Medical assistance reimbursement rates for complex outpatient visits increased.

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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