SF 4613

Introduction - 94th Legislature (2025 - 2026)

Posted on 03/19/2026 09:34 a.m.

A bill for an act
relating to human services; modifying provider disenrollment, premium payment
requirements, and physician-directed clinic staff services coverage; recodifying
certain language; requiring a report; amending Minnesota Statutes 2024, sections
142B.01, subdivision 8; 245A.02, subdivision 5a; 245D.081, subdivision 3;
256B.057, subdivision 9; 256B.0625, subdivision 4; 256B.0949, subdivision 17;
256L.05, subdivision 3; 256L.06, subdivision 3; Minnesota Statutes 2025
Supplement, sections 256B.04, subdivision 21; 256B.0759, subdivision 4;
256B.0949, subdivision 16; Laws 2024, chapter 125, article 4, section 12,
subdivision 5; proposing coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

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

Subd. 8.

Controlling individual.

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

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

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

(3) the individual designated as the compliance officer under section deleted text begin 256B.04, deleted text begin subdivision
deleted text end 21, paragraph (g) deleted text end new text begin 256B.044, subdivision 7, paragraph (b) new text end ;

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

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

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

(b) Controlling individual does not include:

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

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

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

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

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

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

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

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

Sec. 2.

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

Subd. 5a.

Controlling individual.

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

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

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

(3) the individual designated as the compliance officer under section deleted text begin 256B.04, subdivision
21, paragraph (g) deleted text end new text begin 256B.044, subdivision 7, paragraph (b) new text end ;

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

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

(b) Controlling individual does not include:

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

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

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

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

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

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

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

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

Sec. 3.

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

Subd. 3.

Program management and oversight.

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

(1) maintaining a current understanding of the licensing requirements sufficient to ensure
compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph
(e), and when applicable, as identified in section deleted text begin 256B.04, subdivision 21, paragraph (g) deleted text end new text begin
256B.044, subdivision 7 new text end ;

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

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

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

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

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

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

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

Sec. 4.

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

Subd. 21.

Provider enrollment.

deleted text begin (a) deleted text end The commissioner shall enroll providers and conduct
screening activities as required by new text begin sections 256B.044 to 256B.0444 and new text end Code of Federal
Regulations, title 42, section 455, subpart E.

deleted text begin A provider must enroll each provider-controlled location where direct services are
provided. The commissioner may deny a provider's incomplete application if a provider
fails to respond to the commissioner's request for additional information within 60 days of
the request. The commissioner must conduct a background study under chapter deleted text end deleted text begin 245C deleted text end deleted text begin ,
including a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses
(1) to (5), for a provider described in this paragraph. The background study requirement
may be satisfied if the commissioner conducted a fingerprint-based background study on
the provider that includes a review of databases in section 245C.08, subdivision 1, paragraph
(a), clauses (1) to (5).
deleted text end

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

deleted text begin (i) The commissioner shall terminate or deny the enrollment of any individual or entity
if the individual or entity has been terminated from participation in Medicare or under the
Medicaid program or Children's Health Insurance Program of any other state. The
commissioner may exempt a rehabilitation agency from termination or denial that would
otherwise be required under this paragraph, if the agency:
deleted text end

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

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

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

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

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

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

deleted text begin (2) At the time of initial enrollment or reenrollment, durable medical equipment providers
and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating
provider's Medicaid revenue in the previous calendar year is up to and including $300,000,
the provider agency must purchase a surety bond of $50,000. If a revalidating provider's
Medicaid revenue in the previous calendar year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and
fees in pursuing a claim on the bond. Any action to obtain monetary recovery or sanctions
from a surety bond must occur within six years from the date the debt is affirmed by a final
agency decision. An agency decision is final when the right to appeal the debt has been
exhausted or the time to appeal has expired under section 256B.064.
deleted text end

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

deleted text begin (m) The Department of Human Services may require a provider to purchase a surety
bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment
if: (1) the provider fails to demonstrate financial viability, (2) the department determines
there is significant evidence of or potential for fraud and abuse by the provider, or (3) the
provider or category of providers is designated high-risk pursuant to paragraph (f) and as
per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in an
amount of $100,000 or ten percent of the provider's payments from Medicaid during the
immediately preceding 12 months, whichever is greater. The surety bond must name the
Department of Human Services as an obligee and must allow for recovery of costs and fees
in pursuing a claim on the bond. This paragraph does not apply if the provider currently
maintains a surety bond under the requirements in section 256B.051, 256B.0659, 256B.0701,
or 256B.85.
deleted text end

Sec. 5.

