Provider disenrollment, premium payment requirements, and physician-directed clinic staff services coverage modified; enrollment for county-administered rural medical assistance program modified; language recodified; and report required.

A bill for an act

relating to human services; modifying provider disenrollment, premium payment

requirements, and physician-directed clinic staff services coverage; modifying

enrollment for the county-administered rural medical assistance program;

recodifying certain language; requiring a report; amending Minnesota Statutes

2024, sections 142B.01, subdivision 8; 245A.02, subdivision 5a; 245D.081,

subdivision 3; 256B.057, subdivision 9; 256B.0625, subdivision 4; 256B.0949,

subdivision 17; 256L.05, subdivision 3; 256L.06, subdivision 3; Minnesota Statutes

2025 Supplement, sections 256B.04, subdivision 21; 256B.0759, subdivision 4;

256B.0949, subdivision 16; 256B.695, subdivision 5; Laws 2024, chapter 125,

article 4, section 12, subdivision 5; proposing coding for new law in Minnesota

Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2024, section 142B.01, subdivision 8, is amended to read:

Subd. 8.

Controlling individual.

(a) "Controlling individual" means an owner of a

program or service provider licensed under this chapter and the following individuals, if

applicable:

(1) each officer of the organization, including the chief executive officer and chief

financial officer;

(2) the individual designated as the authorized agent under section
142B.10, subdivision

1, paragraph (b);

(3) the individual designated as the compliance officer under section
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256B.04,
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subdivision
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21, paragraph (g)
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new text begin
256B.044, subdivision 7, paragraph (b)
new text end
;

(4) each managerial official whose responsibilities include the direction of the

management or policies of a program;

(5) the individual designated as the primary provider of care for a special family child

care program under section
142B.41, subdivision 4
, paragraph (d); and

(6) the president and treasurer of the board of directors of a nonprofit corporation.

(b) Controlling individual does not include:

(1) a bank, savings bank, trust company, savings association, credit union, industrial

loan and thrift company, investment banking firm, or insurance company unless the entity

operates a program directly or through a subsidiary;

(2) an individual who is a state or federal official, or state or federal employee, or a

member or employee of the governing body of a political subdivision of the state or federal

government that operates one or more programs, unless the individual is also an officer,

owner, or managerial official of the program; receives remuneration from the program; or

owns any of the beneficial interests not excluded in this subdivision;

(3) an individual who owns less than five percent of the outstanding common shares of

a corporation:

(i) whose securities are exempt under section
80A.45
, clause (6); or

(ii) whose transactions are exempt under section
80A.46
, clause (2);

(4) an individual who is a member of an organization exempt from taxation under section

290.05
, unless the individual is also an officer, owner, or managerial official of the program

or owns any of the beneficial interests not excluded in this subdivision. This clause does

not exclude from the definition of controlling individual an organization that is exempt from

taxation; or

(5) an employee stock ownership plan trust, or a participant or board member of an

employee stock ownership plan, unless the participant or board member is a controlling

individual according to paragraph (a).

(c) For purposes of this subdivision, "managerial official" means an individual who has

the decision-making authority related to the operation of the program, and the responsibility

for the ongoing management of or direction of the policies, services, or employees of the

program. A site director who has no ownership interest in the program is not considered to

be a managerial official for purposes of this definition.

Sec. 2.

Minnesota Statutes 2024, section 245A.02, subdivision 5a, is amended to read:

Subd. 5a.

Controlling individual.

(a) "Controlling individual" means an owner of a

program or service provider licensed under this chapter and the following individuals, if

applicable:

(1) each officer of the organization, including the chief executive officer and chief

financial officer;

(2) the individual designated as the authorized agent under section
245A.04, subdivision

1
, paragraph (b);

(3) the individual designated as the compliance officer under section
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256B.04, subdivision

21
, paragraph (g)
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new text begin
256B.044, subdivision 7, paragraph (b)
new text end
;

(4) each managerial official whose responsibilities include the direction of the

management or policies of a program; and

(5) the president and treasurer of the board of directors of a nonprofit corporation.

(b) Controlling individual does not include:

(1) a bank, savings bank, trust company, savings association, credit union, industrial

loan and thrift company, investment banking firm, or insurance company unless the entity

operates a program directly or through a subsidiary;

(2) an individual who is a state or federal official, or state or federal employee, or a

member or employee of the governing body of a political subdivision of the state or federal

government that operates one or more programs, unless the individual is also an officer,

owner, or managerial official of the program, receives remuneration from the program, or

owns any of the beneficial interests not excluded in this subdivision;

(3) an individual who owns less than five percent of the outstanding common shares of

a corporation:

(i) whose securities are exempt under section
80A.45
, clause (6); or

(ii) whose transactions are exempt under section
80A.46
, clause (2);

(4) an individual who is a member of an organization exempt from taxation under section

290.05
, unless the individual is also an officer, owner, or managerial official of the program

or owns any of the beneficial interests not excluded in this subdivision. This clause does

not exclude from the definition of controlling individual an organization that is exempt from

taxation; or

(5) an employee stock ownership plan trust, or a participant or board member of an

employee stock ownership plan, unless the participant or board member is a controlling

individual according to paragraph (a).

(c) For purposes of this subdivision, "managerial official" means an individual who has

the decision-making authority related to the operation of the program, and the responsibility

for the ongoing management of or direction of the policies, services, or employees of the

program. A site director who has no ownership interest in the program is not considered to

be a managerial official for purposes of this definition.

Sec. 3.

Minnesota Statutes 2024, section 245D.081, subdivision 3, is amended to read:

Subd. 3.

Program management and oversight.

