HF 4981

as introduced - 93rd Legislature (2023 - 2024) Posted on 03/21/2024 03:49pm

A bill for an act
relating to health insurance; establishing Medical Assistance rate adjustments for
physician and professional services; increasing rates for certain residential services;
requiring a statewide reimbursement rate for behavioral health home services;
appropriating money; amending Minnesota Statutes 2022, sections 256B.0757,
subdivision 5, by adding a subdivision; 256B.76, subdivision 6; Minnesota Statutes
2023 Supplement, sections 254B.05, subdivision 5; 256.969, subdivision 2b;
256B.76, subdivision 1; 256B.761; repealing Minnesota Statutes 2022, section
256B.0625, subdivision 38.

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

Section 1.

Minnesota Statutes 2023 Supplement, section 254B.05, subdivision 5, is amended
to read:

Subd. 5.

Rate requirements.

(a) The commissioner shall establish rates new text begin consistent with
the requirements of section 254B.12 new text end for substance use disorder services and service
enhancements funded under this chapter.

new text begin (b) Effective for residential substance use disorder services listed in this subdivision and
rendered on or after January 1, 2025, the commissioner shall increase rates by ... percent.
The commissioner shall adjust rates for such services annually, by January 1 of each year,
according to the change from the midpoint of the previous rate year to the midpoint of the
rate year for which the rate is being determined using the Centers for Medicare and Medicaid
Services Medicare Economic Index as forecasted in the fourth quarter of the calendar year
before the rate year. This paragraph does not apply to federally qualified health centers,
rural health centers, Indian health services, certified community behavioral health clinics,
cost-based rates, and rates that are negotiated with the county.
new text end

new text begin (c) For payments made under paragraph (b), if and to the extent that the commissioner
identifies that the state has received federal financial participation for residential substance
use disorder services in excess of the amount allowed under Code of Federal Regulations,
title 42, section 447.321, the state shall repay the excess amount to the Centers for Medicare
and Medicaid Services with state money and maintain the full payment rate under paragraph
(b).
new text end

new text begin (d) Effective for services rendered on or after January 1, 2025, the commissioner shall
increase capitation payments made to managed care plans and county-based purchasing
plans to reflect the rate increase for residential substance use disorder services. Managed
care plans and county-based purchasing plans must use the capitation rate increase provided
under this paragraph to increase payment rates to residential substance use disorder services
providers. The commissioner must monitor the effect of this rate increase on enrollee access
to residential substance use disorder services. If for any contract year federal approval is
not received for this paragraph, the commissioner must adjust the capitation rates paid to
managed care plans and county-based purchasing plans for that contract year to reflect the
removal of this provision. Contracts between managed care plans and county-based
purchasing plans and providers to whom this paragraph applies must allow recovery of
payments from those providers if capitation rates are adjusted in accordance with this
paragraph. Payment recoveries must not exceed the amount equal to any increase in rates
that results from this provision.
new text end

deleted text begin (b) deleted text end new text begin (e) new text end Eligible substance use disorder treatment services include:

(1) those licensed, as applicable, according to chapter 245G or applicable Tribal license
and provided according to the following ASAM levels of care:

(i) ASAM level 0.5 early intervention services provided according to section 254B.19,
subdivision 1, clause (1);

(ii) ASAM level 1.0 outpatient services provided according to section 254B.19,
subdivision 1, clause (2);

(iii) ASAM level 2.1 intensive outpatient services provided according to section 254B.19,
subdivision 1, clause (3);

(iv) ASAM level 2.5 partial hospitalization services provided according to section
254B.19, subdivision 1, clause (4);

(v) ASAM level 3.1 clinically managed low-intensity residential services provided
according to section 254B.19, subdivision 1, clause (5);

(vi) ASAM level 3.3 clinically managed population-specific high-intensity residential
services provided according to section 254B.19, subdivision 1, clause (6); and

(vii) ASAM level 3.5 clinically managed high-intensity residential services provided
according to section 254B.19, subdivision 1, clause (7);

(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;

(3) treatment coordination services provided according to section 245G.07, subdivision
1, paragraph (a), clause (5);

(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);