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

new text begin Subdivision 1. new text end

new text begin Designating categorical risk levels. new text end

new text begin (a) The commissioner must designate
provider types as "limited-risk," "moderate-risk," or "high-risk," based on the criteria and
standards used to designate Medicare providers in Code of Federal Regulations, title 42,
section 424.518. The commissioner must publish a list of provider types and designated
categorical risk levels in the Minnesota Health Care Program Provider Manual.
new text end

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

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

new text begin Subd. 2. new text end

new text begin Service location enrollment. new text end

new text begin A provider must enroll each provider-controlled
location where direct services are provided.
new text end

new text begin Subd. 3. new text end

new text begin Incomplete provider enrollment applications. new text end

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

new text begin Subd. 4. new text end

new text begin Required background studies. new text end

new text begin (a) The commissioner must conduct a
background study under chapter 245C, including a review of databases in section 245C.08,
subdivision 1, paragraph (a), clauses (1) to (5), for a provider applying for enrollment under
section 256B.04, subdivision 21. The background study requirement may be satisfied if the
commissioner conducted a fingerprint-based background study on the provider that included
a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses (1) to (5).
new text end

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

new text begin Subd. 5. new text end

new text begin Surety bonds. new text end

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

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

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

new text begin (3) the provider or category of providers is designated high-risk pursuant to subdivision
1 and Code of Federal Regulations, title 42, section 455.450.
new text end

new text begin (b) The surety bond must be in an amount of $100,000 or ten percent of the provider's
payments from Medicaid during the immediately preceding 12 months, whichever is greater.
The surety bond must name the Department of Human Services as an obligee and must
allow for recovery of costs and fees in pursuing a claim on the bond.
new text end

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

new text begin Subd. 6. new text end

new text begin Required permission to conduct on-site inspection. new text end

new text begin As a condition of
enrollment in medical assistance, the commissioner shall require that a provider designated
moderate-risk or high-risk by CMS or the commissioner permit CMS, CMS's agents, or
CMS's designated contractors and the state agency, the state agency's agents, or the state
agency's designated contractors to conduct unannounced on-site inspections of any provider
location.
new text end

new text begin Subd. 7. new text end

new text begin Compliance programs. new text end

new text begin (a) The commissioner may require, as a condition of
enrollment in medical assistance, that a provider within a particular industry sector or
category establish a compliance program that contains the core elements established by
CMS.
new text end

new text begin (b) If an enrolled provider is required by the commissioner or by law to designate an
individual as the provider's compliance officer, the compliance officer must:
new text end

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

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

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

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

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

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

new text begin Subd. 8. new text end

new text begin Correspondence and notification. new text end

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

Sec. 6.

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

new text begin Subdivision 1. new text end

new text begin Provider revalidation schedule. new text end

new text begin The commissioner shall revalidate:
new text end

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

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

new text begin (3) each early intensive developmental and behavioral intervention agency at least once
every three years; and
new text end

new text begin (4) at the commissioner's discretion, any medical-assistance-only provider type the
commissioner deems high-risk under section 256B.044, subdivision 1.
new text end

new text begin Subd. 2. new text end

new text begin Revalidation procedures. new text end

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

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

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

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

Sec. 7.