(a) The license holder must designate

a managerial staff person or persons to provide program management and oversight of the

services provided by the license holder. The designated manager is responsible for the

following:

(1) maintaining a current understanding of the licensing requirements sufficient to ensure

compliance throughout the program as identified in section
245A.04, subdivision
1, paragraph

(e), and when applicable, as identified in section
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256B.04, subdivision 21
, paragraph (g)
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256B.044, subdivision 7
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;

(2) ensuring the duties of the designated coordinator are fulfilled according to the

requirements in subdivision 2;

(3) ensuring the program implements corrective action identified as necessary by the

program following review of incident and emergency reports according to the requirements

in section
245D.11, subdivision 2
, clause (7). An internal review of incident reports of

alleged or suspected maltreatment must be conducted according to the requirements in

section
245A.65, subdivision 1
, paragraph (b);

(4) evaluation of satisfaction of persons served by the program, the person's legal

representative, if any, and the case manager, with the service delivery and progress toward

accomplishing outcomes identified in sections
245D.07
and
245D.071
, and ensuring and

protecting each person's rights as identified in section
245D.04
;

(5) ensuring staff competency requirements are met according to the requirements in

section
245D.09, subdivision 3
, and ensuring staff orientation and training is provided

according to the requirements in section
245D.09, subdivisions 4
, 4a, and 5;

(6) ensuring corrective action is taken when ordered by the commissioner and that the

terms and conditions of the license and any variances are met; and

(7) evaluating the information identified in clauses (1) to (6) to develop, document, and

implement ongoing program improvements.

(b) The designated manager must be competent to perform the duties as required and

must minimally meet the education and training requirements identified in subdivision 2,

paragraph (b), and have a minimum of three years of supervisory level experience in a

program that provides care or education to vulnerable adults or children.

Sec. 4.

Minnesota Statutes 2025 Supplement, section 256B.04, subdivision 21, is amended

to read:

Subd. 21.

Provider enrollment.

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(a)
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The commissioner shall enroll providers and conduct

screening activities as required by
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sections 256B.044 to 256B.0444 and
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Code of Federal

Regulations, title 42, section 455, subpart E.

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A provider must enroll each provider-controlled location where direct services are

provided. The commissioner may deny a provider's incomplete application if a provider

fails to respond to the commissioner's request for additional information within 60 days of

the request. The commissioner must conduct a background study under chapter

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245C

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,

including a review of databases in section
245C.08, subdivision 1
, paragraph (a), clauses

(1) to (5), for a provider described in this paragraph. The background study requirement

may be satisfied if the commissioner conducted a fingerprint-based background study on

the provider that includes a review of databases in section
245C.08, subdivision 1
, paragraph

(a), clauses (1) to (5).

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(b) The commissioner shall revalidate:

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(1) each provider under this subdivision at least once every five years;

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(2) each personal care assistance agency, CFSS provider-agency, and CFSS financial

management services provider under this subdivision at least once every three years;

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(3) each EIDBI agency under this subdivision at least once every three years; and

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(4) at the commissioner's discretion, any medical-assistance-only provider type the

commissioner deems "high-risk" under this subdivision.

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(c) The commissioner shall conduct revalidation as follows:

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(1) provide 30-day notice of the revalidation due date including instructions for

revalidation and a list of materials the provider must submit;

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(2) if a provider fails to submit all required materials by the due date, notify the provider

of the deficiency within 30 days after the due date and allow the provider an additional 30

days from the notification date to comply; and

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(3) if a provider fails to remedy a deficiency within the 30-day time period, give 60-day

notice of termination and immediately suspend the provider's ability to bill. The provider

does not have the right to appeal suspension of ability to bill.

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(d) If a provider fails to comply with any individual provider requirement or condition

of participation, the commissioner may suspend the provider's ability to bill until the provider

comes into compliance. The commissioner's decision to suspend the provider is not subject

to an administrative appeal.

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(e) Correspondence and notifications, including notifications of termination and other

actions, may be delivered electronically to a provider's MN-ITS mailbox. This paragraph

does not apply to correspondences and notifications related to background studies.

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(f) If the commissioner or the Centers for Medicare and Medicaid Services determines

that a provider is designated "high-risk," the commissioner may withhold payment from

providers within that category upon initial enrollment for a 90-day period. The withholding

for each provider must begin on the date of the first submission of a claim.

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(g) An enrolled provider that is also licensed by the commissioner under chapter

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245A

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,

is licensed as a home care provider by the Department of Health under chapter 144A, or is

licensed as an assisted living facility under chapter

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144G

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and has a home and

community-based services designation on the home care license under section
144A.484
,

must designate an individual as the entity's compliance officer. The compliance officer

must:

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(1) develop policies and procedures to assure adherence to medical assistance laws and

regulations and to prevent inappropriate claims submissions;

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(2) train the employees of the provider entity, and any agents or subcontractors of the

provider entity including billers, on the policies and procedures under clause (1);

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(3) respond to allegations of improper conduct related to the provision or billing of

medical assistance services, and implement action to remediate any resulting problems;

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(4) use evaluation techniques to monitor compliance with medical assistance laws and

regulations;

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(5) promptly report to the commissioner any identified violations of medical assistance

laws or regulations; and

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(6) within 60 days of discovery by the provider of a medical assistance reimbursement

overpayment, report the overpayment to the commissioner and make arrangements with

the commissioner for the commissioner's recovery of the overpayment.

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The commissioner may require, as a condition of enrollment in medical assistance, that a

provider within a particular industry sector or category establish a compliance program that

contains the core elements established by the Centers for Medicare and Medicaid Services.

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(h) The commissioner may revoke the enrollment of an ordering or rendering provider

for a period of not more than one year, if the provider fails to maintain and, upon request

from the commissioner, provide access to documentation relating to written orders or requests

for payment for durable medical equipment, certifications for home health services, or

referrals for other items or services written or ordered by such provider, when the

commissioner has identified a pattern of a lack of documentation. A pattern means a failure

to maintain documentation or provide access to documentation on more than one occasion.

Nothing in this paragraph limits the authority of the commissioner to sanction a provider

under the provisions of section
256B.064
.

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(i) The commissioner shall terminate or deny the enrollment of any individual or entity

if the individual or entity has been terminated from participation in Medicare or under the

Medicaid program or Children's Health Insurance Program of any other state. The

commissioner may exempt a rehabilitation agency from termination or denial that would

otherwise be required under this paragraph, if the agency:

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(1) is unable to retain Medicare certification and enrollment solely due to a lack of billing

to the Medicare program;

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(2) meets all other applicable Medicare certification requirements based on an on-site

review completed by the commissioner of health; and

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(3) serves primarily a pediatric population.

