Minnesota Legislature
HF 2299
as introduced - 94th Legislature (2025 - 2026) Posted on 03/13/2025 03:02pm
Bill Text Versions
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| Introduction | Posted on 03/13/2025 |
Current Version - as introduced
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A bill for an act
relating to human services; modifying payment methodologies for certain enteral
nutrition equipment and supplies; modifying processes for establishing payment
rates for certain medical equipment and supplies; amending Minnesota Statutes
2024, section 256B.766.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2024, section 256B.766, is amended to read:
256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.
new text begin Subdivision 1. new text end
new text begin Payment reductions for base care services effective July 1, 2009. new text end
deleted text begin (a)deleted text end
Effective for services provided on or after July 1, 2009, total payments for basic care services,
shall be reduced by three percent, except that for the period July 1, 2009, through June 30,
2011, total payments shall be reduced by 4.5 percent for the medical assistance and general
assistance medical care programs, prior to third-party liability and spenddown calculation.
new text begin Subd. 2. new text end
new text begin Classification of therapies as basic care services. new text end
deleted text begin Effective July 1, 2010,deleted text end The
commissioner shall classify physical therapy services, occupational therapy services, and
speech-language pathology and related services as basic care services. The reduction in deleted text begin this
paragraphdeleted text end new text begin subdivision 1new text end shall apply to physical therapy services, occupational therapy
services, and speech-language pathology and related services provided on or after July 1,
2010.
new text begin Subd. 3. new text end
new text begin Payment reductions to managed care plans effective October 1, 2009. new text end
deleted text begin (b)deleted text end
Payments made to managed care plans and county-based purchasing plans shall be reduced
for services provided on or after October 1, 2009, to reflect the reduction new text begin in subdivision 1
new text end effective July 1, 2009, and payments made to the plans shall be reduced effective October
1, 2010, to reflect the reduction new text begin in subdivision 1 new text end effective July 1, 2010.
new text begin Subd. 4. new text end
new text begin Temporary payment reductions effective September 1, 2011. new text end
deleted text begin (c)deleted text end new text begin (a)new text end Effective
for services provided on or after September 1, 2011, through June 30, 2013, total payments
for outpatient hospital facility fees shall be reduced by five percent from the rates in effect
on August 31, 2011.
deleted text begin (d)deleted text end new text begin (b)new text end Effective for services provided on or after September 1, 2011, through June 30,
2013, total payments for ambulatory surgery centers facility fees, medical supplies and
durable medical equipment not subject to a volume purchase contract, prosthetics and
orthotics, renal dialysis services, laboratory services, public health nursing services, physical
therapy services, occupational therapy services, speech therapy services, eyeglasses not
subject to a volume purchase contract, hearing aids not subject to a volume purchase contract,
and anesthesia services shall be reduced by three percent from the rates in effect on August
31, 2011.
new text begin Subd. 5. new text end
new text begin Payment increases effective September 1, 2014. new text end
deleted text begin (e)deleted text end new text begin (a)new text end Effective for services
provided on or after September 1, 2014, payments for ambulatory surgery centers facility
fees, hospice services, renal dialysis services, laboratory services, public health nursing
services, eyeglasses not subject to a volume purchase contract, and hearing aids not subject
to a volume purchase contract shall be increased by three percent and payments for outpatient
hospital facility fees shall be increased by three percent.
new text begin (b) new text end Payments made to managed care plans and county-based purchasing plans shall not
be adjusted to reflect payments under this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end .
new text begin Subd. 6. new text end
new text begin Temporary payment reductions effective July 1, 2014. new text end
deleted text begin (f)deleted text end Payments for
medical supplies and durable medical equipment not subject to a volume purchase contract,
and prosthetics and orthotics, provided on or after July 1, 2014, through June 30, 2015, shall
be decreased by .33 percent.
new text begin Subd. 7. new text end
new text begin Payment increases effective July 1, 2015. new text end
new text begin (a) new text end Payments for medical supplies
and durable medical equipment not subject to a volume purchase contract, and prosthetics
and orthotics, provided on or after July 1, 2015, shall be increased by three percent from
the rates as determined under deleted text begin paragraphs (i) and (j)deleted text end new text begin subdivisions 9 and 10new text end .
deleted text begin (g)deleted text end new text begin (b)new text end Effective for services provided on or after July 1, 2015, payments for outpatient
hospital facility fees, medical supplies and durable medical equipment not subject to a
volume purchase contract, prosthetics, and orthotics to 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.
new text begin (c) new text end Payments made to managed care plans and county-based purchasing plans shall not
be adjusted to reflect payments under deleted text begin thisdeleted text end paragraphnew text begin (b)new text end .
new text begin Subd. 8. new text end
new text begin Exempt services. new text end
deleted text begin (h)deleted text end This section does not apply to physician and professional
services, inpatient hospital services, family planning services, mental health services, dental
services, prescription drugs, medical transportation, federally qualified health centers, rural
health centers, Indian health services, and Medicare cost-sharing.
new text begin Subd. 9. new text end
new text begin Individually priced items. new text end
deleted text begin (i)deleted text end new text begin (a)new text end Effective for services provided on or after
July 1, 2015, the following categories of medical supplies and durable medical equipment
shall be individually priced items: customized and other specialized tracheostomy tubes
and supplies, electric patient lifts, and durable medical equipment repair and service.
