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A bill for an act
relating to health care; increasing medical assistance reimbursement rates for
complex outpatient visits; amending Minnesota Statutes 2025 Supplement, section
256B.76, subdivision 1.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2025 Supplement, section 256B.76, subdivision 1, is amended
to read:
Subdivision 1.
Physician and professional services reimbursement adjustments.
(a)
Effective for services rendered on or after October 1, 1992, the commissioner shall make
payments for physician services as follows:
(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care," "critical
care," cesarean delivery and pharmacologic management provided to psychiatric patients,
and level three codes for enhanced services for prenatal high risk, shall be paid at the lower
of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992;
(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect on
September 30, 1992.
(b) Effective for services rendered on or after January 1, 2000, payment rates for physician
and professional services shall be increased by three percent over the rates in effect on
December 31, 1999, except for home health agency and family planning agency services.
The increases in this paragraph shall be implemented January 1, 2000, for managed care.
(c) Effective for services rendered on or after July 1, 2009, payment rates for physician
and professional services shall be reduced by five percent, except that for the period July
1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent for the medical
assistance and general assistance medical care programs, over the rates in effect on June
30, 2009. This reduction and the reductions in paragraph (d) do not apply to office or other
outpatient visits, preventive medicine visits and family planning visits billed by physicians,
advanced practice registered nurses, or physician assistants in a family planning agency or
in one of the following primary care practices: general practice, general internal medicine,
general pediatrics, general geriatrics, and family medicine. This reduction and the reductions
in paragraph (d) do not apply to federally qualified health centers, rural health centers, and
Indian health services. Effective October 1, 2009, payments made to managed care plans
and county-based purchasing plans under sections
256B.69
,
256B.692
, and
256L.12
shall
reflect the payment reduction described in this paragraph.
(d) Effective for services rendered on or after July 1, 2010, payment rates for physician
and professional services shall be reduced an additional seven percent over the five percent
reduction in rates described in paragraph (c). This additional reduction does not apply to
physical therapy services, occupational therapy services, and speech pathology and related
services provided on or after July 1, 2010. This additional reduction does not apply to
physician services billed by a psychiatrist or an advanced practice registered nurse with a
specialty in mental health. Effective October 1, 2010, payments made to managed care plans
and county-based purchasing plans under sections
256B.69
,
256B.692
, and
256L.12
shall
reflect the payment reduction described in this paragraph.
(e) Effective for services rendered on or after September 1, 2011, through June 30, 2013,
payment rates for physician and professional services shall be reduced three percent from
the rates in effect on August 31, 2011. This reduction does not apply to physical therapy
services, occupational therapy services, and speech pathology and related services.
(f) Effective for services rendered on or after September 1, 2014, payment rates for
physician and professional services, including physical therapy, occupational therapy, speech
pathology, and mental health services shall be increased by five percent from the rates in
effect on August 31, 2014. In calculating this rate increase, the commissioner shall not
include in the base rate for August 31, 2014, the rate increase provided under section
256B.76, subdivision 7
. This increase does not apply to federally qualified health centers,
rural health centers, and Indian health services. Payments made to managed care plans and
county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.
(g) Effective for services rendered on or after July 1, 2015, payment rates for physical
therapy, occupational therapy, and speech pathology and related services provided by a
hospital meeting the criteria specified in section
62Q.19, subdivision 1
, paragraph (a), clause
(4), shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments
made to managed care plans and county-based purchasing plans shall not be adjusted to
reflect payments under this paragraph.
(h) Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section
256B.0949
.
(i) The commissioner may reimburse physicians and other licensed professionals for
costs incurred to pay the fee for testing newborns who are medical assistance enrollees for
heritable and congenital disorders under section
144.125, subdivision 1
, paragraph (c), when
the sample is collected outside of an inpatient hospital and the cost is not recognized by
another payment source.
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(j) Effective for services rendered on or after January 1, 2027, payment rates for outpatient
evaluation and management visits for chronic and intractable pain shall be increased by ten
percent over the rates in effect on December 31, 2026, when the submitted claim includes
the Healthcare Common Procedure Coding System add-on code G2211. Effective January
1, 2027, the commissioner shall increase capitation payments made to managed care plans
and county-based purchasing plans to reflect the rate increase provided under this paragraph.
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