SF 3117

Introduction - 94th Legislature (2025 - 2026)

Posted on 07/18/2025 01:59 p.m.

A bill for an act
relating to human services; requiring the commissioner of human services to
revalidate providers enrolled in Minnesota health care programs every three years;
amending Minnesota Statutes 2024, section 256B.04, subdivision 21.

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

Section 1.

Minnesota Statutes 2024, section 256B.04, subdivision 21, is amended to read:

Subd. 21.

Provider enrollment.

(a) The commissioner shall enroll providers and conduct
screening activities as required by Code of Federal Regulations, title 42, section 455, subpart
E. A provider must enroll each provider-controlled location where direct services are
provided. The commissioner may deny a provider's incomplete application if a provider
fails to respond to the commissioner's request for additional information within 60 days of
the request. The commissioner must conduct a background study under chapter 245C,
including a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses
(1) to (5), for a provider described in this paragraph. The background study requirement
may be satisfied if the commissioner conducted a fingerprint-based background study on
the provider that includes a review of databases in section 245C.08, subdivision 1, paragraph
(a), clauses (1) to (5).

(b) The commissioner shall revalidate each deleted text begin : (1) deleted text end provider under this subdivision at least
once every deleted text begin five deleted text end new text begin three new text end years deleted text begin ; and (2) personal care assistance agency under this subdivision
once every three years deleted text end .

(c) The commissioner shall conduct revalidation as follows:

(1) provide 30-day notice of the revalidation due date including instructions for
revalidation and a list of materials the provider must submit;

(2) if a provider fails to submit all required materials by the due date, notify the provider
of the deficiency within 30 days after the due date and allow the provider an additional 30
days from the notification date to comply; and

(3) if a provider fails to remedy a deficiency within the 30-day time period, give 60-day
notice of termination and immediately suspend the provider's ability to bill. The provider
does not have the right to appeal suspension of ability to bill.

(d) If a provider fails to comply with any individual provider requirement or condition
of participation, the commissioner may suspend the provider's ability to bill until the provider
comes into compliance. The commissioner's decision to suspend the provider is not subject
to an administrative appeal.

(e) Correspondence and notifications, including notifications of termination and other
actions, may be delivered electronically to a provider's MN-ITS mailbox. This paragraph
does not apply to correspondences and notifications related to background studies.

(f) 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.

(g) An enrolled provider that is also licensed by the commissioner under chapter 245A,
is licensed as a home care provider by the Department of Health under chapter 144A, or is
licensed as an assisted living facility under chapter 144G 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.

(h) 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.

(i) 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. The
commissioner may exempt a rehabilitation agency from termination or denial that would
otherwise be required under this paragraph, if the agency:

(1) is unable to retain Medicare certification and enrollment solely due to a lack of billing
to the Medicare program;

(2) meets all other applicable Medicare certification requirements based on an on-site
review completed by the commissioner of health; and

(3) serves primarily a pediatric population.

(j) 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.

(k) 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.

(l)(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.

(m) 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 (f) 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.