1.1 	A bill for an act
1.2 	relating to human services; modifying requirements for provider enrollment in 
1.3 	medical assistance; modifying program integrity requirements for the medical 
1.4 	assistance program, other human services programs, and programs administered 
1.5 	by the commissioner of children, youth, and families; directing the commissioner 
1.6 	of human services to make recommendations on provider enrollment standards, 
1.7 	modernizing program integrity infrastructure, and program integrity interventions; 
1.8 	directing the commissioner of human services to conduct audits; requiring reports; 
1.9 	making technical changes; authorizing rulemaking; amending Minnesota Statutes 
1.10 	2024, sections 142A.03, by adding a subdivision; 142B.01, subdivision 8; 245.095, 
1.11 	by adding a subdivision; 245A.02, subdivision 5a; 245D.081, subdivision 3; 256.01, 
1.12 	by adding a subdivision; 256B.04, subdivision 5; 256B.064, subdivisions 1b, 1d, 
1.13 	2, 3, 4, 5, by adding subdivisions; 256B.073, subdivision 2; 256B.0949, subdivision 
1.14 	17; 256B.4912, subdivisions 12, 14, 15, by adding a subdivision; Minnesota Statutes 
1.15 	2025 Supplement, sections 15.013, by adding a subdivision; 245A.04, subdivisions 
1.16 	1, 7; 245A.05; 256B.04, subdivision 21; 256B.051, subdivision 6; 256B.064, 
1.17 	subdivision 1a; 256B.0701, subdivision 9; 256B.0759, subdivision 4; 256B.0949, 
1.18 	subdivision 16; 256B.4912, subdivision 1; proposing coding for new law in 
1.19 	Minnesota Statutes, chapters 142A; 256; 256B; repealing Minnesota Statutes 2025 
1.20 	Supplement, sections 256B.051, subdivision 6b; 256B.0701, subdivision 11.
1.21 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.22 	ARTICLE 1
1.23 	PROGRAM INTEGRITY REQUIREMENTS

1.24 	Section 1. Minnesota Statutes 2025 Supplement, section 15.013, is amended by adding a 
1.25 	subdivision to read:
1.26 		Subd. 7.Exemption. This section does not apply to the medical assistance program 
1.27 	administered by the commissioner of human services.

1.28 	EFFECTIVE DATE. This section is effective the day following final enactment.

2.1 	Sec. 2. Minnesota Statutes 2024, section 142A.03, is amended by adding a subdivision to 
2.2 	read:
2.3 		Subd. 36.Program integrity report. Beginning November 30, 2026, and annually 
2.4 	thereafter, the commissioner must provide a report to the chairs and ranking minority 
2.5 	members of the legislative committees with jurisdiction over children, youth, and families 
2.6 	on program integrity functions within the Department of Children, Youth, and Families. 
2.7 	The report must include:
2.8 	(1) an update from the Office of Inspector General at the Department of Children, Youth, 
2.9 	and Families with historical metrics and descriptive data, including the office's capacity to 
2.10 	meet licensing demands and data for the past five years on the number of maltreatment 
2.11 	reports and licensing complaints received, the results of maltreatment investigations, the 
2.12 	number of licenses issued for each provider type, the number of licensing investigations 
2.13 	and reviews completed, and the number of correction orders issued; and
2.14 	(2) an update from the Office of Inspector General at the Department of Children, Youth, 
2.15 	and Families that generally includes caseload, site visit data, the number of child care 
2.16 	assistance program investigations and administrative reviews within the past five years, 
2.17 	recipient fraud investigation results involving multiple benefits from the past five years, 
2.18 	and updates on major fraud investigations.

2.19 	Sec. 3. [142A.125] ELIGIBILITY TO RECEIVE PUBLIC MONEY; PRE-AWARD 
2.20 	RISK ASSESSMENT.
2.21 		Subdivision 1.Pre-award risk assessment; grant recipients. (a) Prior to receiving a 
2.22 	grant award for a program administered by the commissioner, a potential grantee must 
2.23 	provide the commissioner with the applicable information specified under section 16B.981, 
2.24 	subdivision 2, for the most recent three-year period. This information must also include:
2.25 	(1) the potential grantee's history of performing services during the most recent three-year 
2.26 	period that are substantially similar to the services the potential grantee is seeking to receive 
2.27 	public funds to provide; and
2.28 	(2) for a potential grantee that is a for-profit business or nonprofit organization, evidence 
2.29 	of registration and good standing with the secretary of state for the most recent three-year 
2.30 	period, if applicable.
2.31 	(b) For any information not submitted to the commissioner as required under this section 
2.32 	because the potential grantee determined it to be inapplicable, the potential grantee must 
3.1 	submit documentation noting each item that was not submitted and the reason why the 
3.2 	potential grantee determined it was inapplicable.
3.3 		Subd. 2.Pre-award risk assessment; licensure and reenrollment. (a) Prior to renewing 
3.4 	a license or reenrolling in a program administered by the commissioner, a provider, vendor, 
3.5 	or individual must provide the commissioner with the applicable information specified 
3.6 	under section 16B.981, subdivision 2, for the most recent licensure or enrollment period.
3.7 	(b) Notwithstanding paragraph (a), for a provider, vendor, or individual who has been 
3.8 	licensed or enrolled in a program administered by the commissioner for at least three years, 
3.9 	the provider, vendor, or individual must provide the commissioner with the applicable 
3.10 	information specified under section 16B.981, subdivision 2, for the most recent three-year 
3.11 	period.
3.12 	(c) For any information not submitted to the commissioner as required under this section 
3.13 	because the provider, vendor, or individual determined it to be inapplicable, the provider, 
3.14 	vendor, or individual must submit documentation noting each item that was not submitted 
3.15 	and the reason why the provider, vendor, or individual determined it was inapplicable.
3.16 		Subd. 3.Commissioner duties. (a) The commissioner must review all information 
3.17 	provided under subdivisions 1 and 2 prior to awarding a grant, renewing a license, or 
3.18 	reenrolling a provider. For any documentation submitted to the commissioner under 
3.19 	subdivision 1, paragraph (b), or subdivision 2, paragraph (c), the commissioner must review 
3.20 	and confirm that the determination of inapplicability made by the potential grantee or the 
3.21 	provider, vendor, or individual is correct. For any incorrect determination, the potential 
3.22 	grantee or the provider, vendor, or individual must submit the required information before 
3.23 	receiving grant funds, renewing a license, or reenrolling in a program.
3.24 	(b) Notwithstanding section 16B.981, if, after reviewing the information provided under 
3.25 	subdivision 1, the commissioner has concerns that there is a substantial risk that a potential 
3.26 	grantee cannot or would not perform the required duties under the grant agreement, the 
3.27 	commissioner must not award the grant.
3.28 	(c) If, after reviewing the information provided under subdivision 2, the commissioner 
3.29 	has concerns that there is a substantial risk that the provider, vendor, or individual seeking 
3.30 	to renew a license or reenroll in a program administered by the commissioner cannot or 
3.31 	would not perform the necessary duties required under the license or enrollment agreement, 
3.32 	the commissioner must deny the license renewal or reenrollment request.

4.1 	Sec. 4. Minnesota Statutes 2024, section 245.095, is amended by adding a subdivision to 
4.2 	read:
4.3 		Subd. 7.Exemption. Subdivision 5 does not apply to any individual or entity that receives 
4.4 	payments from medical assistance or provides goods or services for which payment is made 
4.5 	from medical assistance.

4.6 	EFFECTIVE DATE. This section is effective the day following final enactment.

4.7 	Sec. 5. Minnesota Statutes 2024, section 256.01, is amended by adding a subdivision to 
4.8 	read:
4.9 		Subd. 45.Program integrity report. Beginning November 30, 2026, and annually 
4.10 	thereafter, the commissioner must provide a report to the chairs and ranking minority 
4.11 	members of the legislative committees with jurisdiction over human services on program 
4.12 	integrity functions within the Department of Human Services. The report must include:
4.13 	(1) an update from the Background Studies Division within the Office of Inspector 
4.14 	General at the Department of Human Services with historical metrics and descriptive data 
4.15 	on background studies and licensure, including the number of background studies completed 
4.16 	within the past five years and the number of disqualifications that occurred;
4.17 	(2) an update from the Licensing Division within the Office of Inspector General at the 
4.18 	Department of Human Services with historical metrics and descriptive data, including the 
4.19 	division's capacity to meet licensing demands and data for the past five years on the number 
4.20 	of maltreatment reports and licensing complaints received, the results of maltreatment 
4.21 	investigations, the number of licenses issued for each provider type, the number of licensing 
4.22 	investigations and reviews completed, and the number of correction orders issued; and
4.23 	(3) an update from the Financial Fraud and Abuse Investigations Division within the 
4.24 	Office of Inspector General at the Department of Human Services that generally includes 
4.25 	caseload, screening and site visit data, the number of provider medical assistance managed 
4.26 	care investigations within the past five years, the number of screening investigations within 
4.27 	the past five years, and updates on major fraud investigations.

4.28 	Sec. 6. [256.0113] ELIGIBILITY TO RECEIVE PUBLIC MONEY; PRE-AWARD 
4.29 	RISK ASSESSMENT.
4.30 		Subdivision 1.Pre-award risk assessment; grant recipients. (a) Prior to receiving a 
4.31 	grant award for a program administered by the commissioner, a potential grantee must 
5.1 	provide the commissioner with the applicable information specified under section 16B.981, 
5.2 	subdivision 2, for the most recent three-year period. This information must also include:
5.3 	(1) the potential grantee's history of performing services during the most recent three-year 
5.4 	period that are substantially similar to the services the potential grantee is seeking to receive 
5.5 	public funds to provide; and
5.6 	(2) for a potential grantee that is a for-profit business or nonprofit organization, evidence 
5.7 	of registration and good standing with the secretary of state for the most recent three-year 
5.8 	period, if applicable.
5.9 	(b) For any information not submitted to the commissioner as required under this section 
5.10 	because the potential grantee determined it to be inapplicable, the potential grantee must 
5.11 	submit documentation noting each item that was not submitted and the reason why the 
5.12 	potential grantee determined it was inapplicable.
5.13 		Subd. 2.Pre-award risk assessment; licensure. (a) Prior to renewing a license for a 
5.14 	program administered by the commissioner, a provider, vendor, or individual must provide 
5.15 	the commissioner with the applicable information specified under section 16B.981, 
5.16 	subdivision 2, for the most recent licensure period.
5.17 	(b) Notwithstanding paragraph (a), for a provider, vendor, or individual who has been 
5.18 	licensed in a program administered by the commissioner for at least three years, the provider, 
5.19 	vendor, or individual must provide the commissioner with the applicable information 
5.20 	specified under section 16B.981, subdivision 2, for the most recent three-year period.
5.21 	(c) For any information not submitted to the commissioner as required under this section 
5.22 	because the provider, vendor, or individual determined it to be inapplicable, the provider, 
5.23 	vendor, or individual must submit documentation noting each item that was not submitted 
5.24 	and the reason why the provider, vendor, or individual determined it was inapplicable.
5.25 		Subd. 3.Pre-award risk assessment; reenrollment and revalidation. (a) Prior to 
5.26 	reenrollment or revalidation in a program administered by the commissioner, a provider, 
5.27 	vendor, or individual must provide the commissioner with the applicable information 
5.28 	specified under section 16B.981, subdivision 2, for the most recent enrollment period.
5.29 	(b) Notwithstanding paragraph (a), for a provider, vendor, or individual who has been 
5.30 	enrolled in a program administered by the commissioner for at least three years, the provider, 
5.31 	vendor, or individual must provide the commissioner with the applicable information 
5.32 	specified under section 16B.981, subdivision 2, for the most recent three-year period.
6.1 	(c) For any information not submitted to the commissioner as required under this section 
6.2 	because the provider, vendor, or individual determined it to be inapplicable, the provider, 
6.3 	vendor, or individual must submit documentation noting each item that was not submitted 
6.4 	and the reason why the provider, vendor, or individual determined it was inapplicable.
6.5 		Subd. 4.Commissioner duties. (a) The commissioner must review all information 
6.6 	provided under subdivisions 1 to 3 prior to awarding a grant, renewing a license, or 
6.7 	reenrolling or revalidating a provider, vendor, or individual. For any documentation submitted 
6.8 	to the commissioner under subdivision 1, paragraph (b); subdivision 2, paragraph (c); or 
6.9 	subdivision 3, paragraph (c), the commissioner must review and confirm that the 
6.10 	determination of inapplicability made by the potential grantee or the provider, vendor, or 
6.11 	individual is correct. For any incorrect determination, the potential grantee or the provider, 
6.12 	vendor, or individual must submit the required information prior to receiving grant funds, 
6.13 	renewing a license, reenrollment in a program, or revalidation.
6.14 	(b) Notwithstanding section 16B.981, if, after reviewing the information provided under 
6.15 	subdivision 1, the commissioner has concerns that there is a substantial risk that a potential 
6.16 	grantee cannot or would not perform the required duties under the grant agreement, the 
6.17 	commissioner must not award the grant.
6.18 	(c) If, after reviewing the information provided under subdivision 2 or 3, the 
6.19 	commissioner has concerns that there is a substantial risk that the provider, vendor, or 
6.20 	individual seeking to renew a license, or applying for reenrollment or revalidation, cannot 
6.21 	or would not perform the necessary duties required under the license or enrollment agreement, 
6.22 	the commissioner must deny the license renewal or terminate the participation of the provider, 
6.23 	vendor, or individual in the program.

6.24 	Sec. 7. Minnesota Statutes 2025 Supplement, section 256B.064, subdivision 1a, is amended 
6.25 	to read:
6.26 		Subd. 1a.Grounds for sanctions. (a) The commissioner may impose sanctions against 
6.27 	any individual or entity that receives payments from medical assistance or provides goods 
6.28 	or services for which payment is made from medical assistance for any of the following:
6.29 	(1) fraud, theft, or abuse in connection with the provision of goods and services to 
6.30 	recipients of public assistance for which payment is made from medical assistance;
6.31 	(2) a pattern of presentment of false or duplicate claims or claims for services not 
6.32 	medically necessary;
7.1 	(3) a pattern of making false statements of material facts for the purpose of obtaining 
7.2 	greater compensation than that to which the individual or entity is legally entitled;
7.3 	(4) suspension or termination as a Medicare vendor;
7.4 	(5) refusal to grant the state agency access during regular business hours to examine all 
7.5 	records necessary to disclose the extent of services provided to program recipients and 
7.6 	appropriateness of claims for payment;
7.7 	(6) failure to repay an overpayment or a fine finally established under this section;
7.8 	(7) failure to correct errors in the maintenance of health service or financial records for 
7.9 	which a fine was imposed or after issuance of a warning by the commissioner; and
7.10 	(8) any reason for which an individual or entity could be excluded from participation in 
7.11 	the Medicare program under section 1128, 1128A, or 1866(b)(2) of the Social Security Act.
7.12 	(b) For the purposes of this section, goods or services for which payment is made from 
7.13 	medical assistance includes but is not limited to care and services identified in section 
7.14 	256B.0625 or provided pursuant to any federally approved waiver.
7.15 	(c) Regardless of the source of payment or other item of value, the commissioner may 
7.16 	impose sanctions against any individual or entity that solicits, receives, pays, or offers to 
7.17 	pay any illegal remuneration as described in section 142E.51, subdivision 6a, in violation 
7.18 	of section 609.542, subdivision 2, or in violation of United States Code, title 42, section 
7.19 	1320a-7b(b)(1) or (2). No conviction is required before the commissioner can impose 
7.20 	sanctions under this paragraph.
7.21 	(d) The commissioner may impose sanctions against a pharmacy provider for failure to 
7.22 	respond to a cost of dispensing survey under section 256B.0625, subdivision 13e, paragraph 
7.23 	(g).
7.24 	(e) The commissioner may impose sanctions against a pharmacy provider for failure to 
7.25 	respond to a Minnesota drug acquisition cost survey under section 256B.0625, subdivision 
7.26 	13e, paragraph (i).
7.27 	(f) For the purposes of this section, "abuse" means the activities listed in paragraph (a), 
7.28 	clauses (2), (3), and (7), but does not include billing errors that result in unintended 
7.29 	overcharges.

7.30 	Sec. 8. Minnesota Statutes 2024, section 256B.064, subdivision 1b, is amended to read:
7.31 		Subd. 1b.Sanctions available. (a) The commissioner may impose the following sanctions 
7.32 	for the conduct described in subdivision 1a: suspension or withholding of suspending
8.1 	payments to an individual or entity and; withholding payments to an individual or entity;
8.2 	suspending or terminating participation in the program,; terminating participation in the 
8.3 	program; or imposition of imposing a fine under subdivision 2, paragraph (g) 2a.
8.4 	(b) When imposing sanctions under this section subdivision, the commissioner shall
8.5 	must consider the nature, chronicity, or severity of the conduct and the effect of the conduct 
8.6 	on the health and safety of persons served by the individual or entity.
8.7 	(c) The commissioner shall must suspend an individual's or entity's participation in the 
8.8 	program for a minimum of five years if the individual or entity is convicted of a crime, 
8.9 	received a stay of adjudication, or entered a court-ordered diversion program for an offense 
8.10 	related to a provision of a health service under medical assistance, including a federally 
8.11 	approved waiver, or health care fraud.
8.12 	(d) Regardless of imposition of sanctions, the commissioner may make a referral to the 
8.13 	appropriate state licensing board.

8.14 	EFFECTIVE DATE. This section is effective the day following final enactment.

8.15 	Sec. 9. Minnesota Statutes 2024, section 256B.064, subdivision 1d, is amended to read:
8.16 		Subd. 1d.Investigative costs. (a) The commissioner may seek recovery of investigative 
8.17 	costs from any individual or entity that willfully submits a claim for reimbursement for 
8.18 	services that the individual or entity knows, or reasonably should have known, is a false 
8.19 	representation and that results in the payment of public funds for which the individual or 
8.20 	entity is ineligible.
8.21 	(b) Billing errors that result in unintentional overcharges shall are not be grounds for 
8.22 	investigative cost recoupment.

8.23 	EFFECTIVE DATE. This section is effective the day following final enactment.

8.24 	Sec. 10. Minnesota Statutes 2024, section 256B.064, subdivision 2, is amended to read:
8.25 		Subd. 2.Imposition of monetary recovery and sanctions; generally. (a) The 
8.26 	commissioner shall must determine any monetary amounts to be recovered and sanctions 
8.27 	to be imposed upon an individual or entity under this section. Except as provided in 
8.28 	paragraphs (b) and (d), neither subdivisions 2b to 2d, the commissioner must not obtain a 
8.29 	monetary recovery nor or impose a sanction will be imposed by the commissioner without 
8.30 	prior notice and an opportunity for a hearing, according to chapter 14, on the commissioner's 
8.31 	proposed action, provided that the commissioner may suspend or reduce payment to an 
8.32 	individual or entity, except a nursing home or convalescent care facility, after notice and 
9.1 	prior to the hearing if in the commissioner's opinion that action is necessary to protect the 
9.2 	public welfare and the interests of the program.
9.3 	(b) Except when the commissioner finds good cause not to suspend payments under 
9.4 	Code of Federal Regulations, title 42, section 455.23(e) or (f), the commissioner shall 
9.5 	withhold or reduce payments to an individual or entity without providing advance notice 
9.6 	of such withholding or reduction if either of the following occurs:
9.7 	(1) the individual or entity is convicted of a crime involving the conduct described in 
9.8 	subdivision 1a; or
9.9 	(2) the commissioner determines there is a credible allegation of fraud for which an 
9.10 	investigation is pending under the program. Allegations are considered credible when they 
9.11 	have an indicium of reliability and the state agency has reviewed all allegations, facts, and 
9.12 	evidence carefully and acts judiciously on a case-by-case basis. A credible allegation of 
9.13 	fraud is an allegation which has been verified by the state, from any source, including but 
9.14 	not limited to:
9.15 	(i) fraud hotline complaints;
9.16 	(ii) claims data mining; and
9.17 	(iii) patterns identified through provider audits, civil false claims cases, and law 
9.18 	enforcement investigations.
9.19 	(c) The commissioner must send notice of the withholding or reduction of payments 
9.20 	under paragraph (b) within five days of taking such action unless requested in writing by a 
9.21 	law enforcement agency to temporarily withhold the notice. The notice must:
9.22 	(1) state that payments are being withheld according to paragraph (b);
9.23 	(2) set forth the general allegations as to the nature of the withholding action, but need 
9.24 	not disclose any specific information concerning an ongoing investigation;
9.25 	(3) except in the case of a conviction for conduct described in subdivision 1a, state that 
9.26 	the withholding is for a temporary period and cite the circumstances under which withholding 
9.27 	will be terminated;
9.28 	(4) identify the types of claims to which the withholding applies; and
9.29 	(5) inform the individual or entity of the right to submit written evidence for consideration 
9.30 	by the commissioner.
9.31 	(d) The withholding or reduction of payments will not continue after the commissioner 
9.32 	determines there is insufficient evidence of fraud by the individual or entity, or after legal 
10.1 	proceedings relating to the alleged fraud are completed, unless the commissioner has sent 
10.2 	notice of intention to impose monetary recovery or sanctions under paragraph (a). Upon 
10.3 	conviction for a crime related to the provision, management, or administration of a health 
10.4 	service under medical assistance, a payment held pursuant to this section by the commissioner 
10.5 	or a managed care organization that contracts with the commissioner under section 256B.035 
10.6 	is forfeited to the commissioner or managed care organization, regardless of the amount 
10.7 	charged in the criminal complaint or the amount of criminal restitution ordered.
10.8 	(e) The commissioner shall suspend or terminate an individual's or entity's participation 
10.9 	in the program without providing advance notice and an opportunity for a hearing when the 
10.10 	suspension or termination is required because of the individual's or entity's exclusion from 
10.11 	participation in Medicare. Within five days of taking such action, the commissioner must 
10.12 	send notice of the suspension or termination. The notice must:
10.13 	(1) state that suspension or termination is the result of the individual's or entity's exclusion 
10.14 	from Medicare;
10.15 	(2) identify the effective date of the suspension or termination; and
10.16 	(3) inform the individual or entity of the need to be reinstated to Medicare before 
10.17 	reapplying for participation in the program.
10.18 	(f) (b) Upon receipt of a notice under paragraph (a) or subdivision 2c or 2d that a 
10.19 	monetary recovery or sanction is to be or has been imposed, an individual or entity may 
10.20 	request a contested case, as defined in section 14.02, subdivision 3, by filing with the 
10.21 	commissioner a written request of appeal. The appeal request must be received by the 
10.22 	commissioner no later than 30 days after the date the notification of monetary recovery or 
10.23 	sanction was mailed to the individual or entity. The appeal request must specify:
10.24 	(1) each disputed item, the reason for the dispute, and an estimate of the dollar amount 
10.25 	involved for each disputed item;
10.26 	(2) the computation that the individual or entity believes is correct;
10.27 	(3) the authority in statute or rule upon which the individual or entity relies for each 
10.28 	disputed item;
10.29 	(4) the name and address of the person or entity with whom contacts may be made 
10.30 	regarding the appeal; and
10.31 	(5) other information required by the commissioner.
11.1 	(g) The commissioner may order an individual or entity to forfeit a fine for failure to 
11.2 	fully document services according to standards in this chapter and Minnesota Rules, chapter 
11.3 	9505. The commissioner may assess fines if specific required components of documentation 
11.4 	are missing. The fine for incomplete documentation shall equal 20 percent of the amount 
11.5 	paid on the claims for reimbursement submitted by the individual or entity, or up to $5,000, 
11.6 	whichever is less. If the commissioner determines that an individual or entity repeatedly 
11.7 	violated this chapter, chapter 254B or 245G, or Minnesota Rules, chapter 9505, related to 
11.8 	the provision of services to program recipients and the submission of claims for payment, 
11.9 	the commissioner may order an individual or entity to forfeit a fine based on the nature, 
11.10 	severity, and chronicity of the violations, in an amount of up to $5,000 or 20 percent of the 
11.11 	value of the claims, whichever is greater.
11.12 	(h) The individual or entity shall pay the fine assessed on or before the payment date 
11.13 	specified. If the individual or entity fails to pay the fine, the commissioner may withhold 
11.14 	or reduce payments and recover the amount of the fine. A timely appeal shall stay payment 
11.15 	of the fine until the commissioner issues a final order.

