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SF4222 • 2026
Medical assistance provider enrollment requirements modifications
Medical assistance provider enrollment requirements modifications
Healthcare
Passed Legislature
This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.
Bill History
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2026-04-07
House
Comm report: Amended, No recommendation, re-referred to Finance
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2026-03-26
House
Comm report: Amended, No recommendation, re-referred to Human Services
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2026-03-23
House
Author added Fateh
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2026-03-09
House
Introduction and first reading
Official Summary Text
Medical assistance provider enrollment requirements modifications
Current Bill Text
Read the full stored bill text
A bill for an act relating to human services; modifying requirements for provider enrollment in medical assistance; modifying program integrity requirements for the medical assistance program, other human services programs, and programs administered by the commissioner of children, youth, and families; directing the commissioner of human services to make recommendations on provider enrollment standards, modernizing program integrity infrastructure, and program integrity interventions; directing the commissioner of human services to conduct audits; requiring reports; making technical changes; authorizing rulemaking; amending Minnesota Statutes 2024, sections 142A.03, by adding a subdivision; 142B.01, subdivision 8; 245.095, by adding a subdivision; 245A.02, subdivision 5a; 245D.081, subdivision 3; 256.01, by adding a subdivision; 256B.04, subdivision 5; 256B.064, subdivisions 1b, 1d, 2, 3, 4, 5, by adding subdivisions; 256B.073, subdivision 2; 256B.0949, subdivision 17; 256B.4912, subdivisions 12, 14, 15, by adding a subdivision; Minnesota Statutes 2025 Supplement, sections 15.013, by adding a subdivision; 245A.04, subdivisions 1, 7; 245A.05; 256B.04, subdivision 21; 256B.051, subdivision 6; 256B.064, subdivision 1a; 256B.0701, subdivision 9; 256B.0759, subdivision 4; 256B.0949, subdivision 16; 256B.4912, subdivision 1; proposing coding for new law in Minnesota Statutes, chapters 142A; 256; 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: ARTICLE 1 PROGRAM INTEGRITY REQUIREMENTS Section 1. Minnesota Statutes 2025 Supplement, section 15.013, is amended by adding a subdivision to read: new text begin Subd. 7. new text end new text begin Exemption. new text end new text begin This section does not apply to the medical assistance program administered by the commissioner of human services. new text end new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 2. Minnesota Statutes 2024, section 142A.03, is amended by adding a subdivision to read: new text begin Subd. 36. new text end new text begin Program integrity report. new text end new text begin Beginning November 30, 2026, and annually thereafter, the commissioner must provide a report to the chairs and ranking minority members of the legislative committees with jurisdiction over children, youth, and families on program integrity functions within the Department of Children, Youth, and Families. The report must include: new text end new text begin (1) an update from the Office of Inspector General at the Department of Children, Youth, and Families with historical metrics and descriptive data, including the office's capacity to meet licensing demands and data for the past five years on the number of maltreatment reports and licensing complaints received, the results of maltreatment investigations, the number of licenses issued for each provider type, the number of licensing investigations and reviews completed, and the number of correction orders issued; and new text end new text begin (2) an update from the Office of Inspector General at the Department of Children, Youth, and Families that generally includes caseload, site visit data, the number of child care assistance program investigations and administrative reviews within the past five years, recipient fraud investigation results involving multiple benefits from the past five years, and updates on major fraud investigations. new text end Sec. 3. new text begin [142A.125] ELIGIBILITY TO RECEIVE PUBLIC MONEY; PRE-AWARD RISK ASSESSMENT. new text end new text begin Subdivision 1. new text end new text begin Pre-award risk assessment; grant recipients. new text end new text begin (a) Prior to receiving a grant award for a program administered by the commissioner, a potential grantee must provide the commissioner with the applicable information specified under section 16B.981, subdivision 2, for the most recent three-year period. This information must also include: new text end new text begin (1) the potential grantee's history of performing services during the most recent three-year period that are substantially similar to the services the potential grantee is seeking to receive public funds to provide; and new text end new text begin (2) for a potential grantee that is a for-profit business or nonprofit organization, evidence of registration and good standing with the secretary of state for the most recent three-year period, if applicable. new text end new text begin (b) For any information not submitted to the commissioner as required under this section because the potential grantee determined it to be inapplicable, the potential grantee must submit documentation noting each item that was not submitted and the reason why the potential grantee determined it was inapplicable. new text end new text begin Subd. 2. new text end new text begin Pre-award risk assessment; licensure and reenrollment. new text end new text begin (a) Prior to renewing a license or reenrolling in a program administered by the commissioner, a provider, vendor, or individual must provide the commissioner with the applicable information specified under section 16B.981, subdivision 2, for the most recent licensure or enrollment period. new text end new text begin (b) Notwithstanding paragraph (a), for a provider, vendor, or individual who has been licensed or enrolled in a program administered by the commissioner for at least three years, the provider, vendor, or individual must provide the commissioner with the applicable information specified under section 16B.981, subdivision 2, for the most recent three-year period. new text end new text begin (c) For any information not submitted to the commissioner as required under this section because the provider, vendor, or individual determined it to be inapplicable, the provider, vendor, or individual must submit documentation noting each item that was not submitted and the reason why the provider, vendor, or individual determined it was inapplicable. new text end new text begin Subd. 3. new text end new text begin Commissioner duties. new text end new text begin (a) The commissioner must review all information provided under subdivisions 1 and 2 prior to awarding a grant, renewing a license, or reenrolling a provider. For any documentation submitted to the commissioner under subdivision 1, paragraph (b), or subdivision 2, paragraph (c), the commissioner must review and confirm that the determination of inapplicability made by the potential grantee or the provider, vendor, or individual is correct. For any incorrect determination, the potential grantee or the provider, vendor, or individual must submit the required information before receiving grant funds, renewing a license, or reenrolling in a program. new text end new text begin (b) Notwithstanding section 16B.981, if, after reviewing the information provided under subdivision 1, the commissioner has concerns that there is a substantial risk that a potential grantee cannot or would not perform the required duties under the grant agreement, the commissioner must not award the grant. new text end new text begin (c) If, after reviewing the information provided under subdivision 2, the commissioner has concerns that there is a substantial risk that the provider, vendor, or individual seeking to renew a license or reenroll in a program administered by the commissioner cannot or would not perform the necessary duties required under the license or enrollment agreement, the commissioner must deny the license renewal or reenrollment request. new text end Sec. 4. Minnesota Statutes 2024, section 245.095, is amended by adding a subdivision to read: new text begin Subd. 7. new text end new text begin Exemption. new text end new text begin Subdivision 5 does not apply to any individual or entity that receives payments from medical assistance or provides goods or services for which payment is made from medical assistance. new text end new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 5. Minnesota Statutes 2024, section 256.01, is amended by adding a subdivision to read: new text begin Subd. 45. new text end new text begin Program integrity report. new text end new text begin Beginning November 30, 2026, and annually thereafter, the commissioner must provide a report to the chairs and ranking minority members of the legislative committees with jurisdiction over human services on program integrity functions within the Department of Human Services. The report must include: new text end new text begin (1) an update from the Background Studies Division within the Office of Inspector General at the Department of Human Services with historical metrics and descriptive data on background studies and licensure, including the number of background studies completed within the past five years and the number of disqualifications that occurred; new text end new text begin (2) an update from the Licensing Division within the Office of Inspector General at the Department of Human Services with historical metrics and descriptive data, including the division's capacity to meet licensing demands and data for the past five years on the number of maltreatment reports and licensing complaints received, the results of maltreatment investigations, the number of licenses issued for each provider type, the number of licensing investigations and reviews completed, and the number of correction orders issued; and new text end new text begin (3) an update from the Financial Fraud and Abuse Investigations Division within the Office of Inspector General at the Department of Human Services that generally includes caseload, screening and site visit data, the number of provider medical assistance managed care