(5) withdrawal management services provided according to chapter 245F;

(6) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;

(7) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;

(8) ASAM 3.5 clinically managed high-intensity residential services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license, which
provide ASAM level of care 3.5 according to section 254B.19, subdivision 1, clause (7),
and are provided by a state-operated vendor or to clients who have been civilly committed
to the commissioner, present the most complex and difficult care needs, and are a potential
threat to the community; and

(9) room and board facilities that meet the requirements of subdivision 1a.

deleted text begin (c) deleted text end new text begin (f) new text end The commissioner shall establish higher rates for programs that meet the
requirements of paragraph deleted text begin (b) deleted text end new text begin (e) new text end and one of the following additional requirements:

(1) programs that serve parents with their children if the program:

(i) provides on-site child care during the hours of treatment activity that:

(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or

(B) is licensed under chapter 245A and sections 245G.01 to 245G.19; or

(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:

(A) a child care center under Minnesota Rules, chapter 9503; or

(B) a family child care home under Minnesota Rules, chapter 9502;

(2) culturally specific or culturally responsive programs as defined in section 254B.01,
subdivision 4a;

(3) disability responsive programs as defined in section 254B.01, subdivision 4b;

(4) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; or

(5) programs that offer services to individuals with co-occurring mental health and
substance use disorder problems if:

(i) the program meets the co-occurring requirements in section 245G.20;

(ii) 25 percent of the counseling staff are licensed mental health professionals under
section 245I.04, subdivision 2, or are students or licensing candidates under the supervision
of a licensed alcohol and drug counselor supervisor and mental health professional under
section 245I.04, subdivision 2, except that no more than 50 percent of the mental health
staff may be students or licensing candidates with time documented to be directly related
to provisions of co-occurring services;

(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;

(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;

(v) family education is offered that addresses mental health and substance use disorder
and the interaction between the two; and

(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.

deleted text begin (d) deleted text end new text begin (g) new text end In order to be eligible for a higher rate under paragraph deleted text begin (c) deleted text end new text begin (f) new text end , clause (1), a
program that provides arrangements for off-site child care must maintain current
documentation at the substance use disorder facility of the child care provider's current
licensure to provide child care services.

deleted text begin (e) deleted text end new text begin (h) new text end Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph deleted text begin (c) deleted text end new text begin (f) new text end , clause deleted text begin (4) deleted text end new text begin (5) new text end , items (i) to (iv).

deleted text begin (f) deleted text end new text begin (i) new text end Subject to federal approval, substance use disorder services that are otherwise
covered as direct face-to-face services may be provided via telehealth as defined in section
256B.0625, subdivision 3b. The use of telehealth to deliver services must be medically
appropriate to the condition and needs of the person being served. Reimbursement shall be
at the same rates and under the same conditions that would otherwise apply to direct
face-to-face services.

deleted text begin (g) deleted text end new text begin (j) new text end For the purpose of reimbursement under this section, substance use disorder
treatment services provided in a group setting without a group participant maximum or
maximum client to staff ratio under chapter 245G shall not exceed a client to staff ratio of
48 to one. At least one of the attending staff must meet the qualifications as established
under this chapter for the type of treatment service provided. A recovery peer may not be
included as part of the staff ratio.

deleted text begin (h) deleted text end new text begin (k) new text end Payment for outpatient substance use disorder services that are licensed according
to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
prior authorization of a greater number of hours is obtained from the commissioner.

deleted text begin (i) deleted text end new text begin (l) new text end Payment for substance use disorder services under this section must start from the
day of service initiation, when the comprehensive assessment is completed within the
required timelines.

Sec. 2.

Minnesota Statutes 2023 Supplement, section 256.969, subdivision 2b, is amended
to read:

Subd. 2b.

Hospital payment rates.

(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:

(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;

(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;

(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and

(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.

(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.

(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year or years for the rates effective November 1,
2014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral,
ensuring that the total aggregate payments under the rebased system are equal to the total
aggregate payments that were made for the same number and types of services in the base
year. Separate budget neutrality calculations shall be determined for payments made to
critical access hospitals and payments made to hospitals paid under the DRG system. Only
the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being
rebased during the entire base period shall be incorporated into the budget neutrality
calculation.

