Medical assistance provide enrollment requirements modification for high-risk providers and certain home and community-based providers

A bill for an act

relating to human services; modifying medical assistance provider enrollment

requirements for high-risk providers and certain home and community-based

providers; making technical corrections; requiring compliance training for high-risk

medical assistance providers; requiring disclosure of the use of consultants to

prepare certain license applications; requiring commissioner of human services to

release unredacted initial Optum reports; amending Minnesota Statutes 2024,

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

3; 256B.073, subdivision 2; 256B.0949, subdivision 17; 256B.4912, subdivisions

12, 14, 15, by adding a subdivision; Minnesota Statutes 2025 Supplement, sections

245A.04, subdivisions 1, 7; 245A.05; 256B.04, subdivision 21; 256B.051,

subdivision 6; 256B.0701, subdivision 9; 256B.0759, subdivision 4; 256B.0949,

subdivision 16; 256B.4912, subdivision 1; proposing coding for new law in

Minnesota Statutes, chapter 256B; repealing Minnesota Statutes 2025 Supplement,

sections 256B.051, subdivision 6b; 256B.0701, subdivision 11.

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
deleted text begin
256B.04,
deleted text begin
subdivision
deleted text end

21, paragraph (g)
deleted text end
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
deleted text begin
256B.04, subdivision

21
, paragraph (g)
deleted text end
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 2025 Supplement, section 245A.04, subdivision 1, is amended

to read:

Subdivision 1.

Application for licensure.

(a) An individual, organization, or government

entity that is subject to licensure under section
245A.03
must apply for a license. The

application must be made on the forms and in the manner prescribed by the commissioner.

The commissioner shall provide the applicant with instruction in completing the application

and provide information about the rules and requirements of other state agencies that affect

the applicant. An applicant seeking licensure in Minnesota with headquarters outside of

Minnesota must have a program office located within 30 miles of the Minnesota border.

An applicant who intends to buy or otherwise acquire a program or services licensed under

this chapter that is owned by another license holder must apply for a license under this

chapter and comply with the application procedures in this section and section
245A.043
.

The commissioner shall act on the application within 90 working days after a complete

application and any required reports have been received from other state agencies or

departments, counties, municipalities, or other political subdivisions. The commissioner

shall not consider an application to be complete until the commissioner receives all of the

required information. If the applicant or a controlling individual is the subject of a pending

administrative, civil, or criminal investigation, the application is not complete until the

investigation has closed or the related legal proceedings are complete.

When the commissioner receives an application for initial licensure that is incomplete

because the applicant failed to submit required documents or that is substantially deficient

because the documents submitted do not meet licensing requirements, the commissioner

shall provide the applicant written notice that the application is incomplete or substantially

deficient. In the written notice to the applicant the commissioner shall identify documents

that are missing or deficient and give the applicant 45 days to resubmit a second application

that is substantially complete. An applicant's failure to submit a substantially complete

application after receiving notice from the commissioner is a basis for license denial under

section
245A.043
.

(b) An application for licensure must identify all controlling individuals as defined in

section
245A.02, subdivision 5a
, and must designate one individual to be the authorized

agent. The application must be signed by the authorized agent and must include the authorized

agent's first, middle, and last name; mailing address; and email address. By submitting an

application for licensure, the authorized agent consents to electronic communication with

the commissioner throughout the application process. The authorized agent must be

authorized to accept service on behalf of all of the controlling individuals. A government

entity that holds multiple licenses under this chapter may designate one authorized agent

for all licenses issued under this chapter or may designate a different authorized agent for

each license. Service on the authorized agent is service on all of the controlling individuals.

It is not a defense to any action arising under this chapter that service was not made on each

controlling individual. The designation of a controlling individual as the authorized agent

under this paragraph does not affect the legal responsibility of any other controlling individual

under this chapter.

(c) An applicant or license holder must have a policy that prohibits license holders,

employees, subcontractors, and volunteers, when directly responsible for persons served

by the program, from abusing prescription medication or being in any manner under the

influence of a chemical that impairs the individual's ability to provide services or care. The

license holder must train employees, subcontractors, and volunteers about the program's

drug and alcohol policy before the employee, subcontractor, or volunteer has direct contact,

as defined in section
245C.02, subdivision 11
, with a person served by the program.

(d) An applicant and license holder must have a program grievance procedure that permits

persons served by the program and their authorized representatives to bring a grievance to

the highest level of authority in the program.

(e) The commissioner may limit communication during the application process to the

authorized agent or the controlling individuals identified on the license application and for

whom a background study was initiated under chapter 245C. Upon implementation of the

provider licensing and reporting hub, applicants and license holders must use the hub in the

manner prescribed by the commissioner. The commissioner may require the applicant,

except for child foster care, to demonstrate competence in the applicable licensing

requirements by successfully completing a written examination. The commissioner may

develop a prescribed written examination format.

(f) When an applicant is an individual, the applicant must provide:

(1) the applicant's taxpayer identification numbers including the Social Security number

or Minnesota tax identification number, and federal employer identification number if the

applicant has employees;

(2) at the request of the commissioner, a copy of the most recent filing with the secretary

of state that includes the complete business name, if any;

(3) if doing business under a different name, the doing business as (DBA) name, as

registered with the secretary of state;

(4) if applicable, the applicant's National Provider Identifier (NPI) number and Unique

Minnesota Provider Identifier (UMPI) number; and

(5) at the request of the commissioner, the notarized signature of the applicant or

authorized agent.