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(j) As a condition of enrollment in medical assistance, the commissioner shall require

that a provider designated "moderate" or "high-risk" by the Centers for Medicare and

Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid

Services, its agents, or its designated contractors and the state agency, its agents, or its

designated contractors to conduct unannounced on-site inspections of any provider location.

The commissioner shall publish in the Minnesota Health Care Program Provider Manual a

list of provider types designated "limited," "moderate," or "high-risk," based on the criteria

and standards used to designate Medicare providers in Code of Federal Regulations, title

42, section 424.518. The list and criteria are not subject to the requirements of chapter

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14

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.

The commissioner's designations are not subject to administrative appeal.

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(k) As a condition of enrollment in medical assistance, the commissioner shall require

that a high-risk provider, or a person with a direct or indirect ownership interest in the

provider of five percent or higher, consent to criminal background checks, including

fingerprinting, when required to do so under state law or by a determination by the

commissioner or the Centers for Medicare and Medicaid Services that a provider is designated

high-risk for fraud, waste, or abuse.

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(l)(1) Upon initial enrollment, reenrollment, and notification of revalidation, all durable

medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers

meeting the durable medical equipment provider and supplier definition in clause (3),

operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is

annually renewed and designates the Minnesota Department of Human Services as the

obligee, and must be submitted in a form approved by the commissioner. For purposes of

this clause, the following medical suppliers are not required to obtain a surety bond: a

federally qualified health center, a home health agency, the Indian Health Service, a

pharmacy, and a rural health clinic.

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(2) At the time of initial enrollment or reenrollment, durable medical equipment providers

and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating

provider's Medicaid revenue in the previous calendar year is up to and including $300,000,

the provider agency must purchase a surety bond of $50,000. If a revalidating provider's

Medicaid revenue in the previous calendar year is over $300,000, the provider agency must

purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and

fees in pursuing a claim on the bond. Any action to obtain monetary recovery or sanctions

from a surety bond must occur within six years from the date the debt is affirmed by a final

agency decision. An agency decision is final when the right to appeal the debt has been

exhausted or the time to appeal has expired under section
256B.064
.

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(3) "Durable medical equipment provider or supplier" means a medical supplier that can

purchase medical equipment or supplies for sale or rental to the general public and is able

to perform or arrange for necessary repairs to and maintenance of equipment offered for

sale or rental.

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(m) The Department of Human Services may require a provider to purchase a surety

bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment

if: (1) the provider fails to demonstrate financial viability, (2) the department determines

there is significant evidence of or potential for fraud and abuse by the provider, or (3) the

provider or category of providers is designated high-risk pursuant to paragraph (f) and as

per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in an

amount of $100,000 or ten percent of the provider's payments from Medicaid during the

immediately preceding 12 months, whichever is greater. The surety bond must name the

Department of Human Services as an obligee and must allow for recovery of costs and fees

in pursuing a claim on the bond. This paragraph does not apply if the provider currently

maintains a surety bond under the requirements in section
256B.051
,
256B.0659
,
256B.0701
,

or
256B.85
.

deleted text end

Sec. 5.

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[256B.044] PROVIDER ENROLLMENT.

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new text begin

Subdivision 1.

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Designating categorical risk levels.

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(a) The commissioner must designate

provider types as "limited-risk," "moderate-risk," or "high-risk," based on the criteria and

standards used to designate Medicare providers in Code of Federal Regulations, title 42,

section 424.518. The commissioner must publish a list of provider types and designated

categorical risk levels in the Minnesota Health Care Program Provider Manual.

new text end

new text begin

(b) The list and criteria are not subject to the requirements of chapter 14, and section

14.386 does not apply.

new text end

new text begin

(c) The commissioner's designations are not subject to administrative appeal.

new text end

new text begin

Subd. 2.

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Service location enrollment.

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A provider must enroll each provider-controlled

location where direct services are provided.

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Subd. 3.

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Incomplete provider enrollment applications.

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The commissioner may deny

a provider's incomplete enrollment application if a provider fails to respond to the

commissioner's request for additional information within 60 days of the request.

new text end

new text begin

Subd. 4.

new text end

new text begin

Required background studies.

new text end

new text begin

(a) The commissioner must conduct a

background study under chapter 245C, including a review of databases in section 245C.08,

subdivision 1, paragraph (a), clauses (1) to (5), for a provider applying for enrollment under

section 256B.04, subdivision 21. The background study requirement may be satisfied if the

commissioner conducted a fingerprint-based background study on the provider that included

a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses (1) to (5).

new text end

new text begin

(b) As a condition of enrollment in medical assistance, the commissioner must require

that a high-risk provider, or a person with a direct or indirect ownership interest in the

provider of five percent or higher, consent to criminal background checks, including

fingerprinting, when required to do so under state law or by a determination by the

commissioner or the Centers for Medicare and Medicaid Services (CMS) that a provider is

designated high-risk.

new text end

new text begin

Subd. 5.

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Surety bonds.

new text end

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(a) The commissioner may require a provider to purchase a

surety bond as a condition of initial enrollment, revalidation, reenrollment, reinstatement,

or continued enrollment if:

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new text begin

(1) the provider fails to demonstrate financial viability;

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new text begin

(2) the commissioner determines there is significant evidence of or potential for fraud

and abuse by the provider; or

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new text begin

(3) the provider or category of providers is designated high-risk pursuant to subdivision

1 and Code of Federal Regulations, title 42, section 455.450.

new text end

new text begin

(b) The surety bond must be in an amount of $100,000 or ten percent of the provider's

payments from Medicaid during the immediately preceding 12 months, whichever is greater.

