SF 4222

1st Engrossment - 94th Legislature (2025 - 2026)

Posted on 04/06/2026 01:50 p.m.

A bill for an act
relating to human services; modifying requirements for provider enrollment in
medical assistance; modifying program integrity requirements for the medical
assistance program; directing the commissioner of human services to create a
medical assistance program integrity advisory board; directing the commissioner
of human services to make recommendations on provider enrollment standards,
modernizing program integrity infrastructure, and program integrity interventions;
directing the commissioner of human services to conduct audits; requiring reports;
making technical changes; authorizing rulemaking; appropriating money; amending
Minnesota Statutes 2024, sections 142B.01, subdivision 8; 245.095, by adding a
subdivision; 245A.02, subdivision 5a; 245D.081, subdivision 3; 256B.04,
subdivision 5; 256B.064, subdivisions 1b, 1d, 2, 3, 4, 5, by adding subdivisions;
256B.0949, subdivision 17; Minnesota Statutes 2025 Supplement, sections 15.013,
by adding a subdivision; 256B.04, subdivision 21; 256B.064, subdivision 1a;
256B.0759, subdivision 4; 256B.0949, subdivision 16; proposing coding for new
law in Minnesota Statutes, chapter 256B.

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

ARTICLE 1

PROGRAM INTEGRITY REQUIREMENTS

Section 1.

Minnesota Statutes 2025 Supplement, section 15.013, is amended by adding a
subdivision to read:

new text begin Subd. 7. new text end

new text begin Exemption. new text end

new text begin This section does not apply to the medical assistance program
administered by the commissioner of human services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

Minnesota Statutes 2024, section 245.095, is amended by adding a subdivision to
read:

new text begin Subd. 7. new text end

new text begin Exemption. new text end

new text begin Subdivision 5 does not apply to any individual or entity that receives
payments from medical assistance or provides goods or services for which payment is made
from medical assistance.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 3.

Minnesota Statutes 2025 Supplement, section 256B.064, subdivision 1a, is amended
to read:

Subd. 1a.

Grounds for sanctions.

(a) The commissioner may impose sanctions against
any individual or entity that receives payments from medical assistance or provides goods
or services for which payment is made from medical assistance for any of the following:

(1) fraud, theft, or abuse in connection with the provision of goods and services to
recipients of public assistance for which payment is made from medical assistance;

(2) a pattern of presentment of false or duplicate claims or claims for services not
medically necessary;

(3) a pattern of making false statements of material facts for the purpose of obtaining
greater compensation than that to which the individual or entity 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; and

(8) any reason for which an individual or entity could be excluded from participation in
the Medicare program under section 1128, 1128A, or 1866(b)(2) of the Social Security Act.

(b) For the purposes of this section, goods or services for which payment is made from
medical assistance includes but is not limited to care and services identified in section
256B.0625 or provided pursuant to any federally approved waiver.

(c) Regardless of the source of payment or other item of value, the commissioner may
impose sanctions against any individual or entity that solicits, receives, pays, or offers to
pay any illegal remuneration as described in section 142E.51, subdivision 6a, in violation
of section 609.542, subdivision 2, or in violation of United States Code, title 42, section
1320a-7b(b)(1) or (2). No conviction is required before the commissioner can impose
sanctions under this paragraph.

(d) The commissioner may impose sanctions against a pharmacy provider for failure to
respond to a cost of dispensing survey under section 256B.0625, subdivision 13e, paragraph
(g).

(e) The commissioner may impose sanctions against a pharmacy provider for failure to
respond to a Minnesota drug acquisition cost survey under section 256B.0625, subdivision
13e, paragraph (i).

new text begin (f) For the purposes of this section, "abuse" means the activities listed in paragraph (a),
clauses (2), (3), and (7), but does not include billing errors that result in unintended
overcharges.
new text end

Sec. 4.

Minnesota Statutes 2024, section 256B.064, subdivision 1b, is amended to read:

Subd. 1b.

Sanctions available.

new text begin (a) new text end The commissioner may impose the following sanctions
for the conduct described in subdivision 1a: deleted text begin suspension or withholding of deleted text end new text begin suspending new text end
payments to an individual or entity deleted text begin and deleted text end new text begin ; withholding payments to an individual or entity; new text end
suspending deleted text begin or terminating deleted text end participation in the program deleted text begin , deleted text end new text begin ; terminating participation in the
program; new text end or deleted text begin imposition of deleted text end new text begin imposing new text end a fine under subdivision deleted text begin 2, paragraph (g) deleted text end new text begin 2a new text end .

new text begin (b) new text end When imposing sanctions under this deleted text begin section deleted text end new text begin subdivision new text end , the commissioner deleted text begin shall deleted text end new text begin
must new text end consider the nature, chronicity, or severity of the conduct and the effect of the conduct
on the health and safety of persons served by the individual or entity.

new text begin (c) new text end The commissioner deleted text begin shall deleted text end new text begin must new text end suspend an individual's or entity's participation in the
program for a minimum of five years if the individual or entity is convicted of a crime,
received a stay of adjudication, or entered a court-ordered diversion program for an offense
related to a provision of a health service under medical assistance, including a federally
approved waiver, or health care fraud.

new text begin (d) new text end Regardless of imposition of sanctions, the commissioner may make a referral to the
appropriate state licensing board.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 5.

Minnesota Statutes 2024, section 256B.064, subdivision 1d, is amended to read:

Subd. 1d.

Investigative costs.

new text begin (a) new text end The commissioner may seek recovery of investigative
costs from any individual or entity that willfully submits a claim for reimbursement for
services that the individual or entity knows, or reasonably should have known, is a false
representation and that results in the payment of public funds for which the individual or
entity is ineligible.

new text begin (b) new text end Billing errors that result in unintentional overcharges deleted text begin shall deleted text end new text begin are new text end not deleted text begin be deleted text end grounds for
investigative cost recoupment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 6.

Minnesota Statutes 2024, section 256B.064, subdivision 2, is amended to read:

Subd. 2.

Imposition of monetary recovery and sanctions new text begin ; generally new text end .

(a) The
commissioner deleted text begin shall deleted text end new text begin must new text end determine any monetary amounts to be recovered and sanctions
to be imposed upon an individual or entity under this section. Except as provided in
deleted text begin paragraphs (b) and (d), neither deleted text end new text begin subdivisions 2b to 2d, the commissioner must not obtain new text end a
monetary recovery deleted text begin nor deleted text end new text begin or impose new text end a sanction deleted text begin will be imposed by the commissioner deleted text end without
prior notice and an opportunity for a hearing, according to chapter 14, on the commissioner's
proposed action deleted text begin , provided that the commissioner may suspend or reduce payment to an
individual or entity, except a nursing home or convalescent care facility, after notice and
prior to the hearing if in the commissioner's opinion that action is necessary to protect the
public welfare and the interests of the program deleted text end .

deleted text begin (b) Except when the commissioner finds good cause not to suspend payments under
Code of Federal Regulations, title 42, section 455.23(e) or (f), the commissioner shall
withhold or reduce payments to an individual or entity without providing advance notice
of such withholding or reduction if either of the following occurs:
deleted text end

deleted text begin (1) the individual or entity is convicted of a crime involving the conduct described in
subdivision 1a; or
deleted text end

deleted text begin (2) the commissioner determines there is a credible allegation of fraud for which an
investigation is pending under the program. Allegations are considered credible when they
have an indicium of reliability and the state agency has reviewed all allegations, facts, and
evidence carefully and acts judiciously on a case-by-case basis. A credible allegation of
fraud is an allegation which has been verified by the state, from any source, including but
not limited to:
deleted text end

deleted text begin (i) fraud hotline complaints;
deleted text end

deleted text begin (ii) claims data mining; and
deleted text end

deleted text begin (iii) patterns identified through provider audits, civil false claims cases, and law
enforcement investigations.
deleted text end

deleted text begin (c) The commissioner must send notice of the withholding or reduction of payments
under paragraph (b) within five days of taking such action unless requested in writing by a
law enforcement agency to temporarily withhold the notice. The notice must:
deleted text end

deleted text begin (1) state that payments are being withheld according to paragraph (b);
deleted text end

deleted text begin (2) set forth the general allegations as to the nature of the withholding action, but need
not disclose any specific information concerning an ongoing investigation;
deleted text end