(g) When an applicant is an organization, the applicant must provide:

(1) the applicant's taxpayer identification numbers including the Minnesota tax

identification number and federal employer identification number;

(2) at the request of the commissioner, a copy of the most recent filing with the secretary

of state that includes the complete business name, and if doing business under a different

name, the doing business as (DBA) name, as registered with the secretary of state;

(3) the first, middle, and last name, and address for all individuals who will be controlling

individuals, including all officers, owners, and managerial officials as defined in section

245A.02, subdivision 5a
, and the date that the background study was initiated by the applicant

for each controlling individual;

(4) if applicable, the applicant's NPI number and UMPI number;

(5) the documents that created the organization and that determine the organization's

internal governance and the relations among the persons that own the organization, have

an interest in the organization, or are members of the organization, in each case as provided

or authorized by the organization's governing statute, which may include a partnership

agreement, bylaws, articles of organization, organizational chart, and operating agreement,

or comparable documents as provided in the organization's governing statute; and

(6) the notarized signature of the applicant or authorized agent.

(h) When the applicant is a government entity, the applicant must provide:

(1) the name of the government agency, political subdivision, or other unit of government

seeking the license and the name of the program or services that will be licensed;

(2) the applicant's taxpayer identification numbers including the Minnesota tax

identification number and federal employer identification number;

(3) a letter signed by the manager, administrator, or other executive of the government

entity authorizing the submission of the license application; and

(4) if applicable, the applicant's NPI number and UMPI number.

(i) At the time of application for licensure or renewal of a license under this chapter, the

applicant or license holder must acknowledge on the form provided by the commissioner

if the applicant or license holder elects to receive any public funding reimbursement from

the commissioner for services provided under the license that:

(1) the applicant's or license holder's compliance with the provider enrollment agreement

or registration requirements for receipt of public funding may be monitored by the

commissioner as part of a licensing investigation or licensing inspection; and

(2) noncompliance with the provider enrollment agreement or registration requirements

for receipt of public funding that is identified through a licensing investigation or licensing

inspection, or noncompliance with a licensing requirement that is a basis of enrollment for

reimbursement for a service, may result in:

(i) a correction order or a conditional license under section
245A.06
, or sanctions under

section
245A.07
;

(ii) nonpayment of claims submitted by the license holder for public program

reimbursement;

(iii) recovery of payments made for the service;

(iv) disenrollment in the public payment program; or

(v) other administrative, civil, or criminal penalties as provided by law.

new text begin

(j) An applicant or license holder who acknowledges under paragraph (i) that the applicant

or license holder elects to receive any publicly funded reimbursement from the commissioner

for services provided under the license that are designated by the commissioner as high-risk

under section 256B.044, subdivision 1, must provide an attestation with the notarized

signature of the applicant or authorized agent stating whether the applicant or authorized

agent received from an unaffiliated business or consultant any assistance preparing:

new text end

new text begin

(1) the application;

new text end

new text begin

(2) the renewal;

new text end

new text begin

(3) any documentation or written policies submitted with the application;

new text end

new text begin

(4) any documentation or written policies submitted with the renewal; or

new text end

new text begin

(5) any documentation or written policies maintained as a requirement of licensure or

enrollment as a medical assistance provider.

new text end

Sec. 4.

Minnesota Statutes 2025 Supplement, section 245A.04, subdivision 7, is amended

to read:

Subd. 7.

Grant of license; license extension.

(a) If the commissioner determines that

the program complies with all applicable rules and laws, the commissioner shall issue a

license consistent with this section or, if applicable, a temporary change of ownership license

under section
245A.043
. At minimum, the license shall state:

(1) the name of the license holder;

(2) the address of the program;

(3) the effective date and expiration date of the license;

(4) the type of license and the specific service the license holder is licensed to provide;

(5) the maximum number and ages of persons that may receive services from the program;

and

(6) any special conditions of licensure.

(b) The commissioner may issue a license for a period not to exceed two years if:

(1) the commissioner is unable to conduct the observation required by subdivision 4,

paragraph (a), clause (3), because the program is not yet operational;

(2) certain records and documents are not available because persons are not yet receiving

services from the program; and

(3) the applicant complies with applicable laws and rules in all other respects.

(c) A decision by the commissioner to issue a license does not guarantee that any person

or persons will be placed or cared for in the licensed program.

(d) Except as provided in paragraphs (i) and (j), the commissioner shall not issue a

license if the applicant, license holder, or an affiliated controlling individual has:

(1) been disqualified and the disqualification was not set aside and no variance has been

granted;

(2) been denied a license under this chapter or chapter 142B within the past two years;

(3) had a license issued under this chapter or chapter 142B revoked within the past five

years; or

(4) failed to submit the information required of an applicant under subdivision 1,

paragraph (f), (g),
deleted text begin
or
deleted text end
(h)
new text begin
, or (j)
new text end
, after being requested by the commissioner.

When a license issued under this chapter or chapter 142B is revoked, the license holder

and each affiliated controlling individual with a revoked license may not hold any license

under chapter 245A for five years following the revocation, and other licenses held by the

applicant or license holder or licenses affiliated with each controlling individual shall also

be revoked.