The surety bond must name the Department of Human Services as an obligee and must

allow for recovery of costs and fees in pursuing a claim on the bond.

new text end

new text begin

(c) This subdivision does not apply if the provider currently maintains a surety bond

under the requirements in section 256B.051, 256B.0659, 256B.0701, or 256B.85.

new text end

new text begin

Subd. 6.

new text end

new text begin

Required permission to conduct on-site inspection.

new text end

new text begin

As a condition of

enrollment in medical assistance, the commissioner shall require that a provider designated

moderate-risk or high-risk by CMS or the commissioner permit CMS, CMS's agents, or

CMS's designated contractors and the state agency, the state agency's agents, or the state

agency's designated contractors to conduct unannounced on-site inspections of any provider

location.

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Subd. 7.

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Compliance programs.

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(a) The commissioner may require, as a condition of

enrollment in medical assistance, that a provider within a particular industry sector or

category establish a compliance program that contains the core elements established by

CMS.

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new text begin

(b) If an enrolled provider is required by the commissioner or by law to designate an

individual as the provider's compliance officer, the compliance officer must:

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new text begin

(1) develop policies and procedures to ensure adherence to medical assistance laws and

regulations and to prevent inappropriate claims submissions;

new text end

new text begin

(2) train the employees of the provider entity and any agents or subcontractors of the

provider entity, including billers, on the policies and procedures under clause (1);

new text end

new text begin

(3) respond to allegations of improper conduct related to the provision or billing of

medical assistance services and implement action to remediate any resulting problems;

new text end

new text begin

(4) use evaluation techniques to monitor compliance with medical assistance laws and

regulations;

new text end

new text begin

(5) promptly report to the commissioner any identified violations of medical assistance

laws or regulations; and

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new text begin

(6) within 60 days of discovery by the provider of a medical assistance reimbursement

overpayment, report the overpayment to the commissioner and make arrangements with

the commissioner for the commissioner's recovery of the overpayment.

new text end

new text begin

Subd. 8.

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Correspondence and notification.

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The commissioner may deliver

correspondence and notifications, including notifications of termination and other actions,

electronically to a provider's MN-ITS mailbox. This subdivision does not apply to

correspondence and notifications related to background studies.

new text end

Sec. 6.

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[256B.0441] PROVIDER REVALIDATION.

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Subdivision 1.

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Provider revalidation schedule.

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The commissioner shall revalidate:

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(1) each provider at least once every five years;

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(2) each personal care assistance agency, community first services and supports (CFSS)

agency-provider, and CFSS financial management services provider at least once every

three years;

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(3) each early intensive developmental and behavioral intervention agency at least once

every three years; and

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(4) at the commissioner's discretion, any medical-assistance-only provider type the

commissioner deems high-risk under section 256B.044, subdivision 1.

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Subd. 2.

new text end

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Revalidation procedures.

new text end

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The commissioner shall conduct revalidation as

follows:

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(1) provide 30 days' notice of the revalidation due date including instructions for

revalidation and a list of materials the provider must submit;

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new text begin

(2) if a provider fails to submit all required materials by the due date, notify the provider

of the deficiency within 30 days after the due date and allow the provider an additional 30

days from the notification date to comply; and

new text end

new text begin

(3) if a provider fails to remedy a deficiency within the 30-day time period, give 60 days'

notice of termination and immediately suspend the provider's ability to bill. The provider

does not have the right to appeal suspension of ability to bill.

new text end

Sec. 7.

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[256B.0442] PROVIDER ENROLLMENT SUSPENSIONS AND

TERMINATIONS.

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new text begin

Subdivision 1.

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Commissioner's general authority to suspend individual provider's

enrollment.

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(a) If a provider fails to comply with any individual provider requirement or

condition of participation, the commissioner may suspend the provider's ability to bill until

the provider comes into compliance.

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(b) The commissioner's decision to suspend the provider is not subject to an administrative

appeal.

new text end

new text begin

Subd. 2.

new text end

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Commissioner's authority to revoke enrollment of certain providers for

lack of documentation.

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new text begin

(a) The commissioner may revoke the enrollment of an ordering

or rendering provider for a period of not more than one year, if the provider fails to maintain

and, upon request from the commissioner, provide access to documentation relating to

written orders or requests for payment for durable medical equipment, certifications for

home health services, or referrals for other items or services written or ordered by the

provider, when the commissioner has identified a pattern of a lack of documentation. A

pattern means a failure to maintain documentation or provide access to documentation on

more than one occasion.

new text end

new text begin

(b) Nothing in this subdivision limits the authority of the commissioner to sanction a

provider under section 256B.064.

new text end

new text begin

Subd. 3.

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new text begin

Commissioner's duty to terminate provider enrollment.

new text end

new text begin

(a) Except as

provided in paragraph (b), the commissioner must terminate or deny the enrollment of any

individual or entity if the individual or entity has been terminated from participation in

Medicare or under the Medicaid program or Children's Health Insurance Program of any

other state.

new text end

new text begin

(b) The commissioner may exempt a rehabilitation agency from termination or denial

that would otherwise be required under paragraph (a), if the agency:

new text end

new text begin

(1) is unable to retain Medicare certification and enrollment solely due to a lack of billing

to the Medicare program;

new text end

new text begin

(2) meets all other applicable Medicare certification requirements based on an on-site

review completed by the commissioner of health; and

new text end

new text begin

(3) serves primarily a pediatric population.

new text end

new text begin

Subd. 4.

new text end

new text begin

Commissioner's authority to terminate provider enrollment for lack of

submitted claims.

new text end

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The commissioner may terminate the enrollment of an individual or

entity provider if the individual or entity provider has not submitted any claims in the

previous 12 consecutive calendar months.

new text end

Sec. 8.

new text begin

[256B.0443] PROVIDER PAYMENT WITHHOLDS.