deleted text begin (3) except in the case of a conviction for conduct described in subdivision 1a, state that
the withholding is for a temporary period and cite the circumstances under which withholding
will be terminated;
deleted text end

deleted text begin (4) identify the types of claims to which the withholding applies; and
deleted text end

deleted text begin (5) inform the individual or entity of the right to submit written evidence for consideration
by the commissioner.
deleted text end

deleted text begin (d) The withholding or reduction of payments will not continue after the commissioner
determines there is insufficient evidence of fraud by the individual or entity, or after legal
proceedings relating to the alleged fraud are completed, unless the commissioner has sent
notice of intention to impose monetary recovery or sanctions under paragraph (a). Upon
conviction for a crime related to the provision, management, or administration of a health
service under medical assistance, a payment held pursuant to this section by the commissioner
or a managed care organization that contracts with the commissioner under section 256B.035
is forfeited to the commissioner or managed care organization, regardless of the amount
charged in the criminal complaint or the amount of criminal restitution ordered.
deleted text end

deleted text begin (e) The commissioner shall suspend or terminate an individual's or entity's participation
in the program without providing advance notice and an opportunity for a hearing when the
suspension or termination is required because of the individual's or entity's exclusion from
participation in Medicare. Within five days of taking such action, the commissioner must
send notice of the suspension or termination. The notice must:
deleted text end

deleted text begin (1) state that suspension or termination is the result of the individual's or entity's exclusion
from Medicare;
deleted text end

deleted text begin (2) identify the effective date of the suspension or termination; and
deleted text end

deleted text begin (3) inform the individual or entity of the need to be reinstated to Medicare before
reapplying for participation in the program.
deleted text end

deleted text begin (f) deleted text end new text begin (b) new text end Upon receipt of a notice under paragraph (a) new text begin or subdivision 2c or 2d new text end that a
monetary recovery or sanction is to be new text begin or has been new text end imposed, an individual or entity may
request a contested case, as defined in section 14.02, subdivision 3, by filing with the
commissioner a written request of appeal. The appeal request must be received by the
commissioner no later than 30 days after the date the notification of monetary recovery or
sanction was mailed to the individual or entity. The appeal request must specify:

(1) each disputed item, the reason for the dispute, and an estimate of the dollar amount
involved for each disputed item;

(2) the computation that the individual or entity believes is correct;

(3) the authority in statute or rule upon which the individual or entity relies for each
disputed item;

(4) the name and address of the person or entity with whom contacts may be made
regarding the appeal; and

(5) other information required by the commissioner.

deleted text begin (g) The commissioner may order an individual or entity to forfeit a fine for failure to
fully document services according to standards in this chapter and Minnesota Rules, chapter
deleted text end deleted text begin 9505 deleted text end deleted text begin . The commissioner may assess fines if specific required components of documentation
are missing. The fine for incomplete documentation shall equal 20 percent of the amount
paid on the claims for reimbursement submitted by the individual or entity, or up to $5,000,
whichever is less. If the commissioner determines that an individual or entity repeatedly
violated this chapter, chapter deleted text end deleted text begin 254B deleted text end deleted text begin or deleted text end deleted text begin 245G deleted text end deleted text begin , or Minnesota Rules, chapter deleted text end deleted text begin 9505 deleted text end deleted text begin , related to
the provision of services to program recipients and the submission of claims for payment,
the commissioner may order an individual or entity to forfeit a fine based on the nature,
severity, and chronicity of the violations, in an amount of up to $5,000 or 20 percent of the
value of the claims, whichever is greater.
deleted text end

deleted text begin (h) The individual or entity shall pay the fine assessed on or before the payment date
specified. If the individual or entity fails to pay the fine, the commissioner may withhold
or reduce payments and recover the amount of the fine. A timely appeal shall stay payment
of the fine until the commissioner issues a final order.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 7.

Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision
to read:

new text begin Subd. 2a. new text end

new text begin Imposition of fines. new text end

new text begin (a) The commissioner may order an individual or entity
to forfeit a fine for failure to fully document services according to standards in this chapter
and Minnesota Rules, chapter 9505. The commissioner may assess fines if specific required
components of documentation are missing. The fine for incomplete documentation equals
20 percent of the amount paid on the claims for reimbursement submitted by the individual
or entity, or up to $5,000, whichever is less. If the commissioner determines that an individual
or entity repeatedly violated this chapter, chapter 245G or 254B, or Minnesota Rules, chapter
9505, related to the provision of services to program recipients and the submission of claims
for payment, the commissioner may order an individual or entity to forfeit a fine based on
the nature, severity, and chronicity of the violations, in an amount of up to $5,000 or 20
percent of the value of the claims, whichever is greater.
new text end

new text begin (b) The individual or entity must pay the fine assessed on or before the payment date
specified by the commissioner. If the individual or entity fails to pay the fine, the
commissioner may withhold or reduce payments and recover the amount of the fine. A
timely appeal stays payment of the fine until the commissioner issues a final order.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 8.

Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision
to read:

new text begin Subd. 2b. new text end

new text begin Mandatory suspension or termination after exclusion from participation
in Medicare. new text end

new text begin (a) The commissioner must suspend or terminate an individual's or entity's
participation in the program without providing advance notice and an opportunity for a
hearing when the suspension or termination is required because of the individual's or entity's
exclusion from participation in Medicare.
new text end

new text begin (b) Within five days of taking an action under paragraph (a), the commissioner must
send notice of the suspension or termination. The notice must:
new text end

new text begin (1) state that the suspension or termination is the result of the individual's or entity's
exclusion from Medicare;
new text end

new text begin (2) identify the effective date of the suspension or termination; and
new text end

new text begin (3) inform the individual or entity of the need to be reinstated to Medicare before
reapplying for participation in the program.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 9.

Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision
to read:

new text begin Subd. 2c. new text end

new text begin Imposition of monetary recovery and sanctions before a hearing. new text end

new text begin (a) Except
as provided in paragraph (b), the commissioner may withhold or reduce payment to an
individual or entity after notice but before a hearing if, in the commissioner's opinion,
withholding or reducing payment is necessary to protect the public welfare and the interests
of the program.
new text end

new text begin (b) Notwithstanding subdivision 2d, unless the commissioner first complies with the
applicable requirements of paragraph (c), the commissioner must not withhold or reduce
payments to the following entities:
new text end

new text begin (1) a nursing home;
new text end

new text begin (2) a convalescing care facility;
new text end

new text begin (3) an entity providing residential supports and services as described in section 245D.03,
subdivision 1, paragraph (c), clause (3); or
new text end

new text begin (4) an entity providing integrated community services described in section 245D.03,
subdivision 1, paragraph (c), clause (8).
new text end

new text begin (c) When withholding or reducing payments under paragraph (a) or subdivision 2d to
an entity listed in paragraph (b), the commissioner must confirm suitable alternative services
and housing are established for the affected recipient before withholding or reducing
payments if withholding or reducing payments puts a recipient of the goods or services
provided by the entity in imminent danger of harm or at risk of homelessness.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 10.

Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision
to read:

new text begin Subd. 2d. new text end

new text begin Imposition of monetary recovery and sanctions without prior notice. new text end

new text begin (a)
Except as provided in subdivision 2c, when law enforcement requests that the commissioner
not suspend payments, or when the commissioner finds good cause not to suspend payments
under Code of Federal Regulations, title 42, section 455.23(e) or (f), the commissioner must
withhold or reduce payments to an individual or entity without providing advance notice
of the withholding or reduction if either of the following occurs:
new text end

new text begin (1) the individual or entity is convicted of a crime involving the conduct described in
subdivision 1a; or
new text end

new text begin (2) the commissioner determines there is a credible allegation of fraud for which an
investigation is pending under the program. Allegations are considered credible when they
are supported by a preponderance of the evidence and the state agency has reviewed and
verified all allegations, facts, and evidence carefully and acts judiciously on a case-by-case
basis. A credible allegation of abuse is not a credible allegation of fraud.
new text end

new text begin (b) If the commissioner withholds or reduces payments under paragraph (a), clause (2),
the commissioner may withhold payments only for the specific submitted claims that the
commissioner has determined are potentially fraudulent and referred to law enforcement,
unless the commissioner determines that the credible allegation of fraud is an allegation of
pervasive fraud.
new text end