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

new text begin Subdivision 1. new text end

new text begin Commissioner's general authority to suspend individual provider's
enrollment. new text end

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

new text begin (b) The commissioner's decision to suspend the provider is not subject to an administrative
appeal.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner's authority to revoke enrollment of certain providers for
lack of documentation. new text end

new text begin (a) The commissioner may revoke the enrollment of an ordering
or rendering provider for a period of not more than one year, if the provider fails to maintain
and, upon request from the commissioner, provide access to documentation relating to
written orders or requests for payment for durable medical equipment, certifications for
home health services, or referrals for other items or services written or ordered by the
provider, when the commissioner has identified a pattern of a lack of documentation. A
pattern means a failure to maintain documentation or provide access to documentation on
more than one occasion.
new text end

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

new text begin Subd. 3. new text end

new text begin Commissioner's duty to terminate provider enrollment. new text end

new text begin (a) Except as
provided in paragraph (b), the commissioner must terminate or deny the enrollment of any
individual or entity if the individual or entity has been terminated from participation in
Medicare or under the Medicaid program or Children's Health Insurance Program of any
other state.
new text end

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

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

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

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

new text begin Subd. 4. new text end

new text begin Commissioner's authority to terminate provider enrollment for lack of
submitted claims. new text end

new text begin The commissioner may terminate the enrollment of an individual or
entity provider if the individual or entity provider has not submitted any claims in the
previous 12 consecutive calendar months.
new text end

Sec. 8.

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

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

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

Sec. 9.

new text begin [256B.0444] ADDITIONAL PROVIDER ENROLLMENT REQUIREMENTS
FOR SPECIFIC PROVIDER TYPES.
new text end

new text begin Subdivision 1. new text end

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

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

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

new text begin (c) At the time of initial enrollment or reenrollment, durable medical equipment providers
or suppliers defined in paragraph (a) must purchase a surety bond of $50,000. If a revalidating
provider's Medicaid revenue in the previous calendar year is up to and including $300,000,
the provider agency must purchase a surety bond of $50,000. If a revalidating provider's
Medicaid revenue in the previous calendar year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and
fees in pursuing a claim on the bond. Any action to obtain monetary recovery or sanctions
from a surety bond must occur within six years from the date the debt is affirmed by a final
agency decision. An agency decision is final when the right to appeal the debt has been
exhausted or the time to appeal has expired under section 256B.064.
new text end

new text begin Subd. 2. new text end

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

new text begin An enrolled
provider that is also licensed by the commissioner under chapter 245A must designate an
individual as the licensee's compliance officer under section 256B.044, subdivision 7,
paragraph (b).
new text end

new text begin Subd. 3. new text end

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

new text begin An enrolled provider that
is also licensed by the commissioner of health as a home care provider under chapter 144A
with a home and community-based services designation under section 144A.484 on the
home care license, or as an assisted living facility under chapter 144G, must designate an
individual as the licensee's compliance officer under section 256B.044, subdivision 7,
paragraph (b).
new text end

Sec. 10.

Minnesota Statutes 2024, section 256B.057, subdivision 9, is amended to read:

Subd. 9.

Employed persons with disabilities.

(a) Medical assistance may be paid for
a person who is employed and who:

(1) but for excess earnings or assets meets the definition of disabled under the
Supplemental Security Income program; and

(2) pays a premium and other obligations under paragraph (d).

(b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible
for medical assistance under this subdivision, a person must have more than $65 of earned
income, be receiving an unemployment insurance benefit under chapter 268 that the person
began receiving while eligible under this subdivision, or be receiving family and medical
leave benefits under chapter 268B that the person began receiving while eligible under this
subdivision. A person who is self-employed must file and pay all applicable taxes. Any
spousal income shall be disregarded for purposes of eligibility and premium determinations.

(c) After the month of enrollment, a person enrolled in medical assistance under this
subdivision who would otherwise be ineligible and be disenrolled due to one of the following
circumstances may retain eligibility for up to four consecutive months after a month of job
loss if the person:

(1) is temporarily unable to work and without receipt of earned income due to a medical
condition, as verified by a physician, advanced practice registered nurse, or physician
assistant; or

(2) loses employment for reasons not attributable to the enrollee, and is without receipt
of earned income.

To receive a four-month extension of continued eligibility under this paragraph, enrollees
must verify the medical condition or provide notification of job loss, continue to meet all
other eligibility requirements, and continue to pay all calculated premium costs.

(d) All enrollees must pay a premium to be eligible for medical assistance under this
subdivision, except as provided under clause (5).