11.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

11.17 	Sec. 11. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision 
11.18 	to read:
11.19 		Subd. 2a.Imposition of fines. (a) The commissioner may order an individual or entity 
11.20 	to forfeit a fine for failure to fully document services according to standards in this chapter 
11.21 	and Minnesota Rules, chapter 9505. The commissioner may assess fines if specific required 
11.22 	components of documentation are missing. The fine for incomplete documentation equals 
11.23 	20 percent of the amount paid on the claims for reimbursement submitted by the individual 
11.24 	or entity, or up to $5,000, whichever is less. If the commissioner determines that an individual 
11.25 	or entity repeatedly violated this chapter, chapter 245G or 254B, or Minnesota Rules, chapter 
11.26 	9505, related to the provision of services to program recipients and the submission of claims 
11.27 	for payment, the commissioner may order an individual or entity to forfeit a fine based on 
11.28 	the nature, severity, and chronicity of the violations, in an amount of up to $5,000 or 20 
11.29 	percent of the value of the claims, whichever is greater.
11.30 	(b) The individual or entity must pay the fine assessed on or before the payment date 
11.31 	specified by the commissioner. If the individual or entity fails to pay the fine, the 
11.32 	commissioner may withhold or reduce payments and recover the amount of the fine. A 
11.33 	timely appeal stays payment of the fine until the commissioner issues a final order.

11.34 	EFFECTIVE DATE. This section is effective the day following final enactment.

12.1 	Sec. 12. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision 
12.2 	to read:
12.3 		Subd. 2b.Mandatory suspension or termination after exclusion from participation 
12.4 	in Medicare. (a) The commissioner must suspend or terminate an individual's or entity's 
12.5 	participation in the program without providing advance notice and an opportunity for a 
12.6 	hearing when the suspension or termination is required because of the individual's or entity's 
12.7 	exclusion from participation in Medicare.
12.8 	(b) Within five days of taking an action under paragraph (a), the commissioner must 
12.9 	send notice of the suspension or termination. The notice must:
12.10 	(1) state that the suspension or termination is the result of the individual's or entity's 
12.11 	exclusion from Medicare;
12.12 	(2) identify the effective date of the suspension or termination; and
12.13 	(3) inform the individual or entity of the need to be reinstated to Medicare before 
12.14 	reapplying for participation in the program.

12.15 	EFFECTIVE DATE. This section is effective the day following final enactment.

12.16 	Sec. 13. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision 
12.17 	to read:
12.18 		Subd. 2c.Imposition of monetary recovery and sanctions before a hearing. (a) Except 
12.19 	as provided in paragraph (b), the commissioner may withhold or reduce payment to an 
12.20 	individual or entity after notice but before a hearing if, in the commissioner's opinion, 
12.21 	withholding or reducing payment is necessary to protect the public welfare and the interests 
12.22 	of the program.
12.23 	(b) Notwithstanding subdivision 2d, unless the commissioner first complies with the 
12.24 	applicable requirements of paragraph (c), the commissioner must not withhold or reduce 
12.25 	payments to the following entities:
12.26 	(1) a nursing home;
12.27 	(2) a convalescing care facility;
12.28 	(3) an entity providing residential supports and services as described in section 245D.03, 
12.29 	subdivision 1, paragraph (c), clause (3); or
12.30 	(4) an entity providing integrated community services described in section 245D.03, 
12.31 	subdivision 1, paragraph (c), clause (8).
13.1 	(c) When withholding or reducing payments under paragraph (a) or subdivision 2d to 
13.2 	an entity listed in paragraph (b), the commissioner must confirm suitable alternative services 
13.3 	and housing are established for the affected recipient before withholding or reducing 
13.4 	payments if withholding or reducing payments puts a recipient of the goods or services 
13.5 	provided by the entity in imminent danger of harm or at risk of homelessness.

13.6 	EFFECTIVE DATE. This section is effective the day following final enactment.

13.7 	Sec. 14. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision 
13.8 	to read:
13.9 		Subd. 2d.Imposition of monetary recovery and sanctions without prior notice. (a) 
13.10 	Except as provided in subdivision 2c, when law enforcement requests that the commissioner 
13.11 	not suspend payments, or when the commissioner finds good cause not to suspend payments 
13.12 	under Code of Federal Regulations, title 42, section 455.23(e) or (f), the commissioner must 
13.13 	withhold or reduce payments to an individual or entity without providing advance notice 
13.14 	of the withholding or reduction if either of the following occurs:
13.15 	(1) the individual or entity is convicted of a crime involving the conduct described in 
13.16 	subdivision 1a; or
13.17 	(2) the commissioner determines there is a credible allegation of fraud for which an 
13.18 	investigation is pending under the program. Allegations are considered credible when they 
13.19 	are supported by a preponderance of the evidence and the state agency has reviewed and 
13.20 	verified all allegations, facts, and evidence carefully and acts judiciously on a case-by-case 
13.21 	basis. A credible allegation of abuse is not a credible allegation of fraud.
13.22 	(b) If the commissioner withholds or reduces payments under paragraph (a), clause (2), 
13.23 	the commissioner may withhold payments only for the specific submitted claims that the 
13.24 	commissioner has determined are potentially fraudulent and referred to law enforcement, 
13.25 	unless the commissioner determines that the credible allegation of fraud is an allegation of 
13.26 	pervasive fraud.
13.27 	(c) For purposes of this subdivision, "fraud" means presenting information that is false 
13.28 	in whole or in part to the commissioner with the intent of obtaining greater compensation 
13.29 	for the provision of a good or service available under this chapter than the vendor of the 
13.30 	good or service is legally entitled.
13.31 	(d) The commissioner may consider an allegation of fraud from any source, including 
13.32 	but not limited to:
13.33 	(1) fraud hotline complaints;
14.1 	(2) claims data mining;
14.2 	(3) patterns identified through provider audits, civil false claims cases, law enforcement 
14.3 	investigations, and investigations by other state or federal agencies; and
14.4 	(4) court filings or other legal documents.
14.5 	(e) The commissioner must send notice of the withholding or reduction of payments 
14.6 	under paragraph (a) within five days of withholding or reducing payment unless requested 
14.7 	in writing by a law enforcement agency to temporarily withhold the notice. The notice need 
14.8 	not disclose specific information concerning an ongoing investigation. The notice must:
14.9 	(1) state that payments are being withheld according to paragraph (a);
14.10 	(2) set forth the allegations as to the nature of the withholding action, which must specify:
14.11 	(i) each disputed item, and for each disputed item the reason for the dispute and an 
14.12 	estimate of the dollar amount involved;
14.13 	(ii) the computation that the commissioner believes is correct;
14.14 	(iii) the statute or rule the commissioner believes the individual or entity violated; and
14.15 	(iv) other information necessary to aid the individual or entity when providing written 
14.16 	evidence under clause (5) or filing an appeal under section 256B.064, subdivision 2;
14.17 	(3) except in the case of a conviction for conduct described in subdivision 1a, state that 
14.18 	the withholding is for a temporary period not to exceed 60 days and cite the circumstances 
14.19 	under which withholding will be terminated;
14.20 	(4) identify the types of claims to which the withholding applies; and
14.21 	(5) inform the individual or entity of the right to submit written evidence for consideration 
14.22 	by the commissioner.
14.23 	(f) The commissioner must acknowledge receipt of any written evidence submitted by 
14.24 	the individual or entity within five days of receipt of the written evidence. Within five days 
14.25 	of the commissioner's acknowledgment of receipt, the commissioner must (1) cease to 
14.26 	withhold or reduce payments, or (2) respond to the individual or entity with an explanation 
14.27 	of the commissioner's continued determination that there is sufficient evidence of fraud to 
14.28 	continue withholding or reducing payments.
14.29 	(g) The commissioner must cease to withhold or reduce payments under this subdivision 
14.30 	after 60 days have passed, after the commissioner determines there is insufficient evidence 
14.31 	of fraud by the individual or entity, or after legal proceedings relating to the alleged fraud 
15.1 	are completed, unless the commissioner has sent notice of intention to impose monetary 
15.2 	recovery or sanctions.

15.3 	Sec. 15. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision 
15.4 	to read:
15.5 		Subd. 2e.Forfeiture of withheld payments upon criminal conviction. Upon conviction 
15.6 	for a crime related to the provision, management, or administration of a health service under 
15.7 	medical assistance, a payment held pursuant to this section by the commissioner or a managed 
15.8 	care organization that contracts with the commissioner under section 256B.035 is forfeited 
15.9 	to the commissioner or managed care organization, regardless of the amount charged in the 
15.10 	criminal complaint or the amount of criminal restitution ordered.

15.11 	EFFECTIVE DATE. This section is effective the day following final enactment.

15.12 	Sec. 16. Minnesota Statutes 2024, section 256B.064, subdivision 3, is amended to read:
15.13 		Subd. 3. Mandates on prohibited payments.  (a) The commissioner shall must maintain 
15.14 	and publish a list of each excluded individual and entity that was convicted of a crime related 
15.15 	to the provision, management, or administration of a medical assistance health service, or 
15.16 	suspended or terminated under subdivision 2 2b. Medical assistance payments cannot be 
15.17 	made by an individual or entity for items or services furnished either directly or indirectly 
15.18 	by an excluded individual or entity, or at the direction of excluded individuals or entities.
15.19 	(b) The entity must check the exclusion list on a monthly basis and document the date 
15.20 	and time the exclusion list was checked and the name and title of the person who checked 
15.21 	the exclusion list. The entity must immediately terminate payments to an individual or entity 
15.22 	on the exclusion list.
15.23 	(c) An entity's requirement to check the exclusion list and to terminate payments to 
15.24 	individuals or entities on the exclusion list applies to each individual or entity on the 
15.25 	exclusion list, even if the named individual or entity is not responsible for direct patient 
15.26 	care or direct submission of a claim to medical assistance.
15.27 	(d) An entity that pays medical assistance program funds to an individual or entity on 
15.28 	the exclusion list must refund any payment related to either items or services rendered by 
15.29 	an individual or entity on the exclusion list from the date the individual or entity is first paid 
15.30 	or the date the individual or entity is placed on the exclusion list, whichever is later, and an 
15.31 	entity may be subject to:
15.32 	(1) sanctions under subdivision 2 this section;
16.1 	(2) a civil monetary penalty of up to $25,000 for each determination by the department 
16.2 	that the vendor employed or contracted with an individual or entity on the exclusion list; 
16.3 	and
16.4 	(3) other fines or penalties allowed by law.

16.5 	EFFECTIVE DATE. This section is effective the day following final enactment.

16.6 	Sec. 17. Minnesota Statutes 2024, section 256B.064, subdivision 4, is amended to read:
16.7 		Subd. 4.Notice. (a) The department shall must serve the notice required under subdivision
16.8 	subdivisions 2 and 2d using a signature-verified confirmed delivery method to the address 
16.9 	submitted to the department by the individual or entity. Service is complete upon mailing.
16.10 	(b) The department shall must give notice in writing to a recipient placed in the Minnesota 
16.11 	restricted recipient program under section 256B.0646 and Minnesota Rules, part 9505.2200. 
16.12 	The department shall must send the notice by first class mail to the recipient's current address 
16.13 	on file with the department. A recipient placed in the Minnesota restricted recipient program 
16.14 	may contest the placement by submitting a written request for a hearing to the department 
16.15 	within 90 days of the notice being mailed.

16.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

16.17 	Sec. 18. Minnesota Statutes 2024, section 256B.064, subdivision 5, is amended to read:
16.18 		Subd. 5.Immunity; good faith reporters. (a) A person who makes a good faith report 
16.19 	is immune from any civil or criminal liability that might otherwise arise from reporting or 
16.20 	participating in the investigation. Nothing in this subdivision affects an individual's or 
16.21 	entity's responsibility for an overpayment established under this subdivision.
16.22 	(b) A person employed by a lead investigative agency who is conducting or supervising 
16.23 	an investigation or enforcing the law according to the applicable law or rule is immune from 
16.24 	any civil or criminal liability that might otherwise arise from the person's actions, if the 
16.25 	person is acting in good faith and exercising due care.
16.26 	(c) For purposes of this subdivision, "person" includes a natural person or any form of 
16.27 	a business or legal entity.
16.28 	(d) After an investigation is complete, the reporter's name must be kept confidential. 
16.29 	The subject of the report may compel disclosure of the reporter's name only with the consent 
16.30 	of the reporter or upon a written finding by a district court that the report was false and there 
16.31 	is evidence that the report was made in bad faith. This subdivision does not alter disclosure 
17.1 	responsibilities or obligations under the Rules of Criminal Procedure, except that when the 
17.2 	identity of the reporter is relevant to a criminal prosecution the district court shall must
17.3 	conduct an in-camera review before determining whether to order disclosure of the reporter's 
17.4 	identity.

17.5 	EFFECTIVE DATE. This section is effective the day following final enactment.

17.6 	Sec. 19. DIRECTION TO COMMISSIONER OF HUMAN SERVICES; MEDICAL 
17.7 	ASSISTANCE PROVIDER ENROLLMENT STANDARDS.
 17.8 	(a) By January 1, 2027, the commissioner of human services must make recommendations 
17.9 	to the chairs and ranking minority members of the legislative committees with jurisdiction 
17.10 	over human services policy and finance regarding statutory and program changes to ensure 
17.11 	only qualified, prepared, and financially stable providers are permitted to enroll as a medical 
17.12 	assistance provider type designated by the commissioner as high-risk under Minnesota 
17.13 	Statutes, section 256B.04, subdivision 21.
17.14 	(b) The commissioner must include in the recommendations enhanced provider enrollment 
17.15 	screening standards related to the provider's regulatory knowledge, operational readiness, 
17.16 	internal controls, financial liquidity and solvency, and capacity to comply with state and 
17.17 	federal Medicaid requirements.
17.18 	(c) In developing the recommendations, the commissioner must consult with the Health 
17.19 	Law Section of the Minnesota State Bar Association, representatives of the medical assistance 
17.20 	providers subject to the recommendations being considered, and other impacted groups.

17.21 	Sec. 20. DIRECTION TO COMMISSIONER OF HUMAN SERVICES; PROGRAM 
17.22 	INTEGRITY TECHNOLOGY MODERNIZATION.
 17.23 	By January 1, 2027, the commissioner of human services must develop recommendations 
17.24 	on how to modernize program integrity infrastructure within the Department of Human 
17.25 	Services. The recommendations must include the infrastructure's capability to provide 
17.26 	near-real-time analytics and risk scoring; prepayment review and anomaly detection; 
17.27 	cross-matching of enrollment data, licensure data, and claims data; and security dashboards 
17.28 	for audits and investigations with privacy safeguards. By January 15, 2027, the commissioner 
17.29 	must provide recommendations to the chairs and ranking minority members of the legislative 
17.30 	committees with jurisdiction over human services program integrity functions.

18.1 	Sec. 21. DIRECTION TO COMMISSIONER OF HUMAN SERVICES; PROGRAM 
18.2 	STRUCTURE AND DESIGN AUDITS.
 18.3 	(a) By August 1, 2026, the commissioner of human services must select and contract 
18.4 	with an independent research entity to conduct comprehensive program structure and design 
18.5 	audits on the services listed in paragraph (b). Each audit must identify structural incentive 
18.6 	misalignments; undue compliance burdens on good-faith providers; regulatory and billing 
18.7 	ambiguities; and gaps in utilization controls. Each audit must also provide evidence-based 
18.8 	redesign recommendations.
18.9 	(b) The services that must be audited by the independent research entity include:
18.10 	(1) adult companion services;
18.11 	(2) adult day services;
18.12 	(3) adult rehabilitative mental health services;
18.13 	(4) assertive community treatment;
18.14 	(5) community first services and supports;
18.15 	(6) early intensive developmental and behavioral intervention;
18.16 	(7) individualized home supports;
18.17 	(8) integrated community supports;
18.18 	(9) intensive residential treatment services;
18.19 	(10) night supervision services;
18.20 	(11) nonemergency medical transportation services;
18.21 	(12) peer recovery support services; and
18.22 	(13) recuperative care.
18.23 	(c) Each audit must be completed by January 1, 2027. The commissioner must submit 
18.24 	each completed audit report within 30 days of receipt to the chairs and ranking minority 
18.25 	members of the legislative committees with jurisdiction over human services program 
18.26 	integrity functions.

19.1 	ARTICLE 2
19.2 	MEDICAL ASSISTANCE PROVIDER ENROLLMENT MODIFICATIONS

19.3 	Section 1. Minnesota Statutes 2024, section 142B.01, subdivision 8, is amended to read:
19.4 		Subd. 8.Controlling individual. (a) "Controlling individual" means an owner of a 
19.5 	program or service provider licensed under this chapter and the following individuals, if 
19.6 	applicable:
19.7 	(1) each officer of the organization, including the chief executive officer and chief 
19.8 	financial officer;
19.9 	(2) the individual designated as the authorized agent under section 142B.10, subdivision 
19.10 	1, paragraph (b);
19.11 	(3) the individual designated as the compliance officer under section 256B.04, subdivision 
19.12 	21, paragraph (g) 256B.044, subdivision 8, paragraph (b);
19.13 	(4) each managerial official whose responsibilities include the direction of the 
19.14 	management or policies of a program;
19.15 	(5) the individual designated as the primary provider of care for a special family child 
19.16 	care program under section 142B.41, subdivision 4, paragraph (d); and
19.17 	(6) the president and treasurer of the board of directors of a nonprofit corporation.
19.18 	(b) Controlling individual does not include:
19.19 	(1) a bank, savings bank, trust company, savings association, credit union, industrial 
19.20 	loan and thrift company, investment banking firm, or insurance company unless the entity 
19.21 	operates a program directly or through a subsidiary;
19.22 	(2) an individual who is a state or federal official, or state or federal employee, or a 
19.23 	member or employee of the governing body of a political subdivision of the state or federal 
19.24 	government that operates one or more programs, unless the individual is also an officer, 
19.25 	owner, or managerial official of the program; receives remuneration from the program; or 
19.26 	owns any of the beneficial interests not excluded in this subdivision;
19.27 	(3) an individual who owns less than five percent of the outstanding common shares of 
19.28 	a corporation:
19.29 	(i) whose securities are exempt under section 80A.45, clause (6); or
19.30 	(ii) whose transactions are exempt under section 80A.46, clause (2);
20.1 	(4) an individual who is a member of an organization exempt from taxation under section 
20.2 	290.05, unless the individual is also an officer, owner, or managerial official of the program 
20.3 	or owns any of the beneficial interests not excluded in this subdivision. This clause does 
20.4 	not exclude from the definition of controlling individual an organization that is exempt from 
20.5 	taxation; or
20.6 	(5) an employee stock ownership plan trust, or a participant or board member of an 
20.7 	employee stock ownership plan, unless the participant or board member is a controlling 
20.8 	individual according to paragraph (a).
20.9 	(c) For purposes of this subdivision, "managerial official" means an individual who has 
20.10 	the decision-making authority related to the operation of the program, and the responsibility 
20.11 	for the ongoing management of or direction of the policies, services, or employees of the 
20.12 	program. A site director who has no ownership interest in the program is not considered to 
20.13 	be a managerial official for purposes of this definition.