new text begin (c) For purposes of this subdivision, "fraud" means presenting information that is false
in whole or in part to the commissioner with the intent of obtaining greater compensation
for the provision of a good or service available under this chapter than the vendor of the
good or service is legally entitled.
new text end

new text begin (d) The commissioner may consider an allegation of fraud from any source, including
but not limited to:
new text end

new text begin (1) fraud hotline complaints;
new text end

new text begin (2) claims data mining;
new text end

new text begin (3) patterns identified through provider audits, civil false claims cases, law enforcement
investigations, and investigations by other state or federal agencies; and
new text end

new text begin (4) court filings or other legal documents.
new text end

new text begin (e) The commissioner must send notice of the withholding or reduction of payments
under paragraph (a) within five days of withholding or reducing payment unless requested
in writing by a law enforcement agency to temporarily withhold the notice. The notice need
not disclose specific information concerning an ongoing investigation. The notice must:
new text end

new text begin (1) state that payments are being withheld according to paragraph (a);
new text end

new text begin (2) set forth the allegations as to the nature of the withholding action, which must specify:
new text end

new text begin (i) each disputed item, and for each disputed item the reason for the dispute and an
estimate of the dollar amount involved;
new text end

new text begin (ii) the computation that the commissioner believes is correct;
new text end

new text begin (iii) the statute or rule the commissioner believes the individual or entity violated; and
new text end

new text begin (iv) other information necessary to aid the individual or entity when providing written
evidence under clause (5) or filing an appeal under section 256B.064, subdivision 2;
new text end

new text begin (3) except in the case of a conviction for conduct described in subdivision 1a, state that
the withholding is for a temporary period not to exceed 60 days and cite the circumstances
under which withholding will be terminated;
new text end

new text begin (4) identify the types of claims to which the withholding applies; and
new text end

new text begin (5) inform the individual or entity of the right to submit written evidence for consideration
by the commissioner.
new text end

new text begin (f) The commissioner must acknowledge receipt of any written evidence submitted by
the individual or entity within five days of receipt of the written evidence. Within five days
of the commissioner's acknowledgment of receipt, the commissioner must (1) cease to
withhold or reduce payments, or (2) respond to the individual or entity with an explanation
of the commissioner's continued determination that there is sufficient evidence of fraud to
continue withholding or reducing payments.
new text end

new text begin (g) The commissioner must cease to withhold or reduce payments under this subdivision
after 60 days have passed, after the commissioner determines there is insufficient evidence
of fraud by the individual or entity, or after legal proceedings relating to the alleged fraud
are completed, unless the commissioner has sent notice of intention to impose monetary
recovery or sanctions.
new text end

Sec. 11.

Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision
to read:

new text begin Subd. 2e. new text end

new text begin Forfeiture of withheld payments upon criminal conviction. new text end

new text begin Upon conviction
for a crime related to the provision, management, or administration of a health service under
medical assistance, a payment held pursuant to this section by the commissioner or a managed
care organization that contracts with the commissioner under section 256B.035 is forfeited
to the commissioner or managed care organization, regardless of the amount charged in the
criminal complaint or the amount of criminal restitution ordered.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 12.

Minnesota Statutes 2024, section 256B.064, subdivision 3, is amended to read:

Subd. 3.

Mandates on prohibited payments.

(a) The commissioner deleted text begin shall deleted text end new text begin must new text end maintain
and publish a list of each excluded individual and entity that was convicted of a crime related
to the provision, management, or administration of a medical assistance health service, or
suspended or terminated under subdivision deleted text begin 2 deleted text end new text begin 2b new text end . Medical assistance payments cannot be
made by an individual or entity for items or services furnished either directly or indirectly
by an excluded individual or entity, or at the direction of excluded individuals or entities.

(b) The entity must check the exclusion list on a monthly basis and document the date
and time the exclusion list was checked and the name and title of the person who checked
the exclusion list. The entity must immediately terminate payments to an individual or entity
on the exclusion list.

(c) An entity's requirement to check the exclusion list and to terminate payments to
individuals or entities on the exclusion list applies to each individual or entity on the
exclusion list, even if the named individual or entity is not responsible for direct patient
care or direct submission of a claim to medical assistance.

(d) An entity that pays medical assistance program funds to an individual or entity on
the exclusion list must refund any payment related to either items or services rendered by
an individual or entity on the exclusion list from the date the individual or entity is first paid
or the date the individual or entity is placed on the exclusion list, whichever is later, and an
entity may be subject to:

(1) sanctions under deleted text begin subdivision 2 deleted text end new text begin this section new text end ;

(2) a civil monetary penalty of up to $25,000 for each determination by the department
that the vendor employed or contracted with an individual or entity on the exclusion list;
and

(3) other fines or penalties allowed by law.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 13.

Minnesota Statutes 2024, section 256B.064, subdivision 4, is amended to read:

Subd. 4.

Notice.

(a) The department deleted text begin shall deleted text end new text begin must new text end serve the notice required under deleted text begin subdivision deleted text end new text begin
subdivisions new text end 2 new text begin and 2d new text end using a signature-verified confirmed delivery method to the address
submitted to the department by the individual or entity. Service is complete upon mailing.

(b) The department deleted text begin shall deleted text end new text begin must new text end give notice in writing to a recipient placed in the Minnesota
restricted recipient program under section 256B.0646 and Minnesota Rules, part 9505.2200.
The department deleted text begin shall deleted text end new text begin must new text end send the notice by first class mail to the recipient's current address
on file with the department. A recipient placed in the Minnesota restricted recipient program
may contest the placement by submitting a written request for a hearing to the department
within 90 days of the notice being mailed.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 14.

Minnesota Statutes 2024, section 256B.064, subdivision 5, is amended to read:

Subd. 5.

Immunity; good faith reporters.

(a) A person who makes a good faith report
is immune from any civil or criminal liability that might otherwise arise from reporting or
participating in the investigation. Nothing in this subdivision affects an individual's or
entity's responsibility for an overpayment established under this subdivision.

(b) A person employed by a lead investigative agency who is conducting or supervising
an investigation or enforcing the law according to the applicable law or rule is immune from
any civil or criminal liability that might otherwise arise from the person's actions, if the
person is acting in good faith and exercising due care.

(c) For purposes of this subdivision, "person" includes a natural person or any form of
a business or legal entity.

(d) After an investigation is complete, the reporter's name must be kept confidential.
The subject of the report may compel disclosure of the reporter's name only with the consent
of the reporter or upon a written finding by a district court that the report was false and there
is evidence that the report was made in bad faith. This subdivision does not alter disclosure
responsibilities or obligations under the Rules of Criminal Procedure, except that when the
identity of the reporter is relevant to a criminal prosecution the district court deleted text begin shall deleted text end new text begin must new text end
conduct an in-camera review before determining whether to order disclosure of the reporter's
identity.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 15. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; MEDICAL
ASSISTANCE PROGRAM INTEGRITY ADVISORY BOARD.
new text end

new text begin (a) By January 1, 2027, the commissioner of human services must establish a medical
assistance program integrity advisory board. The board must oversee medical assistance
program integrity efforts, evaluate the efforts, and provide recommendations, including but
not limited to legislative changes, to the commissioner on ways to improve medical assistance
program integrity. The board must advise the commissioner on enforcement proportionality,
analytics governance, and program integrity metrics.
new text end

new text begin (b) The board must consist of seven members appointed by the commissioner of human
services and must include:
new text end

new text begin (1) at least one member who is a forensic accountant;
new text end

new text begin (2) at least one member who is a data scientist;
new text end

new text begin (3) at least one member who is a long-term services and supports program expert;
new text end

new text begin (4) at least one member who is a program design and evaluation specialist; and
new text end

new text begin (5) at least one member of the public.
new text end

new text begin (c) The commissioner must annually select a board chair from among the members. The
commissioner must develop procedures for appointing new members, compensation for
members, and term length, if any, for members.
new text end

Sec. 16. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; MEDICAL
ASSISTANCE PROVIDER ENROLLMENT STANDARDS.
new text end

new text begin (a) By January 1, 2027, the commissioner of human services must make recommendations
to the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance regarding statutory and program changes to ensure
only qualified, prepared, and financially stable providers are permitted to enroll as a medical
assistance provider type designated by the commissioner as high-risk under Minnesota
Statutes, section 256B.04, subdivision 21.
new text end

new text begin (b) The commissioner must include in the recommendations enhanced provider enrollment
screening standards related to the provider's regulatory knowledge, operational readiness,
internal controls, financial liquidity and solvency, and capacity to comply with state and
federal Medicaid requirements.
new text end

new text begin (c) In developing the recommendations, the commissioner must consult with the Health
Law Section of the Minnesota State Bar Association, representatives of the medical assistance
providers subject to the recommendations being considered, and other impacted groups.
new text end