(e) Notwithstanding paragraph (d), the commissioner may elect not to revoke a license

affiliated with a license holder or controlling individual that had a license revoked within

the past five years if the commissioner determines that (1) the license holder or controlling

individual is operating the program in substantial compliance with applicable laws and rules

and (2) the program's continued operation is in the best interests of the community being

served.

(f) Notwithstanding paragraph (d), the commissioner may issue a new license in response

to an application that is affiliated with an applicant, license holder, or controlling individual

that had an application denied within the past two years or a license revoked within the past

five years if the commissioner determines that (1) the applicant or controlling individual

has operated one or more programs in substantial compliance with applicable laws and rules

and (2) the program's operation would be in the best interests of the community to be served.

(g) In determining whether a program's operation would be in the best interests of the

community to be served, the commissioner shall consider factors such as the number of

persons served, the availability of alternative services available in the surrounding

community, the management structure of the program, whether the program provides

culturally specific services, and other relevant factors.

(h) The commissioner shall not issue or reissue a license under this chapter if an individual

living in the household where the services will be provided as specified under section

245C.03, subdivision 1
, has been disqualified and the disqualification has not been set aside

and no variance has been granted.

(i) Pursuant to section
245A.07, subdivision 1
, paragraph (b), when a license issued

under this chapter has been suspended or revoked and the suspension or revocation is under

appeal, the program may continue to operate pending a final order from the commissioner.

If the license under suspension or revocation will expire before a final order is issued, a

temporary provisional license may be issued provided any applicable license fee is paid

before the temporary provisional license is issued.

(j) Notwithstanding paragraph (i), when a revocation is based on the disqualification of

a controlling individual or license holder, and the controlling individual or license holder

is ordered under section
245C.17
to be immediately removed from direct contact with

persons receiving services or is ordered to be under continuous, direct supervision when

providing direct contact services, the program may continue to operate only if the program

complies with the order and submits documentation demonstrating compliance with the

order. If the disqualified individual fails to submit a timely request for reconsideration, or

if the disqualification is not set aside and no variance is granted, the order to immediately

remove the individual from direct contact or to be under continuous, direct supervision

remains in effect pending the outcome of a hearing and final order from the commissioner.

(k) Unless otherwise specified by statute, all licenses issued under this chapter expire

at 12:01 a.m. on the day after the expiration date stated on the license. A license holder must

comply with the requirements in section
245A.10
and be reissued a new license to operate

the program or the program must not be operated after the expiration date. Adult foster care,

family adult day services, child foster residence setting, and community residential services

license holders must apply for and be granted a new license to operate the program or the

program must not be operated after the expiration date. Upon implementation of the provider

licensing and reporting hub, licenses may be issued each calendar year.

(l) The commissioner shall not issue or reissue a license under this chapter if it has been

determined that a Tribal licensing authority has established jurisdiction to license the program

or service.

(m) The commissioner of human services may coordinate and share data with the

commissioner of children, youth, and families to enforce this section.

(n) For substance use disorder treatment programs, for the purposes of paragraph (a),

clause (5), the maximum number of persons who may receive services from the program

includes persons served at satellite locations.

Sec. 5.

Minnesota Statutes 2025 Supplement, section 245A.05, is amended to read:

245A.05 DENIAL OF APPLICATION.

(a) The commissioner may deny a license if an applicant or controlling individual:

(1) fails to submit a substantially complete application after receiving notice from the

commissioner under section
245A.04, subdivision 1
;

(2) fails to comply with applicable laws or rules;

(3) knowingly withholds relevant information from or gives false or misleading

information to the commissioner in connection with an application for a license or during

an investigation;

(4) has a disqualification that has not been set aside under section
245C.22
and no

variance has been granted;

(5) has an individual living in the household who received a background study under

section
245C.03, subdivision 1
, paragraph (a), clause (2), who has a disqualification that

has not been set aside under section
245C.22
, and no variance has been granted;

(6) is associated with an individual who received a background study under section

245C.03, subdivision 1
, paragraph (a), clause (6), who may have unsupervised access to

children or vulnerable adults, and who has a disqualification that has not been set aside

under section
245C.22
, and no variance has been granted;

(7) fails to comply with section
245A.04, subdivision 1
, paragraph (f)
deleted text begin
or
deleted text end
new text begin
,
new text end
(g)
new text begin
, or (j)
new text end
;

(8) fails to demonstrate competent knowledge as required by section
245A.04, subdivision

6;

(9) has a history of noncompliance as a license holder or controlling individual with

applicable laws or rules, including but not limited to this chapter and chapters 142E and

245C;

(10) is prohibited from holding a license according to section
245.095
; or

(11) is the subject of a pending administrative, civil, or criminal investigation.

(b) An applicant whose application has been denied by the commissioner must be given

notice of the denial, which must state the reasons for the denial in plain language. Notice

must be given by certified mail, by personal service, or through the provider licensing and

reporting hub. The notice must state the reasons the application was denied and must inform

the applicant of the right to a contested case hearing under chapter 14 and Minnesota Rules,

parts
1400.8505
to
1400.8612
. The applicant may appeal the denial by notifying the

commissioner in writing by certified mail, by personal service, or through the provider

licensing and reporting hub. If mailed, the appeal must be postmarked and sent to the

commissioner within 20 calendar days after the applicant received the notice of denial. If

an appeal request is made by personal service, it must be received by the commissioner

within 20 calendar days after the applicant received the notice of denial. If the order is issued

through the provider hub, the appeal must be received by the commissioner within 20

calendar days from the date the commissioner issued the order through the hub. Section

245A.08
applies to hearings held to appeal the commissioner's denial of an application.