investigations within the past five years, the number of screening investigations within the past five years, and updates on major fraud investigations. new text end Sec. 6. new text begin [256.0113] ELIGIBILITY TO RECEIVE PUBLIC MONEY; PRE-AWARD RISK ASSESSMENT. new text end new text begin Subdivision 1. new text end new text begin Pre-award risk assessment; grant recipients. new text end new text begin (a) Prior to receiving a grant award for a program administered by the commissioner, a potential grantee must provide the commissioner with the applicable information specified under section 16B.981, subdivision 2, for the most recent three-year period. This information must also include: new text end new text begin (1) the potential grantee's history of performing services during the most recent three-year period that are substantially similar to the services the potential grantee is seeking to receive public funds to provide; and new text end new text begin (2) for a potential grantee that is a for-profit business or nonprofit organization, evidence of registration and good standing with the secretary of state for the most recent three-year period, if applicable. new text end new text begin (b) For any information not submitted to the commissioner as required under this section because the potential grantee determined it to be inapplicable, the potential grantee must submit documentation noting each item that was not submitted and the reason why the potential grantee determined it was inapplicable. new text end new text begin Subd. 2. new text end new text begin Pre-award risk assessment; licensure. new text end new text begin (a) Prior to renewing a license for a program administered by the commissioner, a provider, vendor, or individual must provide the commissioner with the applicable information specified under section 16B.981, subdivision 2, for the most recent licensure period. new text end new text begin (b) Notwithstanding paragraph (a), for a provider, vendor, or individual who has been licensed in a program administered by the commissioner for at least three years, the provider, vendor, or individual must provide the commissioner with the applicable information specified under section 16B.981, subdivision 2, for the most recent three-year period. new text end new text begin (c) For any information not submitted to the commissioner as required under this section because the provider, vendor, or individual determined it to be inapplicable, the provider, vendor, or individual must submit documentation noting each item that was not submitted and the reason why the provider, vendor, or individual determined it was inapplicable. new text end new text begin Subd. 3. new text end new text begin Pre-award risk assessment; reenrollment and revalidation. new text end new text begin (a) Prior to reenrollment or revalidation in a program administered by the commissioner, a provider, vendor, or individual must provide the commissioner with the applicable information specified under section 16B.981, subdivision 2, for the most recent enrollment period. new text end new text begin (b) Notwithstanding paragraph (a), for a provider, vendor, or individual who has been enrolled in a program administered by the commissioner for at least three years, the provider, vendor, or individual must provide the commissioner with the applicable information specified under section 16B.981, subdivision 2, for the most recent three-year period. new text end new text begin (c) For any information not submitted to the commissioner as required under this section because the provider, vendor, or individual determined it to be inapplicable, the provider, vendor, or individual must submit documentation noting each item that was not submitted and the reason why the provider, vendor, or individual determined it was inapplicable. new text end new text begin Subd. 4. new text end new text begin Commissioner duties. new text end new text begin (a) The commissioner must review all information provided under subdivisions 1 to 3 prior to awarding a grant, renewing a license, or reenrolling or revalidating a provider, vendor, or individual. For any documentation submitted to the commissioner under subdivision 1, paragraph (b); subdivision 2, paragraph (c); or subdivision 3, paragraph (c), the commissioner must review and confirm that the determination of inapplicability made by the potential grantee or the provider, vendor, or individual is correct. For any incorrect determination, the potential grantee or the provider, vendor, or individual must submit the required information prior to receiving grant funds, renewing a license, reenrollment in a program, or revalidation. new text end new text begin (b) Notwithstanding section 16B.981, if, after reviewing the information provided under subdivision 1, the commissioner has concerns that there is a substantial risk that a potential grantee cannot or would not perform the required duties under the grant agreement, the commissioner must not award the grant. new text end new text begin (c) If, after reviewing the information provided under subdivision 2 or 3, the commissioner has concerns that there is a substantial risk that the provider, vendor, or individual seeking to renew a license, or applying for reenrollment or revalidation, cannot or would not perform the necessary duties required under the license or enrollment agreement, the commissioner must deny the license renewal or terminate the participation of the provider, vendor, or individual in the program. new text end Sec. 7. Minnesota Statutes 2025 Supplement, section 256B.064, subdivision 1a, is amended to read: Subd. 1a. Grounds for sanctions. (a) The commissioner may impose sanctions against any individual or entity that receives payments from medical assistance or provides goods or services for which payment is made from medical assistance for any of the following: (1) fraud, theft, or abuse in connection with the provision of goods and services to recipients of public assistance for which payment is made from medical assistance; (2) a pattern of presentment of false or duplicate claims or claims for services not medically necessary; (3) a pattern of making false statements of material facts for the purpose of obtaining greater compensation than that to which the individual or entity is legally entitled; (4) suspension or termination as a Medicare vendor; (5) refusal to grant the state agency access during regular business hours to examine all records necessary to disclose the extent of services provided to program recipients and appropriateness of claims for payment; (6) failure to repay an overpayment or a fine finally established under this section; (7) failure to correct errors in the maintenance of health service or financial records for which a fine was imposed or after issuance of a warning by the commissioner; and (8) any reason for which an individual or entity could be excluded from participation in the Medicare program under section 1128, 1128A, or 1866(b)(2) of the Social Security Act. (b) For the purposes of this section, goods or services for which payment is made from medical assistance includes but is not limited to care and services identified in section 256B.0625 or provided pursuant to any federally approved waiver. (c) Regardless of the source of payment or other item of value, the commissioner may impose sanctions against any individual or entity that solicits, receives, pays, or offers to pay any illegal remuneration as described in section 142E.51, subdivision 6a , in violation of section 609.542, subdivision 2 , or in violation of United States Code, title 42, section 1320a-7b(b)(1) or (2). No conviction is required before the commissioner can impose sanctions under this paragraph. (d) The commissioner may impose sanctions against a pharmacy provider for failure to respond to a cost of dispensing survey under section 256B.0625, subdivision 13e , paragraph (g). (e) The commissioner may impose sanctions against a pharmacy provider for failure to respond to a Minnesota drug acquisition cost survey under section 256B.0625, subdivision 13e, paragraph (i). new text begin (f) For the purposes of this section, "abuse" means the activities listed in paragraph (a), clauses (2), (3), and (7), but does not include billing errors that result in unintended overcharges. new text end Sec. 8. Minnesota Statutes 2024, section 256B.064, subdivision 1b, is amended to read: Subd. 1b. Sanctions available. new text begin (a) new text end The commissioner may impose the following sanctions for the conduct described in subdivision 1a: deleted text begin suspension or withholding of deleted text end new text begin suspending new text end payments to an individual or entity deleted text begin and deleted text end new text begin ; withholding payments to an individual or entity; new text end suspending deleted text begin or terminating deleted text end participation in the program deleted text begin , deleted text end new text begin ; terminating participation in the program; new text end or deleted text begin imposition of deleted text end new text begin imposing new text end a fine under subdivision deleted text begin 2, paragraph (g) deleted text end new text begin 2a new text end . new text begin (b) new text end When imposing sanctions under this deleted text begin section deleted text end new text begin subdivision new text end , the commissioner deleted text begin shall deleted text end new text begin must new text end consider the nature, chronicity, or severity of the conduct and the effect of the conduct on the health and safety of persons served by the individual or entity. new text begin (c) new text end The commissioner deleted text begin shall deleted text end new text begin must new text end suspend an individual's or entity's participation in the program for a minimum of five years if the individual or entity is convicted of a crime, received a stay of adjudication, or entered a court-ordered diversion program for an offense related to a provision of a health service under medical assistance, including a federally approved waiver, or health care fraud. new text begin (d) new text end Regardless of imposition of sanctions, the commissioner may make a referral to the appropriate state licensing board. new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 9. Minnesota Statutes 2024, section 256B.064, subdivision 1d, is amended to read: Subd. 1d. Investigative costs. new text begin (a) new text end The commissioner may seek recovery of investigative costs