Sec. 17. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; PROGRAM
INTEGRITY TECHNOLOGY MODERNIZATION.
new text end

new text begin By January 1, 2027, the commissioner of human services must develop recommendations
on how to modernize program integrity infrastructure within the Department of Human
Services. The recommendations must include the infrastructure's capability to provide
near-real-time analytics and risk scoring; prepayment review and anomaly detection;
cross-matching of enrollment data, licensure data, and claims data; and security dashboards
for audits and investigations with privacy safeguards. By January 15, 2027, the commissioner
must provide recommendations to the chairs and ranking minority members of the legislative
committees with jurisdiction over human services program integrity functions.
new text end

Sec. 18. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; PROGRAM
STRUCTURE AND DESIGN AUDITS.
new text end

new text begin (a) By August 1, 2026, the commissioner of human services must select and contract
with an independent research entity to conduct comprehensive program structure and design
audits on the services listed in paragraph (b). Each audit must identify structural incentive
misalignments; undue compliance burdens on good-faith providers; regulatory and billing
ambiguities; and gaps in utilization controls. Each audit must also provide evidence-based
redesign recommendations.
new text end

new text begin (b) The services that must be audited by the independent research entity include:
new text end

new text begin (1) adult companion services;
new text end

new text begin (2) adult day services;
new text end

new text begin (3) adult rehabilitative mental health services;
new text end

new text begin (4) assertive community treatment;
new text end

new text begin (5) community first services and supports;
new text end

new text begin (6) early intensive developmental and behavioral intervention;
new text end

new text begin (7) individualized home supports;
new text end

new text begin (8) integrated community supports;
new text end

new text begin (9) intensive residential treatment services;
new text end

new text begin (10) night supervision services;
new text end

new text begin (11) nonemergency medical transportation services;
new text end

new text begin (12) peer recovery support services; and
new text end

new text begin (13) recuperative care.
new text end

new text begin (c) Each audit must be completed by January 1, 2027. The commissioner must submit
each completed audit report within 30 days of receipt to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services program
integrity functions.
new text end

Sec. 19. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES;
PROPORTIONAL MEDICAL ASSISTANCE PROGRAM INTEGRITY
INTERVENTIONS.
new text end

new text begin (a) By January 1, 2027, the commissioner of human services must make recommendations
to the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance on modernizing medical assistance program integrity
efforts to strengthen fraud deterrence and promote clarity, proportionality based on the
severity of an infraction, provider education, client protection, and continuity of care.
new text end

new text begin (b) The commissioner must include in the recommendations a comprehensive approach
to proportional medical assistance program integrity interventions commensurate with the
severity of an infraction of a medical assistance program requirement.
new text end

new text begin (c) For the purposes of the recommendations, the commissioner must consider three
levels of severity:
new text end

new text begin (1) low-severity conduct, which includes clerical or documentation deficiencies with no
evidence of intent to defraud;
new text end

new text begin (2) moderate-severity conduct, which includes repeat errors, evidence of weak internal
controls, or other behavior that results in a pattern of improper payment; and
new text end

new text begin (3) high-severity conduct, which includes intentional actions by a provider to defraud
and gain unearned payment.
new text end

new text begin (d) For the purposes of the recommendations, the commissioner must consider three
levels of intervention:
new text end

new text begin (1) provider education for low-severity conduct;
new text end

new text begin (2) targeted audits for moderate-severity conduct; and
new text end

new text begin (3) suspended provider enrollment for high-severity conduct.
new text end

new text begin (e) In developing the recommendations, the commissioner must consult with the Health
Law Section of the Minnesota State Bar Association, representatives of the medical assistance
providers subject to the recommendations being considered, and other impacted groups.
new text end

Sec. 20. new text begin APPROPRIATION; MINNESOTA ATTORNEY GENERAL.
new text end

new text begin $391,000 in fiscal year 2027 is appropriated from the general fund to the attorney general
to increase the number of staff within the Medicaid Fraud Control Unit to improve program
integrity and increase the Medical Fraud Control Unit's capacity for compliance efforts.
new text end

ARTICLE 2

MEDICAL ASSISTANCE PROVIDER ENROLLMENT MODIFICATIONS

Section 1.

Minnesota Statutes 2024, section 142B.01, subdivision 8, is amended to read:

Subd. 8.

Controlling individual.

(a) "Controlling individual" means an owner of a
program or service provider licensed under this chapter and the following individuals, if
applicable:

(1) each officer of the organization, including the chief executive officer and chief
financial officer;

(2) the individual designated as the authorized agent under section 142B.10, subdivision
1, paragraph (b);

(3) the individual designated as the compliance officer under section deleted text begin 256B.04, deleted text begin subdivision
deleted text end 21, paragraph (g) deleted text end new text begin 256B.044, subdivision 8, paragraph (b) new text end ;

(4) each managerial official whose responsibilities include the direction of the
management or policies of a program;

(5) the individual designated as the primary provider of care for a special family child
care program under section 142B.41, subdivision 4, paragraph (d); and

(6) the president and treasurer of the board of directors of a nonprofit corporation.

(b) Controlling individual does not include:

(1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
operates a program directly or through a subsidiary;

(2) an individual who is a state or federal official, or state or federal employee, or a
member or employee of the governing body of a political subdivision of the state or federal
government that operates one or more programs, unless the individual is also an officer,
owner, or managerial official of the program; receives remuneration from the program; or
owns any of the beneficial interests not excluded in this subdivision;

(3) an individual who owns less than five percent of the outstanding common shares of
a corporation:

(i) whose securities are exempt under section 80A.45, clause (6); or

(ii) whose transactions are exempt under section 80A.46, clause (2);

(4) an individual who is a member of an organization exempt from taxation under section
290.05, unless the individual is also an officer, owner, or managerial official of the program
or owns any of the beneficial interests not excluded in this subdivision. This clause does
not exclude from the definition of controlling individual an organization that is exempt from
taxation; or

(5) an employee stock ownership plan trust, or a participant or board member of an
employee stock ownership plan, unless the participant or board member is a controlling
individual according to paragraph (a).

(c) For purposes of this subdivision, "managerial official" means an individual who has
the decision-making authority related to the operation of the program, and the responsibility
for the ongoing management of or direction of the policies, services, or employees of the
program. A site director who has no ownership interest in the program is not considered to
be a managerial official for purposes of this definition.

Sec. 2.

Minnesota Statutes 2024, section 245A.02, subdivision 5a, is amended to read:

Subd. 5a.

Controlling individual.

(a) "Controlling individual" means an owner of a
program or service provider licensed under this chapter and the following individuals, if
applicable:

(1) each officer of the organization, including the chief executive officer and chief
financial officer;

(2) the individual designated as the authorized agent under section 245A.04, subdivision
1, paragraph (b);

(3) the individual designated as the compliance officer under section deleted text begin 256B.04, subdivision
21, paragraph (g) deleted text end new text begin 256B.044, subdivision 8, paragraph (b) new text end ;

(4) each managerial official whose responsibilities include the direction of the
management or policies of a program; and

(5) the president and treasurer of the board of directors of a nonprofit corporation.

(b) Controlling individual does not include:

(1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
operates a program directly or through a subsidiary;

(2) an individual who is a state or federal official, or state or federal employee, or a
member or employee of the governing body of a political subdivision of the state or federal
government that operates one or more programs, unless the individual is also an officer,
owner, or managerial official of the program, receives remuneration from the program, or
owns any of the beneficial interests not excluded in this subdivision;

(3) an individual who owns less than five percent of the outstanding common shares of
a corporation:

(i) whose securities are exempt under section 80A.45, clause (6); or

(ii) whose transactions are exempt under section 80A.46, clause (2);

(4) an individual who is a member of an organization exempt from taxation under section
290.05, unless the individual is also an officer, owner, or managerial official of the program
or owns any of the beneficial interests not excluded in this subdivision. This clause does
not exclude from the definition of controlling individual an organization that is exempt from
taxation; or

(5) an employee stock ownership plan trust, or a participant or board member of an
employee stock ownership plan, unless the participant or board member is a controlling
individual according to paragraph (a).

