SF 5024

Introduction - 94th Legislature (2025 - 2026)

Posted on 04/10/2026 09:16 a.m.

A bill for an act
relating to insurance; requiring health carriers to offer reference-based pricing
health plans; prohibiting open-ended promise-to-pay contracts; establishing a
provider number framework; authorizing rulemaking; amending Minnesota Statutes
2024, sections 62J.81, by adding a subdivision; 62J.826, subdivision 1, by adding
subdivisions; proposing coding for new law in Minnesota Statutes, chapters 62J;
62K.

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

Section 1.

new text begin [62J.809] HOSPITAL-ASSOCIATED INFECTION COSTS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Health care facility" means any hospital, ambulatory surgical center, or other inpatient
or outpatient facility where patients receive medical treatment.
new text end

new text begin (c) "Hospital-associated infection" or "HAI" means any infection that a patient acquires
during the course of receiving treatment in a health care facility that was not present or
incubating at the time of admission, including but not limited to:
new text end

new text begin (1) surgical site infections;
new text end

new text begin (2) catheter-associated urinary tract infections;
new text end

new text begin (3) central line-associated bloodstream infections;
new text end

new text begin (4) ventilator-associated pneumonia;
new text end

new text begin (5) clostridioides difficile infections; and
new text end

new text begin (6) other health care-associated infections, as defined by the Centers for Disease Control
and Prevention.
new text end

new text begin (d) "Treatment costs" means all costs associated with diagnosing, treating, and managing
an HAI, including but not limited to extended hospitalization, additional procedures,
medications, laboratory tests, and follow-up care.
new text end

new text begin Subd. 2. new text end

new text begin Prohibition on charging for HAI treatment. new text end

new text begin (a) No health care facility shall
charge, bill, or seek payment from any patient or payer for the treatment costs of any HAI.
new text end

new text begin (b) This prohibition applies regardless of whether the patient has private health insurance,
is self-pay, or has any other form of nongovernmental coverage.
new text end

new text begin (c) The prohibition in paragraph (a) includes:
new text end

new text begin (1) all facility charges associated with extended hospitalization due to HAI;
new text end

new text begin (2) all professional services rendered to treat the HAI;
new text end

new text begin (3) all medications, laboratory tests, imaging, and other diagnostic services related to
HAI treatment;
new text end

new text begin (4) all rehabilitation or follow-up care necessitated by the HAI; and
new text end

new text begin (5) any charges from subcontractors treating the HAI.
new text end

new text begin (d) The health care facility where the HAI was acquired shall bear full financial
responsibility for all treatment costs, regardless of where subsequent treatment is provided.
If the facility where the HAI was acquired is not qualified to treat the HAI in its facility,
the facility is financially liable for the cost of treatment at another facility.
new text end

Sec. 2.

Minnesota Statutes 2024, section 62J.81, is amended by adding a subdivision to
read:

new text begin Subd. 3. new text end

new text begin Prohibition on open-ended promise-to-pay contracts. new text end

new text begin (a) For purposes of
this subdivision, "open-ended promise-to-pay contract" means any agreement that obligates
a patient to pay for health care services without prior disclosure of the specific amount to
be charged.
new text end

new text begin (b) A health care provider is prohibited from requesting a patient to sign an open-ended
promise-to-pay contract.
new text end

new text begin (c) All open-ended promise-to-pay contracts are void and unenforceable, except that
open-ended promise-to-pay contracts executed before July 1, 2026, are not enforceable for
services rendered on or after that date.
new text end

new text begin (d) Notwithstanding this subdivision, health care providers are permitted to require
patients to sign agreements acknowledging financial responsibility only if the agreements:
new text end

new text begin (1) specify the provider's number, as defined in section 62J.826, subdivision 4;
new text end

new text begin (2) identify any services that may not be covered by insurance; and
new text end

new text begin (3) disclose the estimated patient responsibility based on the provider's number and the
patient's insurance coverage.
new text end

Sec. 3.