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new text begin

(a) If the commissioner or the Centers for Medicare and Medicaid Services designates

a provider type as high-risk under section 256B.044, subdivision 1, the commissioner may

withhold payment from providers within that category upon initial enrollment for a 90-day

period.

new text end

new text begin

(b) The withholding for each provider must begin on the date of the first submission of

a claim.

new text end

Sec. 9.

new text begin

[256B.0444] ADDITIONAL PROVIDER ENROLLMENT REQUIREMENTS

FOR SPECIFIC PROVIDER TYPES.

new text end

new text begin

Subdivision 1.

new text end

new text begin

Durable medical equipment provider or supplier.

new text end

new text begin

(a) For purposes of

this subdivision, "durable medical equipment provider or supplier" means a medical supplier

that can purchase medical equipment or supplies for sale or rent to the general public and

is able to perform or arrange for necessary repairs to and maintenance of equipment offered

for sale or rent.

new text end

new text begin

(b) Upon initial enrollment, reenrollment, and notification of revalidation, all durable

medical equipment, prosthetics, orthotics, and supplies medical suppliers meeting the durable

medical equipment provider or supplier definition in paragraph (a), operating in Minnesota,

and receiving Medicaid money must purchase a surety bond that is annually renewed,

designates the Department of Human Services as the obligee, and is submitted in a form

approved by the commissioner. For purposes of this paragraph, the following medical

suppliers are not required to obtain a surety bond: a federally qualified health center, a home

health agency, the Indian Health Service, a pharmacy, and a rural health clinic.

new text end

new text begin

(c) At the time of initial enrollment or reenrollment, durable medical equipment providers

or suppliers defined in paragraph (a) must purchase a surety bond of $50,000. If a revalidating

provider's Medicaid revenue in the previous calendar year is up to and including $300,000,

the provider agency must purchase a surety bond of $50,000. If a revalidating provider's

Medicaid revenue in the previous calendar year is over $300,000, the provider agency must

purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and

fees in pursuing a claim on the bond. Any action to obtain monetary recovery or sanctions

from a surety bond must occur within six years from the date the debt is affirmed by a final

agency decision. An agency decision is final when the right to appeal the debt has been

exhausted or the time to appeal has expired under section 256B.064.

new text end

new text begin

Subd. 2.

new text end

new text begin

Providers licensed by the commissioner of human services.

new text end

new text begin

An enrolled

provider that is also licensed by the commissioner under chapter 245A must designate an

individual as the licensee's compliance officer under section 256B.044, subdivision 7,

paragraph (b).

new text end

new text begin

Subd. 3.

new text end

new text begin

Providers licensed by the commissioner of health.

new text end

new text begin

An enrolled provider that

is also licensed by the commissioner of health as a home care provider under chapter 144A

with a home and community-based services designation under section 144A.484 on the

home care license, or as an assisted living facility under chapter 144G, must designate an

individual as the licensee's compliance officer under section 256B.044, subdivision 7,

paragraph (b).

new text end

Sec. 10.

Minnesota Statutes 2024, section 256B.057, subdivision 9, is amended to read:

Subd. 9.

Employed persons with disabilities.

(a) Medical assistance may be paid for

a person who is employed and who:

(1) but for excess earnings or assets meets the definition of disabled under the

Supplemental Security Income program; and

(2) pays a premium and other obligations under paragraph (d).

(b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible

for medical assistance under this subdivision, a person must have more than $65 of earned

income, be receiving an unemployment insurance benefit under chapter 268 that the person

began receiving while eligible under this subdivision, or be receiving family and medical

leave benefits under chapter 268B that the person began receiving while eligible under this

subdivision. A person who is self-employed must file and pay all applicable taxes. Any

spousal income shall be disregarded for purposes of eligibility and premium determinations.

(c) After the month of enrollment, a person enrolled in medical assistance under this

subdivision who would otherwise be ineligible and be disenrolled due to one of the following

circumstances may retain eligibility for up to four consecutive months after a month of job

loss if the person:

(1) is temporarily unable to work and without receipt of earned income due to a medical

condition, as verified by a physician, advanced practice registered nurse, or physician

assistant; or

(2) loses employment for reasons not attributable to the enrollee, and is without receipt

of earned income.

To receive a four-month extension of continued eligibility under this paragraph, enrollees

must verify the medical condition or provide notification of job loss, continue to meet all

other eligibility requirements, and continue to pay all calculated premium costs.

(d) All enrollees must pay a premium to be eligible for medical assistance under this

subdivision, except as provided under clause (5).

(1) An enrollee must pay the greater of a $35 premium or the premium calculated based

on the person's gross earned and unearned income and the applicable family size using a

sliding fee scale established by the commissioner, which begins at one percent of income

at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income for

those with incomes at or above 300 percent of the federal poverty guidelines.

(2) Annual adjustments in the premium schedule based upon changes in the federal

poverty guidelines shall be effective for premiums due in July of each year.

(3) All enrollees who receive unearned income must pay one-half of one percent of

unearned income in addition to the premium amount, except as provided under clause (5).

(4) Increases in benefits under title II of the Social Security Act shall not be counted as

income for purposes of this subdivision until July 1 of each year.

(5) Effective July 1, 2009, American Indians are exempt from paying premiums as

required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public

Law 111-5. For purposes of this clause, an American Indian is any person who meets the

definition of Indian according to Code of Federal Regulations, title 42, section
447.50
.

(e) A person's eligibility and premium shall be determined by the local county agency.

Premiums must be paid to the commissioner. All premiums are dedicated to the

commissioner.

(f) Any required premium shall be determined at application and redetermined at the

enrollee's 12-month income review or when a change in income or household size is reported.

Enrollees must report any change in income or household size within 30 days of when the

change occurs. A decreased premium resulting from a reported change in income or

household size shall be effective the first day of the next available billing month after the

change is reported. Except for changes occurring from annual cost-of-living increases, a

change resulting in an increased premium shall not affect the premium amount until the

next 12-month review.

(g) Premium payment is due upon notification from the commissioner of the premium

amount required. Premiums may be paid in installments at the discretion of the commissioner.