(c) For purposes of this subdivision, "managerial official" means an individual who has
the decision-making authority related to the operation of the program, and the responsibility
for the ongoing management of or direction of the policies, services, or employees of the
program. A site director who has no ownership interest in the program is not considered to
be a managerial official for purposes of this definition.

Sec. 3.

Minnesota Statutes 2024, section 245D.081, subdivision 3, is amended to read:

Subd. 3.

Program management and oversight.

(a) The license holder must designate
a managerial staff person or persons to provide program management and oversight of the
services provided by the license holder. The designated manager is responsible for the
following:

(1) maintaining a current understanding of the licensing requirements sufficient to ensure
compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph
(e), and when applicable, as identified in section deleted text begin 256B.04, subdivision 21, paragraph (g) deleted text end new text begin
256B.044, subdivision 8 new text end ;

(2) ensuring the duties of the designated coordinator are fulfilled according to the
requirements in subdivision 2;

(3) ensuring the program implements corrective action identified as necessary by the
program following review of incident and emergency reports according to the requirements
in section 245D.11, subdivision 2, clause (7). An internal review of incident reports of
alleged or suspected maltreatment must be conducted according to the requirements in
section 245A.65, subdivision 1, paragraph (b);

(4) evaluation of satisfaction of persons served by the program, the person's legal
representative, if any, and the case manager, with the service delivery and progress toward
accomplishing outcomes identified in sections 245D.07 and 245D.071, and ensuring and
protecting each person's rights as identified in section 245D.04;

(5) ensuring staff competency requirements are met according to the requirements in
section 245D.09, subdivision 3, and ensuring staff orientation and training is provided
according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;

(6) ensuring corrective action is taken when ordered by the commissioner and that the
terms and conditions of the license and any variances are met; and

(7) evaluating the information identified in clauses (1) to (6) to develop, document, and
implement ongoing program improvements.

(b) The designated manager must be competent to perform the duties as required and
must minimally meet the education and training requirements identified in subdivision 2,
paragraph (b), and have a minimum of three years of supervisory level experience in a
program that provides care or education to vulnerable adults or children.

Sec. 4.

Minnesota Statutes 2024, section 256B.04, subdivision 5, is amended to read:

Subd. 5.

Annual report required.

The state agency within 60 days after the close of
each fiscal year, shall prepare and print for the fiscal year a report that includes new text begin : new text end a full
account of the operations and expenditure of funds under this chapter deleted text begin , deleted text end new text begin ; new text end a full account of the
activities undertaken in accordance with subdivision 10 deleted text begin , deleted text end new text begin ; new text end adequate and complete statistics
divided by counties about all medical assistance provided in accordance with this chapter deleted text begin , deleted text end new text begin ;
a full account of all pre-enrollment, postenrollment, and unannounced site visits to providers
under section 256B.044, subdivision 5; new text end and any other information it may deem advisable.

Sec. 5.

Minnesota Statutes 2025 Supplement, section 256B.04, subdivision 21, is amended
to read:

Subd. 21.

Provider enrollment.

deleted text begin (a) deleted text end The commissioner shall enroll providers and conduct
screening activities as required by Code of Federal Regulations, title 42, section 455, subpart
E new text begin , and sections 256B.044 to 256B.0445 new text end .

deleted text begin 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 deleted text end deleted text begin 245C deleted text end deleted text begin ,
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).
deleted text end

deleted text begin (b) The commissioner shall revalidate:
deleted text end

deleted text begin (1) each provider under this subdivision at least once every five years;
deleted text end

deleted text begin (2) each personal care assistance agency, CFSS provider-agency, and CFSS financial
management services provider under this subdivision at least once every three years;
deleted text end

deleted text begin (3) each EIDBI agency under this subdivision at least once every three years; and
deleted text end

deleted text begin (4) at the commissioner's discretion, any medical-assistance-only provider type the
commissioner deems "high-risk" under this subdivision.
deleted text end

deleted text begin (c) The commissioner shall conduct revalidation as follows:
deleted text end

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

deleted text begin (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
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (g) An enrolled provider that is also licensed by the commissioner under chapter deleted text end deleted text begin 245A deleted text end deleted text begin ,
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 deleted text end deleted text begin 144G deleted text end deleted text begin 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:
deleted text end

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

deleted text begin (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);
deleted text end

deleted text begin (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;
deleted text end

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

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

deleted text begin (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.
deleted text end

deleted text begin 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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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:
deleted text end

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

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

deleted text begin (3) serves primarily a pediatric population.
deleted text end

deleted text begin (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 deleted text end deleted text begin 14 deleted text end deleted text begin .
The commissioner's designations are not subject to administrative appeal.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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. Any action to obtain monetary recovery or sanctions
from a surety bond must occur within six years from the date the debt is affirmed by a final
agency decision. An agency decision is final when the right to appeal the debt has been
exhausted or the time to appeal has expired under section 256B.064.
deleted text end

deleted text begin (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 end

deleted text begin (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.051, 256B.0659, 256B.0701,
or 256B.85.
deleted text end

Sec. 6.

new text begin [256B.044] PROVIDER ENROLLMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Designating categorical risk levels. new text end

new text begin (a) The commissioner must designate
provider types as "limited-risk," "moderate-risk," 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 commissioner must publish a list of provider types and designated
categorical risk levels in the Minnesota Health Care Program Provider Manual.
new text end

new text begin (b) The list and criteria are not subject to the requirements of chapter 14, and section
14.386 does not apply.
new text end

new text begin (c) The commissioner's designations are not subject to administrative appeal.
new text end

new text begin Subd. 2. new text end

new text begin Required verifications and checks. new text end

new text begin The commissioner must perform the
following verifications and checks prior to making an enrollment determination and
periodically thereafter:
new text end

new text begin (1) verify that the provider meets applicable federal and state requirements for the
provider type;
new text end

new text begin (2) conduct license verifications, as applicable, including verification of current licensure
in Minnesota and in any other state in which the provider is or was previously licensed, in
accordance with Code of Federal Regulations, title 42, section 455.412;
new text end

new text begin (3) conduct database checks on a pre-enrollment and postenrollment basis to ensure that
the provider continues to meet the enrollment criteria for the provider type, in accordance
with Code of Federal Regulations, title 42, section 455.436;
new text end

new text begin (4) confirm that the provider and any disclosed owners, managing employees, or
controlling individuals are not excluded from participation in any state's Medicaid program,
Medicare, or any other federal health care program;
new text end

new text begin (5) verify the provider's National Provider Identifier and, as applicable, Medicare
enrollment status;
new text end

new text begin (6) verify the provider's tax identification number and business registration status;
new text end

new text begin (7) verify the provider's ownership and control disclosures as required under federal
law; and
new text end

new text begin (8) conduct any additional screenings, verifications, or reviews that are necessary to
protect the integrity of the medical assistance program or that are required under federal
law.
new text end

new text begin Subd. 3. new text end

new text begin Required background studies. new text end

new text begin (a) The commissioner must conduct a
background study under chapter 245C, for a provider applying for enrollment. The
background study must include a review of databases in section 245C.08, subdivision 1,
paragraph (a), clauses (1) to (5), and any other databases required under federal law.
new text end

new text begin (b) The commissioner must conduct a background study under this subdivision for each
individual with an ownership or control interest in, or who is an officer, director, agent,
managing employee, or other person with operational or managerial control of the provider.
new text end

new text begin (c) Fingerprint-based studies are required when mandated by federal law or when a
provider is designated moderate-risk or high-risk under subdivision 1.
new text end

new text begin (d) The commissioner may conduct background studies postenrollment as necessary.
new text end

new text begin (e) A provider's failure to submit to the commissioner the information required for a
background study under this subdivision is grounds for denial or termination of enrollment
in medical assistance.
new text end

new text begin (f) A provider's enrollment must be denied or terminated if a provider or individual
subject to a background study under this subdivision is disqualified under chapter 245C or
is excluded from participating in any federal health care programs.
new text end

new text begin Subd. 4. new text end

new text begin Service location enrollment. new text end

new text begin (a) A provider must enroll each provider-controlled
location where direct services are provided. "Provider-controlled location" means a physical
site owned, leased, operated, or otherwise controlled by the provider.
new text end