(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).

(e) For discharges occurring on or after November 1, 2014, the commissioner may make
additional adjustments to the rebased rates, and when evaluating whether additional
adjustments should be made, the commissioner shall consider the impact of the rates on the
following:

(1) pediatric services;

(2) behavioral health services;

(3) trauma services as defined by the National Uniform Billing Committee;

(4) transplant services;

(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;

(6) outlier admissions;

(7) low-volume providers; and

(8) services provided by small rural hospitals that are not critical access hospitals.

(f) Hospital payment rates established under paragraph (c) must incorporate the following:

(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;

(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;

(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and

(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.

(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.

(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year or years and the next base year or years. In
any year that inpatient claims volume falls below the threshold required to ensure a
statistically valid sample of claims, the commissioner may combine claims data from two
consecutive years to serve as the base year. Years in which inpatient claims volume is
reduced or altered due to a pandemic or other public health emergency shall not be used as
a base year or part of a base year if the base year includes more than one year. Changes in
costs between base years shall be measured using the lower of the hospital cost index defined
in subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim. The commissioner shall establish the base year for each rebasing period considering
the most recent year or years for which filed Medicare cost reports are available, except
that the base years for the rebasing effective July 1, 2023, are calendar years 2018 and 2019.
The estimated change in the average payment per hospital discharge resulting from a
scheduled rebasing must be calculated and made available to the legislature by January 15
of each year in which rebasing is scheduled to occur, and must include by hospital the
differential in payment rates compared to the individual hospital's costs.

(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:

(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;

(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and

(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.

(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:

(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;

(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);

(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and

(6) geographic location.

(k) Effective for discharges occurring on or after January 1, 2024, the rates paid to
hospitals described in paragraph (a), clauses (2) to (4), must include a rate factor specific
to each hospital that qualifies for a medical education and research cost distribution under
section 62J.692, subdivision 4, paragraph (a).

new text begin (l) Effective for discharges occurring on or after January 1, 2025, the commissioner shall
increase payments for inpatient behavioral health services provided by hospitals paid under
the DRG methodology by increasing the adjustment for behavioral health services under
paragraph (e).
new text end

new text begin (m) Effective for discharges occurring on or after January 1, 2025, the commissioner
shall increase capitation payments made to managed care plans and county-based purchasing
plans to reflect the rate increase provided under paragraph (l). Managed care plans and
county-based purchasing plans must use the capitation rate increase provided under this
paragraph to increase payment rates for inpatient behavioral health services provided by
hospitals paid under the DRG methodology. The commissioner must monitor the effect of
this rate increase on enrollee access to inpatient behavioral health services. If for any contract
year federal approval is not received for this paragraph, the commissioner must adjust the
capitation rates paid to managed care plans and county-based purchasing plans for that
contract year to reflect the removal of this provision. Contracts between managed care plans
and county-based purchasing plans and providers to whom this paragraph applies must
allow recovery of payments from those providers if capitation rates are adjusted in accordance
with this paragraph. Payment recoveries must not exceed the amount equal to any increase
in rates that results from this provision.
new text end

Sec. 3.

Minnesota Statutes 2022, section 256B.0757, subdivision 5, is amended to read:

Subd. 5.

Payments new text begin for health home services new text end .

The commissioner shall make payments
to each designated provider for the provision of health home services described in subdivision
3 new text begin , except for behavioral health home services, new text end to each eligible individual under subdivision
2 that selects the health home as a provider.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 4.

Minnesota Statutes 2022, section 256B.0757, is amended by adding a subdivision
to read:

new text begin Subd. 5a. new text end

new text begin Payments for behavioral health home services. new text end

new text begin (a) Notwithstanding
subdivision 5, the commissioner shall determine and implement a single statewide
reimbursement rate for behavioral health home services under this section. The rate must
be no less than $408 per member per month. The commissioner must adjust the statewide
reimbursement rate annually according to the change from the midpoint of the previous rate
year to the midpoint of the rate year for which the rate is being determined using the Centers
for Medicare and Medicaid Services Medicare Economic Index as forecasted in the fourth
quarter of the calendar year before the rate year.
new text end

new text begin (b) The commissioner must review and update the behavioral health home services rate
under paragraph (a) at least every four years. The updated rate must account for the average
hours required for behavioral health home team members spent providing services and the
Department of Labor prevailing wage for required behavioral health home team members.
The updated rate must ensure that behavioral health home services rates are sufficient to
allow providers to meet required certifications, training, and practice transformation
standards, staff qualification requirements, and service delivery standards.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 5.