20.14 	Sec. 2. Minnesota Statutes 2024, section 245A.02, subdivision 5a, is amended to read:
20.15 		Subd. 5a.Controlling individual. (a) "Controlling individual" means an owner of a 
20.16 	program or service provider licensed under this chapter and the following individuals, if 
20.17 	applicable:
20.18 	(1) each officer of the organization, including the chief executive officer and chief 
20.19 	financial officer;
20.20 	(2) the individual designated as the authorized agent under section 245A.04, subdivision 
20.21 	1, paragraph (b);
20.22 	(3) the individual designated as the compliance officer under section 256B.04, subdivision 
20.23 	21, paragraph (g) 256B.044, subdivision 8, paragraph (b);
20.24 	(4) each managerial official whose responsibilities include the direction of the 
20.25 	management or policies of a program; and
20.26 	(5) the president and treasurer of the board of directors of a nonprofit corporation.
20.27 	(b) Controlling individual does not include:
20.28 	(1) a bank, savings bank, trust company, savings association, credit union, industrial 
20.29 	loan and thrift company, investment banking firm, or insurance company unless the entity 
20.30 	operates a program directly or through a subsidiary;
20.31 	(2) an individual who is a state or federal official, or state or federal employee, or a 
20.32 	member or employee of the governing body of a political subdivision of the state or federal 
21.1 	government that operates one or more programs, unless the individual is also an officer, 
21.2 	owner, or managerial official of the program, receives remuneration from the program, or 
21.3 	owns any of the beneficial interests not excluded in this subdivision;
21.4 	(3) an individual who owns less than five percent of the outstanding common shares of 
21.5 	a corporation:
21.6 	(i) whose securities are exempt under section 80A.45, clause (6); or
21.7 	(ii) whose transactions are exempt under section 80A.46, clause (2);
21.8 	(4) an individual who is a member of an organization exempt from taxation under section 
21.9 	290.05, unless the individual is also an officer, owner, or managerial official of the program 
21.10 	or owns any of the beneficial interests not excluded in this subdivision. This clause does 
21.11 	not exclude from the definition of controlling individual an organization that is exempt from 
21.12 	taxation; or
21.13 	(5) an employee stock ownership plan trust, or a participant or board member of an 
21.14 	employee stock ownership plan, unless the participant or board member is a controlling 
21.15 	individual according to paragraph (a).
21.16 	(c) For purposes of this subdivision, "managerial official" means an individual who has 
21.17 	the decision-making authority related to the operation of the program, and the responsibility 
21.18 	for the ongoing management of or direction of the policies, services, or employees of the 
21.19 	program. A site director who has no ownership interest in the program is not considered to 
21.20 	be a managerial official for purposes of this definition.

21.21 	Sec. 3. Minnesota Statutes 2024, section 245D.081, subdivision 3, is amended to read:
21.22 		Subd. 3.Program management and oversight. (a) The license holder must designate 
21.23 	a managerial staff person or persons to provide program management and oversight of the 
21.24 	services provided by the license holder. The designated manager is responsible for the 
21.25 	following:
21.26 	(1) maintaining a current understanding of the licensing requirements sufficient to ensure 
21.27 	compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph 
21.28 	(e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph (g)
21.29 	256B.044, subdivision 8;
21.30 	(2) ensuring the duties of the designated coordinator are fulfilled according to the 
21.31 	requirements in subdivision 2;
22.1 	(3) ensuring the program implements corrective action identified as necessary by the 
22.2 	program following review of incident and emergency reports according to the requirements 
22.3 	in section 245D.11, subdivision 2, clause (7). An internal review of incident reports of 
22.4 	alleged or suspected maltreatment must be conducted according to the requirements in 
22.5 	section 245A.65, subdivision 1, paragraph (b);
22.6 	(4) evaluation of satisfaction of persons served by the program, the person's legal 
22.7 	representative, if any, and the case manager, with the service delivery and progress toward 
22.8 	accomplishing outcomes identified in sections 245D.07 and 245D.071, and ensuring and 
22.9 	protecting each person's rights as identified in section 245D.04;
22.10 	(5) ensuring staff competency requirements are met according to the requirements in 
22.11 	section 245D.09, subdivision 3, and ensuring staff orientation and training is provided 
22.12 	according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;
22.13 	(6) ensuring corrective action is taken when ordered by the commissioner and that the 
22.14 	terms and conditions of the license and any variances are met; and
22.15 	(7) evaluating the information identified in clauses (1) to (6) to develop, document, and 
22.16 	implement ongoing program improvements.
22.17 	(b) The designated manager must be competent to perform the duties as required and 
22.18 	must minimally meet the education and training requirements identified in subdivision 2, 
22.19 	paragraph (b), and have a minimum of three years of supervisory level experience in a 
22.20 	program that provides care or education to vulnerable adults or children.

22.21 	Sec. 4. Minnesota Statutes 2024, section 256B.04, subdivision 5, is amended to read:
22.22 		Subd. 5.Annual report required. The state agency within 60 days after the close of 
22.23 	each fiscal year, shall prepare and print for the fiscal year a report that includes: a full 
22.24 	account of the operations and expenditure of funds under this chapter,; a full account of the 
22.25 	activities undertaken in accordance with subdivision 10,; adequate and complete statistics 
22.26 	divided by counties about all medical assistance provided in accordance with this chapter,; 
22.27 	a full account of all pre-enrollment, postenrollment, and unannounced site visits to providers 
22.28 	under section 256B.044, subdivision 5; and any other information it may deem advisable.

23.1 	Sec. 5. Minnesota Statutes 2025 Supplement, section 256B.04, subdivision 21, is amended 
23.2 	to read:
23.3 		Subd. 21.Provider enrollment. (a) The commissioner shall enroll providers and conduct 
23.4 	screening activities as required by Code of Federal Regulations, title 42, section 455, subpart 
23.5 	E, and sections 256B.044 to 256B.0445.
23.6 	A provider must enroll each provider-controlled location where direct services are 
23.7 	provided. The commissioner may deny a provider's incomplete application if a provider 
23.8 	fails to respond to the commissioner's request for additional information within 60 days of 
23.9 	the request. The commissioner must conduct a background study under chapter 245C, 
23.10 	including a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses 
23.11 	(1) to (5), for a provider described in this paragraph. The background study requirement 
23.12 	may be satisfied if the commissioner conducted a fingerprint-based background study on 
23.13 	the provider that includes a review of databases in section 245C.08, subdivision 1, paragraph 
23.14 	(a), clauses (1) to (5).
23.15 	(b) The commissioner shall revalidate:
23.16 	(1) each provider under this subdivision at least once every five years;
23.17 	(2) each personal care assistance agency, CFSS provider-agency, and CFSS financial 
23.18 	management services provider under this subdivision at least once every three years;
23.19 	(3) each EIDBI agency under this subdivision at least once every three years; and
23.20 	(4) at the commissioner's discretion, any medical-assistance-only provider type the 
23.21 	commissioner deems "high-risk" under this subdivision.
23.22 	(c) The commissioner shall conduct revalidation as follows:
23.23 	(1) provide 30-day notice of the revalidation due date including instructions for 
23.24 	revalidation and a list of materials the provider must submit;
23.25 	(2) if a provider fails to submit all required materials by the due date, notify the provider 
23.26 	of the deficiency within 30 days after the due date and allow the provider an additional 30 
23.27 	days from the notification date to comply; and
23.28 	(3) if a provider fails to remedy a deficiency within the 30-day time period, give 60-day 
23.29 	notice of termination and immediately suspend the provider's ability to bill. The provider 
23.30 	does not have the right to appeal suspension of ability to bill.
23.31 	(d) If a provider fails to comply with any individual provider requirement or condition 
23.32 	of participation, the commissioner may suspend the provider's ability to bill until the provider 
24.1 	comes into compliance. The commissioner's decision to suspend the provider is not subject 
24.2 	to an administrative appeal.
24.3 	(e) Correspondence and notifications, including notifications of termination and other 
24.4 	actions, may be delivered electronically to a provider's MN-ITS mailbox. This paragraph 
24.5 	does not apply to correspondences and notifications related to background studies.
24.6 	(f) If the commissioner or the Centers for Medicare and Medicaid Services determines 
24.7 	that a provider is designated "high-risk," the commissioner may withhold payment from 
24.8 	providers within that category upon initial enrollment for a 90-day period. The withholding 
24.9 	for each provider must begin on the date of the first submission of a claim.
24.10 	(g) An enrolled provider that is also licensed by the commissioner under chapter 245A, 
24.11 	is licensed as a home care provider by the Department of Health under chapter 144A, or is 
24.12 	licensed as an assisted living facility under chapter 144G and has a home and 
24.13 	community-based services designation on the home care license under section 144A.484, 
24.14 	must designate an individual as the entity's compliance officer. The compliance officer 
24.15 	must:
24.16 	(1) develop policies and procedures to assure adherence to medical assistance laws and 
24.17 	regulations and to prevent inappropriate claims submissions;
24.18 	(2) train the employees of the provider entity, and any agents or subcontractors of the 
24.19 	provider entity including billers, on the policies and procedures under clause (1);
24.20 	(3) respond to allegations of improper conduct related to the provision or billing of 
24.21 	medical assistance services, and implement action to remediate any resulting problems;
24.22 	(4) use evaluation techniques to monitor compliance with medical assistance laws and 
24.23 	regulations;
24.24 	(5) promptly report to the commissioner any identified violations of medical assistance 
24.25 	laws or regulations; and
24.26 	(6) within 60 days of discovery by the provider of a medical assistance reimbursement 
24.27 	overpayment, report the overpayment to the commissioner and make arrangements with 
24.28 	the commissioner for the commissioner's recovery of the overpayment.
24.29 	The commissioner may require, as a condition of enrollment in medical assistance, that a 
24.30 	provider within a particular industry sector or category establish a compliance program that 
24.31 	contains the core elements established by the Centers for Medicare and Medicaid Services.
25.1 	(h) The commissioner may revoke the enrollment of an ordering or rendering provider 
25.2 	for a period of not more than one year, if the provider fails to maintain and, upon request 
25.3 	from the commissioner, provide access to documentation relating to written orders or requests 
25.4 	for payment for durable medical equipment, certifications for home health services, or 
25.5 	referrals for other items or services written or ordered by such provider, when the 
25.6 	commissioner has identified a pattern of a lack of documentation. A pattern means a failure 
25.7 	to maintain documentation or provide access to documentation on more than one occasion. 
25.8 	Nothing in this paragraph limits the authority of the commissioner to sanction a provider 
25.9 	under the provisions of section 256B.064.
25.10 	(i) The commissioner shall terminate or deny the enrollment of any individual or entity 
25.11 	if the individual or entity has been terminated from participation in Medicare or under the 
25.12 	Medicaid program or Children's Health Insurance Program of any other state. The 
25.13 	commissioner may exempt a rehabilitation agency from termination or denial that would 
25.14 	otherwise be required under this paragraph, if the agency:
25.15 	(1) is unable to retain Medicare certification and enrollment solely due to a lack of billing 
25.16 	to the Medicare program;
25.17 	(2) meets all other applicable Medicare certification requirements based on an on-site 
25.18 	review completed by the commissioner of health; and
25.19 	(3) serves primarily a pediatric population.
25.20 	(j) As a condition of enrollment in medical assistance, the commissioner shall require 
25.21 	that a provider designated "moderate" or "high-risk" by the Centers for Medicare and 
25.22 	Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid 
25.23 	Services, its agents, or its designated contractors and the state agency, its agents, or its 
25.24 	designated contractors to conduct unannounced on-site inspections of any provider location. 
25.25 	The commissioner shall publish in the Minnesota Health Care Program Provider Manual a 
25.26 	list of provider types designated "limited," "moderate," or "high-risk," based on the criteria 
25.27 	and standards used to designate Medicare providers in Code of Federal Regulations, title 
25.28 	42, section 424.518. The list and criteria are not subject to the requirements of chapter 14. 
25.29 	The commissioner's designations are not subject to administrative appeal.
25.30 	(k) As a condition of enrollment in medical assistance, the commissioner shall require 
25.31 	that a high-risk provider, or a person with a direct or indirect ownership interest in the 
25.32 	provider of five percent or higher, consent to criminal background checks, including 
25.33 	fingerprinting, when required to do so under state law or by a determination by the 
26.1 	commissioner or the Centers for Medicare and Medicaid Services that a provider is designated 
26.2 	high-risk for fraud, waste, or abuse.
26.3 	(l)(1) Upon initial enrollment, reenrollment, and notification of revalidation, all durable 
26.4 	medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers 
26.5 	meeting the durable medical equipment provider and supplier definition in clause (3), 
26.6 	operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is 
26.7 	annually renewed and designates the Minnesota Department of Human Services as the 
26.8 	obligee, and must be submitted in a form approved by the commissioner. For purposes of 
26.9 	this clause, the following medical suppliers are not required to obtain a surety bond: a 
26.10 	federally qualified health center, a home health agency, the Indian Health Service, a 
26.11 	pharmacy, and a rural health clinic.
26.12 	(2) At the time of initial enrollment or reenrollment, durable medical equipment providers 
26.13 	and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating 
26.14 	provider's Medicaid revenue in the previous calendar year is up to and including $300,000, 
26.15 	the provider agency must purchase a surety bond of $50,000. If a revalidating provider's 
26.16 	Medicaid revenue in the previous calendar year is over $300,000, the provider agency must 
26.17 	purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and 
26.18 	fees in pursuing a claim on the bond. Any action to obtain monetary recovery or sanctions 
26.19 	from a surety bond must occur within six years from the date the debt is affirmed by a final 
26.20 	agency decision. An agency decision is final when the right to appeal the debt has been 
26.21 	exhausted or the time to appeal has expired under section 256B.064.
26.22 	(3) "Durable medical equipment provider or supplier" means a medical supplier that can 
26.23 	purchase medical equipment or supplies for sale or rental to the general public and is able 
26.24 	to perform or arrange for necessary repairs to and maintenance of equipment offered for 
26.25 	sale or rental.
26.26 	(m) The Department of Human Services may require a provider to purchase a surety 
26.27 	bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment 
26.28 	if: (1) the provider fails to demonstrate financial viability, (2) the department determines 
26.29 	there is significant evidence of or potential for fraud and abuse by the provider, or (3) the 
26.30 	provider or category of providers is designated high-risk pursuant to paragraph (f) and as 
26.31 	per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in an 
26.32 	amount of $100,000 or ten percent of the provider's payments from Medicaid during the 
26.33 	immediately preceding 12 months, whichever is greater. The surety bond must name the 
26.34 	Department of Human Services as an obligee and must allow for recovery of costs and fees 
26.35 	in pursuing a claim on the bond. This paragraph does not apply if the provider currently 
27.1 	maintains a surety bond under the requirements in section 256B.051, 256B.0659, 256B.0701, 
27.2 	or 256B.85.

27.3 	Sec. 6. [256B.044] PROVIDER ENROLLMENT.
27.4 		Subdivision 1.Designating categorical risk levels. (a) The commissioner must designate 
27.5 	provider types as "limited-risk," "moderate-risk," or "high-risk" based on the criteria and 
27.6 	standards used to designate Medicare providers in Code of Federal Regulations, title 42, 
27.7 	section 424.518. The commissioner must publish a list of provider types and designated 
27.8 	categorical risk levels in the Minnesota Health Care Program Provider Manual.
27.9 	(b) The list and criteria are not subject to the requirements of chapter 14, and section 
27.10 	14.386 does not apply.
27.11 	(c) The commissioner's designations are not subject to administrative appeal.
27.12 		Subd. 2.Required verifications and checks. The commissioner must perform the 
27.13 	following verifications and checks prior to making an enrollment determination and 
27.14 	periodically thereafter:
27.15 	(1) verify that the provider meets applicable federal and state requirements for the 
27.16 	provider type;
27.17 	(2) conduct license verifications, as applicable, including verification of current licensure 
27.18 	in Minnesota and in any other state in which the provider is or was previously licensed, in 
27.19 	accordance with Code of Federal Regulations, title 42, section 455.412;
27.20 	(3) conduct database checks on a pre-enrollment and postenrollment basis to ensure that 
27.21 	the provider continues to meet the enrollment criteria for the provider type, in accordance 
27.22 	with Code of Federal Regulations, title 42, section 455.436;
27.23 	(4) confirm that the provider and any disclosed owners, managing employees, or 
27.24 	controlling individuals are not excluded from participation in any state's Medicaid program, 
27.25 	Medicare, or any other federal health care program;
27.26 	(5) verify the provider's National Provider Identifier and, as applicable, Medicare 
27.27 	enrollment status;
27.28 	(6) verify the provider's tax identification number and business registration status;
27.29 	(7) verify the provider's ownership and control disclosures as required under federal 
27.30 	law; and
28.1 	(8) conduct any additional screenings, verifications, or reviews that are necessary to 
28.2 	protect the integrity of the medical assistance program or that are required under federal 
28.3 	law.
28.4 		Subd. 3.Required background studies. (a) The commissioner must conduct a 
28.5 	background study under chapter 245C, for a provider applying for enrollment. The 
28.6 	background study must include a review of databases in section 245C.08, subdivision 1, 
28.7 	paragraph (a), clauses (1) to (5), and any other databases required under federal law.
28.8 	(b) The commissioner must conduct a background study under this subdivision for each 
28.9 	individual with an ownership or control interest in, or who is an officer, director, agent, 
28.10 	managing employee, or other person with operational or managerial control of the provider.
28.11 	(c) Fingerprint-based studies are required when mandated by federal law or when a 
28.12 	provider is designated moderate-risk or high-risk under subdivision 1.
28.13 	(d) The commissioner may conduct background studies postenrollment as necessary.
28.14 	(e) A provider's failure to submit to the commissioner the information required for a 
28.15 	background study under this subdivision is grounds for denial or termination of enrollment 
28.16 	in medical assistance.
28.17 	(f) A provider's enrollment must be denied or terminated if a provider or individual 
28.18 	subject to a background study under this subdivision is disqualified under chapter 245C or 
28.19 	is excluded from participating in any federal health care programs.
28.20 		Subd. 4.Service location enrollment. (a) A provider must enroll each provider-controlled 
28.21 	location where direct services are provided. "Provider-controlled location" means a physical 
28.22 	site owned, leased, operated, or otherwise controlled by the provider.
28.23 	(b) Providers must report all provider-controlled locations where direct services are 
28.24 	provided to the commissioner and obtain approval before billing for services provided at a 
28.25 	new location.
28.26 	(c) Separate enrollment is not required for services provided in a recipient's home or 
28.27 	community setting, telehealth services delivered from an enrolled site, compliant mobile 
28.28 	services, or other federally permissible exemptions.
28.29 	(d) A provider's failure to enroll each provider-controlled location where direct services 
28.30 	are provided is grounds for sanctions under section 256B.064.
28.31 		Subd. 5.Site visits. (a) As a condition of enrollment in medical assistance, the 
28.32 	commissioner shall require that a provider permit the Centers for Medicare and Medicaid 
29.1 	Services (CMS), CMS's agents, or CMS's designated contractors and the Department of 
29.2 	Human Services (DHS), DHS's agents, or DHS's designated contractors to conduct 
29.3 	unannounced site visits of any of a provider's enrolled locations.
29.4 	(b) At a minimum, the commissioner must conduct the following site visits at each of 
29.5 	a provider's enrolled locations:
29.6 	(1) pre-enrollment site visits for providers designated as moderate-risk or high-risk under 
29.7 	subdivision 1;
29.8 	(2) postenrollment site visits for providers designated as moderate-risk or high-risk under 
29.9 	subdivision 1; and
29.10 	(3) unannounced site visits, as follows:
29.11 	(i) prior to payment of the provider's first claim after enrollment, when required under 
29.12 	federal law or due to program integrity concerns;
29.13 	(ii) within 12 months after the provider begins to bill claims; and
29.14 	(iii) prior to revalidation under section 256B.0441, subdivision 3.
29.15 	(c) The commissioner may conduct additional announced or unannounced site visits 
29.16 	when necessary to verify compliance with enrollment requirements or to protect program 
29.17 	integrity.
29.18 	(d) A provider's failure to permit a required site visit is grounds for denial, suspension, 
29.19 	or termination of enrollment and may result in denial of claims or recoupment of payments.
29.20 		Subd. 6.Surety bonds. (a) The commissioner must require a provider to purchase a 
29.21 	surety bond as a condition of initial enrollment, reenrollment, revalidation, reinstatement, 
29.22 	or continued enrollment if:
29.23 	(1) the provider fails to demonstrate financial viability;
29.24 	(2) the commissioner determines there is significant evidence of or potential for fraud 
29.25 	and abuse by the provider; or
29.26 	(3) the provider or category of providers is designated high-risk pursuant to subdivision 
29.27 	1.
29.28 	(b) The surety bond must be in an amount of $100,000 or ten percent of the provider's 
29.29 	payments from Medicaid during the immediately preceding 12 months, whichever is greater. 
29.30 	The surety bond must name DHS as an obligee and must allow for recovery of costs and 
29.31 	fees in pursuing a claim on the bond.
30.1 	(c) This subdivision does not apply if the provider currently maintains a surety bond 
30.2 	under the requirements in section 256B.051, 256B.0659, 256B.0701, or 256B.85.
30.3 		Subd. 7.Financial capacity. As a condition of enrolling in medical assistance, the 
30.4 	commissioner must require, in a form and manner prescribed by the commissioner, that a 
30.5 	provider demonstrate sufficient financial capacity to operate, repay improper payments, 
30.6 	and make payroll for 90 days.
30.7 		Subd. 8.Compliance programs. (a) The commissioner may require, as a condition of 
30.8 	enrollment in medical assistance, that a provider in a particular industry, of a particular 
30.9 	provider type, or with a particular risk categorization under subdivision 1, establish and 
30.10 	maintain a compliance program consistent with federal program integrity guidance issued 
30.11 	by CMS or the United States Department of Health and Human Services Office of Inspector 
30.12 	General.
30.13 	(b) If an enrolled provider is required by the commissioner or by federal or state law to 
30.14 	designate an individual as the provider's compliance officer, the provider must appoint an 
30.15 	individual responsible for implementing and overseeing the compliance program.
30.16 	(c) At a minimum, the compliance program must include policies and procedures designed 
30.17 	to:
30.18 	(1) ensure adherence to federal and state laws and program requirements governing 
30.19 	medical assistance and prevent the submission of improper claims;
30.20 	(2) train employees, agents, contractors, and subcontractors, including billing personnel, 
30.21 	on applicable federal and state laws and program requirements;
30.22 	(3) establish procedures for receiving, investigating, and responding to allegations of 
30.23 	improper conduct and for implementing corrective actions;
30.24 	(4) use auditing, monitoring, or other evaluation techniques to assess ongoing compliance;
30.25 	(5) promptly report to the commissioner any credible evidence of violations of federal 
30.26 	and state laws or regulations governing medical assistance; and
30.27 	(6) report and return identified medical assistance overpayments within 60 days after 
30.28 	discovery or by the date any corresponding cost report is due, whichever is later, in 
30.29 	accordance with federal law.
30.30 		Subd. 9.Incomplete provider enrollment applications. The commissioner must deny 
30.31 	a provider's incomplete enrollment application if a provider fails to respond to the 
30.32 	commissioner's request for additional information within 60 days of the request.
31.1 		Subd. 10.Correspondence and notification. The commissioner must deliver 
31.2 	correspondence and notifications, including notifications of termination and other actions, 
31.3 	electronically to a provider's MN-ITS mailbox. This subdivision does not apply to 
31.4 	correspondences and notifications related to background studies.