new text begin (b) Providers must report all provider-controlled locations where direct services are
provided to the commissioner and obtain approval before billing for services provided at a
new location.
new text end

new text begin (c) Separate enrollment is not required for services provided in a recipient's home or
community setting, telehealth services delivered from an enrolled site, compliant mobile
services, or other federally permissible exemptions.
new text end

new text begin (d) A provider's failure to enroll each provider-controlled location where direct services
are provided is grounds for sanctions under section 256B.064.
new text end

new text begin Subd. 5. new text end

new text begin Site visits. new text end

new text begin (a) As a condition of enrollment in medical assistance, the
commissioner shall require that a provider permit the Centers for Medicare and Medicaid
Services (CMS), CMS's agents, or CMS's designated contractors and the Department of
Human Services (DHS), DHS's agents, or DHS's designated contractors to conduct
unannounced site visits of any of a provider's enrolled locations.
new text end

new text begin (b) At a minimum, the commissioner must conduct the following site visits at each of
a provider's enrolled locations:
new text end

new text begin (1) pre-enrollment site visits for providers designated as moderate-risk or high-risk under
subdivision 1;
new text end

new text begin (2) postenrollment site visits for providers designated as moderate-risk or high-risk under
subdivision 1; and
new text end

new text begin (3) unannounced site visits, as follows:
new text end

new text begin (i) prior to payment of the provider's first claim after enrollment, when required under
federal law or due to program integrity concerns;
new text end

new text begin (ii) within 12 months after the provider begins to bill claims; and
new text end

new text begin (iii) prior to revalidation under section 256B.0441, subdivision 3.
new text end

new text begin (c) The commissioner may conduct additional announced or unannounced site visits
when necessary to verify compliance with enrollment requirements or to protect program
integrity.
new text end

new text begin (d) A provider's failure to permit a required site visit is grounds for denial, suspension,
or termination of enrollment and may result in denial of claims or recoupment of payments.
new text end

new text begin Subd. 6. new text end

new text begin Surety bonds. new text end

new text begin (a) The commissioner must require a provider to purchase a
surety bond as a condition of initial enrollment, reenrollment, revalidation, reinstatement,
or continued enrollment if:
new text end

new text begin (1) the provider fails to demonstrate financial viability;
new text end

new text begin (2) the commissioner determines there is significant evidence of or potential for fraud
and abuse by the provider; or
new text end

new text begin (3) the provider or category of providers is designated high-risk pursuant to subdivision
1.
new text end

new text begin (b) 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 DHS as an obligee and must allow for recovery of costs and
fees in pursuing a claim on the bond.
new text end

new text begin (c) This subdivision does not apply if the provider currently maintains a surety bond
under the requirements in section 256B.051, 256B.0659, 256B.0701, or 256B.85.
new text end

new text begin Subd. 7. new text end

new text begin Financial capacity. new text end

new text begin As a condition of enrolling in medical assistance, the
commissioner must require, in a form and manner prescribed by the commissioner, that a
provider demonstrate sufficient financial capacity to operate, repay improper payments,
and make payroll for 90 days.
new text end

new text begin Subd. 8. new text end

new text begin Compliance programs. new text end

new text begin (a) The commissioner may require, as a condition of
enrollment in medical assistance, that a provider in a particular industry, of a particular
provider type, or with a particular risk categorization under subdivision 1, establish and
maintain a compliance program consistent with federal program integrity guidance issued
by CMS or the United States Department of Health and Human Services Office of Inspector
General.
new text end

new text begin (b) If an enrolled provider is required by the commissioner or by federal or state law to
designate an individual as the provider's compliance officer, the provider must appoint an
individual responsible for implementing and overseeing the compliance program.
new text end

new text begin (c) At a minimum, the compliance program must include policies and procedures designed
to:
new text end

new text begin (1) ensure adherence to federal and state laws and program requirements governing
medical assistance and prevent the submission of improper claims;
new text end

new text begin (2) train employees, agents, contractors, and subcontractors, including billing personnel,
on applicable federal and state laws and program requirements;
new text end

new text begin (3) establish procedures for receiving, investigating, and responding to allegations of
improper conduct and for implementing corrective actions;
new text end

new text begin (4) use auditing, monitoring, or other evaluation techniques to assess ongoing compliance;
new text end

new text begin (5) promptly report to the commissioner any credible evidence of violations of federal
and state laws or regulations governing medical assistance; and
new text end

new text begin (6) report and return identified medical assistance overpayments within 60 days after
discovery or by the date any corresponding cost report is due, whichever is later, in
accordance with federal law.
new text end

new text begin Subd. 9. new text end

new text begin Incomplete provider enrollment applications. new text end

new text begin The commissioner must deny
a provider's incomplete enrollment application if a provider fails to respond to the
commissioner's request for additional information within 60 days of the request.
new text end

new text begin Subd. 10. new text end

new text begin Correspondence and notification. new text end

new text begin The commissioner must deliver
correspondence and notifications, including notifications of termination and other actions,
electronically to a provider's MN-ITS mailbox. This subdivision does not apply to
correspondences and notifications related to background studies.
new text end

Sec. 7.

new text begin [256B.0441] PROVIDER REVALIDATION.
new text end

new text begin Subdivision 1. new text end

new text begin Requirement. new text end

new text begin The commissioner must revalidate each enrolled provider
according to this section.
new text end

new text begin Subd. 2. new text end

new text begin Schedule. new text end

new text begin (a) The commissioner shall revalidate:
new text end

new text begin (1) each provider at least once every five years;
new text end

new text begin (2) each personal care assistance agency, CFSS provider-agency, and CFSS financial
management services provider at least once every three years;
new text end

new text begin (3) each EIDBI agency at least once every three years; and
new text end

new text begin (4) each medical-assistance-only provider type the commissioner deems high-risk under
section 256B.044, subdivision 1, at least every three years.
new text end

new text begin (b) The commissioner must conduct revalidation of a provider more frequently when
required under federal law or when necessary to protect program integrity.
new text end

new text begin Subd. 3. new text end

new text begin Procedures. new text end

new text begin (a) The commissioner shall conduct revalidation as follows:
new text end

new text begin (1) provide 30-day notice to the provider of the provider's revalidation due date, including
instructions for revalidation, a list of materials the provider must submit, and a notice about
the unannounced site visit required under paragraph (b);
new text end

new text begin (2) if a provider fails to submit all required materials or satisfy the requirements of
paragraph (b) by the due date, notify the provider of the deficiency within 14 days after the
due date and allow the provider an additional 14 days from the notification date to comply;
and
new text end

new text begin (3) if a provider fails to remedy a deficiency within the additional 28-day time period,
give 15-day notice of termination and immediately suspend the provider's ability to bill.
The commissioner's decision to suspend the provider's ability to bill is not subject to an
administrative appeal.
new text end

new text begin (b) The commissioner must conduct unannounced site visits at each of a provider's
enrolled locations under section 256B.044, subdivision 4, no more than 30 days prior to the
provider's revalidation due date.
new text end

new text begin (c) A provider must demonstrate financial capacity, as described under section 256B.044,
subdivision 7, as a requirement of revalidation under this subdivision.
new text end

Sec. 8.