Sec. 6.

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
deleted text begin
256B.04, subdivision 21
, paragraph (g)
deleted text end
new text begin

256B.044, subdivision 7
new text end
;

(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. 7.

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

to read:

Subd. 21.

Provider enrollment.

deleted text begin
(a)
deleted text end
The commissioner shall enroll providers and conduct

screening activities as required by Code of Federal Regulations, title 42, section 455, subpart

E
new text begin
, and sections 256B.044 to 256B.0445
new text end
.

deleted text begin

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

deleted text end

deleted text begin

245C

deleted text end

deleted text begin

,

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).

deleted text end

deleted text begin

(b) The commissioner shall revalidate:

deleted text end

deleted text begin

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

deleted text end

deleted text begin

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

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

deleted text end

deleted text begin

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

deleted text end

deleted text begin

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

commissioner deems "high-risk" under this subdivision.

deleted text end

deleted text begin

(c) The commissioner shall conduct revalidation as follows:

deleted text end

deleted text begin

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

revalidation and a list of materials the provider must submit;

deleted text end

deleted 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

deleted text end

deleted text begin

(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.

deleted text end

deleted text begin

(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.

deleted text end

deleted text begin

(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.

deleted text end

deleted text begin

(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.

deleted text end

deleted text begin

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

deleted text end

deleted text begin

245A

deleted text end

deleted text begin

,

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

deleted text end

deleted text begin

144G

deleted text end

deleted text begin

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:

deleted text end

deleted text begin

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

regulations and to prevent inappropriate claims submissions;

deleted text end

deleted 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);

deleted text end

deleted 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;

deleted text end

deleted text begin

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

regulations;

deleted text end

deleted text begin

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

laws or regulations; and

deleted text end

deleted 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.

deleted text end

deleted text begin

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.

deleted text end

deleted text begin

(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
.

deleted text end

deleted text begin

(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:

deleted text end

deleted text begin

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

to the Medicare program;

deleted text end

deleted text begin

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

review completed by the commissioner of health; and

deleted text end

deleted text begin

(3) serves primarily a pediatric population.

deleted text end

deleted text begin

(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

deleted text end

deleted text begin

14

deleted text end

deleted text begin

.

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

deleted text end

deleted text begin

(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.

deleted text end

deleted text begin

(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.

deleted text end

deleted text begin

(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
.

deleted text end

deleted text begin

(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.

deleted text end

deleted text begin

(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. 8.

new text begin

[256B.044] PROVIDER ENROLLMENT.

new text end

new text begin

Subdivision 1.

new text end

new text begin

Designating categorical risk levels.

new text end

new text begin

(a) The commissioner shall publish

in the Minnesota Health Care Program Provider Manual a list of provider types designated

"limited-risk," "moderate-risk," or "high-risk," based on the criteria and standards used by

the Centers for Medicare and Medicaid Services (CMS) to designate Medicare providers

in Code of Federal Regulations, title 42, section 424.518.

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.

new text end

new text begin

Service location enrollment.

new text end

new text begin

A provider must enroll each provider-controlled

location where direct services are provided.

new text end

new text begin

Subd. 3.

new text end

new text begin

Incomplete provider enrollment applications.

new text end

new text begin

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 CMS that a provider is designated high-risk.

new text end

new text begin

Subd. 5.

new text end

new text begin

Surety bonds.

new text end

new text begin

(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:

new text end

new text begin

(1) the provider fails to demonstrate financial viability;

new text end

new text begin

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

and abuse by the provider; or

new text end

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.

new text end

new text begin

Subd. 7.

new text end

new text begin

Compliance programs.

new text end

new text begin

(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.

new text end

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:

new text end

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

new text end

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.

new text end

new text begin

Correspondence and notification.

new text end

new text begin

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. 9.

new text begin

[256B.0441] PROVIDER REVALIDATION.

new text end

new text begin

Subdivision 1.

new text end

new text begin

Provider revalidation schedule.

new text end

new text begin

The commissioner shall revalidate:

new text end

new text begin

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

new text end

new text begin

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

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

three years;

new text end

new text begin

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

every three years; and

new text end

new text begin

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

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

new text end

new text begin

Subd. 2.

new text end

new text begin

Revalidation procedures.

new text end

new text begin

The commissioner shall conduct revalidation as

follows:

new text end

new text begin

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

revalidation and a list of materials the provider must submit;

new text end

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. 10.

new text begin

[256B.0442] PROVIDER ENROLLMENT SUSPENSIONS AND

TERMINATIONS.

new text end

new text begin

Subdivision 1.

new text end

new text begin

Commissioner's general authority to suspend individual provider's

enrollment.

new text end

new text begin

(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.

new text end

new text begin

(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

new text begin

Commissioner's authority to revoke enrollment of certain providers for

lack of documentation.

new text end

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.

new text end

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

Sec. 11.