from any individual or entity that willfully submits a claim for reimbursement for services that the individual or entity knows, or reasonably should have known, is a false representation and that results in the payment of public funds for which the individual or entity is ineligible. new text begin (b) new text end Billing errors that result in unintentional overcharges deleted text begin shall deleted text end new text begin are new text end not deleted text begin be deleted text end grounds for investigative cost recoupment. new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 10. Minnesota Statutes 2024, section 256B.064, subdivision 2, is amended to read: Subd. 2. Imposition of monetary recovery and sanctions new text begin ; generally new text end . (a) The commissioner deleted text begin shall deleted text end new text begin must new text end determine any monetary amounts to be recovered and sanctions to be imposed upon an individual or entity under this section. Except as provided in deleted text begin paragraphs (b) and (d), neither deleted text end new text begin subdivisions 2b to 2d, the commissioner must not obtain new text end a monetary recovery deleted text begin nor deleted text end new text begin or impose new text end a sanction deleted text begin will be imposed by the commissioner deleted text end without prior notice and an opportunity for a hearing, according to chapter 14, on the commissioner's proposed action deleted text begin , provided that the commissioner may suspend or reduce payment to an individual or entity, except a nursing home or convalescent care facility, after notice and prior to the hearing if in the commissioner's opinion that action is necessary to protect the public welfare and the interests of the program deleted text end . deleted text begin (b) Except when the commissioner finds good cause not to suspend payments under Code of Federal Regulations, title 42, section 455.23(e) or (f), the commissioner shall withhold or reduce payments to an individual or entity without providing advance notice of such withholding or reduction if either of the following occurs: deleted text end deleted text begin (1) the individual or entity is convicted of a crime involving the conduct described in subdivision 1a; or deleted text end deleted text begin (2) the commissioner determines there is a credible allegation of fraud for which an investigation is pending under the program. Allegations are considered credible when they have an indicium of reliability and the state agency has reviewed all allegations, facts, and evidence carefully and acts judiciously on a case-by-case basis. A credible allegation of fraud is an allegation which has been verified by the state, from any source, including but not limited to: deleted text end deleted text begin (i) fraud hotline complaints; deleted text end deleted text begin (ii) claims data mining; and deleted text end deleted text begin (iii) patterns identified through provider audits, civil false claims cases, and law enforcement investigations. deleted text end deleted text begin (c) The commissioner must send notice of the withholding or reduction of payments under paragraph (b) within five days of taking such action unless requested in writing by a law enforcement agency to temporarily withhold the notice. The notice must: deleted text end deleted text begin (1) state that payments are being withheld according to paragraph (b); deleted text end deleted text begin (2) set forth the general allegations as to the nature of the withholding action, but need not disclose any specific information concerning an ongoing investigation; deleted text end deleted text begin (3) except in the case of a conviction for conduct described in subdivision 1a, state that the withholding is for a temporary period and cite the circumstances under which withholding will be terminated; deleted text end deleted text begin (4) identify the types of claims to which the withholding applies; and deleted text end deleted text begin (5) inform the individual or entity of the right to submit written evidence for consideration by the commissioner. deleted text end deleted text begin (d) The withholding or reduction of payments will not continue after the commissioner determines there is insufficient evidence of fraud by the individual or entity, or after legal proceedings relating to the alleged fraud are completed, unless the commissioner has sent notice of intention to impose monetary recovery or sanctions under paragraph (a). Upon conviction for a crime related to the provision, management, or administration of a health service under medical assistance, a payment held pursuant to this section by the commissioner or a managed care organization that contracts with the commissioner under section 256B.035 is forfeited to the commissioner or managed care organization, regardless of the amount charged in the criminal complaint or the amount of criminal restitution ordered. deleted text end deleted text begin (e) The commissioner shall suspend or terminate an individual's or entity's participation in the program without providing advance notice and an opportunity for a hearing when the suspension or termination is required because of the individual's or entity's exclusion from participation in Medicare. Within five days of taking such action, the commissioner must send notice of the suspension or termination. The notice must: deleted text end deleted text begin (1) state that suspension or termination is the result of the individual's or entity's exclusion from Medicare; deleted text end deleted text begin (2) identify the effective date of the suspension or termination; and deleted text end deleted text begin (3) inform the individual or entity of the need to be reinstated to Medicare before reapplying for participation in the program. deleted text end deleted text begin (f) deleted text end new text begin (b) new text end Upon receipt of a notice under paragraph (a) new text begin or subdivision 2c or 2d new text end that a monetary recovery or sanction is to be new text begin or has been new text end imposed, an individual or entity may request a contested case, as defined in section 14.02, subdivision 3 , by filing with the commissioner a written request of appeal. The appeal request must be received by the commissioner no later than 30 days after the date the notification of monetary recovery or sanction was mailed to the individual or entity. The appeal request must specify: (1) each disputed item, the reason for the dispute, and an estimate of the dollar amount involved for each disputed item; (2) the computation that the individual or entity believes is correct; (3) the authority in statute or rule upon which the individual or entity relies for each disputed item; (4) the name and address of the person or entity with whom contacts may be made regarding the appeal; and (5) other information required by the commissioner. deleted text begin (g) The commissioner may order an individual or entity to forfeit a fine for failure to fully document services according to standards in this chapter and Minnesota Rules, chapter deleted text end deleted text begin 9505 deleted text end deleted text begin . The commissioner may assess fines if specific required components of documentation are missing. The fine for incomplete documentation shall equal 20 percent of the amount paid on the claims for reimbursement submitted by the individual or entity, or up to $5,000, whichever is less. If the commissioner determines that an individual or entity repeatedly violated this chapter, chapter deleted text end deleted text begin 254B deleted text end deleted text begin or deleted text end deleted text begin 245G deleted text end deleted text begin , or Minnesota Rules, chapter deleted text end deleted text begin 9505 deleted text end deleted text begin , related to the provision of services to program recipients and the submission of claims for payment, the commissioner may order an individual or entity to forfeit a fine based on the nature, severity, and chronicity of the violations, in an amount of up to $5,000 or 20 percent of the value of the claims, whichever is greater. deleted text end deleted text begin (h) The individual or entity shall pay the fine assessed on or before the payment date specified. If the individual or entity fails to pay the fine, the commissioner may withhold or reduce payments and recover the amount of the fine. A timely appeal shall stay payment of the fine until the commissioner issues a final order. deleted text end new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 11. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision to read: new text begin Subd. 2a. new text end new text begin Imposition of fines. new text end new text begin (a) The commissioner may order an individual or entity to forfeit a fine for failure to fully document services according to standards in this chapter and Minnesota Rules, chapter 9505. The commissioner may assess fines if specific required components of documentation are missing. The fine for incomplete documentation equals 20 percent of the amount paid on the claims for reimbursement submitted by the individual or entity, or up to $5,000, whichever is less. If the commissioner determines that an individual or entity repeatedly violated this chapter, chapter 245G or 254B, or Minnesota Rules, chapter 9505, related to the provision of services to program recipients and the submission of claims for payment, the commissioner may order an individual or entity to forfeit a fine based on the nature, severity, and chronicity of the violations, in an amount of up to $5,000 or 20 percent of the value of the claims, whichever is greater. new text end new text begin (b) The individual or entity must pay the fine assessed on or before the payment date specified by the commissioner. If the individual or entity fails to pay the fine, the commissioner may withhold or reduce payments and recover the amount of the fine. A timely appeal stays payment of the fine until the commissioner issues a final order. new text end new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 12. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision to read: new text begin Subd. 2b. new text end new text begin Mandatory suspension or termination after exclusion from participation in Medicare. new text end new text begin (a) The commissioner must suspend or terminate an individual's or entity's participation in the program without providing advance notice and an opportunity for a hearing when the suspension or termination is required because of the individual's or entity's exclusion from participation in Medicare. new text end new text begin (b) Within five days of taking an action under paragraph (a), the commissioner must send notice of the suspension or termination. The notice must: new text end new text begin (1) state that the suspension or termination is the result of the individual's or entity's exclusion from Medicare; new text end new text begin (2) identify the effective date of the suspension or termination; and new text end new text begin (3) inform the individual or entity of the need to be reinstated to Medicare before reapplying for participation in the program. new text end new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 13. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision to read: new text begin Subd. 2c. new text end new text begin Imposition of monetary recovery and sanctions before a hearing. new text end new text begin (a) Except as provided in paragraph (b), the commissioner may withhold or reduce payment to an individual or entity after notice but before a hearing if, in the commissioner's opinion, withholding or reducing payment is necessary to protect the public welfare and the interests of the program. new text end new text begin (b) Notwithstanding subdivision 2d, unless the commissioner first complies with the applicable requirements of paragraph (c), the commissioner must not withhold or reduce payments to the following entities: new text end new text begin (1) a nursing home; new text end new text begin (2) a convalescing care facility; new text end new text begin (3) an entity providing residential supports and services as described in section 245D.03, subdivision 1, paragraph (c), clause (3); or new text end new text begin (4) an entity providing integrated community services described in section 245D.03, subdivision 1, paragraph (c), clause (8). new text end new text begin (c) When withholding or reducing payments under paragraph (a) or subdivision 2d to an entity listed in paragraph (b), the commissioner must confirm suitable alternative services and housing are established for the affected recipient before withholding or reducing payments if withholding or reducing payments puts a recipient of the goods or services provided by the entity in imminent danger of harm or at risk of homelessness. new text end new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 14. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision to read: new text begin Subd. 2d. new text end new text begin Imposition of monetary recovery and sanctions without prior notice. new text end new text begin (a) Except as provided in subdivision 2c, when law enforcement requests that the commissioner not suspend payments, or when the commissioner finds good cause not to suspend payments under Code of Federal Regulations, title 42, section 455.23(e) or (f), the commissioner must withhold or reduce payments to an individual or entity without providing advance notice of the withholding or reduction if either of the following occurs: new text end new text begin (1) the individual or entity is convicted of a crime involving the conduct described in subdivision 1a; or new text end new text begin (2) the commissioner determines there is a credible allegation of fraud for which an investigation is pending under the program. Allegations are considered credible when they are supported by a preponderance of the evidence and the state agency has reviewed and verified all allegations, facts, and evidence carefully and acts judiciously on a case-by-case basis. A credible allegation of abuse is not a credible allegation of fraud. new text end new text begin (b) If the commissioner withholds or reduces payments under paragraph (a), clause (2), the commissioner may withhold payments only for the specific submitted claims that the commissioner has determined are potentially fraudulent and referred to law enforcement, unless the commissioner determines that the credible allegation of fraud is an allegation of pervasive fraud. new text end new text begin (c) For purposes of this subdivision, "fraud" means presenting information that is false in whole or in part to the commissioner with the intent of obtaining greater compensation for the provision of a good or service available under this chapter than the vendor of the good or service is legally entitled. new text end new text begin (d) The commissioner may consider an allegation of fraud from any source, including but not limited to: new text end new text begin (1) fraud hotline complaints; new text end new text begin (2) claims data mining; new text end new text begin (3) patterns identified through provider audits, civil false claims cases, law enforcement investigations, and investigations by other state or federal agencies; and new text end new text begin (4) court filings or other legal documents. new text end new text begin (e) The commissioner must send notice of the withholding or reduction of payments under paragraph (a) within five days of withholding or reducing payment unless requested in writing by a law enforcement agency to temporarily withhold the notice. The notice need not disclose specific information concerning an ongoing investigation. The notice must: new text end new text begin (1) state that payments are being withheld according to paragraph (a); new text end new text begin (2) set forth the allegations as to the nature of the withholding action, which must specify: new text end new text begin (i) each disputed item, and for each disputed item the reason for the dispute and an estimate of the dollar amount involved; new text end new text begin (ii) the computation that the commissioner believes is correct; new text end new text begin (iii) the statute or rule the commissioner believes the individual or entity violated; and new text end new text begin (iv) other information necessary to aid the individual or entity when providing written evidence under clause (5) or filing an appeal under section 256B.064, subdivision 2; new text end new text begin (3) except in the case of a conviction for conduct described in subdivision 1a, state that the withholding is for a temporary period not to exceed 60 days and cite the circumstances under which withholding will be terminated; new text end new text begin (4) identify the types of claims to which the withholding applies; and new text end new text begin (5) inform the individual or entity of the right to submit written evidence for consideration by the commissioner. new text end new text begin (f) The commissioner must acknowledge receipt of any written evidence submitted by the individual or entity within five days of receipt of the written evidence. Within five days of the commissioner's acknowledgment of receipt, the commissioner must (1) cease to withhold or reduce payments, or (2) respond to the individual or entity with an explanation of the commissioner's continued determination that there is sufficient evidence of fraud to continue withholding or reducing payments. new text end new text begin (g) The commissioner must cease to withhold or reduce payments under this subdivision after 60 days have passed, after the commissioner determines there is insufficient evidence of fraud by the individual or entity, or after legal proceedings relating to the alleged fraud are completed, unless the commissioner has sent notice of intention to impose monetary recovery or sanctions. new text end Sec. 15. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision to read: new text begin Subd. 2e. new text end new text begin Forfeiture of withheld payments upon criminal conviction. new text end new text begin Upon conviction for a crime related to the provision, management, or administration of a health service under medical assistance, a payment held pursuant to this section by the commissioner or a managed care organization that contracts with the commissioner under section 256B.035 is forfeited to the commissioner or managed care organization, regardless of the amount charged in the criminal complaint or the amount of criminal restitution ordered. new text end new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 16. Minnesota Statutes 2024, section 256B.064, subdivision 3, is amended to read: Subd. 3. Mandates on prohibited payments. (a) The commissioner deleted text begin shall deleted text end new text begin must new text end maintain and publish a list of each excluded individual and entity that was convicted of a crime related to the provision, management, or administration of a medical assistance health service, or suspended or terminated under subdivision deleted text begin 2 deleted text end new text begin 2b new text end . Medical assistance payments cannot be made by an individual or entity for items or services furnished either directly or indirectly by an excluded individual or entity, or at the direction of excluded individuals or entities. (b) The entity must check the exclusion list on a monthly basis and document the date and time the exclusion list was checked and the name and title of the person who checked the exclusion list. The entity must immediately terminate payments to an individual or entity on the exclusion list. (c) An entity's requirement to check the exclusion list and to terminate payments to individuals or entities on the exclusion list applies to each individual or entity on the exclusion list, even if the named individual or entity is not responsible for direct patient care or direct submission of a claim to medical assistance. (d) An entity that pays medical assistance program funds to an individual or entity on the exclusion list must refund any payment related to either items or services rendered by an individual or entity on the exclusion list from the date the individual or entity is first paid or the date the individual or entity is placed on the exclusion list, whichever is later, and an entity may be subject to: (1) sanctions under deleted text begin subdivision 2 deleted text end new text begin this section new text end ; (2) a civil monetary penalty of up to $25,000 for each determination by the department that the vendor employed or contracted with an individual or entity on the exclusion list; and (3) other fines or penalties allowed by law. new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 17. Minnesota Statutes 2024, section 256B.064, subdivision 4, is amended to read: Subd. 4. Notice. (a) The department deleted text begin shall