SF 988

as introduced - 89th Legislature (2015 - 2016) Posted on 03/30/2015 11:32am

A bill for an act
relating to human services; exempting providers of durable medical equipment,
prosthetics, orthotics, or medical supplies from the Medicare payment limit
and the Medicare enrollment requirement; amending Minnesota Statutes 2014,
sections 256B.0625, subdivision 31; 256B.767.

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

Section 1.

Minnesota Statutes 2014, section 256B.0625, subdivision 31, is amended to
read:

Subd. 31.

Medical supplies and equipment.

(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall
be made for wheelchairs and wheelchair accessories for recipients who are residents
of intermediate care facilities for the developmentally disabled. Reimbursement for
wheelchairs and wheelchair accessories for ICF/DD recipients shall be subject to the same
conditions and limitations as coverage for recipients who do not reside in institutions. A
wheelchair purchased outside of the facility's payment rate is the property of the recipient.
deleted text begin The commissioner may set reimbursement rates for specified categories of medical
supplies at levels below the Medicare payment rate.
deleted text end

(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.

new text begin (c) The commissioner may exempt a vendor of durable medical equipment,
prosthetics, orthotics, or medical supplies from the Medicare enrollment requirement
in paragraph (b) if:
new text end

new text begin (1) the vendor is providing a service or item to a recipient and the service or item is
covered under medical assistance, but is not covered under Medicare; or
new text end

deleted text begin (c) deleted text end new text begin (2) new text end when necessary to ensure access to durable medical equipment, prosthetics,
orthotics, or medical supplies, deleted text begin the commissioner may exempt a vendor from the Medicare
enrollment requirement if deleted text end new text begin and the following requirements are met new text end :

deleted text begin (1) deleted text end new text begin (i) new text end the vendor supplies only one type of durable medical equipment, prosthetic,
orthotic, or medical supply;

deleted text begin (2) deleted text end new text begin (ii) new text end the vendor serves ten or fewer medical assistance recipients per year;

deleted text begin (3) deleted text end new text begin (iii) new text end the commissioner finds that other vendors are not available to provide same
or similar durable medical equipment, prosthetics, orthotics, or medical supplies; and

deleted text begin (4) deleted text end new text begin (iv) new text end the vendor complies with all screening requirements in this chapter and
Code of Federal Regulations, title 42, part 455. The commissioner may also exempt a
vendor from the Medicare enrollment requirement if the vendor is accredited by a Centers
for Medicare and Medicaid Services approved national accreditation organization as
complying with the Medicare program's supplier and quality standards and the vendor
serves primarily pediatric patients.

(d) Durable medical equipment means a device or equipment that:

(1) can withstand repeated use;

(2) is generally not useful in the absence of an illness, injury, or disability; and

(3) is provided to correct or accommodate a physiological disorder or physical
condition or is generally used primarily for a medical purpose.

(e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device
must be locked in order to prevent use not related to communication.

Sec. 2.

Minnesota Statutes 2014, section 256B.767, is amended to read:

256B.767 MEDICARE PAYMENT LIMIT.

(a) Effective for services rendered on or after July 1, 2010, fee-for-service payment
rates for physician and professional services under section 256B.76, subdivision 1, and
basic care services subject to the rate reduction specified in section 256B.766, shall not
exceed the Medicare payment rate for the applicable service, as adjusted for any changes
in Medicare payment rates after July 1, 2010. The commissioner shall implement this
section after any other rate adjustment that is effective July 1, 2010, and shall reduce rates
under this section by first reducing or eliminating provider rate add-ons.

(b) This section does not apply to services provided by advanced practice certified
nurse midwives licensed under chapter 148 or traditional midwives licensed under chapter
147D. Notwithstanding this exemption, medical assistance fee-for-service payment rates
for advanced practice certified nurse midwives and licensed traditional midwives shall
equal and shall not exceed the medical assistance payment rate to physicians for the
applicable service.

(c) This section does not apply to mental health services or physician services billed
by a psychiatrist or an advanced practice registered nurse with a specialty in mental health.

(d) deleted text begin Effective for durable medical equipment, prosthetics, orthotics, or supplies
provided on or after July 1, 2013, through June 30, 2015, the payment rate for items
that are subject to the rates established under Medicare's National Competitive Bidding
Program shall be equal to the rate that applies to the same item when not subject to the
rate established under Medicare's National Competitive Bidding Program. This paragraph
does not apply to mail-order diabetic supplies and does not apply to items provided to
dually eligible recipients when Medicare is the primary payer of the item deleted text end new text begin This section does
not apply to durable medical equipment, prosthetics, orthotics, or supplies new text end .