Minnesota Statutes 2023 Supplement, section 256B.76, subdivision 1, is amended
to read:

Subdivision 1.

Physician and professional services reimbursement.

deleted text begin (a) Effective for
services rendered on or after October 1, 1992, the commissioner shall make payments for
physician services as follows:
deleted text end

deleted text begin (1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care," "critical
care," cesarean delivery and pharmacologic management provided to psychiatric patients,
and level three codes for enhanced services for prenatal high risk, shall be paid at the lower
of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992;
deleted text end

deleted text begin (2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
deleted text end

deleted text begin (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect on
September 30, 1992.
deleted text end

deleted text begin (b) deleted text end new text begin (a) new text end Effective for services rendered on or after January 1, 2000, new text begin through December
31, 2024, new text end payment rates for physician and professional services shall be increased by three
percent over the rates in effect on December 31, 1999, except for home health agency and
family planning agency services. The increases in this paragraph shall be implemented
January 1, 2000, for managed care.

deleted text begin (c) deleted text end new text begin (b) new text end Effective for services rendered on or after July 1, 2009, new text begin through December 31,
2024, new text end payment rates for physician and professional services shall be reduced by five percent,
except that for the period July 1, 2009, through June 30, 2010, payment rates shall be reduced
by 6.5 percent for the medical assistance and general assistance medical care programs,
over the rates in effect on June 30, 2009. This reduction and the reductions in paragraph deleted text begin (d) deleted text end new text begin
(c) new text end do not apply to office or other outpatient visits, preventive medicine visits and family
planning visits billed by physicians, advanced practice registered nurses, or physician
assistants in a family planning agency or in one of the following primary care practices:
general practice, general internal medicine, general pediatrics, general geriatrics, and family
medicine. This reduction and the reductions in paragraph deleted text begin (d) deleted text end new text begin (c) new text end do not apply to federally
qualified health centers, rural health centers, and Indian health services. Effective October
1, 2009, payments made to managed care plans and county-based purchasing plans under
sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reduction described in
this paragraph.

deleted text begin (d) deleted text end new text begin (c) new text end Effective for services rendered on or after July 1, 2010, new text begin through December 31,
2024, new text end payment rates for physician and professional services shall be reduced an additional
seven percent over the five percent reduction in rates described in paragraph deleted text begin (c) deleted text end new text begin (b) new text end . This
additional reduction does not apply to physical therapy services, occupational therapy
services, and speech pathology and related services provided on or after July 1, 2010. This
additional reduction does not apply to physician services billed by a psychiatrist or an
advanced practice registered nurse with a specialty in mental health. Effective October 1,
2010, payments made to managed care plans and county-based purchasing plans under
sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reduction described in
this paragraph.

deleted text begin (e) Effective for services rendered on or after September 1, 2011, through June 30, 2013,
payment rates for physician and professional services shall be reduced three percent from
the rates in effect on August 31, 2011. This reduction does not apply to physical therapy
services, occupational therapy services, and speech pathology and related services.
deleted text end

deleted text begin (f) deleted text end new text begin (d) new text end Effective for services rendered on or after September 1, 2014, new text begin through December
31, 2024, new text end payment rates for physician and professional services, including physical therapy,
occupational therapy, speech pathology, and mental health services shall be increased by
five percent from the rates in effect on August 31, 2014. In calculating this rate increase,
the commissioner shall not include in the base rate for August 31, 2014, the rate increase
provided under section 256B.76, subdivision 7. This increase does not apply to federally
qualified health centers, rural health centers, and Indian health services. Payments made to
managed care plans and county-based purchasing plans shall not be adjusted to reflect
payments under this paragraph.