(h) Nonpayment of the premium shall result in denial or termination of medical assistance

unless the person demonstrates good cause for nonpayment. "Good cause" means an excuse

for the enrollee's failure to pay the required premium when due because the circumstances

were beyond the enrollee's control or not reasonably foreseeable. The commissioner shall

determine whether good cause exists based on the weight of the supporting evidence

submitted by the enrollee to demonstrate good cause.
new text begin
The commissioner must not determine

that good cause exists for a month for which the premium has already been paid.
new text end
Except

when an installment agreement is accepted by the commissioner, all persons disenrolled

for nonpayment of a premium must pay any past due premiums as well as current premiums

due prior to being reenrolled. Nonpayment shall include payment with a returned, refused,

or dishonored instrument. The commissioner may require a guaranteed form of payment as

the only means to replace a returned, refused, or dishonored instrument.

(i) For enrollees whose income does not exceed 200 percent of the federal poverty

guidelines and who are also enrolled in Medicare, the commissioner shall reimburse the

enrollee for Medicare part B premiums under section
256B.0625, subdivision 15
, paragraph

(a).

(j) The commissioner is authorized to determine that a premium amount was calculated

or billed in error, make corrections to financial records and billing systems, and refund

premiums collected in error.

Sec. 11.

Minnesota Statutes 2024, section 256B.0625, subdivision 4, is amended to read:

Subd. 4.

Outpatient and physician-directed clinic services.

Medical assistance covers

outpatient hospital or physician-directed clinic services.
deleted text begin
The
deleted text end
new text begin
All services provided by
new text end

physician-directed clinic staff
deleted text begin
shall include at least two physicians and all services shall
deleted text end
new text begin

must
new text end
be
deleted text begin
provided
deleted text end
under the
deleted text begin
direct supervision
deleted text end
new text begin
direction
new text end
of a physician. Hospital outpatient

departments are subject to the same limitations and reimbursements as other enrolled vendors

for all services, except initial triage, emergency services, and services not provided or

immediately available in clinics, physicians' offices, or by other enrolled providers.

"Emergency services" means those medical services required for the immediate diagnosis

and treatment of medical conditions that, if not immediately diagnosed and treated, could

lead to serious physical or mental disability or death or are necessary to alleviate severe

pain. Neither the hospital, its employees, nor any physician or dentist, shall be liable in any

action arising out of a determination not to render emergency services or care if reasonable

care is exercised in determining the condition of the person, or in determining the

appropriateness of the facilities, or the qualifications and availability of personnel to render

these services consistent with this section.

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective upon federal approval.

new text end

Sec. 12.

Minnesota Statutes 2025 Supplement, section 256B.0759, subdivision 4, is

amended to read:

Subd. 4.

Provider payment rates.

(a) Payment rates for participating providers must

be increased for services provided to medical assistance enrollees. To receive a rate increase,

participating providers must meet demonstration project requirements and provide evidence

of formal referral arrangements with providers delivering step-up or step-down levels of

care. Providers that have enrolled in the demonstration project but have not met the provider

standards under subdivision 3 as of July 1, 2022, are not eligible for a rate increase under

this subdivision until the date that the provider meets the provider standards in subdivision

3. Services provided from July 1, 2022, to the date that the provider meets the provider

standards under subdivision 3 shall be reimbursed at rates according to section
254B.0505,

subdivision 1
. Rate increases paid under this subdivision to a provider for services provided

between July 1, 2021, and July 1, 2022, are not subject to recoupment when the provider

is taking meaningful steps to meet demonstration project requirements that are not otherwise

required by law, and the provider provides documentation to the commissioner, upon request,

of the steps being taken.

(b) The commissioner may temporarily suspend payments to the provider according to

section
deleted text begin
256B.04, subdivision 21
, paragraph (d)
deleted text end
new text begin
256B.0442, subdivision 1
new text end
, if the provider

does not meet the requirements in paragraph (a). Payments withheld from the provider must

be made once the commissioner determines that the requirements in paragraph (a) are met.

(c) For outpatient individual and group substance use disorder services under section

254B.0505, subdivision 1
, clause (1), and adolescent treatment programs that are licensed

as outpatient treatment programs according to sections
245G.01
to
245G.18
, provided on

or after January 1, 2021, payment rates must be increased by 20 percent over the rates in

effect on December 31, 2020.

(d) Effective January 1, 2021, and contingent on annual federal approval, managed care

plans and county-based purchasing plans must reimburse providers of the substance use

disorder services meeting the criteria described in paragraph (a) who are employed by or

under contract with the plan an amount that is at least equal to the fee-for-service base rate

payment for the substance use disorder services described in paragraph (c). The commissioner

must monitor the effect of this requirement on the rate of access to substance use disorder

services and residential substance use disorder rates. Capitation rates paid to managed care

organizations and county-based purchasing plans must reflect the impact of this requirement.

This paragraph expires if federal approval is not received at any time as required under this

paragraph.

(e) Effective July 1, 2021, contracts between managed care plans and county-based

purchasing plans and providers to whom paragraph (d) applies must allow recovery of

payments from those providers if, for any contract year, federal approval for the provisions

of paragraph (d) is not received, and capitation rates are adjusted as a result. Payment

recoveries must not exceed the amount equal to any decrease in rates that results from this

provision.

(f) For substance use disorder services with medications for opioid use disorder under

section
254B.0505, subdivision 1
, clause (7), provided on or after January 1, 2021, payment

rates must be increased by 20 percent over the rates in effect on December 31, 2020. Upon

implementation of new rates according to section
254B.121
, the 20 percent increase will

no longer apply.

Sec. 13.

Minnesota Statutes 2025 Supplement, section 256B.0949, subdivision 16, is

amended to read:

Subd. 16.

Agency duties.