31.5 	Sec. 7. [256B.0441] PROVIDER REVALIDATION.
31.6 		Subdivision 1.Requirement. The commissioner must revalidate each enrolled provider 
31.7 	according to this section.
31.8 		Subd. 2.Schedule. (a) The commissioner shall revalidate:
31.9 	(1) each provider at least once every five years;
31.10 	(2) each personal care assistance agency, CFSS provider-agency, and CFSS financial 
31.11 	management services provider at least once every three years;
31.12 	(3) each EIDBI agency at least once every three years; and
31.13 	(4) each medical-assistance-only provider type the commissioner deems high-risk under 
31.14 	section 256B.044, subdivision 1, at least every three years.
31.15 	(b) The commissioner must conduct revalidation of a provider more frequently when 
31.16 	required under federal law or when necessary to protect program integrity.
31.17 		Subd. 3.Procedures. (a) The commissioner shall conduct revalidation as follows:
31.18 	(1) provide 30-day notice to the provider of the provider's revalidation due date, including 
31.19 	instructions for revalidation, a list of materials the provider must submit, and a notice about 
31.20 	the unannounced site visit required under paragraph (b);
31.21 	(2) if a provider fails to submit all required materials or satisfy the requirements of 
31.22 	paragraph (b) by the due date, notify the provider of the deficiency within 14 days after the 
31.23 	due date and allow the provider an additional 14 days from the notification date to comply; 
31.24 	and
31.25 	(3) if a provider fails to remedy a deficiency within the additional 28-day time period, 
31.26 	give 15-day notice of termination and immediately suspend the provider's ability to bill. 
31.27 	The commissioner's decision to suspend the provider's ability to bill is not subject to an 
31.28 	administrative appeal.
31.29 	(b) The commissioner must conduct unannounced site visits at each of a provider's 
31.30 	enrolled locations under section 256B.044, subdivision 4, no more than 30 days prior to the 
31.31 	provider's revalidation due date.
32.1 	(c) A provider must demonstrate financial capacity, as described under section 256B.044, 
32.2 	subdivision 7, as a requirement of revalidation under this subdivision.

32.3 	Sec. 8. [256B.0442] PROVIDER ENROLLMENT SUSPENSIONS AND 
32.4 	TERMINATIONS.
32.5 		Subdivision 1.Suspension of billing privileges. (a) If a provider fails to comply with 
32.6 	any individual provider requirement or condition of participation, the commissioner must 
32.7 	suspend the provider's ability to bill until the provider comes into compliance.
32.8 	(b) Notwithstanding any law to the contrary, the commissioner may immediately impose 
32.9 	a suspension under this subdivision when necessary to protect public funds or ensure program 
32.10 	integrity.
32.11 	(c) A suspension under this subdivision does not limit the authority of the commissioner 
32.12 	to issue any other sanction authorized under federal or state law.
32.13 	(d) The commissioner's decision to suspend a provider's ability to bill is not subject to 
32.14 	an administrative appeal.
32.15 		Subd. 2.Revocation for lack of documentation. (a) The commissioner may revoke 
32.16 	the enrollment of an ordering or rendering provider for a period of not more than one year 
32.17 	if the provider fails to maintain and, upon request from the commissioner, provide access 
32.18 	to documentation relating to written orders or requests for payment for durable medical 
32.19 	equipment, certifications for home health services, or referrals for other items or services 
32.20 	written or ordered by the provider when the commissioner has identified a pattern of a lack 
32.21 	of documentation. A pattern means a failure to maintain documentation or provide access 
32.22 	to documentation on more than one occasion.
32.23 	(b) Nothing in this subdivision limits the authority of the commissioner to sanction a 
32.24 	provider under the provisions of section 256B.064.
32.25 		Subd. 3.Mandatory denial or termination of enrollment. (a) The commissioner must 
32.26 	terminate or deny the enrollment of a provider when:
32.27 	(1) an individual with a five percent or greater direct or indirect ownership interest in 
32.28 	the provider does not submit timely and accurate information and cooperate with the 
32.29 	screening methods required under section 256B.044;
32.30 	(2) an individual with a five percent or greater direct or indirect ownership interest in 
32.31 	the provider has been convicted of a criminal offense related to the individual's involvement 
32.32 	in Medicare, Medicaid, or the Children's Health Insurance Program in the last ten years, 
33.1 	unless the commissioner determines that denial or termination of enrollment is not in the 
33.2 	best interests of the medical assistance program and the commissioner documents that 
33.3 	determination in writing;
33.4 	(3) the provider or an individual was terminated from participation in Medicare on or 
33.5 	after January 1, 2011, or under a Medicaid program or Children's Health Insurance Program 
33.6 	of any other state, and is currently included in the termination database under Code of 
33.7 	Federal Regulations, title 42, section 455.417, except as provided in paragraph (b);
33.8 	(4) the provider, or an individual with an ownership or control interest or who is an agent 
33.9 	or managing employee of the provider, fails to submit timely or accurate information, unless 
33.10 	the commissioner determines that termination or denial of enrollment is not in the best 
33.11 	interests of the medical assistance program and the commissioner documents that 
33.12 	determination in writing;
33.13 	(5) the provider, or an individual with a five percent or greater direct or indirect ownership 
33.14 	interest in the provider, fails to submit sets of fingerprints in a form and manner determined 
33.15 	by the commissioner within 30 days of a request from CMS or the commissioner, unless 
33.16 	the commissioner determines that termination or denial of enrollment is not in the best 
33.17 	interests of the medical assistance program and the commissioner documents that 
33.18 	determination in writing;
33.19 	(6) the provider fails to permit access to provider locations for any site visits under 
33.20 	section 256B.044, subdivision 5, unless the commissioner determines that termination or 
33.21 	denial of enrollment is not in the best interests of the medical assistance program and the 
33.22 	commissioner documents that determination in writing; or
33.23 	(7) CMS or the commissioner determines that the provider has falsified any information 
33.24 	provided on the application or cannot verify the identity of any provider applicant.
33.25 	(b) The commissioner may exempt a rehabilitation agency from termination or denial 
33.26 	that would otherwise be required under paragraph (a), clause (3), if the agency:
33.27 	(1) is unable to retain Medicare certification and enrollment solely due to a lack of billing 
33.28 	to the Medicare program;
33.29 	(2) meets all other applicable Medicare certification requirements based on an on-site 
33.30 	review completed by the commissioner of health; and
33.31 	(3) serves primarily a pediatric population.

34.1 	Sec. 9. [256B.0443] PROVIDER PAYMENT WITHHOLDS.
34.2 	(a) If the commissioner or the Centers for Medicare and Medicaid Services designate a 
34.3 	provider type as high-risk under section 256B.044, subdivision 1, the commissioner may 
34.4 	withhold payment from providers within that category upon initial enrollment for a 90-day 
34.5 	period.
34.6 	(b) The withholding for each provider must begin on the date of the first submission of 
34.7 	a claim.

34.8 	Sec. 10. [256B.0444] ENROLLMENT MORATORIUM FOR HIGH-RISK 
34.9 	PROVIDERS.
34.10 		Subdivision 1.Provider enrollment moratorium. (a) If the commissioner or the Centers 
34.11 	for Medicare and Medicaid Services (CMS) designates a provider type as high-risk under 
34.12 	section 256B.044, subdivision 1, the commissioner may issue a statewide or regional 
34.13 	enrollment moratorium and stop accepting and processing applications from providers 
34.14 	within that category within 30 days of the date of the designation or upon federal approval 
34.15 	of the moratorium, whichever is later. A moratorium issued under this section is effective 
34.16 	for a period of up to 24 months from the date the moratorium is issued.
34.17 	(b) Before ending the moratorium under this section, the commissioner must revalidate 
34.18 	the enrollment of each provider within the affected category in accordance with the 
34.19 	revalidation procedures under section 256B.0441, subdivision 2.
34.20 		Subd. 2.Continued enrollment of new clients. Nothing in this section prohibits an 
34.21 	enrolled provider subject to a moratorium under this section from enrolling new clients or 
34.22 	beneficiaries during the period of the enrollment moratorium.
34.23 		Subd. 3.Notice. At least ten days prior to issuing an enrollment moratorium under this 
34.24 	section, the commissioner must notify enrolled providers within the affected category and 
34.25 	the chairs and ranking minority members of the legislative committees with jurisdiction 
34.26 	over health and human services about the actions the commissioner plans to take under this 
34.27 	section. The notice must:
34.28 	(1) include a list of provider types to which the moratorium applies;
34.29 	(2) provide a general explanation for the basis of the high-risk designation; and
34.30 	(3) identify the start dates and anticipated durations of the enrollment moratorium.
34.31 		Subd. 4.Report to legislature. Within 60 days of ending an enrollment moratorium 
34.32 	under this section, the commissioner must submit a report to the chairs and ranking minority 
35.1 	members of the legislative committees with jurisdiction over health and human services. 
35.2 	The report must include, at a minimum:
35.3 	(1) a summary of any sanctions imposed under section 256B.064 on any providers subject 
35.4 	to the moratorium; and
35.5 	(2) recommendations for modifying or terminating the provision of covered services 
35.6 	delivered by provider types subject to the moratorium.

35.7 	Sec. 11. [256B.0445] ADDITIONAL PROVIDER ENROLLMENT REQUIREMENTS 
35.8 	FOR SPECIFIC PROVIDER TYPES.
35.9 		Subdivision 1.Durable medical equipment provider or supplier. (a) For the purposes 
35.10 	of this subdivision, "durable medical equipment provider or supplier" means a medical 
35.11 	supplier that can purchase medical equipment or supplies for sale or rent to the general 
35.12 	public and is able to perform or arrange for necessary repairs to and maintenance of 
35.13 	equipment offered for sale or rent.
35.14 	(b) Upon initial enrollment, reenrollment, and notification of revalidation, all durable 
35.15 	medical equipment, prosthetics, orthotics, and supplies medical suppliers meeting the durable 
35.16 	medical equipment provider or supplier definition in paragraph (a), operating in Minnesota, 
35.17 	and receiving Medicaid money must purchase a surety bond that is annually renewed, 
35.18 	designates the state agency as the obligee, and is submitted in a form approved by the 
35.19 	commissioner. For purposes of this paragraph, the following medical suppliers are not 
35.20 	required to obtain a surety bond: a federally qualified health center, a home health agency, 
35.21 	the Indian Health Service, a pharmacy, and a rural health clinic.
35.22 	(c) At the time of initial enrollment or reenrollment, durable medical equipment providers 
35.23 	or suppliers defined in paragraph (a) must purchase a surety bond of $50,000. If a revalidating 
35.24 	provider's Medicaid revenue in the previous calendar year is up to and including $300,000, 
35.25 	the provider agency must purchase a surety bond of $50,000. If a revalidating provider's 
35.26 	Medicaid revenue in the previous calendar year is over $300,000, the provider agency must 
35.27 	purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and 
35.28 	fees in pursuing a claim on the bond. Any action to obtain monetary recovery or sanctions 
35.29 	from a surety bond must occur within six years from the date the debt is affirmed by a final 
35.30 	agency decision. An agency decision is final when the right to appeal the debt has been 
35.31 	exhausted or the time to appeal has expired under section 256B.064.
35.32 		Subd. 2.Providers licensed by the commissioner of human services. An enrolled 
35.33 	provider that is licensed by the commissioner under chapter 245A must designate an 
36.1 	individual as the licensee's compliance officer under section 256B.044, subdivision 8, 
36.2 	paragraph (b).
36.3 		Subd. 3.Providers licensed by the commissioner of health. An enrolled provider that 
36.4 	is licensed by the commissioner of health as a home care provider under chapter 144A with 
36.5 	a home and community-based services designation under section 144A.484 on the home 
36.6 	care license, or as an assisted living facility under chapter 144G, must designate an individual 
36.7 	as the licensee's compliance officer under section 256B.044, subdivision 8, paragraph (b).

36.8 	Sec. 12. Minnesota Statutes 2025 Supplement, section 256B.0759, subdivision 4, is 
36.9 	amended to read:
36.10 		Subd. 4.Provider payment rates. (a) Payment rates for participating providers must 
36.11 	be increased for services provided to medical assistance enrollees. To receive a rate increase, 
36.12 	participating providers must meet demonstration project requirements and provide evidence 
36.13 	of formal referral arrangements with providers delivering step-up or step-down levels of 
36.14 	care. Providers that have enrolled in the demonstration project but have not met the provider 
36.15 	standards under subdivision 3 as of July 1, 2022, are not eligible for a rate increase under 
36.16 	this subdivision until the date that the provider meets the provider standards in subdivision 
36.17 	3. Services provided from July 1, 2022, to the date that the provider meets the provider 
36.18 	standards under subdivision 3 shall be reimbursed at rates according to section 254B.0505, 
36.19 	subdivision 1. Rate increases paid under this subdivision to a provider for services provided 
36.20 	between July 1, 2021, and July 1, 2022, are not subject to recoupment when the provider 
36.21 	is taking meaningful steps to meet demonstration project requirements that are not otherwise 
36.22 	required by law, and the provider provides documentation to the commissioner, upon request, 
36.23 	of the steps being taken.
36.24 	(b) The commissioner may temporarily suspend payments to the provider according to 
36.25 	section 256B.04, subdivision 21, paragraph (d) 256B.0442, subdivision 1, if the provider 
36.26 	does not meet the requirements in paragraph (a). Payments withheld from the provider must 
36.27 	be made once the commissioner determines that the requirements in paragraph (a) are met.
36.28 	(c) For outpatient individual and group substance use disorder services under section 
36.29 	254B.0505, subdivision 1, clause (1), and adolescent treatment programs that are licensed 
36.30 	as outpatient treatment programs according to sections 245G.01 to 245G.18, provided on 
36.31 	or after January 1, 2021, payment rates must be increased by 20 percent over the rates in 
36.32 	effect on December 31, 2020.
36.33 	(d) Effective January 1, 2021, and contingent on annual federal approval, managed care 
36.34 	plans and county-based purchasing plans must reimburse providers of the substance use 
37.1 	disorder services meeting the criteria described in paragraph (a) who are employed by or 
37.2 	under contract with the plan an amount that is at least equal to the fee-for-service base rate 
37.3 	payment for the substance use disorder services described in paragraph (c). The commissioner 
37.4 	must monitor the effect of this requirement on the rate of access to substance use disorder 
37.5 	services and residential substance use disorder rates. Capitation rates paid to managed care 
37.6 	organizations and county-based purchasing plans must reflect the impact of this requirement. 
37.7 	This paragraph expires if federal approval is not received at any time as required under this 
37.8 	paragraph.
37.9 	(e) Effective July 1, 2021, contracts between managed care plans and county-based 
37.10 	purchasing plans and providers to whom paragraph (d) applies must allow recovery of 
37.11 	payments from those providers if, for any contract year, federal approval for the provisions 
37.12 	of paragraph (d) is not received, and capitation rates are adjusted as a result. Payment 
37.13 	recoveries must not exceed the amount equal to any decrease in rates that results from this 
37.14 	provision.
37.15 	(f) For substance use disorder services with medications for opioid use disorder under 
37.16 	section 254B.0505, subdivision 1, clause (7), provided on or after January 1, 2021, payment 
37.17 	rates must be increased by 20 percent over the rates in effect on December 31, 2020. Upon 
37.18 	implementation of new rates according to section 254B.121, the 20 percent increase will 
37.19 	no longer apply.

37.20 	Sec. 13. Minnesota Statutes 2025 Supplement, section 256B.0949, subdivision 16, is 
37.21 	amended to read:
37.22 		Subd. 16.Agency duties. (a) An agency delivering an EIDBI service under this section 
37.23 	must:
37.24 	(1) enroll as a medical assistance Minnesota health care program provider according to 
37.25 	Minnesota Rules, part 9505.0195, and section 256B.04, subdivision 21 sections 256B.044 
37.26 	to 256B.0445, and meet all applicable provider standards and requirements;
37.27 	(2) designate an individual as the agency's compliance officer who must perform the 
37.28 	duties described in section 256B.04, subdivision 21, paragraph (g) 256B.044, subdivision 
37.29 	8, paragraph (b);
37.30 	(3) demonstrate compliance with federal and state laws for the delivery of and billing 
37.31 	for EIDBI service;
37.32 	(4) verify and maintain records of a service provided to the person or the person's legal 
37.33 	representative as required under Minnesota Rules, parts 9505.2175 and 9505.2197;
38.1 	(5) demonstrate that while enrolled or seeking enrollment as a Minnesota health care 
38.2 	program provider the agency did not have a lead agency contract or provider agreement 
38.3 	discontinued because of a conviction of fraud; or did not have an owner, board member, or 
38.4 	manager fail a state or federal criminal background check or appear on the list of excluded 
38.5 	individuals or entities maintained by the federal Department of Human Services Office of 
38.6 	Inspector General;
38.7 	(6) have established business practices including written policies and procedures, internal 
38.8 	controls, and a system that demonstrates the organization's ability to deliver quality EIDBI 
38.9 	services, appropriately submit claims, conduct required staff training, document staff 
38.10 	qualifications, document service activities, and document service quality;
38.11 	(7) have an office located in Minnesota or a border state;
38.12 	(8) initiate a background study as required under subdivision 16a;
38.13 	(9) report maltreatment according to section 626.557 and chapter 260E;
38.14 	(10) comply with any data requests consistent with the Minnesota Government Data 
38.15 	Practices Act, sections 256B.064 and 256B.27;
38.16 	(11) provide training for all agency staff on the requirements and responsibilities listed 
38.17 	in the Maltreatment of Minors Act, chapter 260E, and the Vulnerable Adult Protection Act, 
38.18 	section 626.557, including mandated and voluntary reporting, nonretaliation, and the agency's 
38.19 	policy for all staff on how to report suspected abuse and neglect;
38.20 	(12) have a written policy to resolve issues collaboratively with the person and the 
38.21 	person's legal representative when possible. The policy must include a timeline for when 
38.22 	the person and the person's legal representative will be notified about issues that arise in 
38.23 	the provision of services;
38.24 	(13) provide the person's legal representative with prompt notification if the person is 
38.25 	injured while being served by the agency. An incident report must be completed by the 
38.26 	agency staff member in charge of the person. A copy of all incident and injury reports must 
38.27 	remain on file at the agency for at least five years from the report of the incident;
38.28 	(14) before starting a service, provide the person or the person's legal representative a 
38.29 	description of the treatment modality that the person shall receive, including the staffing 
38.30 	certification levels and training of the staff who shall provide a treatment;
38.31 	(15) provide clinical supervision for a minimum of one hour for every 16 hours of direct 
38.32 	treatment per person, unless otherwise authorized in the person's individual treatment plan; 
38.33 	and
39.1 	(16) provide required EIDBI intervention observation and direction at least once per 
39.2 	month. Notwithstanding subdivision 13, paragraph (l), required EIDBI intervention 
39.3 	observation and direction under this clause may be conducted via telehealth provided that 
39.4 	no more than two consecutive monthly required EIDBI intervention observation and direction 
39.5 	sessions under this clause are conducted via telehealth.
39.6 	(b) Upon request of the commissioner, an agency delivering services under this section 
39.7 	must:
39.8 	(1) identify the agency's controlling individuals, as defined under section 245A.02, 
39.9 	subdivision 5a;
39.10 	(2) provide disclosures of the use of billing agencies and other consultants who do not 
39.11 	provide EIDBI services; and
39.12 	(3) provide copies of any contracts with consultants or independent contractors who do 
39.13 	not provide EIDBI services, including hours contracted and responsibilities.
39.14 	(c) When delivering the ITP, and annually thereafter, an agency must provide the person 
39.15 	or the person's legal representative with:
39.16 	(1) a written copy and a verbal explanation of the person's or person's legal 
39.17 	representative's rights and the agency's responsibilities;
39.18 	(2) documentation in the person's file the date that the person or the person's legal 
39.19 	representative received a copy and explanation of the person's or person's legal 
39.20 	representative's rights and the agency's responsibilities; and
39.21 	(3) reasonable accommodations to provide the information in another format or language 
39.22 	as needed to facilitate understanding of the person's or person's legal representative's rights 
39.23 	and the agency's responsibilities.