deleted text end new text begin must new text end serve the notice required under deleted text begin subdivision deleted text end new text begin subdivisions new text end 2 new text begin and 2d new text end using a signature-verified confirmed delivery method to the address submitted to the department by the individual or entity. Service is complete upon mailing. (b) The department deleted text begin shall deleted text end new text begin must new text end give notice in writing to a recipient placed in the Minnesota restricted recipient program under section 256B.0646 and Minnesota Rules, part 9505.2200 . The department deleted text begin shall deleted text end new text begin must new text end send the notice by first class mail to the recipient's current address on file with the department. A recipient placed in the Minnesota restricted recipient program may contest the placement by submitting a written request for a hearing to the department within 90 days of the notice being mailed. new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 18. Minnesota Statutes 2024, section 256B.064, subdivision 5, is amended to read: Subd. 5. Immunity; good faith reporters. (a) A person who makes a good faith report is immune from any civil or criminal liability that might otherwise arise from reporting or participating in the investigation. Nothing in this subdivision affects an individual's or entity's responsibility for an overpayment established under this subdivision. (b) A person employed by a lead investigative agency who is conducting or supervising an investigation or enforcing the law according to the applicable law or rule is immune from any civil or criminal liability that might otherwise arise from the person's actions, if the person is acting in good faith and exercising due care. (c) For purposes of this subdivision, "person" includes a natural person or any form of a business or legal entity. (d) After an investigation is complete, the reporter's name must be kept confidential. The subject of the report may compel disclosure of the reporter's name only with the consent of the reporter or upon a written finding by a district court that the report was false and there is evidence that the report was made in bad faith. This subdivision does not alter disclosure responsibilities or obligations under the Rules of Criminal Procedure, except that when the identity of the reporter is relevant to a criminal prosecution the district court deleted text begin shall deleted text end new text begin must new text end conduct an in-camera review before determining whether to order disclosure of the reporter's identity. new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end Sec. 19. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; MEDICAL ASSISTANCE PROVIDER ENROLLMENT STANDARDS. new text end new text begin (a) By January 1, 2027, the commissioner of human services must make recommendations to the chairs and ranking minority members of the legislative committees with jurisdiction over human services policy and finance regarding statutory and program changes to ensure only qualified, prepared, and financially stable providers are permitted to enroll as a medical assistance provider type designated by the commissioner as high-risk under Minnesota Statutes, section 256B.04, subdivision 21. new text end new text begin (b) The commissioner must include in the recommendations enhanced provider enrollment screening standards related to the provider's regulatory knowledge, operational readiness, internal controls, financial liquidity and solvency, and capacity to comply with state and federal Medicaid requirements. new text end new text begin (c) In developing the recommendations, the commissioner must consult with the Health Law Section of the Minnesota State Bar Association, representatives of the medical assistance providers subject to the recommendations being considered, and other impacted groups. new text end Sec. 20. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; PROGRAM INTEGRITY TECHNOLOGY MODERNIZATION. new text end new text begin By January 1, 2027, the commissioner of human services must develop recommendations on how to modernize program integrity infrastructure within the Department of Human Services. The recommendations must include the infrastructure's capability to provide near-real-time analytics and risk scoring; prepayment review and anomaly detection; cross-matching of enrollment data, licensure data, and claims data; and security dashboards for audits and investigations with privacy safeguards. By January 15, 2027, the commissioner must provide recommendations to the chairs and ranking minority members of the legislative committees with jurisdiction over human services program integrity functions. new text end Sec. 21. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; PROGRAM STRUCTURE AND DESIGN AUDITS. new text end new text begin (a) By August 1, 2026, the commissioner of human services must select and contract with an independent research entity to conduct comprehensive program structure and design audits on the services listed in paragraph (b). Each audit must identify structural incentive misalignments; undue compliance burdens on good-faith providers; regulatory and billing ambiguities; and gaps in utilization controls. Each audit must also provide evidence-based redesign recommendations. new text end new text begin (b) The services that must be audited by the independent research entity include: new text end new text begin (1) adult companion services; new text end new text begin (2) adult day services; new text end new text begin (3) adult rehabilitative mental health services; new text end new text begin (4) assertive community treatment; new text end new text begin (5) community first services and supports; new text end new text begin (6) early intensive developmental and behavioral intervention; new text end new text begin (7) individualized home supports; new text end new text begin (8) integrated community supports; new text end new text begin (9) intensive residential treatment services; new text end new text begin (10) night supervision services; new text end new text begin (11) nonemergency medical transportation services; new text end new text begin (12) peer recovery support services; and new text end new text begin (13) recuperative care. new text end new text begin (c) Each audit must be completed by January 1, 2027. The commissioner must submit each completed audit report within 30 days of receipt to the chairs and ranking minority members of the legislative committees with jurisdiction over human services program integrity functions. new text end ARTICLE 2 MEDICAL ASSISTANCE PROVIDER ENROLLMENT MODIFICATIONS 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 8, 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 8, paragraph (b) new text end ; (4) each managerial official whose responsibilities include the direction of the management or policies of a program; and (5) the president and treasurer of the board of directors of a nonprofit corporation. (b) Controlling individual does not include: (1) a bank, savings bank, trust company, savings association, credit union, industrial loan and thrift company, investment banking firm, or insurance company unless the entity operates a program directly or through a subsidiary; (2) an individual who is a state or federal official, or state or federal employee, or a member or employee of the governing body of a political subdivision of the state or federal government that operates one or more programs, unless the individual is also an officer, owner, or managerial official of the program, receives remuneration from the program, or owns any of the beneficial interests not excluded in this subdivision; (3) an individual who owns less than five percent of the outstanding common shares of a corporation: (i) whose securities are exempt under section 80A.45 , clause (6); or (ii) whose transactions are exempt under section 80A.46 , clause (2); (4) an individual who is a member of an organization exempt from taxation under section 290.05 , unless the individual is also an officer, owner, or managerial official of the program or owns any of the beneficial interests not excluded in this subdivision. This clause does not exclude from the definition of controlling individual an organization that is exempt from taxation; or (5) an employee stock ownership plan trust, or a participant or board member of an employee stock ownership plan, unless the participant or board member is a controlling individual according to paragraph (a). (c) For purposes of this subdivision, "managerial official" means an individual who has the decision-making authority related to the operation of the program, and the responsibility for the ongoing management of or direction of the policies, services, or employees of the program. A site director who has no ownership interest in the program is not considered to be a managerial official for purposes of this definition. Sec. 3. Minnesota Statutes 2024, section 245D.081, subdivision 3, is amended to read: Subd. 3. Program management and oversight. (a) The license holder must designate a managerial staff person or persons to provide program management and oversight of the services provided by the license holder. The designated manager is responsible for the following: (1) maintaining a current understanding of the licensing requirements sufficient to ensure compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph (e), and when applicable, as identified in section deleted text begin 256B.04, subdivision 21 , paragraph (g) deleted text end new text begin 256B.044, subdivision 8 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. 4. Minnesota Statutes 2024, section 256B.04, subdivision 5, is amended to read: Subd. 5. Annual report required. The state agency within 60 days after the close of each fiscal year, shall prepare and print for the fiscal year a report that includes new text begin : new text end a full account of the operations and expenditure of funds under this chapter deleted text begin , deleted text end new text begin ; new text end a full account of the activities undertaken in accordance with subdivision 10 deleted text begin , deleted text end new text begin ; new text end adequate and complete statistics divided by counties about all medical assistance provided in accordance with this chapter deleted text begin , deleted text end new text begin ; a full account of all pre-enrollment, postenrollment, and unannounced site visits to providers under section 256B.044, subdivision 5; new text end and any other information it may deem advisable. Sec. 5. 