiring mandatory reporting of child
sexual abuse, child sexual assault, child sex trafficking, or statutory rape new text end .

Sec. 5. new text begin SEVERABILITY.
new text end

new text begin The provisions of this act are severable. If a provision of this act, or its application to
any person, entity, or circumstance, is held to be invalid, this invalidity shall not affect those
provisions or applications of this act that can be given effect without the invalid provision
or application.
new text end