39.24 	Sec. 14. Minnesota Statutes 2024, section 256B.0949, subdivision 17, is amended to read:
39.25 		Subd. 17.Provider shortage; authority for exceptions. (a) In consultation with the 
39.26 	Early Intensive Developmental and Behavioral Intervention Advisory Council and 
39.27 	stakeholders, including agencies, professionals, parents of people with ASD or a related 
39.28 	condition, and advocacy organizations, the commissioner shall determine if a shortage of 
39.29 	EIDBI providers exists. For the purposes of this subdivision, "shortage of EIDBI providers" 
39.30 	means a lack of availability of providers who meet the EIDBI provider qualification 
39.31 	requirements under subdivision 15 that results in the delay of access to timely services under 
39.32 	this section, or that significantly impairs the ability of a provider agency to have sufficient 
40.1 	providers to meet the requirements of this section. The commissioner shall consider 
40.2 	geographic factors when determining the prevalence of a shortage. The commissioner may 
40.3 	determine that a shortage exists only in a specific region of the state, multiple regions of 
40.4 	the state, or statewide. The commissioner shall also consider the availability of various types 
40.5 	of treatment modalities covered under this section.
40.6 	(b) The commissioner, in consultation with the Early Intensive Developmental and 
40.7 	Behavioral Intervention Advisory Council and stakeholders, must establish processes and 
40.8 	criteria for granting an exception under this paragraph. The commissioner may grant an 
40.9 	exception only if the exception would not compromise a person's safety and not diminish 
40.10 	the effectiveness of the treatment. The commissioner may establish an expiration date for 
40.11 	an exception granted under this paragraph. The commissioner may grant an exception for 
40.12 	the following:
40.13 	(1) EIDBI provider qualifications under this section;
40.14 	(2) medical assistance provider enrollment requirements under section 256B.04, 
40.15 	subdivision 21 sections 256B.044 to 256B.0445; or
40.16 	(3) EIDBI provider or agency standards or requirements.
40.17 	(c) If the commissioner, in consultation with the Early Intensive Developmental and 
40.18 	Behavioral Intervention Advisory Council and stakeholders, determines that a shortage no 
40.19 	longer exists, the commissioner must submit a notice that a shortage no longer exists to the 
40.20 	chairs and ranking minority members of the senate and the house of representatives 
40.21 	committees with jurisdiction over health and human services. The commissioner must post 
40.22 	the notice for public comment for 30 days. The commissioner shall consider public comments 
40.23 	before submitting to the legislature a request to end the shortage declaration. The 
40.24 	commissioner shall not declare the shortage of EIDBI providers ended without direction 
40.25 	from the legislature to declare it ended.

40.26 	Sec. 15. DIRECTION TO COMMISSIONER OF HUMAN SERVICES.
 40.27 	The commissioner of human services must amend Minnesota Rules, part 9505.2165, 
40.28 	subpart 4, item C, to remove the citation to United States Code, title 42, section 
40.29 	1320a-7b(b)(3)(D), and insert a citation to United States Code, title 42, section 1320a-7b(b). 
40.30 	The commissioner may use the procedure under Minnesota Statutes, section 14.388, 
40.31 	subdivision 1, clause (3), for changes to Minnesota Rules pursuant to this section. Minnesota 
40.32 	Statutes, section 14.386, does not apply to rules adopted pursuant to this section except as 
40.33 	provided under Minnesota Statutes, section 14.388.

41.1 	ARTICLE 3
41.2 	PROVIDER ENROLLMENT REQUIREMENTS FOR HIGH-RISK PROVIDERS

41.3 	Section 1. Minnesota Statutes 2024, section 142B.01, subdivision 8, is amended to read:
41.4 		Subd. 8.Controlling individual. (a) "Controlling individual" means an owner of a 
41.5 	program or service provider licensed under this chapter and the following individuals, if 
41.6 	applicable:
41.7 	(1) each officer of the organization, including the chief executive officer and chief 
41.8 	financial officer;
41.9 	(2) the individual designated as the authorized agent under section 142B.10, subdivision 
41.10 	1, paragraph (b);
41.11 	(3) the individual designated as the compliance officer under section 256B.04, subdivision 
41.12 	21, paragraph (g) 256B.044, subdivision 7, paragraph (b);
41.13 	(4) each managerial official whose responsibilities include the direction of the 
41.14 	management or policies of a program;
41.15 	(5) the individual designated as the primary provider of care for a special family child 
41.16 	care program under section 142B.41, subdivision 4, paragraph (d); and
41.17 	(6) the president and treasurer of the board of directors of a nonprofit corporation.
41.18 	(b) Controlling individual does not include:
41.19 	(1) a bank, savings bank, trust company, savings association, credit union, industrial 
41.20 	loan and thrift company, investment banking firm, or insurance company unless the entity 
41.21 	operates a program directly or through a subsidiary;
41.22 	(2) an individual who is a state or federal official, or state or federal employee, or a 
41.23 	member or employee of the governing body of a political subdivision of the state or federal 
41.24 	government that operates one or more programs, unless the individual is also an officer, 
41.25 	owner, or managerial official of the program; receives remuneration from the program; or 
41.26 	owns any of the beneficial interests not excluded in this subdivision;
41.27 	(3) an individual who owns less than five percent of the outstanding common shares of 
41.28 	a corporation:
41.29 	(i) whose securities are exempt under section 80A.45, clause (6); or
41.30 	(ii) whose transactions are exempt under section 80A.46, clause (2);
42.1 	(4) an individual who is a member of an organization exempt from taxation under section 
42.2 	290.05, unless the individual is also an officer, owner, or managerial official of the program 
42.3 	or owns any of the beneficial interests not excluded in this subdivision. This clause does 
42.4 	not exclude from the definition of controlling individual an organization that is exempt from 
42.5 	taxation; or
42.6 	(5) an employee stock ownership plan trust, or a participant or board member of an 
42.7 	employee stock ownership plan, unless the participant or board member is a controlling 
42.8 	individual according to paragraph (a).
42.9 	(c) For purposes of this subdivision, "managerial official" means an individual who has 
42.10 	the decision-making authority related to the operation of the program, and the responsibility 
42.11 	for the ongoing management of or direction of the policies, services, or employees of the 
42.12 	program. A site director who has no ownership interest in the program is not considered to 
42.13 	be a managerial official for purposes of this definition.

42.14 	Sec. 2. Minnesota Statutes 2024, section 245A.02, subdivision 5a, is amended to read:
42.15 		Subd. 5a.Controlling individual. (a) "Controlling individual" means an owner of a 
42.16 	program or service provider licensed under this chapter and the following individuals, if 
42.17 	applicable:
42.18 	(1) each officer of the organization, including the chief executive officer and chief 
42.19 	financial officer;
42.20 	(2) the individual designated as the authorized agent under section 245A.04, subdivision 
42.21 	1, paragraph (b);
42.22 	(3) the individual designated as the compliance officer under section 256B.04, subdivision 
42.23 	21, paragraph (g) 256B.044, subdivision 7, paragraph (b);
42.24 	(4) each managerial official whose responsibilities include the direction of the 
42.25 	management or policies of a program; and
42.26 	(5) the president and treasurer of the board of directors of a nonprofit corporation.
42.27 	(b) Controlling individual does not include:
42.28 	(1) a bank, savings bank, trust company, savings association, credit union, industrial 
42.29 	loan and thrift company, investment banking firm, or insurance company unless the entity 
42.30 	operates a program directly or through a subsidiary;
42.31 	(2) an individual who is a state or federal official, or state or federal employee, or a 
42.32 	member or employee of the governing body of a political subdivision of the state or federal 
43.1 	government that operates one or more programs, unless the individual is also an officer, 
43.2 	owner, or managerial official of the program, receives remuneration from the program, or 
43.3 	owns any of the beneficial interests not excluded in this subdivision;
43.4 	(3) an individual who owns less than five percent of the outstanding common shares of 
43.5 	a corporation:
43.6 	(i) whose securities are exempt under section 80A.45, clause (6); or
43.7 	(ii) whose transactions are exempt under section 80A.46, clause (2);
43.8 	(4) an individual who is a member of an organization exempt from taxation under section 
43.9 	290.05, unless the individual is also an officer, owner, or managerial official of the program 
43.10 	or owns any of the beneficial interests not excluded in this subdivision. This clause does 
43.11 	not exclude from the definition of controlling individual an organization that is exempt from 
43.12 	taxation; or
43.13 	(5) an employee stock ownership plan trust, or a participant or board member of an 
43.14 	employee stock ownership plan, unless the participant or board member is a controlling 
43.15 	individual according to paragraph (a).
43.16 	(c) For purposes of this subdivision, "managerial official" means an individual who has 
43.17 	the decision-making authority related to the operation of the program, and the responsibility 
43.18 	for the ongoing management of or direction of the policies, services, or employees of the 
43.19 	program. A site director who has no ownership interest in the program is not considered to 
43.20 	be a managerial official for purposes of this definition.

43.21 	Sec. 3. Minnesota Statutes 2025 Supplement, section 245A.04, subdivision 1, is amended 
43.22 	to read:
43.23 		Subdivision 1.Application for licensure. (a) An individual, organization, or government 
43.24 	entity that is subject to licensure under section 245A.03 must apply for a license. The 
43.25 	application must be made on the forms and in the manner prescribed by the commissioner. 
43.26 	The commissioner shall provide the applicant with instruction in completing the application 
43.27 	and provide information about the rules and requirements of other state agencies that affect 
43.28 	the applicant. An applicant seeking licensure in Minnesota with headquarters outside of 
43.29 	Minnesota must have a program office located within 30 miles of the Minnesota border. 
43.30 	An applicant who intends to buy or otherwise acquire a program or services licensed under 
43.31 	this chapter that is owned by another license holder must apply for a license under this 
43.32 	chapter and comply with the application procedures in this section and section 245A.043.
44.1 	The commissioner shall act on the application within 90 working days after a complete 
44.2 	application and any required reports have been received from other state agencies or 
44.3 	departments, counties, municipalities, or other political subdivisions. The commissioner 
44.4 	shall not consider an application to be complete until the commissioner receives all of the 
44.5 	required information. If the applicant or a controlling individual is the subject of a pending 
44.6 	administrative, civil, or criminal investigation, the application is not complete until the 
44.7 	investigation has closed or the related legal proceedings are complete.
44.8 	When the commissioner receives an application for initial licensure that is incomplete 
44.9 	because the applicant failed to submit required documents or that is substantially deficient 
44.10 	because the documents submitted do not meet licensing requirements, the commissioner 
44.11 	shall provide the applicant written notice that the application is incomplete or substantially 
44.12 	deficient. In the written notice to the applicant the commissioner shall identify documents 
44.13 	that are missing or deficient and give the applicant 45 days to resubmit a second application 
44.14 	that is substantially complete. An applicant's failure to submit a substantially complete 
44.15 	application after receiving notice from the commissioner is a basis for license denial under 
44.16 	section 245A.043.
44.17 	(b) An application for licensure must identify all controlling individuals as defined in 
44.18 	section 245A.02, subdivision 5a, and must designate one individual to be the authorized 
44.19 	agent. The application must be signed by the authorized agent and must include the authorized 
44.20 	agent's first, middle, and last name; mailing address; and email address. By submitting an 
44.21 	application for licensure, the authorized agent consents to electronic communication with 
44.22 	the commissioner throughout the application process. The authorized agent must be 
44.23 	authorized to accept service on behalf of all of the controlling individuals. A government 
44.24 	entity that holds multiple licenses under this chapter may designate one authorized agent 
44.25 	for all licenses issued under this chapter or may designate a different authorized agent for 
44.26 	each license. Service on the authorized agent is service on all of the controlling individuals. 
44.27 	It is not a defense to any action arising under this chapter that service was not made on each 
44.28 	controlling individual. The designation of a controlling individual as the authorized agent 
44.29 	under this paragraph does not affect the legal responsibility of any other controlling individual 
44.30 	under this chapter.
44.31 	(c) An applicant or license holder must have a policy that prohibits license holders, 
44.32 	employees, subcontractors, and volunteers, when directly responsible for persons served 
44.33 	by the program, from abusing prescription medication or being in any manner under the 
44.34 	influence of a chemical that impairs the individual's ability to provide services or care. The 
44.35 	license holder must train employees, subcontractors, and volunteers about the program's 
45.1 	drug and alcohol policy before the employee, subcontractor, or volunteer has direct contact, 
45.2 	as defined in section 245C.02, subdivision 11, with a person served by the program.
45.3 	(d) An applicant and license holder must have a program grievance procedure that permits 
45.4 	persons served by the program and their authorized representatives to bring a grievance to 
45.5 	the highest level of authority in the program.
45.6 	(e) The commissioner may limit communication during the application process to the 
45.7 	authorized agent or the controlling individuals identified on the license application and for 
45.8 	whom a background study was initiated under chapter 245C. Upon implementation of the 
45.9 	provider licensing and reporting hub, applicants and license holders must use the hub in the 
45.10 	manner prescribed by the commissioner. The commissioner may require the applicant, 
45.11 	except for child foster care, to demonstrate competence in the applicable licensing 
45.12 	requirements by successfully completing a written examination. The commissioner may 
45.13 	develop a prescribed written examination format.
45.14 	(f) When an applicant is an individual, the applicant must provide:
45.15 	(1) the applicant's taxpayer identification numbers including the Social Security number 
45.16 	or Minnesota tax identification number, and federal employer identification number if the 
45.17 	applicant has employees;
45.18 	(2) at the request of the commissioner, a copy of the most recent filing with the secretary 
45.19 	of state that includes the complete business name, if any;
45.20 	(3) if doing business under a different name, the doing business as (DBA) name, as 
45.21 	registered with the secretary of state;
45.22 	(4) if applicable, the applicant's National Provider Identifier (NPI) number and Unique 
45.23 	Minnesota Provider Identifier (UMPI) number; and
45.24 	(5) at the request of the commissioner, the notarized signature of the applicant or 
45.25 	authorized agent.
45.26 	(g) When an applicant is an organization, the applicant must provide:
45.27 	(1) the applicant's taxpayer identification numbers including the Minnesota tax 
45.28 	identification number and federal employer identification number;
45.29 	(2) at the request of the commissioner, a copy of the most recent filing with the secretary 
45.30 	of state that includes the complete business name, and if doing business under a different 
45.31 	name, the doing business as (DBA) name, as registered with the secretary of state;
46.1 	(3) the first, middle, and last name, and address for all individuals who will be controlling 
46.2 	individuals, including all officers, owners, and managerial officials as defined in section 
46.3 	245A.02, subdivision 5a, and the date that the background study was initiated by the applicant 
46.4 	for each controlling individual;
46.5 	(4) if applicable, the applicant's NPI number and UMPI number;
46.6 	(5) the documents that created the organization and that determine the organization's 
46.7 	internal governance and the relations among the persons that own the organization, have 
46.8 	an interest in the organization, or are members of the organization, in each case as provided 
46.9 	or authorized by the organization's governing statute, which may include a partnership 
46.10 	agreement, bylaws, articles of organization, organizational chart, and operating agreement, 
46.11 	or comparable documents as provided in the organization's governing statute; and
46.12 	(6) the notarized signature of the applicant or authorized agent.
46.13 	(h) When the applicant is a government entity, the applicant must provide:
46.14 	(1) the name of the government agency, political subdivision, or other unit of government 
46.15 	seeking the license and the name of the program or services that will be licensed;
46.16 	(2) the applicant's taxpayer identification numbers including the Minnesota tax 
46.17 	identification number and federal employer identification number;
46.18 	(3) a letter signed by the manager, administrator, or other executive of the government 
46.19 	entity authorizing the submission of the license application; and
46.20 	(4) if applicable, the applicant's NPI number and UMPI number.
46.21 	(i) At the time of application for licensure or renewal of a license under this chapter, the 
46.22 	applicant or license holder must acknowledge on the form provided by the commissioner 
46.23 	if the applicant or license holder elects to receive any public funding reimbursement from 
46.24 	the commissioner for services provided under the license that:
46.25 	(1) the applicant's or license holder's compliance with the provider enrollment agreement 
46.26 	or registration requirements for receipt of public funding may be monitored by the 
46.27 	commissioner as part of a licensing investigation or licensing inspection; and
46.28 	(2) noncompliance with the provider enrollment agreement or registration requirements 
46.29 	for receipt of public funding that is identified through a licensing investigation or licensing 
46.30 	inspection, or noncompliance with a licensing requirement that is a basis of enrollment for 
46.31 	reimbursement for a service, may result in:
47.1 	(i) a correction order or a conditional license under section 245A.06, or sanctions under 
47.2 	section 245A.07;
47.3 	(ii) nonpayment of claims submitted by the license holder for public program 
47.4 	reimbursement;
47.5 	(iii) recovery of payments made for the service;
47.6 	(iv) disenrollment in the public payment program; or
47.7 	(v) other administrative, civil, or criminal penalties as provided by law.
47.8 	(j) An applicant or license holder who acknowledges under paragraph (i) that the applicant 
47.9 	or license holder elects to receive any publicly funded reimbursement from the commissioner 
47.10 	for services provided under the license that are designated by the commissioner as high-risk 
47.11 	under section 256B.044, subdivision 1, must provide an attestation with the notarized 
47.12 	signature of the applicant or authorized agent stating whether the applicant or authorized 
47.13 	agent received from an unaffiliated business or consultant any assistance preparing:
47.14 	(1) the application;
47.15 	(2) the renewal;
47.16 	(3) any documentation or written policies submitted with the application;
47.17 	(4) any documentation or written policies submitted with the renewal; or
47.18 	(5) any documentation or written policies maintained as a requirement of licensure or 
47.19 	enrollment as a medical assistance provider.