Minnesota Statutes 2024, section 62J.826, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) The definitions in this subdivision apply to this section.

new text begin (b) "Baseline" means the allowable reimbursement amount for any health care service
or item in the medical assistance program as established by the commissioner of human
services.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end "CDT code" means a code value drawn from the Code on Dental Procedures and
Nomenclature published by the American Dental Association.

deleted text begin (c) deleted text end new text begin (d) new text end "Chargemaster" means the list of all individual items and services maintained by
a medical or dental practice for which the medical or dental practice has established a charge.

deleted text begin (d) deleted text end new text begin (e) new text end "Commissioner" means the commissioner of health.

deleted text begin (e) deleted text end new text begin (f) new text end "CPT code" means a code value drawn from the Current Procedural Terminology
published by the American Medical Association.

deleted text begin (f) deleted text end new text begin (g) new text end "Dental service" means a service charged using a CDT code.

deleted text begin (g) deleted text end new text begin (h) new text end "Diagnostic laboratory testing" means a service charged using a CPT code within
the CPT code range of 80047 to 89398.

deleted text begin (h) deleted text end new text begin (i) new text end "Diagnostic radiology service" means a service charged using a CPT code within
the CPT code range of 70010 to 79999 and includes the provision of x-rays, computed
tomography scans, positron emission tomography scans, magnetic resonance imaging scans,
and mammographies.

deleted text begin (i) deleted text end new text begin (j) new text end "Hospital" means an acute care institution licensed under sections 144.50 to 144.58,
but does not include a health care institution conducted for those who rely primarily upon
treatment by prayer or spiritual means in accordance with the creed or tenets of any church
or denomination.

deleted text begin (j) deleted text end new text begin (k) new text end "Medical or dental practice" means a business that:

(1) earns revenue by providing medical care or dental services to the public;

(2) issues payment claims to health plan companies and other payers; and

(3) may be identified by its federal tax identification number.

new text begin (l) "Number" means the percentage of the baseline that a provider accepts as full payment
for all services and items, expressed as a whole number, calculated in accordance with
subdivision 4.
new text end

deleted text begin (k) deleted text end new text begin (m) new text end "Outpatient surgical center" means a health care facility other than a hospital
offering elective outpatient surgery under a license issued under sections 144.50 to 144.58.

deleted text begin (l) deleted text end new text begin (n) new text end "Standard charge" means the regular rate established by the medical or dental
practice for an item or service provided to a specific group of paying patients. This includes
all of the following:

(1) the charge for an individual item or service that is reflected on a medical or dental
practice's chargemaster, absent any discounts;

(2) the charge that a medical or dental practice has negotiated with a third-party payer
for an item or service;

(3) the lowest charge that a medical or dental practice has negotiated with all third-party
payers for an item or service;

(4) the highest charge that a medical or dental practice has negotiated with all third-party
payers for an item or service; and

(5) the charge that applies to an individual who pays cash, or cash equivalent, for an
item or service.

Sec. 4.

Minnesota Statutes 2024, section 62J.826, is amended by adding a subdivision to
read:

new text begin Subd. 4. new text end

new text begin Provider numbers. new text end

new text begin (a) By January 1, 2028, and each year thereafter, the
commissioner of health must, for each provider subject to this section, determine and publicly
publish the provider's number calculated in accordance with this subdivision.
new text end

new text begin (b) The commissioner of health must calculate a provider's number by dividing each of
a provider's current standard charges under subdivision 2 by each charge's baseline,
multiplying the quotients by the percentage of the provider's total charges for which each
standard charge accounts, and adding the products.
new text end

new text begin (c) For providers that render both facility-based and professional services, the
commissioner of health must calculate and disclose two separate numbers as follows:
new text end

new text begin (1) a facility number for all hospital and facility charges, including inpatient, outpatient,
emergency room, and surgical facility services; and
new text end

new text begin (2) a professional services number for all services provided by medical professionals,
including ambulatory surgical centers and clinical services.
new text end

new text begin (d) Each provider must post the provider's number prominently in locations easily
accessible to and visible by patients, including on the provider's website.
new text end

Sec. 5.

Minnesota Statutes 2024, section 62J.826, is amended by adding a subdivision to
read:

new text begin Subd. 5. new text end

new text begin Consumer health information exchanges. new text end

new text begin (a) Privately operated online
platforms are authorized to aggregate data generated and provided to consumers and the
commissioner of health under this section and to display health care provider information,
including numbers, quality metrics, and patient reviews for consumer use.
new text end

new text begin (b) Consumer health information exchanges under paragraph (a) must be owned,
controlled, and operated by private entities. Ownership, control, and operation by a health
care provider, health care system, health plan company, pharmaceutical manufacturer, or
medical device manufacturer is prohibited.
new text end

new text begin (c) The commissioner of health must register consumer health information exchanges
under paragraph (a). To be registered as a consumer health information exchange under this
subdivision, an exchange must:
new text end

new text begin (1) demonstrate technical capability to securely receive, store, and display health care
pricing and quality data;
new text end

new text begin (2) meet the independence requirements in paragraph (b);
new text end

new text begin (3) agree to display all provider data without bias or preferential treatment;
new text end

new text begin (4) implement consumer privacy protections; and
new text end

new text begin (5) maintain public accessibility to basic search functions without charge to consumers.
new text end

Sec. 6.