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. 6. 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 must designate provider types as "limited-risk," "moderate-risk," or "high-risk" based on the criteria and standards used to designate Medicare providers in Code of Federal Regulations, title 42, section 424.518. The commissioner must publish a list of provider types and designated categorical risk levels in the Minnesota Health Care Program Provider Manual. new text end new text begin (b) The list and criteria are not subject to the requirements of chapter 14, and section 14.386 does not apply. new text end new text begin (c) The commissioner's designations are not subject to administrative appeal. new text end new text begin Subd. 2. new text end new text begin Required verifications and checks. new text end new text begin The commissioner must perform the following verifications and checks prior to making an enrollment determination and periodically thereafter: new text end new text begin (1) verify that the provider meets applicable federal and state requirements for the provider type; new text end new text begin (2) conduct license verifications, as applicable, including verification of current licensure in Minnesota and in any other state in which the provider is or was previously licensed, in accordance with Code of Federal Regulations, title 42, section 455.412; new text end new text begin (3) conduct database checks on a pre-enrollment and postenrollment basis to ensure that the provider continues to meet the enrollment criteria for the provider type, in accordance with Code of Federal Regulations, title 42, section 455.436; new text end new text begin (4) confirm that the provider and any disclosed owners, managing employees, or controlling individuals are not excluded from participation in any state's Medicaid program, Medicare, or any other federal health care program; new text end new text begin (5) verify the provider's National Provider Identifier and, as applicable, Medicare enrollment status; new text end new text begin (6) verify the provider's tax identification number and business registration status; new text end new text begin (7) verify the provider's ownership and control disclosures as required under federal law; and new text end new text begin (8) conduct any additional screenings, verifications, or reviews that are necessary to protect the integrity of the medical assistance program or that are required under federal law. new text end new text begin Subd. 3. 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, for a provider applying for enrollment. The background study must include a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses (1) to (5), and any other databases required under federal law. new text end new text begin (b) The commissioner must conduct a background study under this subdivision for each individual with an ownership or control interest in, or who is an officer, director, agent, managing employee, or other person with operational or managerial control of the provider. new text end new text begin (c) Fingerprint-based studies are required when mandated by federal law or when a provider is designated moderate-risk or high-risk under subdivision 1. new text end new text begin (d) The commissioner may conduct background studies postenrollment as necessary. new text end new text begin (e) A provider's failure to submit to the commissioner the information required for a background study under this subdivision is grounds for denial or termination of enrollment in medical assistance. new text end new text begin (f) A provider's enrollment must be denied or terminated if a provider or individual subject to a background study under this subdivision is disqualified under chapter 245C or is excluded from participating in any federal health care programs. new text end new text begin Subd. 4. new text end new text begin Service location enrollment. new text end new text begin (a) A provider must enroll each provider-controlled location where direct services are provided. "Provider-controlled location" means a physical site owned, leased, operated, or otherwise controlled by the provider. new text end new text begin (b) Providers must report all provider-controlled locations where direct services are provided to the commissioner and obtain approval before billing for services provided at a new location. new text end new text begin (c) Separate enrollment is not required for services provided in a recipient's home or community setting, telehealth services delivered from an enrolled site, compliant mobile services, or other federally permissible exemptions. new text end new text begin (d) A provider's failure to enroll each provider-controlled location where direct services are provided is grounds for sanctions under section 256B.064. new text end new text begin Subd. 5. new text end new text begin Site visits. new text end new text begin (a) As a condition of enrollment in medical assistance, the commissioner shall require that a provider permit the Centers for Medicare and Medicaid Services (CMS), CMS's agents, or CMS's designated contractors and the Department of Human Services (DHS), DHS's agents, or DHS's designated contractors to conduct unannounced site visits of any of a provider's enrolled locations. new text end new text begin (b) At a minimum, the commissioner must conduct the following site visits at each of a provider's enrolled locations: new text end new text begin (1) pre-enrollment site visits for providers designated as moderate-risk or high-risk under subdivision 1; new text end new text begin (2) postenrollment site visits for providers designated as moderate-risk or high-risk under subdivision 1; and new text end new text begin (3) unannounced site visits, as follows: new text end new text begin (i) prior to payment of the provider's first claim after enrollment, when required under federal law or due to program integrity concerns; new text end new text begin (ii) within 12 months after the provider begins to bill claims; and new text end new text begin (iii) prior to revalidation under section 256B.0441, subdivision 3. new text end new text begin (c) The commissioner may conduct additional announced or unannounced site visits when necessary to verify compliance with enrollment requirements or to protect program integrity. new text end new text begin (d) A provider's failure to permit a required site visit is grounds for denial, suspension, or termination of enrollment and may result in denial of claims or recoupment of payments. new text end new text begin Subd. 6. new text end new text begin Surety bonds. new text end new text begin (a) The commissioner must require a provider to purchase a surety bond as a condition of initial enrollment, reenrollment, revalidation, 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. 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 DHS 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. 7. new text end new text begin Financial capacity. new text end new text begin As a condition of enrolling in medical assistance, the commissioner must require, in a form and manner prescribed by the commissioner, that a provider demonstrate sufficient financial capacity to operate, repay improper payments, and make payroll for 90 days. new text end new text begin Subd. 8. 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 in a particular industry, of a particular provider type, or with a particular risk categorization under subdivision 1, establish and maintain a compliance program consistent with federal program integrity guidance issued by CMS or the United States Department of Health and Human Services Office of Inspector General. new text end new text begin (b) If an enrolled provider is required by the commissioner or by federal or state law to designate an individual as the provider's compliance officer, the provider must appoint an individual responsible for implementing and overseeing the compliance program. new text end new text begin (c) At a minimum, the compliance program must include policies and procedures designed to: new text end new text begin (1) ensure adherence to federal and state laws and program requirements governing medical assistance and prevent the submission of improper claims; new text end new text begin (2) train employees, agents, contractors, and subcontractors, including billing personnel, on applicable federal and state laws and program requirements; new text end new text begin (3) establish procedures for receiving, investigating, and responding to allegations of improper conduct and for implementing corrective actions; new text end new text begin (4) use auditing, monitoring, or other evaluation techniques to assess ongoing compliance; new text end new text begin (5) promptly report to the commissioner any credible evidence of violations of federal and state laws or regulations governing medical assistance; and new text end new text begin (6) report and return identified medical assistance overpayments within 60 days after discovery or by the date any corresponding cost report is due, whichever is later, in accordance with federal law. new text end new text begin Subd. 9. new text end new text begin Incomplete provider enrollment applications. new text end new text begin The commissioner must 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. 