new text begin

[256B.0443] PROVIDER PAYMENT WITHHOLDS UPON INITIAL

ENROLLMENT.

new text end

new text begin

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

a provider type as high-risk, 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. 12.

new text begin

[256B.0444] ADDITIONAL PROVIDER ENROLLMENT REQUIREMENTS

FOR HIGH-RISK PROVIDERS.

new text end

new text begin

Subdivision 1.

new text end

new text begin

Applicability.

new text end

new text begin

This section applies to any agency that provides a service

designated by the commissioner as high-risk under section 256B.044, subdivision 1. For

purposes of this section, "agency" means the legal entity that is applying to be or is enrolled

with Minnesota health care programs as a medical assistance provider according to Minnesota

Rules, part 9505.0195.

new text end

new text begin

Subd. 2.

new text end

new text begin

Mandatory training compliance.

new text end

new text begin

(a) Effective January 1, 2027, before applying

for enrollment or reenrollment as a medical assistance provider, an agency applying to

provide services designated by the commissioner as high-risk must require all owners of

the agency who are active in the day-to-day management and operations of the agency and

managerial and supervisory employees to complete compliance training. All individuals

who must complete training under this subdivision must repeat the training prior to

revalidation of the agency as a medical assistance provider.

new text end

new text begin

(b) New owners active in day-to-day management and operations of the agency and new

managerial and supervisory employees of the agency must complete compliance training

under this subdivision within 30 calendar days of becoming an owner of or employed by

the agency and prior to conducting any management and operations activities for the agency.

If an individual moves to another agency providing the same service and serves in a similar

ownership or employment capacity, the individual is not required to repeat the training

required under this subdivision. If the individual chooses not to repeat the compliance

training, the individual must provide the agency with documentation proving the individual

completed the compliance training within the provider revalidation schedule for the relevant

provider type as determined by the commissioner under section 256B.0441.

new text end

new text begin

(c) The commissioner must determine the format and content of the compliance training.

The training must include the following topics, adapted as necessary for each provider type

subject to the requirements of this subdivision:

new text end

new text begin

(1) state and federal program billing, documentation, and service delivery requirements;

new text end

new text begin

(2) enrollment requirements;

new text end

new text begin

(3) provider program integrity, including fraud prevention, detection, and penalties;

new text end

new text begin

(4) fair labor standards;

new text end

new text begin

(5) workplace safety requirements; and

new text end

new text begin

(6) recent changes in service requirements.

new text end

new text begin

Subd. 3.

new text end

new text begin

Individual provider number.

new text end

new text begin

(a) Effective January 1, 2027, all individuals

subject to a background study as a result of being employed by or an owner of a high-risk

agency must enroll individually as a medical assistance provider.

new text end

new text begin

(b) The commissioner must issue a unique Minnesota provider identifier to each

individual who satisfies the background study requirements, satisfies the individual

enrollment requirements, and does not have either a national provider identifier or a unique

Minnesota provider identifier. The commissioner must ensure that no individual is issued

multiple unique Minnesota provider identifiers. If the commissioner mistakenly issues

multiple unique Minnesota provider identifiers to the same individual, the commissioner

must provide a means for the numbers to be consolidated.

new text end

new text begin

(c) If an individual provides false or misleading information to the commissioner in an

attempt to cause the commissioner to issue to the individual an additional unique Minnesota

provider identifier, the commissioner may terminate the enrollment of the individual.

new text end

new text begin

Subd. 4.

new text end

new text begin

Required use of an electronic visit verification system.

new text end

new text begin

Effective January 1,

2027, an individual providing a high-risk service must electronically verify the provision

of the services using an electronic visit verification system meeting the requirements of

section 256B.073.

new text end

new text begin

Subd. 5.

new text end

new text begin

Signatures required for provision of service verifications.

new text end

new text begin

(a) Effective

January 1, 2027, an individual providing a high-risk service must sign and obtain the

signature of the service recipient, or of the service recipient's representative, on a provision

of service verification form. The provision of service verification form must include a

statement that by signing the form, the signatory is attesting to the accuracy of all data

entered in the electronic visit verification system. The provision of service verification form

must also include a statement that it is a federal crime to provide false information regarding

the provision of medical assistance services.

new text end

new text begin

(b) The commissioner must determine a minimum frequency at which the required

signatures on a provision of service verification form must be obtained.

new text end

new text begin

Subd. 6.

new text end

new text begin

Documentation of travel time.

new text end

new text begin

Effective January 1, 2027, an individual

providing a high-risk service must document any travel or driving time that is eligible for

reimbursement and for which the individual or high-risk agency seeks a medical assistance

payment. The documentation must include:

new text end

new text begin

(1) start and stop times with a.m. and p.m. designations;

new text end

new text begin

(2) the origination site; and

new text end

new text begin

(3) the destination site.

new text end

Sec. 13.

new text begin

[256B.0445] 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 the 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 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. 14.

Minnesota Statutes 2025 Supplement, section 256B.051, subdivision 6, is amended

to read:

Subd. 6.

Agency qualifications and duties.