new text begin (b) new text end This deleted text begin paragraphdeleted text end new text begin subdivisionnew text end does not apply to medical supplies and durable medical
equipment subject to a volume purchase contract, products subject to the preferred diabetic
testing supply program, and items provided to dually eligible recipients when Medicare is
the primary payer for the item.
new text begin (c) new text end The commissioner shall not apply any medical assistance rate reductions to durable
medical equipment as a result of Medicare competitive bidding.
new text begin Subd. 10. new text end
new text begin Rate increases effective July 1, 2015. new text end
deleted text begin (j)deleted text end new text begin (a)new text end Effective for services provided
on or after July 1, 2015, medical assistance payment rates for durable medical equipment,
prosthetics, orthotics, or supplies shall be increased as follows:
(1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that
were subject to the Medicare competitive bid that took effect in January of 2009 shall be
increased by 9.5 percent; and
(2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on
the medical assistance fee schedule, whether or not subject to the Medicare competitive bid
that took effect in January of 2009, shall be increased by 2.94 percent, with this increase
being applied after calculation of any increased payment rate under clause (1).
deleted text begin Thisdeleted text end new text begin (b)new text end Paragraph new text begin (a) new text end does not apply to medical supplies and durable medical equipment
subject to a volume purchase contract, products subject to the preferred diabetic testing
supply program, items provided to dually eligible recipients when Medicare is the primary
payer for the item, and individually priced items identified in deleted text begin paragraph (i)deleted text end new text begin subdivision 9new text end .
new text begin (c) new text end Payments made to managed care plans and county-based purchasing plans shall not
be adjusted to reflect the rate increases in this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end .
new text begin Subd. 11. new text end
new text begin Rates for ventilators. new text end
deleted text begin (k)deleted text end new text begin (a)new text end Effective for nonpressure support ventilators
provided on or after January 1, 2016, the rate shall be the lower of the submitted charge or
the Medicare fee schedule rate.
new text begin (b) new text end Effective for pressure support ventilators provided on or after January 1, 2016, the
rate shall be the lower of the submitted charge or 47 percent above the Medicare fee schedule
rate.
new text begin (c) new text end For payments made in accordance with this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end , if, and to the
extent that, the commissioner identifies that the state has received federal financial
participation for ventilators in excess of the amount allowed effective January 1, 2018,
under United States Code, title 42, section 1396b(i)(27), the state shall repay the excess
amount to the Centers for Medicare and Medicaid Services with state funds and maintain
the full payment rate under this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end .
new text begin Subd. 12. new text end
new text begin Rates subject to the upper payment limit. new text end
deleted text begin (l)deleted text end Payment rates for durable
medical equipment, prosthetics, orthotics or supplies, that are subject to the upper payment
limit in accordance with section 1903(i)(27) of the Social Security Act, shall be paid the
Medicare rate. Rate increases provided in this chapter shall not be applied to the items listed
in this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end .
new text begin Subd. 13. new text end
new text begin Temporary rates for enteral nutrition and supplies. new text end
deleted text begin (m)deleted text end new text begin (a)new text end For dates of
service on or after July 1, 2023, through June 30, deleted text begin 2025deleted text end new text begin 2027new text end , enteral nutrition and supplies
must be paid according to this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end . If sufficient data exists for a product
or supply, payment must be based upon the 50th percentile of the usual and customary
charges per product code submitted to the commissioner, using only charges submitted per
unit. Increases in rates resulting from the 50th percentile payment method must not exceed
150 percent of the previous fiscal year's rate per code and product combination. Data are
sufficient if: (1) the commissioner has at least 100 paid claim lines by at least ten different
providers for a given product or supply; or (2) in the absence of the data in clause (1), the
commissioner has at least 20 claim lines by at least five different providers for a product or
supply that does not meet the requirements of clause (1). If sufficient data are not available
to calculate the 50th percentile for enteral products or supplies, the payment rate must be
the payment rate in effect on June 30, 2023.
new text begin
(b) This subdivision expires June 30, 2027.
new text end
new text begin Subd. 14. new text end
new text begin Rates for enteral nutrition and supplies. new text end
deleted text begin (n)deleted text end For dates of service on or after
July 1, deleted text begin 2025deleted text end new text begin 2027new text end , enteral nutrition and supplies must be paid according to this deleted text begin paragraphdeleted text end new text begin
subdivisionnew text end and updated annually each January 1. If sufficient data exists for a product or
supply, payment must be based upon the 50th percentile of the usual and customary charges
per product code submitted to the commissioner for the previous calendar year, using only
charges submitted per unit. Increases in rates resulting from the 50th percentile payment
method must not exceed 150 percent of the previous year's rate per code and product
combination. Data are sufficient if: (1) the commissioner has at least 100 paid claim lines
by at least ten different providers for a given product or supply; or (2) in the absence of the
data in clause (1), the commissioner has at least 20 claim lines by at least five different
providers for a product or supply that does not meet the requirements of clause (1). If
sufficient data are not available to calculate the 50th percentile for enteral products or
supplies, the payment must be the manufacturer's suggested retail price of that product or
supply minus 20 percent. If the manufacturer's suggested retail price is not available, payment
must be the actual acquisition cost of that product or supply plus 20 percent.
new text begin Subd. 15. new text end
new text begin Payments based on manufacturer's suggested retail price. new text end
new text begin
For medical
supplies and equipment payments based on the manufacturer's suggested retail price
methodology set forth in Minnesota Rules, part 9505.0445, item S, the commissioner shall
establish the payment amount on an annual basis for enteral formula, low profile feeding
tubes, and feeding tube extension sets.
new text end