SF 4663
Introduction - 94th Legislature (2025 - 2026)
Posted on 03/24/2026 10:30 a.m.
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A bill for an act
relating to human services; establishing medical assistance prepayment review
requirements; requiring a report; proposing coding for new law in Minnesota
Statutes, chapter 256B.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
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[256B.044] PREPAYMENT REVIEW.
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new text begin Subdivision 1. new text end
new text begin Providers subject to prepayment review. new text end
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(a) The commissioner must
establish prepayment review of submitted medical assistance claims when the commissioner
or the Centers for Medicare and Medicaid Services designates:
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(1) a provider type as high-risk under section 256B.04, subdivision 21, paragraph (j),
for fee-for-service claims submitted by providers within that category; and
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(2) a covered service as high-risk, for fee-for-service claims submitted for that service
by any provider, except the Indian Health Service.
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(b) Nothing in this section prevents the commissioner from establishing prepayment
review in other circumstances if required by the Centers for Medicare and Medicaid Services.
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new text begin Subd. 2. new text end
new text begin Review requirements. new text end
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(a) The commissioner must implement a prepayment
review established under subdivision 1, paragraph (a), within 15 days of the date of the
high-risk designation, effective for a period of up to 24 months from the date the review is
implemented.
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(b) A prepayment review established under subdivision 1, paragraph (a), must comply
with the timely processing of claims requirements under Code of Federal Regulations, title
42, section 447.45.
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(c) Before ending prepayment review under subdivision 1, paragraph (a), clause (1), the
commissioner must review all fee-for-service claims submitted by providers subject to the
prepayment review in the 24 months preceding the date the provider type was designated
high-risk.
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new text begin Subd. 3. new text end
new text begin Continued enrollment of new clients. new text end
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Nothing in this section prohibits an
enrolled provider that is subject to prepayment review under subdivision 1, paragraph (a),
from enrolling new clients or beneficiaries during the period of the review.
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new text begin Subd. 4. new text end
new text begin Notice. new text end
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At least ten days prior to implementing a prepayment review, the
commissioner must notify enrolled providers subject to the review and the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services policy and finance about the prepayment review the commissioner plans to
implement under this section. The notice must:
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(1) include a list of provider types or covered services to which prepayment review
applies;
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(2) provide a general explanation for the basis of the review; and
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(3) identify the start date and anticipated duration of the prepayment review.
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new text begin Subd. 5. new text end
new text begin Report to the legislature. new text end
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(a) Within 60 days of ending a prepayment review,
the commissioner must submit a report to the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services policy and finance.
The report must include, at a minimum:
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(1) a summary of any sanctions imposed under section 256B.064 on any providers subject
to prepayment review; and
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(2) recommendations for modifying or terminating the provision of covered services
deemed high-risk or delivered by provider types subject to prepayment review.
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(b) Notwithstanding section 256.01, subdivision 42, this subdivision does not expire.
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