An agency is eligible for reimbursement

under this section only if the agency:

(1) is confirmed by the commissioner as an eligible provider after a pre-enrollment risk

assessment under subdivision 6a;

(2) is enrolled as a medical assistance Minnesota health care program provider and meets

all applicable provider standards and requirements;

(3) demonstrates compliance with federal and state laws and policies for housing

stabilization services as determined by the commissioner;

(4) complies with background study requirements under chapter 245C and maintains

documentation of background study requests and results;

(5) provides at the time of enrollment, reenrollment, and revalidation in a format

determined by the commissioner, proof of surety bond coverage for each business location

providing services. Upon new enrollment, or if the provider's medical assistance revenue

in the previous calendar year is $300,000 or less, the provider agency must purchase a surety

bond of $50,000. If the provider's medical assistance revenue in the previous year is over

$300,000, the provider agency must purchase a surety bond of $100,000. The surety bond

must be in a form approved by the commissioner, must be renewed annually, and 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
;

(6) directly provides housing stabilization services using employees of the agency and

not by using a subcontractor or reporting agent;

(7) ensures all controlling individuals and employees of the agency complete annual

vulnerable adult training; and

(8) completes compliance training as required under
new text begin
section 256B.0444,
new text end
subdivision
deleted text begin
6b
deleted text end
new text begin

2
new text end
.

Sec. 15.

Minnesota Statutes 2025 Supplement, section 256B.0701, subdivision 9, is

amended to read:

Subd. 9.

Provider qualifications and duties.

A provider is eligible for reimbursement

under this section only if the provider:

(1) is confirmed by the commissioner as an eligible provider after a pre-enrollment risk

assessment under subdivision 10;

(2) is enrolled as a medical assistance Minnesota health care program provider and meets

all applicable provider standards and requirements;

(3) demonstrates compliance with federal and state laws and policies for housing

stabilization services as determined by the commissioner;

(4) complies with background study requirements under chapter 245C and maintains

documentation of background study requests and results;

(5) provides at the time of enrollment, reenrollment, and revalidation in a format

determined by the commissioner, proof of surety bond coverage for each business location

providing services. Upon new enrollment, or if the provider's medical assistance revenue

in the previous calendar year is $300,000 or less, the provider agency must purchase a surety

bond of $50,000. If the provider's medical assistance revenue in the previous year is over

$300,000, the provider agency must purchase a surety bond of $100,000. The surety bond

must be in a form approved by the commissioner, must be renewed annually, and 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
;

(6) ensures all controlling individuals and employees of the agency complete annual

vulnerable adult training;

(7) completes compliance training as required under
new text begin
section 256B.0444,
new text end
subdivision
deleted text begin
11
deleted text end
new text begin

2
new text end
; and

(8) complies with the habitability inspection requirements in subdivision 13.

Sec. 16.

Minnesota Statutes 2024, section 256B.073, subdivision 2, is amended to read:

Subd. 2.

Definitions.

(a) For purposes of this section, the terms in this subdivision have

the meanings given
deleted text begin
them
deleted text end
.

(b) "Electronic visit verification" means the electronic documentation of the:

(1) type of service performed;

(2) individual receiving the service;

(3) date of the service;

(4) location of the service delivery;

(5) individual providing the service; and

(6) time the service begins and ends.

(c) "Electronic visit verification system" means a system that provides electronic

verification of services that complies with the 21st Century Cures Act, Public Law 114-255,

and the requirements of subdivision 3.

(d) "Service"
deleted text begin
means one of the following
deleted text end
new text begin
includes
new text end
:

(1) personal care assistance services as defined in section
256B.0625, subdivision 19a
,

and provided according to section
256B.0659
;

(2) community first services and supports under section
256B.85
;

(3) home health services under section
256B.0625, subdivision 6a
;
deleted text begin
or
deleted text end

(4) other medical supplies and equipment or home and community-based services that

are required to be electronically verified by the 21st Century Cures Act, Public Law 114-255
deleted text begin
.
deleted text end
new text begin
;
new text end

new text begin

(5) services provided by a provider type designated by the commissioner as high-risk

under section 256B.044, subdivision 1; and

new text end

new text begin

(6) home and community-based services reimbursed at an hourly or specified

minute-based rate and provided according to a federally approved waiver plan as authorized

under chapter 256S and sections 256B.0913, 256B.092, and 256B.49.

new text end

Sec. 17.

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. 18.

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.0445
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. 19.

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.0445
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. 20.

Minnesota Statutes 2025 Supplement, section 256B.4912, subdivision 1, is

amended to read:

Subdivision 1.

Provider qualifications.

(a) For the home and community-based waivers

providing services to seniors and individuals with disabilities under chapter 256S and

sections
256B.0913
,
256B.092
, and
256B.49
, the commissioner shall establish:

(1) agreements with enrolled waiver service providers to ensure providers meet Minnesota

health care program requirements;

(2) regular reviews of provider qualifications,
deleted text begin
and
deleted text end
including requests
deleted text begin
of
deleted text end
new text begin
for
new text end
proof of

documentation; and

(3) processes to gather the necessary information to determine provider qualifications.

(b) A provider shall not require or coerce any service recipient to change waiver programs

or move to a different location, consistent with the informed choice and independent living

policies under section
256B.4905, subdivisions 1a
, 2a, 3a, 7, and 8.

(c) For staff that provide direct contact, as defined in section
245C.02, subdivision 11
,

for services specified in the federally approved waiver plans, providers must meet the

requirements of chapter 245C and maintain documentation of background study requests

and results. This requirement also applies to consumer-directed community supports.