(a) An agency delivering an EIDBI service under this section

must:

(1) enroll as a medical assistance Minnesota health care program provider according to

Minnesota Rules, part
9505.0195
, and
deleted text begin
section
256B.04, subdivision 21
deleted text end
new text begin
sections 256B.044

to 256B.0444
new text end
, and meet all applicable provider standards and requirements;

(2) designate an individual as the agency's compliance officer who must perform the

duties described in section
deleted text begin
256B.04, subdivision 21
, paragraph (g)
deleted text end
new text begin
256B.044, subdivision

7, paragraph (b)
new text end
;

(3) demonstrate compliance with federal and state laws for the delivery of and billing

for EIDBI service;

(4) verify and maintain records of a service provided to the person or the person's legal

representative as required under Minnesota Rules, parts
9505.2175
and
9505.2197
;

(5) demonstrate that while enrolled or seeking enrollment as a Minnesota health care

program provider the agency did not have a lead agency contract or provider agreement

discontinued because of a conviction of fraud; or did not have an owner, board member, or

manager fail a state or federal criminal background check or appear on the list of excluded

individuals or entities maintained by the federal Department of Human Services Office of

Inspector General;

(6) have established business practices including written policies and procedures, internal

controls, and a system that demonstrates the organization's ability to deliver quality EIDBI

services, appropriately submit claims, conduct required staff training, document staff

qualifications, document service activities, and document service quality;

(7) have an office located in Minnesota or a border state;

(8) initiate a background study as required under subdivision 16a;

(9) report maltreatment according to section
626.557
and chapter 260E;

(10) comply with any data requests consistent with the Minnesota Government Data

Practices Act, sections
256B.064
and
256B.27
;

(11) provide training for all agency staff on the requirements and responsibilities listed

in the Maltreatment of Minors Act, chapter 260E, and the Vulnerable Adult Protection Act,

section
626.557
, including mandated and voluntary reporting, nonretaliation, and the agency's

policy for all staff on how to report suspected abuse and neglect;

(12) have a written policy to resolve issues collaboratively with the person and the

person's legal representative when possible. The policy must include a timeline for when

the person and the person's legal representative will be notified about issues that arise in

the provision of services;

(13) provide the person's legal representative with prompt notification if the person is

injured while being served by the agency. An incident report must be completed by the

agency staff member in charge of the person. A copy of all incident and injury reports must

remain on file at the agency for at least five years from the report of the incident;

(14) before starting a service, provide the person or the person's legal representative a

description of the treatment modality that the person shall receive, including the staffing

certification levels and training of the staff who shall provide a treatment;

(15) provide clinical supervision for a minimum of one hour for every 16 hours of direct

treatment per person, unless otherwise authorized in the person's individual treatment plan;

and

(16) provide required EIDBI intervention observation and direction at least once per

month. Notwithstanding subdivision 13, paragraph (l), required EIDBI intervention

observation and direction under this clause may be conducted via telehealth provided that

no more than two consecutive monthly required EIDBI intervention observation and direction

sessions under this clause are conducted via telehealth.

(b) Upon request of the commissioner, an agency delivering services under this section

must:

(1) identify the agency's controlling individuals, as defined under section
245A.02,

subdivision 5a
;

(2) provide disclosures of the use of billing agencies and other consultants who do not

provide EIDBI services; and

(3) provide copies of any contracts with consultants or independent contractors who do

not provide EIDBI services, including hours contracted and responsibilities.

(c) When delivering the ITP, and annually thereafter, an agency must provide the person

or the person's legal representative with:

(1) a written copy and a verbal explanation of the person's or person's legal

representative's rights and the agency's responsibilities;

(2) documentation in the person's file the date that the person or the person's legal

representative received a copy and explanation of the person's or person's legal

representative's rights and the agency's responsibilities; and

(3) reasonable accommodations to provide the information in another format or language

as needed to facilitate understanding of the person's or person's legal representative's rights

and the agency's responsibilities.

Sec. 14.

Minnesota Statutes 2024, section 256B.0949, subdivision 17, is amended to read:

Subd. 17.

Provider shortage; authority for exceptions.

(a) In consultation with the

Early Intensive Developmental and Behavioral Intervention Advisory Council and

stakeholders, including agencies, professionals, parents of people with ASD or a related

condition, and advocacy organizations, the commissioner shall determine if a shortage of

EIDBI providers exists. For the purposes of this subdivision, "shortage of EIDBI providers"

means a lack of availability of providers who meet the EIDBI provider qualification

requirements under subdivision 15 that results in the delay of access to timely services under

this section, or that significantly impairs the ability of a provider agency to have sufficient

providers to meet the requirements of this section. The commissioner shall consider

geographic factors when determining the prevalence of a shortage. The commissioner may

determine that a shortage exists only in a specific region of the state, multiple regions of

the state, or statewide. The commissioner shall also consider the availability of various types

of treatment modalities covered under this section.

(b) The commissioner, in consultation with the Early Intensive Developmental and

Behavioral Intervention Advisory Council and stakeholders, must establish processes and

criteria for granting an exception under this paragraph. The commissioner may grant an

exception only if the exception would not compromise a person's safety and not diminish

the effectiveness of the treatment. The commissioner may establish an expiration date for

an exception granted under this paragraph. The commissioner may grant an exception for

the following:

(1) EIDBI provider qualifications under this section;

(2) medical assistance provider enrollment requirements under
deleted text begin
section
256B.04
,

subdivision 21
deleted text end
new text begin
sections 256B.044 to 256B.0444
new text end
; or

(3) EIDBI provider or agency standards or requirements.

(c) If the commissioner, in consultation with the Early Intensive Developmental and

Behavioral Intervention Advisory Council and stakeholders, determines that a shortage no

longer exists, the commissioner must submit a notice that a shortage no longer exists to the

chairs and ranking minority members of the senate and the house of representatives

committees with jurisdiction over health and human services. The commissioner must post

the notice for public comment for 30 days. The commissioner shall consider public comments

before submitting to the legislature a request to end the shortage declaration. The

commissioner shall not declare the shortage of EIDBI providers ended without direction

from the legislature to declare it ended.

Sec. 15.

Minnesota Statutes 2025 Supplement, section 256B.695, subdivision 5, is amended

to read:

Subd. 5.

CARMA enrollment.

(a) Subject to
deleted text begin
paragraphs
deleted text end
new text begin
paragraph
new text end
(d)
deleted text begin
and (e)
deleted text end
, eligible

individuals must be automatically enrolled in CARMA, but may decline enrollment. Eligible

individuals may enroll in fee-for-service medical assistance. Eligible individuals may change

their CARMA elections on an annual basis.