(1) An enrollee must pay the greater of a $35 premium or the premium calculated based
on the person's gross earned and unearned income and the applicable family size using a
sliding fee scale established by the commissioner, which begins at one percent of income
at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income for
those with incomes at or above 300 percent of the federal poverty guidelines.

(2) Annual adjustments in the premium schedule based upon changes in the federal
poverty guidelines shall be effective for premiums due in July of each year.

(3) All enrollees who receive unearned income must pay one-half of one percent of
unearned income in addition to the premium amount, except as provided under clause (5).

(4) Increases in benefits under title II of the Social Security Act shall not be counted as
income for purposes of this subdivision until July 1 of each year.

(5) Effective July 1, 2009, American Indians are exempt from paying premiums as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.

(e) A person's eligibility and premium shall be determined by the local county agency.
Premiums must be paid to the commissioner. All premiums are dedicated to the
commissioner.

(f) Any required premium shall be determined at application and redetermined at the
enrollee's 12-month income review or when a change in income or household size is reported.
Enrollees must report any change in income or household size within 30 days of when the
change occurs. A decreased premium resulting from a reported change in income or
household size shall be effective the first day of the next available billing month after the
change is reported. Except for changes occurring from annual cost-of-living increases, a
change resulting in an increased premium shall not affect the premium amount until the
next 12-month review.

(g) Premium payment is due upon notification from the commissioner of the premium
amount required. Premiums may be paid in installments at the discretion of the commissioner.

(h) Nonpayment of the premium shall result in denial or termination of medical assistance
unless the person demonstrates good cause for nonpayment. "Good cause" means an excuse
for the enrollee's failure to pay the required premium when due because the circumstances
were beyond the enrollee's control or not reasonably foreseeable. The commissioner shall
determine whether good cause exists based on the weight of the supporting evidence
submitted by the enrollee to demonstrate good cause. new text begin The commissioner must not determine
that good cause exists for a month for which the premium has already been paid. new text end Except
when an installment agreement is accepted by the commissioner, all persons disenrolled
for nonpayment of a premium must pay any past due premiums as well as current premiums
due prior to being reenrolled. Nonpayment shall include payment with a returned, refused,
or dishonored instrument. The commissioner may require a guaranteed form of payment as
the only means to replace a returned, refused, or dishonored instrument.

(i) For enrollees whose income does not exceed 200 percent of the federal poverty
guidelines and who are also enrolled in Medicare, the commissioner shall reimburse the
enrollee for Medicare part B premiums under section 256B.0625, subdivision 15, paragraph
(a).

(j) The commissioner is authorized to determine that a premium amount was calculated
or billed in error, make corrections to financial records and billing systems, and refund
premiums collected in error.

Sec. 11.

Minnesota Statutes 2024, section 256B.0625, subdivision 4, is amended to read:

Subd. 4.

Outpatient and physician-directed clinic services.

Medical assistance covers
outpatient hospital or physician-directed clinic services. deleted text begin The deleted text end new text begin All services provided by new text end
physician-directed clinic staff deleted text begin shall include at least two physicians and all services shall deleted text end new text begin
must new text end be deleted text begin provided deleted text end under the deleted text begin direct supervision deleted text end new text begin direction new text end of a physician. Hospital outpatient
departments are subject to the same limitations and reimbursements as other enrolled vendors
for all services, except initial triage, emergency services, and services not provided or
immediately available in clinics, physicians' offices, or by other enrolled providers.
"Emergency services" means those medical services required for the immediate diagnosis
and treatment of medical conditions that, if not immediately diagnosed and treated, could
lead to serious physical or mental disability or death or are necessary to alleviate severe
pain. Neither the hospital, its employees, nor any physician or dentist, shall be liable in any
action arising out of a determination not to render emergency services or care if reasonable
care is exercised in determining the condition of the person, or in determining the
appropriateness of the facilities, or the qualifications and availability of personnel to render
these services consistent with this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval.
new text end

Sec. 12.

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

Subd. 4.

Provider payment rates.

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

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

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

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

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

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

Sec. 13.

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

Subd. 16.

Agency duties.