47.20 	Sec. 4. Minnesota Statutes 2025 Supplement, section 245A.04, subdivision 7, is amended 
47.21 	to read:
47.22 		Subd. 7.Grant of license; license extension. (a) If the commissioner determines that 
47.23 	the program complies with all applicable rules and laws, the commissioner shall issue a 
47.24 	license consistent with this section or, if applicable, a temporary change of ownership license 
47.25 	under section 245A.043. At minimum, the license shall state:
47.26 	(1) the name of the license holder;
47.27 	(2) the address of the program;
47.28 	(3) the effective date and expiration date of the license;
47.29 	(4) the type of license and the specific service the license holder is licensed to provide;
48.1 	(5) the maximum number and ages of persons that may receive services from the program; 
48.2 	and
48.3 	(6) any special conditions of licensure.
48.4 	(b) The commissioner may issue a license for a period not to exceed two years if:
48.5 	(1) the commissioner is unable to conduct the observation required by subdivision 4, 
48.6 	paragraph (a), clause (3), because the program is not yet operational;
48.7 	(2) certain records and documents are not available because persons are not yet receiving 
48.8 	services from the program; and
48.9 	(3) the applicant complies with applicable laws and rules in all other respects.
48.10 	(c) A decision by the commissioner to issue a license does not guarantee that any person 
48.11 	or persons will be placed or cared for in the licensed program.
48.12 	(d) Except as provided in paragraphs (i) and (j), the commissioner shall not issue a 
48.13 	license if the applicant, license holder, or an affiliated controlling individual has:
48.14 	(1) been disqualified and the disqualification was not set aside and no variance has been 
48.15 	granted;
48.16 	(2) been denied a license under this chapter or chapter 142B within the past two years;
48.17 	(3) had a license issued under this chapter or chapter 142B revoked within the past five 
48.18 	years; or
48.19 	(4) failed to submit the information required of an applicant under subdivision 1, 
48.20 	paragraph (f), (g), or (h), or (j), after being requested by the commissioner.
48.21 	When a license issued under this chapter or chapter 142B is revoked, the license holder 
48.22 	and each affiliated controlling individual with a revoked license may not hold any license 
48.23 	under chapter 245A for five years following the revocation, and other licenses held by the 
48.24 	applicant or license holder or licenses affiliated with each controlling individual shall also 
48.25 	be revoked.
48.26 	(e) Notwithstanding paragraph (d), the commissioner may elect not to revoke a license 
48.27 	affiliated with a license holder or controlling individual that had a license revoked within 
48.28 	the past five years if the commissioner determines that (1) the license holder or controlling 
48.29 	individual is operating the program in substantial compliance with applicable laws and rules 
48.30 	and (2) the program's continued operation is in the best interests of the community being 
48.31 	served.
49.1 	(f) Notwithstanding paragraph (d), the commissioner may issue a new license in response 
49.2 	to an application that is affiliated with an applicant, license holder, or controlling individual 
49.3 	that had an application denied within the past two years or a license revoked within the past 
49.4 	five years if the commissioner determines that (1) the applicant or controlling individual 
49.5 	has operated one or more programs in substantial compliance with applicable laws and rules 
49.6 	and (2) the program's operation would be in the best interests of the community to be served.
49.7 	(g) In determining whether a program's operation would be in the best interests of the 
49.8 	community to be served, the commissioner shall consider factors such as the number of 
49.9 	persons served, the availability of alternative services available in the surrounding 
49.10 	community, the management structure of the program, whether the program provides 
49.11 	culturally specific services, and other relevant factors.
49.12 	(h) The commissioner shall not issue or reissue a license under this chapter if an individual 
49.13 	living in the household where the services will be provided as specified under section 
49.14 	245C.03, subdivision 1, has been disqualified and the disqualification has not been set aside 
49.15 	and no variance has been granted.
49.16 	(i) Pursuant to section 245A.07, subdivision 1, paragraph (b), when a license issued 
49.17 	under this chapter has been suspended or revoked and the suspension or revocation is under 
49.18 	appeal, the program may continue to operate pending a final order from the commissioner. 
49.19 	If the license under suspension or revocation will expire before a final order is issued, a 
49.20 	temporary provisional license may be issued provided any applicable license fee is paid 
49.21 	before the temporary provisional license is issued.
49.22 	(j) Notwithstanding paragraph (i), when a revocation is based on the disqualification of 
49.23 	a controlling individual or license holder, and the controlling individual or license holder 
49.24 	is ordered under section 245C.17 to be immediately removed from direct contact with 
49.25 	persons receiving services or is ordered to be under continuous, direct supervision when 
49.26 	providing direct contact services, the program may continue to operate only if the program 
49.27 	complies with the order and submits documentation demonstrating compliance with the 
49.28 	order. If the disqualified individual fails to submit a timely request for reconsideration, or 
49.29 	if the disqualification is not set aside and no variance is granted, the order to immediately 
49.30 	remove the individual from direct contact or to be under continuous, direct supervision 
49.31 	remains in effect pending the outcome of a hearing and final order from the commissioner.
49.32 	(k) Unless otherwise specified by statute, all licenses issued under this chapter expire 
49.33 	at 12:01 a.m. on the day after the expiration date stated on the license. A license holder must 
49.34 	comply with the requirements in section 245A.10 and be reissued a new license to operate 
50.1 	the program or the program must not be operated after the expiration date. Adult foster care, 
50.2 	family adult day services, child foster residence setting, and community residential services 
50.3 	license holders must apply for and be granted a new license to operate the program or the 
50.4 	program must not be operated after the expiration date. Upon implementation of the provider 
50.5 	licensing and reporting hub, licenses may be issued each calendar year.
50.6 	(l) The commissioner shall not issue or reissue a license under this chapter if it has been 
50.7 	determined that a Tribal licensing authority has established jurisdiction to license the program 
50.8 	or service.
50.9 	(m) The commissioner of human services may coordinate and share data with the 
50.10 	commissioner of children, youth, and families to enforce this section.
50.11 	(n) For substance use disorder treatment programs, for the purposes of paragraph (a), 
50.12 	clause (5), the maximum number of persons who may receive services from the program 
50.13 	includes persons served at satellite locations.

50.14 	Sec. 5. Minnesota Statutes 2025 Supplement, section 245A.05, is amended to read:
50.15 	245A.05 DENIAL OF APPLICATION.
50.16 	(a) The commissioner may deny a license if an applicant or controlling individual:
50.17 	(1) fails to submit a substantially complete application after receiving notice from the 
50.18 	commissioner under section 245A.04, subdivision 1;
50.19 	(2) fails to comply with applicable laws or rules;
50.20 	(3) knowingly withholds relevant information from or gives false or misleading 
50.21 	information to the commissioner in connection with an application for a license or during 
50.22 	an investigation;
50.23 	(4) has a disqualification that has not been set aside under section 245C.22 and no 
50.24 	variance has been granted;
50.25 	(5) has an individual living in the household who received a background study under 
50.26 	section 245C.03, subdivision 1, paragraph (a), clause (2), who has a disqualification that 
50.27 	has not been set aside under section 245C.22, and no variance has been granted;
50.28 	(6) is associated with an individual who received a background study under section 
50.29 	245C.03, subdivision 1, paragraph (a), clause (6), who may have unsupervised access to 
50.30 	children or vulnerable adults, and who has a disqualification that has not been set aside 
50.31 	under section 245C.22, and no variance has been granted;
51.1 	(7) fails to comply with section 245A.04, subdivision 1, paragraph (f) or, (g), or (j);
51.2 	(8) fails to demonstrate competent knowledge as required by section 245A.04, subdivision 
51.3 	6;
51.4 	(9) has a history of noncompliance as a license holder or controlling individual with 
51.5 	applicable laws or rules, including but not limited to this chapter and chapters 142E and 
51.6 	245C;
51.7 	(10) is prohibited from holding a license according to section 245.095; or
51.8 	(11) is the subject of a pending administrative, civil, or criminal investigation.
51.9 	(b) An applicant whose application has been denied by the commissioner must be given 
51.10 	notice of the denial, which must state the reasons for the denial in plain language. Notice 
51.11 	must be given by certified mail, by personal service, or through the provider licensing and 
51.12 	reporting hub. The notice must state the reasons the application was denied and must inform 
51.13 	the applicant of the right to a contested case hearing under chapter 14 and Minnesota Rules, 
51.14 	parts 1400.8505 to 1400.8612. The applicant may appeal the denial by notifying the 
51.15 	commissioner in writing by certified mail, by personal service, or through the provider 
51.16 	licensing and reporting hub. If mailed, the appeal must be postmarked and sent to the 
51.17 	commissioner within 20 calendar days after the applicant received the notice of denial. If 
51.18 	an appeal request is made by personal service, it must be received by the commissioner 
51.19 	within 20 calendar days after the applicant received the notice of denial. If the order is issued 
51.20 	through the provider hub, the appeal must be received by the commissioner within 20 
51.21 	calendar days from the date the commissioner issued the order through the hub. Section 
51.22 	245A.08 applies to hearings held to appeal the commissioner's denial of an application.

51.23 	Sec. 6. Minnesota Statutes 2024, section 245D.081, subdivision 3, is amended to read:
51.24 		Subd. 3.Program management and oversight. (a) The license holder must designate 
51.25 	a managerial staff person or persons to provide program management and oversight of the 
51.26 	services provided by the license holder. The designated manager is responsible for the 
51.27 	following:
51.28 	(1) maintaining a current understanding of the licensing requirements sufficient to ensure 
51.29 	compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph 
51.30 	(e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph (g)
51.31 	256B.044, subdivision 7;
51.32 	(2) ensuring the duties of the designated coordinator are fulfilled according to the 
51.33 	requirements in subdivision 2;
52.1 	(3) ensuring the program implements corrective action identified as necessary by the 
52.2 	program following review of incident and emergency reports according to the requirements 
52.3 	in section 245D.11, subdivision 2, clause (7). An internal review of incident reports of 
52.4 	alleged or suspected maltreatment must be conducted according to the requirements in 
52.5 	section 245A.65, subdivision 1, paragraph (b);
52.6 	(4) evaluation of satisfaction of persons served by the program, the person's legal 
52.7 	representative, if any, and the case manager, with the service delivery and progress toward 
52.8 	accomplishing outcomes identified in sections 245D.07 and 245D.071, and ensuring and 
52.9 	protecting each person's rights as identified in section 245D.04;
52.10 	(5) ensuring staff competency requirements are met according to the requirements in 
52.11 	section 245D.09, subdivision 3, and ensuring staff orientation and training is provided 
52.12 	according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;
52.13 	(6) ensuring corrective action is taken when ordered by the commissioner and that the 
52.14 	terms and conditions of the license and any variances are met; and
52.15 	(7) evaluating the information identified in clauses (1) to (6) to develop, document, and 
52.16 	implement ongoing program improvements.
52.17 	(b) The designated manager must be competent to perform the duties as required and 
52.18 	must minimally meet the education and training requirements identified in subdivision 2, 
52.19 	paragraph (b), and have a minimum of three years of supervisory level experience in a 
52.20 	program that provides care or education to vulnerable adults or children.

52.21 	Sec. 7. Minnesota Statutes 2025 Supplement, section 256B.04, subdivision 21, is amended 
52.22 	to read:
52.23 		Subd. 21.Provider enrollment. (a) The commissioner shall enroll providers and conduct 
52.24 	screening activities as required by Code of Federal Regulations, title 42, section 455, subpart 
52.25 	E, and sections 256B.044 to 256B.0445.
52.26 	A provider must enroll each provider-controlled location where direct services are 
52.27 	provided. The commissioner may deny a provider's incomplete application if a provider 
52.28 	fails to respond to the commissioner's request for additional information within 60 days of 
52.29 	the request. The commissioner must conduct a background study under chapter 245C, 
52.30 	including a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses 
52.31 	(1) to (5), for a provider described in this paragraph. The background study requirement 
52.32 	may be satisfied if the commissioner conducted a fingerprint-based background study on 
53.1 	the provider that includes a review of databases in section 245C.08, subdivision 1, paragraph 
53.2 	(a), clauses (1) to (5).
53.3 	(b) The commissioner shall revalidate:
53.4 	(1) each provider under this subdivision at least once every five years;
53.5 	(2) each personal care assistance agency, CFSS provider-agency, and CFSS financial 
53.6 	management services provider under this subdivision at least once every three years;
53.7 	(3) each EIDBI agency under this subdivision at least once every three years; and
53.8 	(4) at the commissioner's discretion, any medical-assistance-only provider type the 
53.9 	commissioner deems "high-risk" under this subdivision.
53.10 	(c) The commissioner shall conduct revalidation as follows:
53.11 	(1) provide 30-day notice of the revalidation due date including instructions for 
53.12 	revalidation and a list of materials the provider must submit;
53.13 	(2) if a provider fails to submit all required materials by the due date, notify the provider 
53.14 	of the deficiency within 30 days after the due date and allow the provider an additional 30 
53.15 	days from the notification date to comply; and
53.16 	(3) if a provider fails to remedy a deficiency within the 30-day time period, give 60-day 
53.17 	notice of termination and immediately suspend the provider's ability to bill. The provider 
53.18 	does not have the right to appeal suspension of ability to bill.
53.19 	(d) If a provider fails to comply with any individual provider requirement or condition 
53.20 	of participation, the commissioner may suspend the provider's ability to bill until the provider 
53.21 	comes into compliance. The commissioner's decision to suspend the provider is not subject 
53.22 	to an administrative appeal.
53.23 	(e) Correspondence and notifications, including notifications of termination and other 
53.24 	actions, may be delivered electronically to a provider's MN-ITS mailbox. This paragraph 
53.25 	does not apply to correspondences and notifications related to background studies.
53.26 	(f) If the commissioner or the Centers for Medicare and Medicaid Services determines 
53.27 	that a provider is designated "high-risk," the commissioner may withhold payment from 
53.28 	providers within that category upon initial enrollment for a 90-day period. The withholding 
53.29 	for each provider must begin on the date of the first submission of a claim.
53.30 	(g) An enrolled provider that is also licensed by the commissioner under chapter 245A, 
53.31 	is licensed as a home care provider by the Department of Health under chapter 144A, or is 
53.32 	licensed as an assisted living facility under chapter 144G and has a home and 
54.1 	community-based services designation on the home care license under section 144A.484, 
54.2 	must designate an individual as the entity's compliance officer. The compliance officer 
54.3 	must:
54.4 	(1) develop policies and procedures to assure adherence to medical assistance laws and 
54.5 	regulations and to prevent inappropriate claims submissions;
54.6 	(2) train the employees of the provider entity, and any agents or subcontractors of the 
54.7 	provider entity including billers, on the policies and procedures under clause (1);
54.8 	(3) respond to allegations of improper conduct related to the provision or billing of 
54.9 	medical assistance services, and implement action to remediate any resulting problems;
54.10 	(4) use evaluation techniques to monitor compliance with medical assistance laws and 
54.11 	regulations;
54.12 	(5) promptly report to the commissioner any identified violations of medical assistance 
54.13 	laws or regulations; and
54.14 	(6) within 60 days of discovery by the provider of a medical assistance reimbursement 
54.15 	overpayment, report the overpayment to the commissioner and make arrangements with 
54.16 	the commissioner for the commissioner's recovery of the overpayment.
54.17 	The commissioner may require, as a condition of enrollment in medical assistance, that a 
54.18 	provider within a particular industry sector or category establish a compliance program that 
54.19 	contains the core elements established by the Centers for Medicare and Medicaid Services.
54.20 	(h) The commissioner may revoke the enrollment of an ordering or rendering provider 
54.21 	for a period of not more than one year, if the provider fails to maintain and, upon request 
54.22 	from the commissioner, provide access to documentation relating to written orders or requests 
54.23 	for payment for durable medical equipment, certifications for home health services, or 
54.24 	referrals for other items or services written or ordered by such provider, when the 
54.25 	commissioner has identified a pattern of a lack of documentation. A pattern means a failure 
54.26 	to maintain documentation or provide access to documentation on more than one occasion. 
54.27 	Nothing in this paragraph limits the authority of the commissioner to sanction a provider 
54.28 	under the provisions of section 256B.064.
54.29 	(i) The commissioner shall terminate or deny the enrollment of any individual or entity 
54.30 	if the individual or entity has been terminated from participation in Medicare or under the 
54.31 	Medicaid program or Children's Health Insurance Program of any other state. The 
54.32 	commissioner may exempt a rehabilitation agency from termination or denial that would 
54.33 	otherwise be required under this paragraph, if the agency:
55.1 	(1) is unable to retain Medicare certification and enrollment solely due to a lack of billing 
55.2 	to the Medicare program;
55.3 	(2) meets all other applicable Medicare certification requirements based on an on-site 
55.4 	review completed by the commissioner of health; and
55.5 	(3) serves primarily a pediatric population.
55.6 	(j) As a condition of enrollment in medical assistance, the commissioner shall require 
55.7 	that a provider designated "moderate" or "high-risk" by the Centers for Medicare and 
55.8 	Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid 
55.9 	Services, its agents, or its designated contractors and the state agency, its agents, or its 
55.10 	designated contractors to conduct unannounced on-site inspections of any provider location. 
55.11 	The commissioner shall publish in the Minnesota Health Care Program Provider Manual a 
55.12 	list of provider types designated "limited," "moderate," or "high-risk," based on the criteria 
55.13 	and standards used to designate Medicare providers in Code of Federal Regulations, title 
55.14 	42, section 424.518. The list and criteria are not subject to the requirements of chapter 14. 
55.15 	The commissioner's designations are not subject to administrative appeal.
55.16 	(k) As a condition of enrollment in medical assistance, the commissioner shall require 
55.17 	that a high-risk provider, or a person with a direct or indirect ownership interest in the 
55.18 	provider of five percent or higher, consent to criminal background checks, including 
55.19 	fingerprinting, when required to do so under state law or by a determination by the 
55.20 	commissioner or the Centers for Medicare and Medicaid Services that a provider is designated 
55.21 	high-risk for fraud, waste, or abuse.
55.22 	(l)(1) Upon initial enrollment, reenrollment, and notification of revalidation, all durable 
55.23 	medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers 
55.24 	meeting the durable medical equipment provider and supplier definition in clause (3), 
55.25 	operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is 
55.26 	annually renewed and designates the Minnesota Department of Human Services as the 
55.27 	obligee, and must be submitted in a form approved by the commissioner. For purposes of 
55.28 	this clause, the following medical suppliers are not required to obtain a surety bond: a 
55.29 	federally qualified health center, a home health agency, the Indian Health Service, a 
55.30 	pharmacy, and a rural health clinic.
55.31 	(2) At the time of initial enrollment or reenrollment, durable medical equipment providers 
55.32 	and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating 
55.33 	provider's Medicaid revenue in the previous calendar year is up to and including $300,000, 
55.34 	the provider agency must purchase a surety bond of $50,000. If a revalidating provider's 
56.1 	Medicaid revenue in the previous calendar year is over $300,000, the provider agency must 
56.2 	purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and 
56.3 	fees in pursuing a claim on the bond. Any action to obtain monetary recovery or sanctions 
56.4 	from a surety bond must occur within six years from the date the debt is affirmed by a final 
56.5 	agency decision. An agency decision is final when the right to appeal the debt has been 
56.6 	exhausted or the time to appeal has expired under section 256B.064.
56.7 	(3) "Durable medical equipment provider or supplier" means a medical supplier that can 
56.8 	purchase medical equipment or supplies for sale or rental to the general public and is able 
56.9 	to perform or arrange for necessary repairs to and maintenance of equipment offered for 
56.10 	sale or rental.
56.11 	(m) The Department of Human Services may require a provider to purchase a surety 
56.12 	bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment 
56.13 	if: (1) the provider fails to demonstrate financial viability, (2) the department determines 
56.14 	there is significant evidence of or potential for fraud and abuse by the provider, or (3) the 
56.15 	provider or category of providers is designated high-risk pursuant to paragraph (f) and as 
56.16 	per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in an 
56.17 	amount of $100,000 or ten percent of the provider's payments from Medicaid during the 
56.18 	immediately preceding 12 months, whichever is greater. The surety bond must name the 
56.19 	Department of Human Services as an obligee and must allow for recovery of costs and fees 
56.20 	in pursuing a claim on the bond. This paragraph does not apply if the provider currently 
56.21 	maintains a surety bond under the requirements in section 256B.051, 256B.0659, 256B.0701, 
56.22 	or 256B.85.

56.23 	Sec. 8. [256B.044] PROVIDER ENROLLMENT.
56.24 		Subdivision 1.Designating categorical risk levels. (a) The commissioner shall publish 
56.25 	in the Minnesota Health Care Program Provider Manual a list of provider types designated 
56.26 	"limited-risk," "moderate-risk," or "high-risk," based on the criteria and standards used by 
56.27 	the Centers for Medicare and Medicaid Services (CMS) to designate Medicare providers 
56.28 	in Code of Federal Regulations, title 42, section 424.518.
56.29 	(b) The list and criteria are not subject to the requirements of chapter 14, and section 
56.30 	14.386 does not apply.
56.31 	(c) The commissioner's designations are not subject to administrative appeal.
56.32 		Subd. 2.Service location enrollment. A provider must enroll each provider-controlled 
56.33 	location where direct services are provided.
57.1 		Subd. 3.Incomplete provider enrollment applications. The commissioner may deny 
57.2 	a provider's incomplete enrollment application if a provider fails to respond to the 
57.3 	commissioner's request for additional information within 60 days of the request.
57.4 		Subd. 4.Required background studies. (a) The commissioner must conduct a 
57.5 	background study under chapter 245C, including a review of databases in section 245C.08, 
57.6 	subdivision 1, paragraph (a), clauses (1) to (5), for a provider applying for enrollment under 
57.7 	section 256B.04, subdivision 21. The background study requirement may be satisfied if the 
57.8 	commissioner conducted a fingerprint-based background study on the provider that included 
57.9 	a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses (1) to (5).
57.10 	(b) As a condition of enrollment in medical assistance, the commissioner must require 
57.11 	that a high-risk provider, or a person with a direct or indirect ownership interest in the 
57.12 	provider of five percent or higher, consent to criminal background checks, including 
57.13 	fingerprinting, when required to do so under state law or by a determination by the 
57.14 	commissioner or CMS that a provider is designated high-risk.
57.15 		Subd. 5.Surety bonds. (a) The commissioner may require a provider to purchase a 
57.16 	surety bond as a condition of initial enrollment, revalidation, reenrollment, reinstatement, 
57.17 	or continued enrollment if:
57.18 	(1) the provider fails to demonstrate financial viability;
57.19 	(2) the commissioner determines there is significant evidence of or potential for fraud 
57.20 	and abuse by the provider; or
57.21 	(3) the provider or category of providers is designated high-risk pursuant to subdivision 
57.22 	1 and Code of Federal Regulations, title 42, section 455.450.
57.23 	(b) The surety bond must be in an amount of $100,000 or ten percent of the provider's 
57.24 	payments from Medicaid during the immediately preceding 12 months, whichever is greater. 
57.25 	The surety bond must name the Department of Human Services as an obligee and must 
57.26 	allow for recovery of costs and fees in pursuing a claim on the bond.
57.27 	(c) This subdivision does not apply if the provider currently maintains a surety bond 
57.28 	under the requirements in section 256B.051, 256B.0659, 256B.0701, or 256B.85.
57.29 		Subd. 6.Required permission to conduct on-site inspection. As a condition of 
57.30 	enrollment in medical assistance, the commissioner shall require that a provider designated 
57.31 	moderate-risk or high-risk by CMS or the commissioner permit CMS, CMS's agents, or 
57.32 	CMS's designated contractors and the state agency, the state agency's agents, or the state 
58.1 	agency's designated contractors to conduct unannounced on-site inspections of any provider 
58.2 	location.
58.3 		Subd. 7.Compliance programs. (a) The commissioner may require, as a condition of 
58.4 	enrollment in medical assistance, that a provider within a particular industry sector or 
58.5 	category establish a compliance program that contains the core elements established by 
58.6 	CMS.
58.7 	(b) If an enrolled provider is required by the commissioner or by law to designate an 
58.8 	individual as the provider's compliance officer, the compliance officer must:
58.9 	(1) develop policies and procedures to ensure adherence to medical assistance laws and 
58.10 	regulations and to prevent inappropriate claims submissions;
58.11 	(2) train the employees of the provider entity and any agents or subcontractors of the 
58.12 	provider entity including billers on the policies and procedures under clause (1);
58.13 	(3) respond to allegations of improper conduct related to the provision or billing of 
58.14 	medical assistance services and implement action to remediate any resulting problems;
58.15 	(4) use evaluation techniques to monitor compliance with medical assistance laws and 
58.16 	regulations;
58.17 	(5) promptly report to the commissioner any identified violations of medical assistance 
58.18 	laws or regulations; and
58.19 	(6) within 60 days of discovery by the provider of a medical assistance reimbursement 
58.20 	overpayment, report the overpayment to the commissioner and make arrangements with 
58.21 	the commissioner for the commissioner's recovery of the overpayment.
58.22 		Subd. 8.Correspondence and notification. The commissioner may deliver 
58.23 	correspondence and notifications, including notifications of termination and other actions, 
58.24 	electronically to a provider's MN-ITS mailbox. This subdivision does not apply to 
58.25 	correspondence and notifications related to background studies.