(b) Eligible individuals must be able to enroll in CARMA through the selection process

in accordance with the election period established in section
256B.69, subdivision 4
,

paragraph (e).

(c) Enrollees who were not previously enrolled in the medical assistance program or

MinnesotaCare can change their selection once within the first year after enrollment in

CARMA. Enrollees who were not previously enrolled in CARMA have 90 days to make a

change and changes are allowed for additional special circumstances.

(d) The commissioner may
new text begin
not
new text end
offer a second health plan
new text begin
to eligible individuals
new text end
other

than,
deleted text begin
and
deleted text end
new text begin
or
new text end
in addition to, CARMA
new text begin
except that the commissioner may offer a second health

plan
new text end
to eligible individuals
deleted text begin
when another health plan is
deleted text end
new text begin
enrolling in MinnesotaCare, if
new text end

required by federal law or rule.
new text begin
Eligible individuals who do not select a health plan at the

time of enrollment must automatically be enrolled in CARMA.
new text end

new text begin

(e)
new text end
The commissioner may offer a replacement plan to eligible individuals, as determined

by the commissioner, when counties administering CARMA have their contract terminated

for cause.

deleted text begin

(e)
deleted text end
new text begin
(f)
new text end
The commissioner may, on a county-by-county basis, offer a health plan other

than
deleted text begin
, and in addition to,
deleted text end
CARMA to individuals who are eligible for both Medicare and

medical assistance due to age
new text begin
, income,
new text end
or disability if
deleted text begin
the commissioner deems it necessary

for enrollees to have another choice of health plan. Factors the commissioner must consider

when determining if the other health plan is necessary include the number of available

Medicare Advantage Plan options that are not special needs plans in the county, the size of

the enrolling population, the additional administrative burden placed on providers and

counties by multiple health plan options in a county, the need to ensure the viability and

success of the CARMA program, and the impact to the medical assistance program
deleted text end
new text begin
there

is not already a health plan available under CARMA
new text end
.

deleted text begin

(f) In counties where the commissioner is required by federal law or elects to offer a

second health plan other than CARMA pursuant to paragraphs (d) and (e), eligible enrollees

who do not select a health plan at the time of enrollment must automatically be enrolled in

CARMA.

deleted text end

(g) This subdivision supersedes section
256B.694
.

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective January 1, 2027.

new text end

Sec. 16.

Minnesota Statutes 2024, section 256L.05, subdivision 3, is amended to read:

Subd. 3.

Effective date of coverage.

(a) The effective date of coverage is the first day

of the month following the month in which eligibility is approved and the first premium

payment has been received. The effective date of coverage for new members added to the

family is the first day of the month following the month in which the change is reported.

All eligibility criteria must be met by the family at the time the new family member is added.

The income of the new family member is included with the family's modified adjusted gross

income and the adjusted premium begins in the month the new family member is added.

(b) The initial premium must be received by the last working day of the month for

coverage to begin the first day of the following month.

(c) Notwithstanding any other law to the contrary, benefits under sections
256L.01
to

256L.18
are secondary to a plan of insurance or benefit program under which an eligible

person may have coverage and the commissioner shall use cost avoidance techniques to

ensure coordination of any other health coverage for eligible persons. The commissioner

shall identify eligible persons who may have coverage or benefits under other plans of

insurance or who become eligible for medical assistance.

(d) The effective date of coverage for individuals or families who are exempt from

paying premiums under section
256L.15
,
deleted text begin
subdivision
deleted text end
new text begin
subdivisions
new text end
1
deleted text begin
, paragraph (c)
deleted text end
new text begin
and 2
new text end
,

is the first day of the month following the month in which eligibility is approved.

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective the day following final enactment.

new text end

Sec. 17.

Minnesota Statutes 2024, section 256L.06, subdivision 3, is amended to read:

Subd. 3.

Commissioner's duties and payment.

(a) Premiums are dedicated to the

commissioner for MinnesotaCare.

(b) The commissioner shall develop and implement procedures to: (1) require enrollees

to report changes in income; (2) adjust sliding scale premium payments, based upon both

increases and decreases in enrollee income, at the time the change in income is reported;

and (3) disenroll enrollees from MinnesotaCare for failure to pay required premiums. Failure

to pay includes payment with a dishonored check, a returned automatic bank withdrawal,

or a refused credit card or debit card payment. The commissioner may demand a guaranteed

form of payment, including a cashier's check or a money order, as the only means to replace

a dishonored, returned, or refused payment.

(c) Premiums are calculated on a calendar month basis and may be paid on a monthly,

quarterly, or semiannual basis, with the first payment due upon notice from the commissioner

of the premium amount required. The commissioner shall inform applicants and enrollees

of these premium payment options. Premium payment is required before enrollment is

complete and to maintain
deleted text begin
eligibility
deleted text end
new text begin
coverage
new text end
in MinnesotaCare. Premium payments received

before noon are credited the same day. Premium payments received after noon are credited

on the next working day.

(d) Nonpayment of the premium will result in disenrollment from the plan effective for

the calendar month following the month for which the premium was due. Persons disenrolled

for nonpayment may not reenroll prior to the first day of the month following the payment

of an amount equal to
deleted text begin
two months' premiums
deleted text end
new text begin
one monthly premium
new text end
.

(e) The commissioner shall forgive the past-due premium for persons disenrolled under

paragraph (d) prior to issuing a premium invoice for the
deleted text begin
fourth
deleted text end

new text begin
next
new text end
month
deleted text begin
following

disenrollment
deleted text end
.

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective the day following final enactment.

new text end

Sec. 18.

Laws 2024, chapter 125, article 4, section 12, subdivision 5, is amended to read:

Subd. 5.

Report.

By
deleted text begin
December 15, 2025
deleted text end
new text begin
November 30, 2026
new text end
, the commissioner must

provide a summary report on the pilot program to the chairs and ranking minority members

of the legislative committees with jurisdiction over mental health and county correctional

facilities.

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective retroactively from December 15, 2025.

new text end