(d) Service owners and managerial officials overseeing the management or policies of

services that provide direct contact as specified in the federally approved waiver plans must

meet the requirements of chapter 245C prior to reenrollment or revalidation or, for new

providers, prior to initial enrollment if they have not already done so as a part of service

licensure requirements.

Sec. 21.

Minnesota Statutes 2024, section 256B.4912, is amended by adding a subdivision

to read:

new text begin

Subd. 10a.

new text end

new text begin

Individual provider identifier.

new text end

new text begin

(a) Effective January 1, 2027, staff that

provide direct contact, as defined in section 245C.02, subdivision 11, for services specified

in the federally approved waiver plans must enroll individually with Minnesota health care

programs as a medical assistance provider. This requirement also applies to

consumer-directed community supports.

new text end

new text begin

(b) For individuals enrolling individually under this subdivision, the commissioner must

conform with the requirements of section 256B.0444, subdivision 3.

new text end

Sec. 22.

Minnesota Statutes 2024, section 256B.4912, subdivision 12, is amended to read:

Subd. 12.

Home and community-based service documentation requirements.

(a)
new text begin

Unless the provider is required to use an electronic visit verification system authorized

under section 256B.073, the provider must collect and maintain
new text end
documentation
deleted text begin
may be

collected and maintained
deleted text end
electronically or in paper form
deleted text begin
by providers and must be produced
deleted text end
new text begin
.

The provider must produce all documentation
new text end
upon request by the commissioner.

(b) Documentation of a delivered service must be in English and must be legible according

to the standard of a reasonable person.

(c) If the service is reimbursed at an hourly or specified minute-based rate, each

documentation of the provision of a service, unless otherwise specified, must include:

(1) the date the documentation occurred;

(2) the day, month, and year when the service was provided;

(3) the start and stop times with a.m. and p.m. designations, except for case management

services as defined under chapter 256S and sections
256B.0913, subdivision 7
;
256B.092,

subdivision 1a
; and
256B.49, subdivision 13
;

(4) the service name or description of the service provided; and

(5) the name,
new text begin
individual provider identifier,
new text end
signature, and title, if any, of the provider

of service. If the service is provided by multiple staff members, the provider may designate

a staff member responsible for verifying services and completing the documentation required

by this paragraph.

(d) If the service is reimbursed at a daily rate or does not meet the requirements in

paragraph (c), each documentation of the provision of a service, unless otherwise specified,

must include:

(1) the date the documentation occurred;

(2) the day, month, and year when the service was provided;

(3) the service name or description of the service provided; and

(4) the name,
new text begin
individual provider identifier,
new text end
signature, and title, if any, of the person

providing the service. If the service is provided by multiple staff, the provider may designate

a staff member responsible for verifying services and completing the documentation required

by this paragraph.
new text begin
The designated staff member verifying the services must include in the

documentation of the provision of a service the names and individual provider identifiers

of all staff who provided the service.
new text end

Sec. 23.

Minnesota Statutes 2024, section 256B.4912, subdivision 14, is amended to read:

Subd. 14.

Equipment and supply documentation requirements.

(a)
deleted text begin
In addition to
deleted text end
new text begin
An

equipment and supply services provider must follow
new text end
the requirements in subdivision 12,
new text begin

except for the requirement to provide an individual provider identifier.
new text end
An equipment and

supply services provider must
new text begin
also include
new text end
for each documentation of the provision of a

service
deleted text begin
include
deleted text end
:

(1) the recipient's assessed need for the equipment or supply;

(2) the reason the equipment or supply is not covered by the Medicaid state plan;

(3) the type and brand name of the equipment or supply delivered to or purchased by

the recipient, including whether the equipment or supply was rented or purchased;

(4) the quantity of the equipment or supply delivered or purchased; and

(5) the cost of the equipment or supply if the amount paid for the service depends on

the cost.

(b) A provider must maintain a copy of the shipping invoice or a delivery service tracking

log or other documentation showing the date of delivery that proves the equipment or supply

was delivered to the recipient or a receipt if the equipment or supply was purchased by the

recipient.

Sec. 24.

Minnesota Statutes 2024, section 256B.4912, subdivision 15, is amended to read:

Subd. 15.

Adult day service documentation and billing requirements.

(a) In addition

to the requirements in subdivision 12, a provider of adult day services as defined in section

245A.02, subdivision 2a
, and licensed under Minnesota Rules, parts
9555.9600
to
9555.9730
,

must maintain documentation of:

(1) a needs assessment and current plan of care according to section
245A.143
,

subdivisions 4 to 7, or Minnesota Rules, part
9555.9700
, for each recipient, if applicable;

(2) attendance records as specified under section
245A.14, subdivision 14
, paragraph

(a), including the date of attendance with the day, month, and year; and the pickup and

drop-off time in hours and minutes with a.m. and p.m. designations;

(3) the monthly and quarterly program requirements in Minnesota Rules, part
9555.9710
,

subparts 1, items E and H; 3; 4; and 6, if applicable;

(4) the name
new text begin
, individual provider identifier,
new text end
and qualification of each registered physical

therapist, registered nurse, and registered dietitian who provides services to the adult day

services or nonresidential program; and

(5) the location where the service was provided. If the location is an alternate location

from the usual place of service, the documentation must include the address, or a description

if the address is not available, of both the origin site and destination site; the length of time

at the alternate location with a.m. and p.m. designations; and a list of participants who went

to the alternate location.