10. new text end new text begin Correspondence and notification. new text end new text begin The commissioner must 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 correspondences and notifications related to background studies. new text end Sec. 7. new text begin [256B.0441] PROVIDER REVALIDATION. new text end new text begin Subdivision 1. new text end new text begin Requirement. new text end new text begin The commissioner must revalidate each enrolled provider according to this section. new text end new text begin Subd. 2. new text end new text begin Schedule. new text end new text begin (a) 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, CFSS provider-agency, and CFSS financial management services provider at least once every three years; new text end new text begin (3) each EIDBI agency at least once every three years; and new text end new text begin (4) each medical-assistance-only provider type the commissioner deems high-risk under section 256B.044, subdivision 1, at least every three years. new text end new text begin (b) The commissioner must conduct revalidation of a provider more frequently when required under federal law or when necessary to protect program integrity. new text end new text begin Subd. 3. new text end new text begin Procedures. new text end new text begin (a) The commissioner shall conduct revalidation as follows: new text end new text begin (1) provide 30-day notice to the provider of the provider's revalidation due date, including instructions for revalidation, a list of materials the provider must submit, and a notice about the unannounced site visit required under paragraph (b); new text end new text begin (2) if a provider fails to submit all required materials or satisfy the requirements of paragraph (b) by the due date, notify the provider of the deficiency within 14 days after the due date and allow the provider an additional 14 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 additional 28-day time period, give 15-day notice of termination and immediately suspend the provider's ability to bill. The commissioner's decision to suspend the provider's ability to bill is not subject to an administrative appeal. new text end new text begin (b) The commissioner must conduct unannounced site visits at each of a provider's enrolled locations under section 256B.044, subdivision 4, no more than 30 days prior to the provider's revalidation due date. new text end new text begin (c) A provider must demonstrate financial capacity, as described under section 256B.044, subdivision 7, as a requirement of revalidation under this subdivision. new text end Sec. 8. new text begin [256B.0442] PROVIDER ENROLLMENT SUSPENSIONS AND TERMINATIONS. new text end new text begin Subdivision 1. new text end new text begin Suspension of billing privileges. new text end new text begin (a) If a provider fails to comply with any individual provider requirement or condition of participation, the commissioner must suspend the provider's ability to bill until the provider comes into compliance. new text end new text begin (b) Notwithstanding any law to the contrary, the commissioner may immediately impose a suspension under this subdivision when necessary to protect public funds or ensure program integrity. new text end new text begin (c) A suspension under this subdivision does not limit the authority of the commissioner to issue any other sanction authorized under federal or state law. new text end new text begin (d) The commissioner's decision to suspend a provider's ability to bill is not subject to an administrative appeal. new text end new text begin Subd. 2. new text end new text begin Revocation 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 the provisions of section 256B.064. new text end new text begin Subd. 3. new text end new text begin Mandatory denial or termination of enrollment. new text end new text begin (a) The commissioner must terminate or deny the enrollment of a provider when: new text end new text begin (1) an individual with a five percent or greater direct or indirect ownership interest in the provider does not submit timely and accurate information and cooperate with the screening methods required under section 256B.044; new text end new text begin (2) an individual with a five percent or greater direct or indirect ownership interest in the provider has been convicted of a criminal offense related to the individual's involvement in Medicare, Medicaid, or the Children's Health Insurance Program in the last ten years, unless the commissioner determines that denial or termination of enrollment is not in the best interests of the medical assistance program and the commissioner documents that determination in writing; new text end new text begin (3) the provider or an individual was terminated from participation in Medicare on or after January 1, 2011, or under a Medicaid program or Children's Health Insurance Program of any other state, and is currently included in the termination database under Code of Federal Regulations, title 42, section 455.417, except as provided in paragraph (b); new text end new text begin (4) the provider, or an individual with an ownership or control interest or who is an agent or managing employee of the provider, fails to submit timely or accurate information, unless the commissioner determines that termination or denial of enrollment is not in the best interests of the medical assistance program and the commissioner documents that determination in writing; new text end new text begin (5) the provider, or an individual with a five percent or greater direct or indirect ownership interest in the provider, fails to submit sets of fingerprints in a form and manner determined by the commissioner within 30 days of a request from CMS or the commissioner, unless the commissioner determines that termination or denial of enrollment is not in the best interests of the medical assistance program and the commissioner documents that determination in writing; new text end new text begin (6) the provider fails to permit access to provider locations for any site visits under section 256B.044, subdivision 5, unless the commissioner determines that termination or denial of enrollment is not in the best interests of the medical assistance program and the commissioner documents that determination in writing; or new text end new text begin (7) CMS or the commissioner determines that the provider has falsified any information provided on the application or cannot verify the identity of any provider applicant. 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), clause (3), 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. 9. new text begin [256B.0443] PROVIDER PAYMENT WITHHOLDS. new text end new text begin (a) If the commissioner or the Centers for Medicare and Medicaid Services designate a provider type as high-risk under section 256B.044, subdivision 1, the commissioner may withhold payment from providers within that category upon initial enrollment for a 90-day period. new text end new text begin (b) The withholding for each provider must begin on the date of the first submission of a claim. new text end Sec. 10. new text begin [256B.0444] ENROLLMENT MORATORIUM FOR HIGH-RISK PROVIDERS. new text end new text begin Subdivision 1. new text end new text begin Provider enrollment moratorium. new text end new text begin (a) If the commissioner or the Centers for Medicare and Medicaid Services (CMS) designates a provider type as high-risk under section 256B.044, subdivision 1, the commissioner may issue a statewide or regional enrollment moratorium and stop accepting and processing applications from providers within that category within 30 days of the date of the designation or upon federal approval of the moratorium, whichever is later. A moratorium issued under this section is effective for a period of up to 24 months from the date the moratorium is issued. new text end new text begin (b) Before ending the moratorium under this section, the commissioner must revalidate the enrollment of each provider within the affected category in accordance with the revalidation procedures under section 256B.0441, subdivision 2. new text end new text begin Subd. 2. new text end new text begin Continued enrollment of new clients. new text end new text begin Nothing in this section prohibits an enrolled provider subject to a moratorium under this section from enrolling new clients or beneficiaries during the period of the enrollment moratorium. new text end new text begin Subd. 3. new text end new text begin Notice. new text end new text begin At least ten days prior to issuing an enrollment moratorium under this section, the commissioner must notify enrolled providers within the affected category and the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services about the actions the commissioner plans to take under this section. The notice must: new text end new text begin (1) include a list of provider types to which the moratorium applies; new text end new text begin (2) provide a general explanation for the basis of the high-risk designation; and new text end new text begin (3) identify the start dates and anticipated durations of the enrollment moratorium. new text end new text begin Subd. 4. new text end new text begin Report to legislature. new text end new text begin Within 60 days of ending an enrollment moratorium under this section, the commissioner must submit a report to the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services. The report must include, at a minimum: new text end new text begin (1) a summary of any sanctions imposed under section 256B.064 on any providers subject to the moratorium; and new text end new text begin (2) recommendations for modifying or terminating the provision of covered services delivered by provider types subject to the moratorium. new text end Sec. 11. 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 state agency 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 licensed by the commissioner under chapter 245A must designate an individual as the licensee's compliance officer under section 256B.044, subdivision 8, 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 licensed by the commissioner of health as a home care provider under chapter 144A with a home and community-based services designation under section 144A.484 on the home care license, or as an assisted living facility under chapter 144G, must designate an individual as the licensee's compliance officer under section 256B.044, subdivision 8, paragraph (b). new text end Sec. 12. Minnesota Statutes 2025 Supplement, section 256B.0759, subdivision 4, is amended to read: Subd. 4. Provider payment rates. (a) Payment rates for participating providers must be increased for services provided to medical assistance enrollees. To receive a rate increase, participating providers must meet demonstration project requirements and provide evidence of formal referral arrangements with providers delivering step-up or step-down levels of care. Providers that have enrolled in the demonstration project but have not met the provider standards under subdivision 3 as of July 1, 2022, are not eligible for a rate increase under this subdivision until the date that the provider meets the provider standards in subdivision 3. Services provided from July 1, 2022, to the date that the provider meets the provider standards under subdivision 3 shall be reimbursed at rates according to section 254B.0505, subdivision 1 . Rate increases paid under this subdivision to a provider for services provided between July 1, 2021, and