Plain English Breakdown
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HF4491 • 2026
Medical assistance prepayment review requirements established, and report required.
Medical assistance prepayment review requirements established, and report required.
Healthcare
Passed Legislature
This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.
Bill History
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2026-03-18
House
Introduction and first reading, referred to Human Services Finance and Policy
Official Summary Text
Medical assistance prepayment review requirements established, and report required.
Current Bill Text
Read the full stored bill text
A bill for an act relating to human services; establishing medical assistance prepayment review requirements; requiring a report; proposing coding for new law in Minnesota Statutes, chapter 256B. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: Section 1. new text begin [256B.044] PREPAYMENT REVIEW. new text end new text begin Subdivision 1. new text end new text begin Providers subject to prepayment review. new text end new text begin (a) The commissioner must establish prepayment review of submitted medical assistance claims when the commissioner or the Centers for Medicare and Medicaid Services designates: new text end new text begin (1) a provider type as high-risk under section 256B.04, subdivision 21, paragraph (j), for fee-for-service claims submitted by providers within that category; and new text end new text begin (2) a covered service as high-risk, for fee-for-service claims submitted for that service by any provider, except the Indian Health Service. new text end new text begin (b) Nothing in this section prevents the commissioner from establishing prepayment review in other circumstances if required by the Centers for Medicare and Medicaid Services. new text end new text begin Subd. 2. new text end new text begin Review requirements. new text end new text begin (a) The commissioner must implement a prepayment review established under subdivision 1, paragraph (a), within 15 days of the date of the high-risk designation, effective for a period of up to 24 months from the date the review is implemented. new text end new text begin (b) A prepayment review established under subdivision 1, paragraph (a), must comply with the timely processing of claims requirements under Code of Federal Regulations, title 42, section 447.45. new text end new text begin (c) Before ending prepayment review under subdivision 1, paragraph (a), clause (1), the commissioner must review all fee-for-service claims submitted by providers subject to the prepayment review in the 24 months preceding the date the provider type was designated high-risk. new text end new text begin Subd. 3. new text end new text begin Continued enrollment of new clients. new text end new text begin Nothing in this section prohibits an enrolled provider that is subject to prepayment review under subdivision 1, paragraph (a), from enrolling new clients or beneficiaries during the period of the review. new text end new text begin Subd. 4. new text end new text begin Notice. new text end new text begin At least ten days prior to implementing a prepayment review, the commissioner must notify enrolled providers subject to the review and the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services policy and finance about the prepayment review the commissioner plans to implement under this section. The notice must: new text end new text begin (1) include a list of provider types or covered services to which prepayment review applies; new text end new text begin (2) provide a general explanation for the basis of the review; and new text end new text begin (3) identify the start date and anticipated duration of the prepayment review. new text end new text begin Subd. 5. new text end new text begin Report to the legislature. new text end new text begin (a) Within 60 days of ending a prepayment review, the commissioner must submit a report to the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services policy and finance. The report must include, at a minimum: new text end new text begin (1) a summary of any sanctions imposed under section 256B.064 on any providers subject to prepayment review; and new text end new text begin (2) recommendations for modifying or terminating the provision of covered services deemed high-risk or delivered by provider types subject to prepayment review. new text end new text begin (b) Notwithstanding section 256.01, subdivision 42, this subdivision does not expire. new text end