(b) A provider must not exceed the provider's licensed capacity. If a provider exceeds

the provider's licensed capacity, the
deleted text begin
department
deleted text end
new text begin
commissioner
new text end
must recover all Minnesota

health care programs payments from the date the provider exceeded licensed capacity.

Sec. 25.
new text begin
MANDATORY COMPLIANCE TRAINING FOR CURRENTLY

ENROLLED HIGH-RISK MEDICAL ASSISTANCE PROVIDERS.
new text end

new text begin

The owners and employees of any medical assistance provider agency subject to the

requirements of Minnesota Statutes, section 256B.0444, subdivision 2, and enrolled before

January 1, 2027, must complete initial compliance training by January 1, 2028. Owners and

employees of PCA and CFSS agencies who enrolled before January 1, 2027, and have

previously completed training under Minnesota Statutes, section 256B.0659, subdivision

21, paragraph (c), or 256B.85, subdivision 12, paragraph (c), are not subject to the initial

training requirements of this section but must repeat the compliance training prior to

revalidation as a medical assistance provider.

new text end

Sec. 26.
new text begin
DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;

UNREDACTED INITIAL OPTUM REPORTS.
new text end

new text begin

(a) For the purposes of this section, "initial Optum reports" means the reports produced

by Optum, Inc., under contract with the Department of Human Services and announced in

the news release from the department on February 6, 2026.

new text end

new text begin

(b) Notwithstanding any law to the contrary, upon a joint request by both the chairs and

ranking minority members of a legislative committee with jurisdiction over human services

policy and finance, the commissioner of human services must immediately release the initial

Optum reports to the members of that legislative committee in the reports' entirety without

redactions or edits, except for redactions requested by Optum to protect proprietary

information. Legislators or legislative staff who receive initial Optum reports under this

section must not disseminate or publicize any not public data, as defined in Minnesota

Statutes, section 13.02, subdivision 8a, that the reports contain.

new text end

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective 14 days following final enactment.

new text end

Sec. 27.
new text begin
OPTUM PROHIBITED FROM DISSEMINATING PRIVATE DATA.
new text end

new text begin

Optum, Inc., must not sell, share, or disseminate any private data on individuals, as

defined in Minnesota Statutes, section 13.02, subdivision 12, that Optum receives under or

incidental to Optum's contract or engagement with the Department of Human Services

pursuant to the governor's Executive Order No. 25-10.

new text end

Sec. 28.
new text begin
REPEALER.
new text end

new text begin

Minnesota Statutes 2025 Supplement, sections 256B.051, subdivision 6b; and 256B.0701,

subdivision 11,

new text end

new text begin

are repealed.

new text end

APPENDIX

Repealed Minnesota Statutes: S3861-2

256B.051 HOUSING STABILIZATION SERVICES.

Subd. 6b.

Requirements for provider enrollment.

(a) Effective January 1, 2027, to enroll as a housing stabilization services provider agency, an agency must require all owners of the agency who are active in the day-to-day management and operations of the agency and managerial and supervisory employees to complete compliance training before applying for enrollment and every three years thereafter. Mandatory compliance training format and content must be determined by the commissioner and must include the following topics:

(1) state and federal program billing, documentation, and service delivery requirements;

(2) enrollment requirements;

(3) provider program integrity, including fraud prevention, detection, and penalties;

(4) fair labor standards;

(5) workplace safety requirements; and

(6) recent changes in service requirements.

(b) New owners active in day-to-day management and operations of the agency and new managerial and supervisory employees must complete compliance training under this subdivision to be employed by or conduct management and operations activities for the agency. If an individual moves to another housing stabilization services provider agency and serves in a similar ownership or employment capacity, the individual is not required to repeat the training required under this subdivision if the individual documents completion of the training within the past three years.

(c) Any housing stabilization services provider agency enrolled before January 1, 2027, must complete the compliance training by January 1, 2028, and every three years thereafter.

256B.0701 RECUPERATIVE CARE SERVICES.

Subd. 11.

Requirements for provider enrollment; compliance training.

(a) Effective January 1, 2027, to enroll as a recuperative care provider, a provider must require all owners of the provider who are active in the day-to-day management and operations of the agency and all managerial and supervisory employees to complete compliance training before applying for enrollment and every three years thereafter. Mandatory compliance training format and content must be determined by the commissioner and must include the following topics:

(1) state and federal program billing, documentation, and service delivery requirements;

(2) enrollment requirements;

(3) provider program integrity, including fraud prevention, detection, and penalties;

(4) fair labor standards;

(5) workplace safety requirements; and

(6) recent changes in service requirements.

(b) New owners active in day-to-day management and operations of the provider and new managerial and supervisory employees must complete compliance training under this subdivision to be employed by or conduct management and operations activities for the provider. If an individual moves to another recuperative care provider and serves in a similar ownership or employment capacity, the individual is not required to repeat the training required under this subdivision if the individual documents completion of the training within the past three years.

(c) Any recuperative care provider enrolled before January 1, 2027, must complete the compliance training by January 1, 2028, and every three years thereafter.