HF 1404

as introduced - 88th Legislature (2013 - 2014) Posted on 03/11/2013 02:37pm

A bill for an act
relating to human services; exempting providers of durable medical equipment,
prosthetics, orthotics, or medical supplies from the Medicare payment limit
and the Medicare enrollment requirement; amending Minnesota Statutes 2012,
sections 256B.0625, subdivision 31; 256B.767.

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

Section 1.

Minnesota Statutes 2012, section 256B.0625, subdivision 31, is amended to
read:

Subd. 31.

Medical supplies and equipment.

(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall
be made for wheelchairs and wheelchair accessories for recipients who are residents
of intermediate care facilities for the developmentally disabled. Reimbursement for
wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same
conditions and limitations as coverage for recipients who do not reside in institutions. A
wheelchair purchased outside of the facility's payment rate is the property of the recipient.
The commissioner may set reimbursement rates for specified categories of medical
supplies at levels below the Medicare payment rate.

(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider new text begin , except as provided in paragraphs (c) and (e) new text end .

(c) When necessary to ensure access to durable medical equipment, prosthetics,
orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare
enrollment requirement if:

(1) the vendor supplies only one type of durable medical equipment, prosthetic,
orthotic, or medical supply;

(2) the vendor serves ten or fewer medical assistance recipients per year;

(3) the commissioner finds that other vendors are not available to provide same or
similar durable medical equipment, prosthetics, orthotics, or medical supplies; and

(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with
the Medicare program's supplier and quality standards and the vendor serves primarily
pediatric patients.

(d) Durable medical equipment means a device or equipment that:

(1) can withstand repeated use;

(2) is generally not useful in the absence of an illness, injury, or disability; and

(3) is provided to correct or accommodate a physiological disorder or physical
condition or is generally used primarily for a medical purpose.

new text begin (e) The commissioner may exempt a vendor of durable medical equipment,
prosthetics, orthotics, or medical supplies from the Medicare enrollment requirement, if
the vendor is providing a service or item that is covered for the recipient under medical
assistance, but is not covered under Medicare.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013.
new text end

Sec. 2.

Minnesota Statutes 2012, section 256B.767, is amended to read:

256B.767 MEDICARE PAYMENT LIMIT.

(a) 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 implement this
section after any other rate adjustment that is effective July 1, 2010, and shall reduce rates
under this section by first reducing or eliminating provider rate add-ons.

(b) 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.

(c) 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.

new text begin (d) This section does not apply to payments for durable medical equipment,
prosthetics, orthotics, or supplies.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013.
new text end