deleted text begin (g) deleted text end new text begin (e) new text end Effective for services rendered on or after July 1, 2015, payment rates for physical
therapy, occupational therapy, and speech pathology and related services provided by a
hospital meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause
(4), shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments
made to managed care plans and county-based purchasing plans shall not be adjusted to
reflect payments under this paragraph.

deleted text begin (h) deleted text end new text begin (f) new text end Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.

deleted text begin (i) deleted text end new text begin (g) new text end The commissioner may reimburse physicians and other licensed professionals for
costs incurred to pay the fee for testing newborns who are medical assistance enrollees for
heritable and congenital disorders under section 144.125, subdivision 1, paragraph (c), when
the sample is collected outside of an inpatient hospital or freestanding birth center and the
cost is not recognized by another payment source.

Sec. 6.

Minnesota Statutes 2022, section 256B.76, subdivision 6, is amended to read:

Subd. 6.

Medicare relative value units.

deleted text begin Effective for services rendered on or after
January 1, 2007, the commissioner shall make payments for physician and professional
services based on the Medicare relative value units (RVU's). This change shall be budget
neutral and the cost of implementing RVU's will be incorporated in the established conversion
factor deleted text end new text begin (a) Effective for physician and professional services included in the Medicare Physician
Fee Schedule, the commissioner shall make payments at rates at least equal to 100 percent
of the corresponding rates in the Medicare Physician Fee Schedule. Payment rates set under
this paragraph must use Medicare relative value units (RVUs) and conversion factors at
least equal to those in the Medicare Physician Fee Schedule to implement the resource-based
relative value scale new text end .

new text begin (b) The commissioner shall revise fee-for-service payment methodologies under this
section upon the issuance of a Medicare Physician Fee Schedule final rule by the Centers
for Medicare and Medicaid Services to ensure the payment rates under this subdivision are
at least equal to the corresponding rates in such final rule.
new text end

new text begin (c) Before or at the same time the commissioner revises and implements payment rates
for other services under paragraph (a), the commissioner must revise and implement payment
rates for mental health services based on RVUs and rendered on or after January 1, 2025,
such that the payment rates are at least equal to 100 percent of the Medicare Physician Fee
Schedule in accordance with paragraph (a).
new text end

new text begin (d) All mental health services and substance use disorder services performed in a primary
care or mental health care health professional shortage area, medically underserved area,
or medically underserved population, as maintained and updated by the United States
Department of Health and Human Services, are eligible for a ten percent bonus payment.
Such services are eligible for a bonus based upon the performance of the service in a health
professional shortage area if the provider maintains an office in a health professional shortage
area.
new text end

new text begin (e) Effective for services rendered on or after January 1, 2025, the commissioner shall
increase capitation payments made to managed care plans and county-based purchasing
plans to reflect the rate increases provided under this subdivision. Managed care plans and
county-based purchasing plans must use the capitation rate increase provided under this
paragraph to increase payment rates to the providers corresponding to the rate increases.
The commissioner must monitor the effect of this rate increase on enrollee access to services
under this subdivision. If for any contract year federal approval is not received for this
paragraph, the commissioner must adjust the capitation rates paid to managed care plans
and county-based purchasing plans for that contract year to reflect the removal of this
provision. Contracts between managed care plans and county-based purchasing plans and
providers to whom this paragraph applies must allow recovery of payments from those
providers if capitation rates are adjusted in accordance with this paragraph. Payment
recoveries must not exceed the amount equal to any increase in rates that results from this
provision.
new text end

Sec. 7.

Minnesota Statutes 2023 Supplement, section 256B.761, is amended to read:

256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.

(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day treatment
services, home-based mental health services, and family community support services shall
be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of
1999 charges.

(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993,
with at least 33 percent of the clients receiving rehabilitation services in the most recent
calendar year who are medical assistance recipients, will be increased by 38 percent, when
those services are provided within the comprehensive outpatient rehabilitation facility and
provided to residents of nursing facilities owned by the entity.