July 1, 2022, are not subject to recoupment when the provider is taking meaningful steps to meet demonstration project requirements that are not otherwise required by law, and the provider provides documentation to the commissioner, upon request, of the steps being taken. (b) The commissioner may temporarily suspend payments to the provider according to section deleted text begin 256B.04, subdivision 21 , paragraph (d) deleted text end new text begin 256B.0442, subdivision 1 new text end , if the provider does not meet the requirements in paragraph (a). Payments withheld from the provider must be made once the commissioner determines that the requirements in paragraph (a) are met. (c) For outpatient individual and group substance use disorder services under section 254B.0505, subdivision 1 , clause (1), and adolescent treatment programs that are licensed as outpatient treatment programs according to sections 245G.01 to 245G.18 , provided on or after January 1, 2021, payment rates must be increased by 20 percent over the rates in effect on December 31, 2020. (d) Effective January 1, 2021, and contingent on annual federal approval, managed care plans and county-based purchasing plans must reimburse providers of the substance use disorder services meeting the criteria described in paragraph (a) who are employed by or under contract with the plan an amount that is at least equal to the fee-for-service base rate payment for the substance use disorder services described in paragraph (c). The commissioner must monitor the effect of this requirement on the rate of access to substance use disorder services and residential substance use disorder rates. Capitation rates paid to managed care organizations and county-based purchasing plans must reflect the impact of this requirement. This paragraph expires if federal approval is not received at any time as required under this paragraph. (e) Effective July 1, 2021, contracts between managed care plans and county-based purchasing plans and providers to whom paragraph (d) applies must allow recovery of payments from those providers if, for any contract year, federal approval for the provisions of paragraph (d) is not received, and capitation rates are adjusted as a result. Payment recoveries must not exceed the amount equal to any decrease in rates that results from this provision. (f) For substance use disorder services with medications for opioid use disorder under section 254B.0505, subdivision 1 , clause (7), provided on or after January 1, 2021, payment rates must be increased by 20 percent over the rates in effect on December 31, 2020. Upon implementation of new rates according to section 254B.121 , the 20 percent increase will no longer apply. Sec. 13. Minnesota Statutes 2025 Supplement, section 256B.0949, subdivision 16, is amended to read: Subd. 16. Agency duties. (a) An agency delivering an EIDBI service under this section must: (1) enroll as a medical assistance Minnesota health care program provider according to Minnesota Rules, part 9505.0195 , and deleted text begin section 256B.04, subdivision 21 deleted text end new text begin sections 256B.044 to 256B.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 8, paragraph (b) new text end ; (3) demonstrate compliance with federal and state laws for the delivery of and billing for EIDBI service; (4) verify and maintain records of a service provided to the person or the person's legal representative as required under Minnesota Rules, parts 9505.2175 and 9505.2197 ; (5) demonstrate that while enrolled or seeking enrollment as a Minnesota health care program provider the agency did not have a lead agency contract or provider agreement discontinued because of a conviction of fraud; or did not have an owner, board member, or manager fail a state or federal criminal background check or appear on the list of excluded individuals or entities maintained by the federal Department of Human Services Office of Inspector General; (6) have established business practices including written policies and procedures, internal controls, and a system that demonstrates the organization's ability to deliver quality EIDBI services, appropriately submit claims, conduct required staff training, document staff qualifications, document service activities, and document service quality; (7) have an office located in Minnesota or a border state; (8) initiate a background study as required under subdivision 16a; (9) report maltreatment according to section 626.557 and chapter 260E; (10) comply with any data requests consistent with the Minnesota Government Data Practices Act, sections 256B.064 and 256B.27 ; (11) provide training for all agency staff on the requirements and responsibilities listed in the Maltreatment of Minors Act, chapter 260E, and the Vulnerable Adult Protection Act, section 626.557 , including mandated and voluntary reporting, nonretaliation, and the agency's policy for all staff on how to report suspected abuse and neglect; (12) have a written policy to resolve issues collaboratively with the person and the person's legal representative when possible. The policy must include a timeline for when the person and the person's legal representative will be notified about issues that arise in the provision of services; (13) provide the person's legal representative with prompt notification if the person is injured while being served by the agency. An incident report must be completed by the agency staff member in charge of the person. A copy of all incident and injury reports must remain on file at the agency for at least five years from the report of the incident; (14) before starting a service, provide the person or the person's legal representative a description of the treatment modality that the person shall receive, including the staffing certification levels and training of the staff who shall provide a treatment; (15) provide clinical supervision for a minimum of one hour for every 16 hours of direct treatment per person, unless otherwise authorized in the person's individual treatment plan; and (16) provide required EIDBI intervention observation and direction at least once per month. Notwithstanding subdivision 13, paragraph (l), required EIDBI intervention observation and direction under this clause may be conducted via telehealth provided that no more than two consecutive monthly required EIDBI intervention observation and direction sessions under this clause are conducted via telehealth. (b) Upon request of the commissioner, an agency delivering services under this section must: (1) identify the agency's controlling individuals, as defined under section 245A.02, subdivision 5a ; (2) provide disclosures of the use of billing agencies and other consultants who do not provide EIDBI services; and (3) provide copies of any contracts with consultants or independent contractors who do not provide EIDBI services, including hours contracted and responsibilities. (c) When delivering the ITP, and annually thereafter, an agency must provide the person or the person's legal representative with: (1) a written copy and a verbal explanation of the person's or person's legal representative's rights and the agency's responsibilities; (2) documentation in the person's file the date that the person or the person's legal representative received a copy and explanation of the person's or person's legal representative's rights and the agency's responsibilities; and (3) reasonable accommodations to provide the information in another format or language as needed to facilitate understanding of the person's or person's legal representative's rights and the agency's responsibilities. Sec. 14. Minnesota Statutes 2024, section 256B.0949, subdivision 17, is amended to read: Subd. 17. Provider shortage; authority for exceptions. (a) In consultation with the Early Intensive Developmental and Behavioral Intervention Advisory Council and stakeholders, including agencies, professionals, parents of people with ASD or a related condition, and advocacy organizations, the commissioner shall determine if a shortage of EIDBI providers exists. For the purposes of this subdivision, "shortage of EIDBI providers" means a lack of availability of providers who meet the EIDBI provider qualification requirements under subdivision 15 that results in the delay of access to timely services under this section, or that significantly impairs the ability of a provider agency to have sufficient providers to meet the requirements of this section. The commissioner shall consider geographic factors when determining the prevalence of a shortage. The commissioner may determine that a shortage exists only in a specific region of the state, multiple regions of the state, or statewide. The commissioner shall also consider the availability of various types of treatment modalities covered under this section. (b) The commissioner, in consultation with the Early Intensive Developmental and Behavioral Intervention Advisory Council and stakeholders, must establish processes and criteria for granting an exception under this paragraph. The commissioner may grant an exception only if the exception would not compromise a person's safety and not diminish the effectiveness of the treatment. The commissioner may establish an expiration date for an exception granted under this paragraph. The commissioner may grant an exception for the following: (1) EIDBI provider qualifications under this section; (2) medical assistance provider enrollment requirements under deleted text begin section 256B.04 , subdivision 21 deleted text end new text begin sections 256B.044 to 256B.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. 15. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES. new text end new text begin The commissioner of human services must amend Minnesota Rules, part 9505.2165, subpart 4, item C, to remove the citation to United States Code, title 42, section 1320a-7b(b)(3)(D), and insert a citation to United States Code, title 42, section 1320a-7b(b). The commissioner may use the procedure under Minnesota Statutes, section 14.388, subdivision 1, clause (3), for changes to Minnesota Rules pursuant to this section. Minnesota Statutes, section 14.386, does not apply to rules adopted pursuant to this section except as provided under Minnesota Statutes, section 14.388. new text end ARTICLE 3 PROVIDER ENROLLMENT REQUIREMENTS FOR HIGH-RISK PROVIDERS 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 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: S4222-2 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.