Minnesota Statutes 2024, section 62J.826, is amended by adding a subdivision to
read:

new text begin Subd. 6. new text end

new text begin Rulemaking. new text end

new text begin (a) The commissioner of health must promulgate rules to
implement subdivision 4. Rules promulgated under this paragraph must promote the following
goals:
new text end

new text begin (1) establish a simple, universally understood number pricing system for all health care
services and items based on a single number representing the percentage of medical assistance
baseline rates;
new text end

new text begin (2) expose the current hidden tax paid by private pay patients through public disclosure
of each provider's number;
new text end

new text begin (3) create a consumer-friendly health care marketplace where patients can easily compare
prices and choose the patients' preferred providers;
new text end

new text begin (4) enable competition among health care providers and health plan companies; and
new text end

new text begin (5) eliminate surprise medical billing and price gouging.
new text end

new text begin (b) The commissioner of health must promulgate rules to implement subdivision 5. Rules
promulgated under this paragraph must promote the following goals:
new text end

new text begin (1) establish a framework for privately operated consumer health information exchanges;
new text end

new text begin (2) require health care providers to submit standardized data to registered exchanges;
new text end

new text begin (3) enable consumers to compare health care providers based on price, quality, and
patient reviews; and
new text end

new text begin (4) protect consumer privacy while facilitating information sharing.
new text end

Sec. 7.

new text begin [62K.16] REFERENCE-BASED PRICING HEALTH PLAN.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Provider" has the meaning given in section 62J.03, subdivision 8.
new text end

new text begin (c) "Reference-based pricing health plan" means a health plan in which the payer pays
a set price for each service instead of negotiating prices with providers.
new text end

new text begin Subd. 2. new text end

new text begin General. new text end

new text begin Notwithstanding any law to the contrary and upon any necessary
federal approval, a health carrier that offers a health plan in the individual, small, or large
group market must also offer in the market a reference-based pricing health plan that meets
the requirements of this section.
new text end

new text begin Subd. 3. new text end

new text begin Provider participation. new text end

new text begin (a) An enrollee of a reference-based pricing health
plan may access any health care provider who has agreed to: (1) a reimbursement rate up
to but not greater than the reimbursement rate specified in the enrollee's reference-based
pricing plan; and (2) any other terms and conditions offered by the health carrier. Any terms
and conditions offered by the health carrier must be the same for all health care providers
who agree to participate in the health plan.
new text end

new text begin (b) A health carrier may require a participating provider to meet reasonable data,
utilization review, and quality assurance requirements.
new text end

new text begin (c) A provider who agrees to participate must provide services to all enrollees of the
reference-based pricing plan if the provider's reimbursement rates are equal to or less than
the reimbursement rate specified in the enrollee's reference-based pricing plan.
new text end

new text begin Subd. 4. new text end

new text begin Reimbursement rates. new text end

new text begin (a) The reimbursement rates offered to providers that
agree to participate in a reference-based pricing health plan must be based on a percentage
relative to the rates defined by the most recent medical assistance fee-for-service
reimbursement fee schedules promulgated by the Department of Human Services.
new text end

new text begin (b) For services that do not have a corresponding medical assistance fee-for-service
reimbursement value, the health carrier must negotiate the rates based on other fee schedules
used within the health care market.
new text end

new text begin (c) If a reference-based pricing health plan's reimbursement rate is at least 190 percent
above the medical assistance fee-for-service rate and the health plan is offered in all counties
in Minnesota, the health plan is exempt from the geographic and network adequacy
requirements under section 62K.10.
new text end

new text begin (d) A provider who agrees to participate in the reference-based pricing plan agrees to
accept the reimbursement rate as payment in full under the terms of the plan in accordance
with section 62K.11.
new text end

new text begin Subd. 5. new text end

new text begin Conditions. new text end

new text begin (a) Nothing in this section requires a provider to participate in a
reference-based pricing health plan. A health carrier is prohibited from requiring the provider
to participate in a reference-based pricing health plan as a condition of participation in any
other health plan, product, or other arrangement offered by the health carrier.
new text end

new text begin (b) Nothing in this section requires a health carrier to provide coverage for a service or
treatment that is not covered under the enrollee's health plan.
new text end

new text begin (c) A reference-based pricing health plan may impose cost-sharing requirements,
including co-payments, deductibles, and coinsurance and reasonable referral and prior
authorization requirements.
new text end

new text begin (d) Reference-based pricing health plans must cover all chiropractic services and items
provided to enrollees who are 21 years of age or younger.
new text end