(c) In addition to rate increases otherwise provided, the commissioner may restructure
coverage policy and rates to improve access to adult rehabilitative mental health services
under section 256B.0623 and related mental health support services under section 256B.021,
subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected
state share of increased costs due to this paragraph is transferred from adult mental health
grants under sections 245.4661 and 256E.12. The transfer for fiscal year 2016 is a permanent
base adjustment for subsequent fiscal years. Payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the rate changes described in this paragraph.

(d) Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.

(e) Effective for services rendered on or after January 1, 2024, payment rates for
behavioral health services included in the rate analysis required by Laws 2021, First Special
Session chapter 7, article 17, section 18, except for adult day treatment services under section
256B.0671, subdivision 3; early intensive developmental and behavioral intervention services
under section 256B.0949; and substance use disorder services under chapter 254B, must be
increased by three percent from the rates in effect on December 31, 2023. Effective for
services rendered on or after January 1, 2025, payment rates for behavioral health services
included in the rate analysis required by Laws 2021, First Special Session chapter 7, article
17, section 18, except for adult day treatment services under section 256B.0671, subdivision
3; early intensive developmental behavioral intervention services under section 256B.0949;
and substance use disorder services under chapter 254B, must be annually adjusted according
to the change from the midpoint of the previous rate year to the midpoint of the rate year
for which the rate is being determined using the Centers for Medicare and Medicaid Services
Medicare Economic Index as forecasted in the fourth quarter of the calendar year before
the rate year. For payments made in accordance with this paragraph, if and to the extent
that the commissioner identifies that the state has received federal financial participation
for behavioral health services in excess of the amount allowed under United States Code,
title 42, section 447.321, the state shall repay the excess amount to the Centers for Medicare
and Medicaid Services with state money and maintain the full payment rate under this
paragraph. This paragraph does not apply to federally qualified health centers, rural health
centers, Indian health services, certified community behavioral health clinics, cost-based
rates, and rates that are negotiated with the county. This paragraph expires upon legislative
implementation of the new rate methodology resulting from the rate analysis required by
Laws 2021, First Special Session chapter 7, article 17, section 18.

(f) Effective January 1, 2024, the commissioner shall increase capitation payments made
to managed care plans and county-based purchasing plans to reflect the behavioral health
service rate increase provided in paragraph (e). Managed care and county-based purchasing
plans must use the capitation rate increase provided under this paragraph to increase payment
rates to behavioral health services providers. The commissioner must monitor the effect of
this rate increase on enrollee access to behavioral health services. If for any contract year
federal approval is not received for this paragraph, the commissioner must adjust the
capitation rates paid to managed care plans and county-based purchasing plans for that
contract year to reflect the removal of this provision. Contracts between managed care plans
and county-based purchasing plans and providers to whom this paragraph applies must
allow recovery of payments from those providers if capitation rates are adjusted in accordance
with this paragraph. Payment recoveries must not exceed the amount equal to any increase
in rates that results from this provision.

new text begin (g) Effective for services under this section billed and coded under Healthcare Common
Procedure Coding System H, S, and T codes, the commissioner shall increase the payment
rates as necessary to align with the Medicare Physician Fee Schedule.
new text end

Sec. 8. new text begin APPROPRIATION.
new text end

new text begin $8,785,000 in fiscal year 2025 is appropriated from the general fund to the commissioner
of human services for the payment increases under Minnesota Statutes, section 256.969,
subdivision 2b, paragraphs (l) and (m). The aggregate amount of the increased payments
under Minnesota Statutes, section 256.969, subdivision 2b, paragraphs (l) and (m), must at
least equal the amount of this appropriation.
new text end

Sec. 9. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2022, section 256B.0625, subdivision 38, new text end new text begin is repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: 24-07630

256B.0625 COVERED SERVICES.

Subd. 38.

Payments for mental health services.

Payments for mental health services covered under the medical assistance program that are provided by masters-prepared mental health professionals shall be 80 percent of the rate paid to doctoral-prepared professionals. Payments for mental health services covered under the medical assistance program that are provided by masters-prepared mental health professionals employed by community mental health centers shall be 100 percent of the rate paid to doctoral-prepared professionals. Payments for mental health services covered under the medical assistance program that are provided by physician assistants shall be 80.4 percent of the base rate paid to psychiatrists.