58.26 	Sec. 9. [256B.0441] PROVIDER REVALIDATION.
58.27 		Subdivision 1.Provider revalidation schedule. The commissioner shall revalidate:
58.28 	(1) each provider at least once every five years;
58.29 	(2) each personal care assistance agency, community first services and supports (CFSS) 
58.30 	provider-agency, and CFSS financial management services provider at least once every 
58.31 	three years;
59.1 	(3) each early intensive developmental and behavioral intervention agency at least once 
59.2 	every three years; and
59.3 	(4) at the commissioner's discretion, any medical-assistance-only provider type the 
59.4 	commissioner deems high-risk under section 256B.044, subdivision 1.
59.5 		Subd. 2.Revalidation procedures. The commissioner shall conduct revalidation as 
59.6 	follows:
59.7 	(1) provide 30 days' notice of the revalidation due date including instructions for 
59.8 	revalidation and a list of materials the provider must submit;
59.9 	(2) if a provider fails to submit all required materials by the due date, notify the provider 
59.10 	of the deficiency within 30 days after the due date and allow the provider an additional 30 
59.11 	days from the notification date to comply; and
59.12 	(3) if a provider fails to remedy a deficiency within the 30-day time period, give 60 days' 
59.13 	notice of termination and immediately suspend the provider's ability to bill. The provider 
59.14 	does not have the right to appeal suspension of ability to bill.

59.15 	Sec. 10. [256B.0442] PROVIDER ENROLLMENT SUSPENSIONS AND 
59.16 	TERMINATIONS.
59.17 		Subdivision 1.Commissioner's general authority to suspend individual provider's 
59.18 	enrollment. (a) If a provider fails to comply with any individual provider requirement or 
59.19 	condition of participation, the commissioner may suspend the provider's ability to bill until 
59.20 	the provider comes into compliance.
59.21 	(b) The commissioner's decision to suspend the provider is not subject to an administrative 
59.22 	appeal.
59.23 		Subd. 2.Commissioner's authority to revoke enrollment of certain providers for 
59.24 	lack of documentation. (a) The commissioner may revoke the enrollment of an ordering 
59.25 	or rendering provider for a period of not more than one year if the provider fails to maintain 
59.26 	and, upon request from the commissioner, provide access to documentation relating to 
59.27 	written orders or requests for payment for durable medical equipment, certifications for 
59.28 	home health services, or referrals for other items or services written or ordered by the 
59.29 	provider, when the commissioner has identified a pattern of a lack of documentation. A 
59.30 	pattern means a failure to maintain documentation or provide access to documentation on 
59.31 	more than one occasion.
60.1 	(b) Nothing in this subdivision limits the authority of the commissioner to sanction a 
60.2 	provider under section 256B.064.
60.3 		Subd. 3.Commissioner's duty to terminate provider enrollment. (a) Except as 
60.4 	provided in paragraph (b), the commissioner must terminate or deny the enrollment of any 
60.5 	individual or entity if the individual or entity has been terminated from participation in 
60.6 	Medicare or under the Medicaid program or Children's Health Insurance Program of any 
60.7 	other state.
60.8 	(b) The commissioner may exempt a rehabilitation agency from termination or denial 
60.9 	that would otherwise be required under paragraph (a) if the agency:
60.10 	(1) is unable to retain Medicare certification and enrollment solely due to a lack of billing 
60.11 	to the Medicare program;
60.12 	(2) meets all other applicable Medicare certification requirements based on an on-site 
60.13 	review completed by the commissioner of health; and
60.14 	(3) serves primarily a pediatric population.

60.15 	Sec. 11. [256B.0443] PROVIDER PAYMENT WITHHOLDS UPON INITIAL 
60.16 	ENROLLMENT.
60.17 	(a) If the commissioner or the Centers for Medicare and Medicaid Services designates 
60.18 	a provider type as high-risk, the commissioner may withhold payment from providers within 
60.19 	that category upon initial enrollment for a 90-day period.
60.20 	(b) The withholding for each provider must begin on the date of the first submission of 
60.21 	a claim.

60.22 	Sec. 12. [256B.0444] ADDITIONAL PROVIDER ENROLLMENT REQUIREMENTS 
60.23 	FOR HIGH-RISK PROVIDERS.
60.24 		Subdivision 1.Applicability. This section applies to any agency that provides a service 
60.25 	designated by the commissioner as high-risk under section 256B.044, subdivision 1. For 
60.26 	purposes of this section, "agency" means the legal entity that is applying to be or is enrolled 
60.27 	with Minnesota health care programs as a medical assistance provider according to Minnesota 
60.28 	Rules, part 9505.0195.
60.29 		Subd. 2.Mandatory training compliance. (a) Effective January 1, 2027, before applying 
60.30 	for enrollment or reenrollment as a medical assistance provider, an agency applying to 
60.31 	provide services designated by the commissioner as high-risk must require all owners of 
61.1 	the agency who are active in the day-to-day management and operations of the agency and 
61.2 	managerial and supervisory employees to complete compliance training. All individuals 
61.3 	who must complete training under this subdivision must repeat the training prior to 
61.4 	revalidation of the agency as a medical assistance provider.
61.5 	(b) New owners active in day-to-day management and operations of the agency and new 
61.6 	managerial and supervisory employees of the agency must complete compliance training 
61.7 	under this subdivision within 30 calendar days of becoming an owner of or employed by 
61.8 	the agency and prior to conducting any management and operations activities for the agency. 
61.9 	If an individual moves to another agency providing the same service and serves in a similar 
61.10 	ownership or employment capacity, the individual is not required to repeat the training 
61.11 	required under this subdivision. If the individual chooses not to repeat the compliance 
61.12 	training, the individual must provide the agency with documentation proving the individual 
61.13 	completed the compliance training within the provider revalidation schedule for the relevant 
61.14 	provider type as determined by the commissioner under section 256B.0441.
61.15 	(c) The commissioner must determine the format and content of the compliance training. 
61.16 	The training must include the following topics, adapted as necessary for each provider type 
61.17 	subject to the requirements of this subdivision:
61.18 	(1) state and federal program billing, documentation, and service delivery requirements;
61.19 	(2) enrollment requirements;
61.20 	(3) provider program integrity, including fraud prevention, detection, and penalties;
61.21 	(4) fair labor standards;
61.22 	(5) workplace safety requirements; and
61.23 	(6) recent changes in service requirements.
61.24 		Subd. 3.Individual provider number. (a) Effective January 1, 2027, all individuals 
61.25 	subject to a background study as a result of being employed by or an owner of a high-risk 
61.26 	agency must enroll individually as a medical assistance provider.
61.27 	(b) The commissioner must issue a unique Minnesota provider identifier to each 
61.28 	individual who satisfies the background study requirements, satisfies the individual 
61.29 	enrollment requirements, and does not have either a national provider identifier or a unique 
61.30 	Minnesota provider identifier. The commissioner must ensure that no individual is issued 
61.31 	multiple unique Minnesota provider identifiers. If the commissioner mistakenly issues 
61.32 	multiple unique Minnesota provider identifiers to the same individual, the commissioner 
61.33 	must provide a means for the numbers to be consolidated.
62.1 	(c) If an individual provides false or misleading information to the commissioner in an 
62.2 	attempt to cause the commissioner to issue to the individual an additional unique Minnesota 
62.3 	provider identifier, the commissioner may terminate the enrollment of the individual.
62.4 		Subd. 4.Required use of an electronic visit verification system. Effective January 1, 
62.5 	2027, an individual providing a high-risk service must electronically verify the provision 
62.6 	of the services using an electronic visit verification system meeting the requirements of 
62.7 	section 256B.073.
62.8 		Subd. 5.Signatures required for provision of service verifications. (a) Effective 
62.9 	January 1, 2027, an individual providing a high-risk service must sign and obtain the 
62.10 	signature of the service recipient, or of the service recipient's representative, on a provision 
62.11 	of service verification form. The provision of service verification form must include a 
62.12 	statement that by signing the form, the signatory is attesting to the accuracy of all data 
62.13 	entered in the electronic visit verification system. The provision of service verification form 
62.14 	must also include a statement that it is a federal crime to provide false information regarding 
62.15 	the provision of medical assistance services.
62.16 	(b) The commissioner must determine a minimum frequency at which the required 
62.17 	signatures on a provision of service verification form must be obtained.
62.18 		Subd. 6.Documentation of travel time. Effective January 1, 2027, an individual 
62.19 	providing a high-risk service must document any travel or driving time that is eligible for 
62.20 	reimbursement and for which the individual or high-risk agency seeks a medical assistance 
62.21 	payment. The documentation must include:
62.22 	(1) start and stop times with a.m. and p.m. designations;
62.23 	(2) the origination site; and
62.24 	(3) the destination site.

62.25 	Sec. 13. [256B.0445] ADDITIONAL PROVIDER ENROLLMENT REQUIREMENTS 
62.26 	FOR SPECIFIC PROVIDER TYPES.
62.27 		Subdivision 1.Durable medical equipment provider or supplier. (a) For the purposes 
62.28 	of this subdivision, "durable medical equipment provider or supplier" means a medical 
62.29 	supplier that can purchase medical equipment or supplies for sale or rent to the general 
62.30 	public and is able to perform or arrange for necessary repairs to and maintenance of 
62.31 	equipment offered for sale or rent.
63.1 	(b) Upon initial enrollment, reenrollment, and notification of revalidation, all durable 
63.2 	medical equipment, prosthetics, orthotics, and supplies medical suppliers meeting the durable 
63.3 	medical equipment provider or supplier definition in paragraph (a), operating in Minnesota, 
63.4 	and receiving Medicaid money must purchase a surety bond that is annually renewed, 
63.5 	designates the Department of Human Services as the obligee, and is submitted in a form 
63.6 	approved by the commissioner. For purposes of this paragraph, the following medical 
63.7 	suppliers are not required to obtain a surety bond: a federally qualified health center, a home 
63.8 	health agency, the Indian Health Service, a pharmacy, and a rural health clinic.
63.9 	(c) At the time of initial enrollment or reenrollment, durable medical equipment providers 
63.10 	or suppliers defined in paragraph (a) must purchase a surety bond of $50,000. If a revalidating 
63.11 	provider's Medicaid revenue in the previous calendar year is up to and including $300,000, 
63.12 	the provider agency must purchase a surety bond of $50,000. If a revalidating provider's 
63.13 	Medicaid revenue in the previous calendar year is over $300,000, the provider agency must 
63.14 	purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and 
63.15 	fees in pursuing a claim on the bond. Any action to obtain monetary recovery or sanctions 
63.16 	from a surety bond must occur within six years from the date the debt is affirmed by a final 
63.17 	agency decision. An agency decision is final when the right to appeal the debt has been 
63.18 	exhausted or the time to appeal has expired under section 256B.064.
63.19 		Subd. 2.Providers licensed by the commissioner of human services. An enrolled 
63.20 	provider that is also licensed by the commissioner under chapter 245A must designate an 
63.21 	individual as the licensee's compliance officer under section 256B.044, subdivision 7, 
63.22 	paragraph (b).
63.23 		Subd. 3.Providers licensed by the commissioner of health. An enrolled provider that 
63.24 	is also licensed by the commissioner of health as a home care provider under chapter 144A 
63.25 	with a home and community-based services designation on the home care license or as an 
63.26 	assisted living facility under chapter 144G must designate an individual as the licensee's 
63.27 	compliance officer under section 256B.044, subdivision 7, paragraph (b).

63.28 	Sec. 14. Minnesota Statutes 2025 Supplement, section 256B.051, subdivision 6, is amended 
63.29 	to read:
63.30 		Subd. 6.Agency qualifications and duties. An agency is eligible for reimbursement 
63.31 	under this section only if the agency:
63.32 	(1) is confirmed by the commissioner as an eligible provider after a pre-enrollment risk 
63.33 	assessment under subdivision 6a;
64.1 	(2) is enrolled as a medical assistance Minnesota health care program provider and meets 
64.2 	all applicable provider standards and requirements;
64.3 	(3) demonstrates compliance with federal and state laws and policies for housing 
64.4 	stabilization services as determined by the commissioner;
64.5 	(4) complies with background study requirements under chapter 245C and maintains 
64.6 	documentation of background study requests and results;
64.7 	(5) provides at the time of enrollment, reenrollment, and revalidation in a format 
64.8 	determined by the commissioner, proof of surety bond coverage for each business location 
64.9 	providing services. Upon new enrollment, or if the provider's medical assistance revenue 
64.10 	in the previous calendar year is $300,000 or less, the provider agency must purchase a surety 
64.11 	bond of $50,000. If the provider's medical assistance revenue in the previous year is over 
64.12 	$300,000, the provider agency must purchase a surety bond of $100,000. The surety bond 
64.13 	must be in a form approved by the commissioner, must be renewed annually, and must 
64.14 	allow for recovery of costs and fees in pursuing a claim on the bond. Any action to obtain 
64.15 	monetary recovery or sanctions from a surety bond must occur within six years from the 
64.16 	date the debt is affirmed by a final agency decision. An agency decision is final when the 
64.17 	right to appeal the debt has been exhausted or the time to appeal has expired under section 
64.18 	256B.064;
64.19 	(6) directly provides housing stabilization services using employees of the agency and 
64.20 	not by using a subcontractor or reporting agent;
64.21 	(7) ensures all controlling individuals and employees of the agency complete annual 
64.22 	vulnerable adult training; and
64.23 	(8) completes compliance training as required under section 256B.0444, subdivision 6b
64.24 	2.

64.25 	Sec. 15. Minnesota Statutes 2025 Supplement, section 256B.0701, subdivision 9, is 
64.26 	amended to read:
64.27 		Subd. 9.Provider qualifications and duties. A provider is eligible for reimbursement 
64.28 	under this section only if the provider:
64.29 	(1) is confirmed by the commissioner as an eligible provider after a pre-enrollment risk 
64.30 	assessment under subdivision 10;
64.31 	(2) is enrolled as a medical assistance Minnesota health care program provider and meets 
64.32 	all applicable provider standards and requirements;
65.1 	(3) demonstrates compliance with federal and state laws and policies for housing 
65.2 	stabilization services as determined by the commissioner;
65.3 	(4) complies with background study requirements under chapter 245C and maintains 
65.4 	documentation of background study requests and results;
65.5 	(5) provides at the time of enrollment, reenrollment, and revalidation in a format 
65.6 	determined by the commissioner, proof of surety bond coverage for each business location 
65.7 	providing services. Upon new enrollment, or if the provider's medical assistance revenue 
65.8 	in the previous calendar year is $300,000 or less, the provider agency must purchase a surety 
65.9 	bond of $50,000. If the provider's medical assistance revenue in the previous year is over 
65.10 	$300,000, the provider agency must purchase a surety bond of $100,000. The surety bond 
65.11 	must be in a form approved by the commissioner, must be renewed annually, and must 
65.12 	allow for recovery of costs and fees in pursuing a claim on the bond. Any action to obtain 
65.13 	monetary recovery or sanctions from a surety bond must occur within six years from the 
65.14 	date the debt is affirmed by a final agency decision. An agency decision is final when the 
65.15 	right to appeal the debt has been exhausted or the time to appeal has expired under section 
65.16 	256B.064;
65.17 	(6) ensures all controlling individuals and employees of the agency complete annual 
65.18 	vulnerable adult training;
65.19 	(7) completes compliance training as required under section 256B.0444, subdivision 11
65.20 	2; and
65.21 	(8) complies with the habitability inspection requirements in subdivision 13.

65.22 	Sec. 16. Minnesota Statutes 2024, section 256B.073, subdivision 2, is amended to read:
65.23 		Subd. 2.Definitions. (a) For purposes of this section, the terms in this subdivision have 
65.24 	the meanings given them.
65.25 	(b) "Electronic visit verification" means the electronic documentation of the:
65.26 	(1) type of service performed;
65.27 	(2) individual receiving the service;
65.28 	(3) date of the service;
65.29 	(4) location of the service delivery;
65.30 	(5) individual providing the service; and
65.31 	(6) time the service begins and ends.
66.1 	(c) "Electronic visit verification system" means a system that provides electronic 
66.2 	verification of services that complies with the 21st Century Cures Act, Public Law 114-255, 
66.3 	and the requirements of subdivision 3.
66.4 	(d) "Service" means one of the following includes:
66.5 	(1) personal care assistance services as defined in section 256B.0625, subdivision 19a, 
66.6 	and provided according to section 256B.0659;
66.7 	(2) community first services and supports under section 256B.85;
66.8 	(3) home health services under section 256B.0625, subdivision 6a; or
66.9 	(4) other medical supplies and equipment or home and community-based services that 
66.10 	are required to be electronically verified by the 21st Century Cures Act, Public Law 114-255.;
66.11 	(5) services provided by a provider type designated by the commissioner as high-risk 
66.12 	under section 256B.044, subdivision 1; and
66.13 	(6) home and community-based services reimbursed at an hourly or specified 
66.14 	minute-based rate and provided according to a federally approved waiver plan as authorized 
66.15 	under chapter 256S and sections 256B.0913, 256B.092, and 256B.49.

66.16 	Sec. 17. Minnesota Statutes 2025 Supplement, section 256B.0759, subdivision 4, is 
66.17 	amended to read:
66.18 		Subd. 4.Provider payment rates. (a) Payment rates for participating providers must 
66.19 	be increased for services provided to medical assistance enrollees. To receive a rate increase, 
66.20 	participating providers must meet demonstration project requirements and provide evidence 
66.21 	of formal referral arrangements with providers delivering step-up or step-down levels of 
66.22 	care. Providers that have enrolled in the demonstration project but have not met the provider 
66.23 	standards under subdivision 3 as of July 1, 2022, are not eligible for a rate increase under 
66.24 	this subdivision until the date that the provider meets the provider standards in subdivision 
66.25 	3. Services provided from July 1, 2022, to the date that the provider meets the provider 
66.26 	standards under subdivision 3 shall be reimbursed at rates according to section 254B.0505, 
66.27 	subdivision 1. Rate increases paid under this subdivision to a provider for services provided 
66.28 	between July 1, 2021, and July 1, 2022, are not subject to recoupment when the provider 
66.29 	is taking meaningful steps to meet demonstration project requirements that are not otherwise 
66.30 	required by law, and the provider provides documentation to the commissioner, upon request, 
66.31 	of the steps being taken.
67.1 	(b) The commissioner may temporarily suspend payments to the provider according to 
67.2 	section 256B.04, subdivision 21, paragraph (d) 256B.0442, subdivision 1, if the provider 
67.3 	does not meet the requirements in paragraph (a). Payments withheld from the provider must 
67.4 	be made once the commissioner determines that the requirements in paragraph (a) are met.
67.5 	(c) For outpatient individual and group substance use disorder services under section 
67.6 	254B.0505, subdivision 1, clause (1), and adolescent treatment programs that are licensed 
67.7 	as outpatient treatment programs according to sections 245G.01 to 245G.18, provided on 
67.8 	or after January 1, 2021, payment rates must be increased by 20 percent over the rates in 
67.9 	effect on December 31, 2020.
67.10 	(d) Effective January 1, 2021, and contingent on annual federal approval, managed care 
67.11 	plans and county-based purchasing plans must reimburse providers of the substance use 
67.12 	disorder services meeting the criteria described in paragraph (a) who are employed by or 
67.13 	under contract with the plan an amount that is at least equal to the fee-for-service base rate 
67.14 	payment for the substance use disorder services described in paragraph (c). The commissioner 
67.15 	must monitor the effect of this requirement on the rate of access to substance use disorder 
67.16 	services and residential substance use disorder rates. Capitation rates paid to managed care 
67.17 	organizations and county-based purchasing plans must reflect the impact of this requirement. 
67.18 	This paragraph expires if federal approval is not received at any time as required under this 
67.19 	paragraph.
67.20 	(e) Effective July 1, 2021, contracts between managed care plans and county-based 
67.21 	purchasing plans and providers to whom paragraph (d) applies must allow recovery of 
67.22 	payments from those providers if, for any contract year, federal approval for the provisions 
67.23 	of paragraph (d) is not received, and capitation rates are adjusted as a result. Payment 
67.24 	recoveries must not exceed the amount equal to any decrease in rates that results from this 
67.25 	provision.
67.26 	(f) For substance use disorder services with medications for opioid use disorder under 
67.27 	section 254B.0505, subdivision 1, clause (7), provided on or after January 1, 2021, payment 
67.28 	rates must be increased by 20 percent over the rates in effect on December 31, 2020. Upon 
67.29 	implementation of new rates according to section 254B.121, the 20 percent increase will 
67.30 	no longer apply.