new text begin [256B.0442] PROVIDER ENROLLMENT SUSPENSIONS AND
TERMINATIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Suspension of billing privileges. new text end

new text begin (a) If a provider fails to comply with
any individual provider requirement or condition of participation, the commissioner must
suspend the provider's ability to bill until the provider comes into compliance.
new text end

new text begin (b) Notwithstanding any law to the contrary, the commissioner may immediately impose
a suspension under this subdivision when necessary to protect public funds or ensure program
integrity.
new text end

new text begin (c) A suspension under this subdivision does not limit the authority of the commissioner
to issue any other sanction authorized under federal or state law.
new text end

new text begin (d) The commissioner's decision to suspend a provider's ability to bill is not subject to
an administrative appeal.
new text end

new text begin Subd. 2. new text end

new text begin Revocation for lack of documentation. new text end

new text begin (a) 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 the 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.
new text end

new text begin (b) Nothing in this subdivision limits the authority of the commissioner to sanction a
provider under the provisions of section 256B.064.
new text end

new text begin Subd. 3. new text end

new text begin Mandatory denial or termination of enrollment. new text end

new text begin (a) The commissioner must
terminate or deny the enrollment of a provider when:
new text end

new text begin (1) an individual with a five percent or greater direct or indirect ownership interest in
the provider does not submit timely and accurate information and cooperate with the
screening methods required under section 256B.044;
new text end

new text begin (2) an individual with a five percent or greater direct or indirect ownership interest in
the provider has been convicted of a criminal offense related to the individual's involvement
in Medicare, Medicaid, or the Children's Health Insurance Program in the last ten years,
unless the commissioner determines that denial or termination of enrollment is not in the
best interests of the medical assistance program and the commissioner documents that
determination in writing;
new text end

new text begin (3) the provider or an individual was terminated from participation in Medicare on or
after January 1, 2011, or under a Medicaid program or Children's Health Insurance Program
of any other state, and is currently included in the termination database under Code of
Federal Regulations, title 42, section 455.417, except as provided in paragraph (b);
new text end

new text begin (4) the provider, or an individual with an ownership or control interest or who is an agent
or managing employee of the provider, fails to submit timely or accurate information, unless
the commissioner determines that termination or denial of enrollment is not in the best
interests of the medical assistance program and the commissioner documents that
determination in writing;
new text end

new text begin (5) the provider, or an individual with a five percent or greater direct or indirect ownership
interest in the provider, fails to submit sets of fingerprints in a form and manner determined
by the commissioner within 30 days of a request from CMS or the commissioner, unless
the commissioner determines that termination or denial of enrollment is not in the best
interests of the medical assistance program and the commissioner documents that
determination in writing;
new text end

new text begin (6) the provider fails to permit access to provider locations for any site visits under
section 256B.044, subdivision 5, unless the commissioner determines that termination or
denial of enrollment is not in the best interests of the medical assistance program and the
commissioner documents that determination in writing; or
new text end

new text begin (7) CMS or the commissioner determines that the provider has falsified any information
provided on the application or cannot verify the identity of any provider applicant.
new text end

new text begin (b) The commissioner may exempt a rehabilitation agency from termination or denial
that would otherwise be required under paragraph (a), clause (3), if the agency:
new text end

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

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

new text begin (3) serves primarily a pediatric population.
new text end

Sec. 9.

new text begin [256B.0443] PROVIDER PAYMENT WITHHOLDS.
new text end

new text begin (a) If the commissioner or the Centers for Medicare and Medicaid Services designate a
provider type as high-risk under section 256B.044, subdivision 1, the commissioner may
withhold payment from providers within that category upon initial enrollment for a 90-day
period.
new text end

new text begin (b) The withholding for each provider must begin on the date of the first submission of
a claim.
new text end

Sec. 10.

new text begin [256B.0444] ENROLLMENT MORATORIUM FOR HIGH-RISK
PROVIDERS.
new text end

new text begin Subdivision 1. new text end

new text begin Provider enrollment moratorium. new text end

new text begin (a) If the commissioner or the Centers
for Medicare and Medicaid Services (CMS) designates a provider type as high-risk under
section 256B.044, subdivision 1, the commissioner may issue a statewide or regional
enrollment moratorium and stop accepting and processing applications from providers
within that category within 30 days of the date of the designation or upon federal approval
of the moratorium, whichever is later. A moratorium issued under this section is effective
for a period of up to 24 months from the date the moratorium is issued.
new text end

new text begin (b) Before ending the moratorium under this section, the commissioner must revalidate
the enrollment of each provider within the affected category in accordance with the
revalidation procedures under section 256B.0441, subdivision 2.
new text end

new text begin Subd. 2. new text end

new text begin Continued enrollment of new clients. new text end

new text begin Nothing in this section prohibits an
enrolled provider subject to a moratorium under this section from enrolling new clients or
beneficiaries during the period of the enrollment moratorium.
new text end

new text begin Subd. 3. new text end

new text begin Notice. new text end

new text begin At least ten days prior to issuing an enrollment moratorium under this
section, the commissioner must notify enrolled providers within the affected category and
the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services about the actions the commissioner plans to take under this
section. The notice must:
new text end

new text begin (1) include a list of provider types to which the moratorium applies;
new text end

new text begin (2) provide a general explanation for the basis of the high-risk designation; and
new text end

new text begin (3) identify the start dates and anticipated durations of the enrollment moratorium.
new text end

new text begin Subd. 4. new text end

new text begin Report to legislature. new text end

new text begin Within 60 days of ending an enrollment moratorium
under this section, the commissioner must submit a report to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services.
The report must include, at a minimum:
new text end

new text begin (1) a summary of any sanctions imposed under section 256B.064 on any providers subject
to the moratorium; and
new text end

new text begin (2) recommendations for modifying or terminating the provision of covered services
delivered by provider types subject to the moratorium.
new text end

Sec. 11.

new text begin [256B.0445] ADDITIONAL PROVIDER ENROLLMENT REQUIREMENTS
FOR SPECIFIC PROVIDER TYPES.
new text end

new text begin Subdivision 1. new text end

new text begin Durable medical equipment provider or supplier. new text end

new text begin (a) For the purposes
of this subdivision, "durable medical equipment provider or supplier" means a medical
supplier that can purchase medical equipment or supplies for sale or rent to the general
public and is able to perform or arrange for necessary repairs to and maintenance of
equipment offered for sale or rent.
new text end

new text begin (b) Upon initial enrollment, reenrollment, and notification of revalidation, all durable
medical equipment, prosthetics, orthotics, and supplies medical suppliers meeting the durable
medical equipment provider or supplier definition in paragraph (a), operating in Minnesota,
and receiving Medicaid money must purchase a surety bond that is annually renewed,
designates the state agency as the obligee, and is submitted in a form approved by the
commissioner. For purposes of this paragraph, 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.
new text end

new text begin (c) At the time of initial enrollment or reenrollment, durable medical equipment providers
or suppliers defined in paragraph (a) 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. Any action to obtain monetary recovery or sanctions
from a surety bond must occur within six years from the date the debt is affirmed by a final
agency decision. An agency decision is final when the right to appeal the debt has been
exhausted or the time to appeal has expired under section 256B.064.
new text end

new text begin Subd. 2. new text end

new text begin Providers licensed by the commissioner of human services. new text end

new text begin An enrolled
provider that is licensed by the commissioner under chapter 245A must designate an
individual as the licensee's compliance officer under section 256B.044, subdivision 8,
paragraph (b).
new text end

new text begin Subd. 3. new text end

new text begin Providers licensed by the commissioner of health. new text end

new text begin An enrolled provider that
is licensed by the commissioner of health as a home care provider under chapter 144A with
a home and community-based services designation under section 144A.484 on the home
care license, or as an assisted living facility under chapter 144G, must designate an individual
as the licensee's compliance officer under section 256B.044, subdivision 8, paragraph (b).
new text end

Sec. 12.

Minnesota Statutes 2025 Supplement, section 256B.0759, subdivision 4, is
amended to read:

Subd. 4.

Provider payment rates.

(a) Payment rates for participating providers must
be increased for services provided to medical assistance enrollees. To receive a rate increase,
participating providers must meet demonstration project requirements and provide evidence
of formal referral arrangements with providers delivering step-up or step-down levels of
care. Providers that have enrolled in the demonstration project but have not met the provider
standards under subdivision 3 as of July 1, 2022, are not eligible for a rate increase under
this subdivision until the date that the provider meets the provider standards in subdivision
3. Services provided from July 1, 2022, to the date that the provider meets the provider
standards under subdivision 3 shall be reimbursed at rates according to section 254B.0505,
subdivision 1. Rate increases paid under this subdivision to a provider for services provided
between July 1, 2021, and July 1, 2022, are not subject to recoupment when the provider
is taking meaningful steps to meet demonstration project requirements that are not otherwise
required by law, and the provider provides documentation to the commissioner, upon request,
of the steps being taken.

(b) The commissioner may temporarily suspend payments to the provider according to
section deleted text begin 256B.04, subdivision 21, paragraph (d) deleted text end new text begin 256B.0442, subdivision 1 new text end , if the provider
does not meet the requirements in paragraph (a). Payments withheld from the provider must
be made once the commissioner determines that the requirements in paragraph (a) are met.