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

(1) enroll as a medical assistance Minnesota health care program provider according to
Minnesota Rules, part 9505.0195, and deleted text begin section 256B.04, subdivision 21 deleted text end new text begin sections 256B.044
to 256B.0444 new text end , and meet all applicable provider standards and requirements;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sec. 14.

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

Subd. 17.

Provider shortage; authority for exceptions.

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

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

(1) EIDBI provider qualifications under this section;

(2) medical assistance provider enrollment requirements under deleted text begin section 256B.04,
subdivision 21 deleted text end new text begin sections 256B.044 to 256B.0444 new text end ; or

(3) EIDBI provider or agency standards or requirements.

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

Sec. 15.

Minnesota Statutes 2024, section 256L.05, subdivision 3, is amended to read:

Subd. 3.

Effective date of coverage.

(a) The effective date of coverage is the first day
of the month following the month in which eligibility is approved and the first premium
payment has been received. The effective date of coverage for new members added to the
family is the first day of the month following the month in which the change is reported.
All eligibility criteria must be met by the family at the time the new family member is added.
The income of the new family member is included with the family's modified adjusted gross
income and the adjusted premium begins in the month the new family member is added.

(b) The initial premium must be received by the last working day of the month for
coverage to begin the first day of the following month.

(c) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to
256L.18 are secondary to a plan of insurance or benefit program under which an eligible
person may have coverage and the commissioner shall use cost avoidance techniques to
ensure coordination of any other health coverage for eligible persons. The commissioner
shall identify eligible persons who may have coverage or benefits under other plans of
insurance or who become eligible for medical assistance.

(d) The effective date of coverage for individuals or families who are exempt from
paying premiums under section 256L.15, deleted text begin subdivision deleted text end new text begin subdivisions new text end 1 deleted text begin , paragraph (c) deleted text end new text begin and 2 new text end ,
is the first day of the month following the month in which eligibility is approved.

new text begin EFFECTIVE DATE. new text end

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

Sec. 16.

Minnesota Statutes 2024, section 256L.06, subdivision 3, is amended to read:

Subd. 3.

Commissioner's duties and payment.

(a) Premiums are dedicated to the
commissioner for MinnesotaCare.

(b) The commissioner shall develop and implement procedures to: (1) require enrollees
to report changes in income; (2) adjust sliding scale premium payments, based upon both
increases and decreases in enrollee income, at the time the change in income is reported;
and (3) disenroll enrollees from MinnesotaCare for failure to pay required premiums. Failure
to pay includes payment with a dishonored check, a returned automatic bank withdrawal,
or a refused credit card or debit card payment. The commissioner may demand a guaranteed
form of payment, including a cashier's check or a money order, as the only means to replace
a dishonored, returned, or refused payment.

(c) Premiums are calculated on a calendar month basis and may be paid on a monthly,
quarterly, or semiannual basis, with the first payment due upon notice from the commissioner
of the premium amount required. The commissioner shall inform applicants and enrollees
of these premium payment options. Premium payment is required before enrollment is
complete and to maintain deleted text begin eligibility deleted text end new text begin coverage new text end in MinnesotaCare. Premium payments received
before noon are credited the same day. Premium payments received after noon are credited
on the next working day.

(d) Nonpayment of the premium will result in disenrollment from the plan effective for
the calendar month following the month for which the premium was due. Persons disenrolled
for nonpayment may not reenroll prior to the first day of the month following the payment
of an amount equal to deleted text begin two months' premiums deleted text end new text begin one monthly premium new text end .

(e) The commissioner shall forgive the past-due premium for persons disenrolled under
paragraph (d) prior to issuing a premium invoice for the deleted text begin fourth deleted text end new text begin next new text end month deleted text begin following
disenrollment deleted text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 17.

Laws 2024, chapter 125, article 4, section 12, subdivision 5, is amended to read:

Subd. 5.

Report.

By deleted text begin December 15, 2025 deleted text end new text begin November 30, 2026 new text end , the commissioner must
provide a summary report on the pilot program to the chairs and ranking minority members
of the legislative committees with jurisdiction over mental health and county correctional
facilities.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from December 15, 2025.
new text end