67.31 	Sec. 18. Minnesota Statutes 2025 Supplement, section 256B.0949, subdivision 16, is 
67.32 	amended to read:
67.33 		Subd. 16.Agency duties. (a) An agency delivering an EIDBI service under this section 
67.34 	must:
68.1 	(1) enroll as a medical assistance Minnesota health care program provider according to 
68.2 	Minnesota Rules, part 9505.0195, and section 256B.04, subdivision 21 sections 256B.044 
68.3 	to 256B.0445, and meet all applicable provider standards and requirements;
68.4 	(2) designate an individual as the agency's compliance officer who must perform the 
68.5 	duties described in section 256B.04, subdivision 21, paragraph (g) 256B.044, subdivision 
68.6 	7, paragraph (b);
68.7 	(3) demonstrate compliance with federal and state laws for the delivery of and billing 
68.8 	for EIDBI service;
68.9 	(4) verify and maintain records of a service provided to the person or the person's legal 
68.10 	representative as required under Minnesota Rules, parts 9505.2175 and 9505.2197;
68.11 	(5) demonstrate that while enrolled or seeking enrollment as a Minnesota health care 
68.12 	program provider the agency did not have a lead agency contract or provider agreement 
68.13 	discontinued because of a conviction of fraud; or did not have an owner, board member, or 
68.14 	manager fail a state or federal criminal background check or appear on the list of excluded 
68.15 	individuals or entities maintained by the federal Department of Human Services Office of 
68.16 	Inspector General;
68.17 	(6) have established business practices including written policies and procedures, internal 
68.18 	controls, and a system that demonstrates the organization's ability to deliver quality EIDBI 
68.19 	services, appropriately submit claims, conduct required staff training, document staff 
68.20 	qualifications, document service activities, and document service quality;
68.21 	(7) have an office located in Minnesota or a border state;
68.22 	(8) initiate a background study as required under subdivision 16a;
68.23 	(9) report maltreatment according to section 626.557 and chapter 260E;
68.24 	(10) comply with any data requests consistent with the Minnesota Government Data 
68.25 	Practices Act, sections 256B.064 and 256B.27;
68.26 	(11) provide training for all agency staff on the requirements and responsibilities listed 
68.27 	in the Maltreatment of Minors Act, chapter 260E, and the Vulnerable Adult Protection Act, 
68.28 	section 626.557, including mandated and voluntary reporting, nonretaliation, and the agency's 
68.29 	policy for all staff on how to report suspected abuse and neglect;
68.30 	(12) have a written policy to resolve issues collaboratively with the person and the 
68.31 	person's legal representative when possible. The policy must include a timeline for when 
69.1 	the person and the person's legal representative will be notified about issues that arise in 
69.2 	the provision of services;
69.3 	(13) provide the person's legal representative with prompt notification if the person is 
69.4 	injured while being served by the agency. An incident report must be completed by the 
69.5 	agency staff member in charge of the person. A copy of all incident and injury reports must 
69.6 	remain on file at the agency for at least five years from the report of the incident;
69.7 	(14) before starting a service, provide the person or the person's legal representative a 
69.8 	description of the treatment modality that the person shall receive, including the staffing 
69.9 	certification levels and training of the staff who shall provide a treatment;
69.10 	(15) provide clinical supervision for a minimum of one hour for every 16 hours of direct 
69.11 	treatment per person, unless otherwise authorized in the person's individual treatment plan; 
69.12 	and
69.13 	(16) provide required EIDBI intervention observation and direction at least once per 
69.14 	month. Notwithstanding subdivision 13, paragraph (l), required EIDBI intervention 
69.15 	observation and direction under this clause may be conducted via telehealth provided that 
69.16 	no more than two consecutive monthly required EIDBI intervention observation and direction 
69.17 	sessions under this clause are conducted via telehealth.
69.18 	(b) Upon request of the commissioner, an agency delivering services under this section 
69.19 	must:
69.20 	(1) identify the agency's controlling individuals, as defined under section 245A.02, 
69.21 	subdivision 5a;
69.22 	(2) provide disclosures of the use of billing agencies and other consultants who do not 
69.23 	provide EIDBI services; and
69.24 	(3) provide copies of any contracts with consultants or independent contractors who do 
69.25 	not provide EIDBI services, including hours contracted and responsibilities.
69.26 	(c) When delivering the ITP, and annually thereafter, an agency must provide the person 
69.27 	or the person's legal representative with:
69.28 	(1) a written copy and a verbal explanation of the person's or person's legal 
69.29 	representative's rights and the agency's responsibilities;
69.30 	(2) documentation in the person's file the date that the person or the person's legal 
69.31 	representative received a copy and explanation of the person's or person's legal 
69.32 	representative's rights and the agency's responsibilities; and
70.1 	(3) reasonable accommodations to provide the information in another format or language 
70.2 	as needed to facilitate understanding of the person's or person's legal representative's rights 
70.3 	and the agency's responsibilities.

70.4 	Sec. 19. Minnesota Statutes 2024, section 256B.0949, subdivision 17, is amended to read:
70.5 		Subd. 17.Provider shortage; authority for exceptions. (a) In consultation with the 
70.6 	Early Intensive Developmental and Behavioral Intervention Advisory Council and 
70.7 	stakeholders, including agencies, professionals, parents of people with ASD or a related 
70.8 	condition, and advocacy organizations, the commissioner shall determine if a shortage of 
70.9 	EIDBI providers exists. For the purposes of this subdivision, "shortage of EIDBI providers" 
70.10 	means a lack of availability of providers who meet the EIDBI provider qualification 
70.11 	requirements under subdivision 15 that results in the delay of access to timely services under 
70.12 	this section, or that significantly impairs the ability of a provider agency to have sufficient 
70.13 	providers to meet the requirements of this section. The commissioner shall consider 
70.14 	geographic factors when determining the prevalence of a shortage. The commissioner may 
70.15 	determine that a shortage exists only in a specific region of the state, multiple regions of 
70.16 	the state, or statewide. The commissioner shall also consider the availability of various types 
70.17 	of treatment modalities covered under this section.
70.18 	(b) The commissioner, in consultation with the Early Intensive Developmental and 
70.19 	Behavioral Intervention Advisory Council and stakeholders, must establish processes and 
70.20 	criteria for granting an exception under this paragraph. The commissioner may grant an 
70.21 	exception only if the exception would not compromise a person's safety and not diminish 
70.22 	the effectiveness of the treatment. The commissioner may establish an expiration date for 
70.23 	an exception granted under this paragraph. The commissioner may grant an exception for 
70.24 	the following:
70.25 	(1) EIDBI provider qualifications under this section;
70.26 	(2) medical assistance provider enrollment requirements under section 256B.04, 
70.27 	subdivision 21 sections 256B.044 to 256B.0445; or
70.28 	(3) EIDBI provider or agency standards or requirements.
70.29 	(c) If the commissioner, in consultation with the Early Intensive Developmental and 
70.30 	Behavioral Intervention Advisory Council and stakeholders, determines that a shortage no 
70.31 	longer exists, the commissioner must submit a notice that a shortage no longer exists to the 
70.32 	chairs and ranking minority members of the senate and the house of representatives 
70.33 	committees with jurisdiction over health and human services. The commissioner must post 
71.1 	the notice for public comment for 30 days. The commissioner shall consider public comments 
71.2 	before submitting to the legislature a request to end the shortage declaration. The 
71.3 	commissioner shall not declare the shortage of EIDBI providers ended without direction 
71.4 	from the legislature to declare it ended.

71.5 	Sec. 20. Minnesota Statutes 2025 Supplement, section 256B.4912, subdivision 1, is 
71.6 	amended to read:
71.7 		Subdivision 1.Provider qualifications. (a) For the home and community-based waivers 
71.8 	providing services to seniors and individuals with disabilities under chapter 256S and 
71.9 	sections 256B.0913, 256B.092, and 256B.49, the commissioner shall establish:
71.10 	(1) agreements with enrolled waiver service providers to ensure providers meet Minnesota 
71.11 	health care program requirements;
71.12 	(2) regular reviews of provider qualifications, and including requests of for proof of 
71.13 	documentation; and
71.14 	(3) processes to gather the necessary information to determine provider qualifications.
71.15 	(b) A provider shall not require or coerce any service recipient to change waiver programs 
71.16 	or move to a different location, consistent with the informed choice and independent living 
71.17 	policies under section 256B.4905, subdivisions 1a, 2a, 3a, 7, and 8.
71.18 	(c) For staff that provide direct contact, as defined in section 245C.02, subdivision 11, 
71.19 	for services specified in the federally approved waiver plans, providers must meet the 
71.20 	requirements of chapter 245C and maintain documentation of background study requests 
71.21 	and results. This requirement also applies to consumer-directed community supports.
71.22 	(d) Service owners and managerial officials overseeing the management or policies of 
71.23 	services that provide direct contact as specified in the federally approved waiver plans must 
71.24 	meet the requirements of chapter 245C prior to reenrollment or revalidation or, for new 
71.25 	providers, prior to initial enrollment if they have not already done so as a part of service 
71.26 	licensure requirements.

71.27 	Sec. 21. Minnesota Statutes 2024, section 256B.4912, is amended by adding a subdivision 
71.28 	to read:
71.29 		Subd. 10a.Individual provider identifier. (a) Effective January 1, 2027, staff that 
71.30 	provide direct contact, as defined in section 245C.02, subdivision 11, for services specified 
71.31 	in the federally approved waiver plans must enroll individually with Minnesota health care 
72.1 	programs as a medical assistance provider. This requirement also applies to 
72.2 	consumer-directed community supports.
72.3 	(b) For individuals enrolling individually under this subdivision, the commissioner must 
72.4 	conform with the requirements of section 256B.0444, subdivision 3.

72.5 	Sec. 22. Minnesota Statutes 2024, section 256B.4912, subdivision 12, is amended to read:
72.6 		Subd. 12.Home and community-based service documentation requirements. (a) 
72.7 	Unless the provider is required to use an electronic visit verification system authorized 
72.8 	under section 256B.073, the provider must collect and maintain documentation may be 
72.9 	collected and maintained electronically or in paper form by providers and must be produced. 
72.10 	The provider must produce all documentation upon request by the commissioner.
72.11 	(b) Documentation of a delivered service must be in English and must be legible according 
72.12 	to the standard of a reasonable person.
72.13 	(c) If the service is reimbursed at an hourly or specified minute-based rate, each 
72.14 	documentation of the provision of a service, unless otherwise specified, must include:
72.15 	(1) the date the documentation occurred;
72.16 	(2) the day, month, and year when the service was provided;
72.17 	(3) the start and stop times with a.m. and p.m. designations, except for case management 
72.18 	services as defined under chapter 256S and sections 256B.0913, subdivision 7; 256B.092, 
72.19 	subdivision 1a; and 256B.49, subdivision 13;
72.20 	(4) the service name or description of the service provided; and
72.21 	(5) the name, individual provider identifier, signature, and title, if any, of the provider 
72.22 	of service. If the service is provided by multiple staff members, the provider may designate 
72.23 	a staff member responsible for verifying services and completing the documentation required 
72.24 	by this paragraph.
72.25 	(d) If the service is reimbursed at a daily rate or does not meet the requirements in 
72.26 	paragraph (c), each documentation of the provision of a service, unless otherwise specified, 
72.27 	must include:
72.28 	(1) the date the documentation occurred;
72.29 	(2) the day, month, and year when the service was provided;
72.30 	(3) the service name or description of the service provided; and
73.1 	(4) the name, individual provider identifier, signature, and title, if any, of the person 
73.2 	providing the service. If the service is provided by multiple staff, the provider may designate 
73.3 	a staff member responsible for verifying services and completing the documentation required 
73.4 	by this paragraph. The designated staff member verifying the services must include in the 
73.5 	documentation of the provision of a service the names and individual provider identifiers 
73.6 	of all staff who provided the service.

73.7 	Sec. 23. Minnesota Statutes 2024, section 256B.4912, subdivision 14, is amended to read:
73.8 		Subd. 14.Equipment and supply documentation requirements. (a) In addition to An 
73.9 	equipment and supply services provider must follow the requirements in subdivision 12, 
73.10 	except for the requirement to provide an individual provider identifier. An equipment and 
73.11 	supply services provider must also include for each documentation of the provision of a 
73.12 	service include:
73.13 	(1) the recipient's assessed need for the equipment or supply;
73.14 	(2) the reason the equipment or supply is not covered by the Medicaid state plan;
73.15 	(3) the type and brand name of the equipment or supply delivered to or purchased by 
73.16 	the recipient, including whether the equipment or supply was rented or purchased;
73.17 	(4) the quantity of the equipment or supply delivered or purchased; and
73.18 	(5) the cost of the equipment or supply if the amount paid for the service depends on 
73.19 	the cost.
73.20 	(b) A provider must maintain a copy of the shipping invoice or a delivery service tracking 
73.21 	log or other documentation showing the date of delivery that proves the equipment or supply 
73.22 	was delivered to the recipient or a receipt if the equipment or supply was purchased by the 
73.23 	recipient.

73.24 	Sec. 24. Minnesota Statutes 2024, section 256B.4912, subdivision 15, is amended to read:
73.25 		Subd. 15.Adult day service documentation and billing requirements. (a) In addition 
73.26 	to the requirements in subdivision 12, a provider of adult day services as defined in section 
73.27 	245A.02, subdivision 2a, and licensed under Minnesota Rules, parts 9555.9600 to 9555.9730, 
73.28 	must maintain documentation of:
73.29 	(1) a needs assessment and current plan of care according to section 245A.143, 
73.30 	subdivisions 4 to 7, or Minnesota Rules, part 9555.9700, for each recipient, if applicable;
74.1 	(2) attendance records as specified under section 245A.14, subdivision 14, paragraph 
74.2 	(a), including the date of attendance with the day, month, and year; and the pickup and 
74.3 	drop-off time in hours and minutes with a.m. and p.m. designations;
74.4 	(3) the monthly and quarterly program requirements in Minnesota Rules, part 9555.9710, 
74.5 	subparts 1, items E and H; 3; 4; and 6, if applicable;
74.6 	(4) the name, individual provider identifier, and qualification of each registered physical 
74.7 	therapist, registered nurse, and registered dietitian who provides services to the adult day 
74.8 	services or nonresidential program; and
74.9 	(5) the location where the service was provided. If the location is an alternate location 
74.10 	from the usual place of service, the documentation must include the address, or a description 
74.11 	if the address is not available, of both the origin site and destination site; the length of time 
74.12 	at the alternate location with a.m. and p.m. designations; and a list of participants who went 
74.13 	to the alternate location.
74.14 	(b) A provider must not exceed the provider's licensed capacity. If a provider exceeds 
74.15 	the provider's licensed capacity, the department commissioner must recover all Minnesota 
74.16 	health care programs payments from the date the provider exceeded licensed capacity.

74.17 	Sec. 25. MANDATORY COMPLIANCE TRAINING FOR CURRENTLY 
74.18 	ENROLLED HIGH-RISK MEDICAL ASSISTANCE PROVIDERS.
 74.19 	The owners and employees of any medical assistance provider agency subject to the 
74.20 	requirements of Minnesota Statutes, section 256B.0444, subdivision 2, and enrolled before 
74.21 	January 1, 2027, must complete initial compliance training by January 1, 2028. Owners and 
74.22 	employees of PCA and CFSS agencies who enrolled before January 1, 2027, and have 
74.23 	previously completed training under Minnesota Statutes, section 256B.0659, subdivision 
74.24 	21, paragraph (c), or 256B.85, subdivision 12, paragraph (c), are not subject to the initial 
74.25 	training requirements of this section but must repeat the compliance training prior to 
74.26 	revalidation as a medical assistance provider.

74.27 	Sec. 26. DIRECTION TO COMMISSIONER OF HUMAN SERVICES; 
74.28 	UNREDACTED INITIAL OPTUM REPORTS.
 74.29 	(a) For the purposes of this section, "initial Optum reports" means the reports produced 
74.30 	by Optum, Inc., under contract with the Department of Human Services and announced in 
74.31 	the news release from the department on February 6, 2026.
75.1 	(b) Notwithstanding any law to the contrary, upon a joint request by both the chairs and 
75.2 	ranking minority members of a legislative committee with jurisdiction over human services 
75.3 	policy and finance, the commissioner of human services must immediately release the initial 
75.4 	Optum reports to the members of that legislative committee in the reports' entirety without 
75.5 	redactions or edits, except for redactions requested by Optum to protect proprietary 
75.6 	information. Legislators or legislative staff who receive initial Optum reports under this 
75.7 	section must not disseminate or publicize any not public data, as defined in Minnesota 
75.8 	Statutes, section 13.02, subdivision 8a, that the reports contain.

75.9 	EFFECTIVE DATE. This section is effective 14 days following final enactment.

75.10 	Sec. 27. OPTUM PROHIBITED FROM DISSEMINATING PRIVATE DATA.
 75.11 	Optum, Inc., must not sell, share, or disseminate any private data on individuals, as 
75.12 	defined in Minnesota Statutes, section 13.02, subdivision 12, that Optum receives under or 
75.13 	incidental to Optum's contract or engagement with the Department of Human Services 
75.14 	pursuant to the governor's Executive Order No. 25-10.

75.15 	Sec. 28. REPEALER.
 75.16 	Minnesota Statutes 2025 Supplement, sections 256B.051, subdivision 6b; and 256B.0701, 
75.17 	subdivision 11, are repealed.

	ARTICLE 1	PROGRAM INTEGRITY REQUIREMENTS........	Page.Ln 1.22	
	ARTICLE 2	MEDICAL ASSISTANCE PROVIDER ENROLLMENT MODIFICATIONS........	Page.Ln 19.1	
	ARTICLE 3	PROVIDER ENROLLMENT REQUIREMENTS FOR HIGH-RISK PROVIDERS........	Page.Ln 41.1	

APPENDIX 

Repealed Minnesota Statutes: S4222-2 

256B.051 HOUSING STABILIZATION SERVICES.Subd. 6b.Requirements for provider enrollment. 
(a) Effective January 1, 2027, to enroll as a housing stabilization services provider agency, an agency must require all owners of the agency who are active in the day-to-day management and operations of the agency and managerial and supervisory employees to complete compliance training before applying for enrollment and every three years thereafter. Mandatory compliance training format and content must be determined by the commissioner and must include the following topics: 

(1) state and federal program billing, documentation, and service delivery requirements; 

(2) enrollment requirements; 

(3) provider program integrity, including fraud prevention, detection, and penalties; 

(4) fair labor standards; 

(5) workplace safety requirements; and 

(6) recent changes in service requirements. 

(b) New owners active in day-to-day management and operations of the agency and new managerial and supervisory employees must complete compliance training under this subdivision to be employed by or conduct management and operations activities for the agency. If an individual moves to another housing stabilization services provider agency and serves in a similar ownership or employment capacity, the individual is not required to repeat the training required under this subdivision if the individual documents completion of the training within the past three years. 

(c) Any housing stabilization services provider agency enrolled before January 1, 2027, must complete the compliance training by January 1, 2028, and every three years thereafter. 

256B.0701 RECUPERATIVE CARE SERVICES.Subd. 11.Requirements for provider enrollment; compliance training. 
(a) Effective January 1, 2027, to enroll as a recuperative care provider, a provider must require all owners of the provider who are active in the day-to-day management and operations of the agency and all managerial and supervisory employees to complete compliance training before applying for enrollment and every three years thereafter. Mandatory compliance training format and content must be determined by the commissioner and must include the following topics: 

(1) state and federal program billing, documentation, and service delivery requirements; 

(2) enrollment requirements; 

(3) provider program integrity, including fraud prevention, detection, and penalties; 

(4) fair labor standards; 

(5) workplace safety requirements; and 

(6) recent changes in service requirements. 

(b) New owners active in day-to-day management and operations of the provider and new managerial and supervisory employees must complete compliance training under this subdivision to be employed by or conduct management and operations activities for the provider. If an individual moves to another recuperative care provider and serves in a similar ownership or employment capacity, the individual is not required to repeat the training required under this subdivision if the individual documents completion of the training within the past three years. 

(c) Any recuperative care provider enrolled before January 1, 2027, must complete the compliance training by January 1, 2028, and every three years thereafter.