(c) For outpatient individual and group substance use disorder services under section
254B.0505, subdivision 1, clause (1), and adolescent treatment programs that are licensed
as outpatient treatment programs according to sections 245G.01 to 245G.18, provided on
or after January 1, 2021, payment rates must be increased by 20 percent over the rates in
effect on December 31, 2020.

(d) Effective January 1, 2021, and contingent on annual federal approval, managed care
plans and county-based purchasing plans must reimburse providers of the substance use
disorder services meeting the criteria described in paragraph (a) who are employed by or
under contract with the plan an amount that is at least equal to the fee-for-service base rate
payment for the substance use disorder services described in paragraph (c). The commissioner
must monitor the effect of this requirement on the rate of access to substance use disorder
services and residential substance use disorder rates. Capitation rates paid to managed care
organizations and county-based purchasing plans must reflect the impact of this requirement.
This paragraph expires if federal approval is not received at any time as required under this
paragraph.

(e) Effective July 1, 2021, contracts between managed care plans and county-based
purchasing plans and providers to whom paragraph (d) applies must allow recovery of
payments from those providers if, for any contract year, federal approval for the provisions
of paragraph (d) is not received, and capitation rates are adjusted as a result. Payment
recoveries must not exceed the amount equal to any decrease in rates that results from this
provision.

(f) For substance use disorder services with medications for opioid use disorder under
section 254B.0505, subdivision 1, clause (7), provided on or after January 1, 2021, payment
rates must be increased by 20 percent over the rates in effect on December 31, 2020. Upon
implementation of new rates according to section 254B.121, the 20 percent increase will
no longer apply.

Sec. 13.

Minnesota Statutes 2025 Supplement, section 256B.0949, subdivision 16, is
amended to read:

Subd. 16.

Agency duties.

(a) An agency delivering an EIDBI service under this section
must:

(1) enroll as a medical assistance Minnesota health care program provider according to
Minnesota Rules, part 9505.0195, and deleted text begin section 256B.04, subdivision 21 deleted text end new text begin sections 256B.044
to 256B.0445 new text end , and meet all applicable provider standards and requirements;

(2) designate an individual as the agency's compliance officer who must perform the
duties described in section deleted text begin 256B.04, subdivision 21, paragraph (g) deleted text end new text begin 256B.044, subdivision
8, paragraph (b) new text end ;

(3) demonstrate compliance with federal and state laws for the delivery of and billing
for EIDBI service;

(4) verify and maintain records of a service provided to the person or the person's legal
representative as required under Minnesota Rules, parts 9505.2175 and 9505.2197;

(5) demonstrate that while enrolled or seeking enrollment as a Minnesota health care
program provider the agency did not have a lead agency contract or provider agreement
discontinued because of a conviction of fraud; or did not have an owner, board member, or
manager fail a state or federal criminal background check or appear on the list of excluded
individuals or entities maintained by the federal Department of Human Services Office of
Inspector General;

(6) have established business practices including written policies and procedures, internal
controls, and a system that demonstrates the organization's ability to deliver quality EIDBI
services, appropriately submit claims, conduct required staff training, document staff
qualifications, document service activities, and document service quality;

(7) have an office located in Minnesota or a border state;

(8) initiate a background study as required under subdivision 16a;

(9) report maltreatment according to section 626.557 and chapter 260E;

(10) comply with any data requests consistent with the Minnesota Government Data
Practices Act, sections 256B.064 and 256B.27;

(11) provide training for all agency staff on the requirements and responsibilities listed
in the Maltreatment of Minors Act, chapter 260E, and the Vulnerable Adult Protection Act,
section 626.557, including mandated and voluntary reporting, nonretaliation, and the agency's
policy for all staff on how to report suspected abuse and neglect;

(12) have a written policy to resolve issues collaboratively with the person and the
person's legal representative when possible. The policy must include a timeline for when
the person and the person's legal representative will be notified about issues that arise in
the provision of services;

(13) provide the person's legal representative with prompt notification if the person is
injured while being served by the agency. An incident report must be completed by the
agency staff member in charge of the person. A copy of all incident and injury reports must
remain on file at the agency for at least five years from the report of the incident;

(14) before starting a service, provide the person or the person's legal representative a
description of the treatment modality that the person shall receive, including the staffing
certification levels and training of the staff who shall provide a treatment;

(15) provide clinical supervision for a minimum of one hour for every 16 hours of direct
treatment per person, unless otherwise authorized in the person's individual treatment plan;
and

(16) provide required EIDBI intervention observation and direction at least once per
month. Notwithstanding subdivision 13, paragraph (l), required EIDBI intervention
observation and direction under this clause may be conducted via telehealth provided that
no more than two consecutive monthly required EIDBI intervention observation and direction
sessions under this clause are conducted via telehealth.

(b) Upon request of the commissioner, an agency delivering services under this section
must:

(1) identify the agency's controlling individuals, as defined under section 245A.02,
subdivision 5a;

(2) provide disclosures of the use of billing agencies and other consultants who do not
provide EIDBI services; and

(3) provide copies of any contracts with consultants or independent contractors who do
not provide EIDBI services, including hours contracted and responsibilities.

(c) When delivering the ITP, and annually thereafter, an agency must provide the person
or the person's legal representative with:

(1) a written copy and a verbal explanation of the person's or person's legal
representative's rights and the agency's responsibilities;

(2) documentation in the person's file the date that the person or the person's legal
representative received a copy and explanation of the person's or person's legal
representative's rights and the agency's responsibilities; and

(3) reasonable accommodations to provide the information in another format or language
as needed to facilitate understanding of the person's or person's legal representative's rights
and the agency's responsibilities.

Sec. 14.

Minnesota Statutes 2024, section 256B.0949, subdivision 17, is amended to read:

Subd. 17.

Provider shortage; authority for exceptions.

(a) In consultation with the
Early Intensive Developmental and Behavioral Intervention Advisory Council and
stakeholders, including agencies, professionals, parents of people with ASD or a related
condition, and advocacy organizations, the commissioner shall determine if a shortage of
EIDBI providers exists. For the purposes of this subdivision, "shortage of EIDBI providers"
means a lack of availability of providers who meet the EIDBI provider qualification
requirements under subdivision 15 that results in the delay of access to timely services under
this section, or that significantly impairs the ability of a provider agency to have sufficient
providers to meet the requirements of this section. The commissioner shall consider
geographic factors when determining the prevalence of a shortage. The commissioner may
determine that a shortage exists only in a specific region of the state, multiple regions of
the state, or statewide. The commissioner shall also consider the availability of various types
of treatment modalities covered under this section.

(b) The commissioner, in consultation with the Early Intensive Developmental and
Behavioral Intervention Advisory Council and stakeholders, must establish processes and
criteria for granting an exception under this paragraph. The commissioner may grant an
exception only if the exception would not compromise a person's safety and not diminish
the effectiveness of the treatment. The commissioner may establish an expiration date for
an exception granted under this paragraph. The commissioner may grant an exception for
the following:

(1) EIDBI provider qualifications under this section;

(2) medical assistance provider enrollment requirements under deleted text begin section 256B.04,
subdivision 21 deleted text end new text begin sections 256B.044 to 256B.0445 new text end ; or

(3) EIDBI provider or agency standards or requirements.

(c) If the commissioner, in consultation with the Early Intensive Developmental and
Behavioral Intervention Advisory Council and stakeholders, determines that a shortage no
longer exists, the commissioner must submit a notice that a shortage no longer exists to the
chairs and ranking minority members of the senate and the house of representatives
committees with jurisdiction over health and human services. The commissioner must post
the notice for public comment for 30 days. The commissioner shall consider public comments
before submitting to the legislature a request to end the shortage declaration. The
commissioner shall not declare the shortage of EIDBI providers ended without direction
from the legislature to declare it ended.

Sec. 15. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES.
new text end

new text begin The commissioner of human services must amend Minnesota Rules, part 9505.2165,
subpart 4, item C, to remove the citation to United States Code, title 42, section
1320a-7b(b)(3)(D), and insert a citation to United States Code, title 42, section 1320a-7b(b).
The commissioner may use the procedure under Minnesota Statutes, section 14.388,
subdivision 1, clause (3), for changes to Minnesota Rules pursuant to this section. Minnesota
Statutes, section 14.386, does not apply to rules adopted pursuant to this section except as
provided under Minnesota Statutes, section 14.388.
new text end