Provider-based clinics obtaining and usage of a unique National Provider Identifier(NPI) for reimbursement claims requirement, and all-payer claims data submitted inclusion of a provider-based clinic's unique NPI requirement provision

A bill for an act

relating to health; requiring provider-based clinics to obtain and use a unique

National Provider Identifier (NPI) for reimbursement claims; requiring data

submitted as all-payer claims data to include a provider-based clinic's unique NPI;

amending Minnesota Statutes 2024, section 62U.04, by adding a subdivision;

proposing coding for new law in Minnesota Statutes, chapter 62J.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

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[62J.825] UNIQUE NATIONAL PROVIDER IDENTIFIERS FOR

PROVIDER BASED CLINICS.

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Subdivision 1.

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Definitions.

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

the meanings given.

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(b) "Health care clearinghouse" has the meaning given in Code of Federal Regulations,

title 45, section 160.103.

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(c) "National Provider Identifier" or "NPI" means the standard, unique health identifier

for health care providers that is issued by the national provider system in accordance with

Code of Federal Regulations, title 45, part 162.

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(d) "Provider-based clinic" means the site of an off-campus clinic or provider office,

located at least 250 yards from the main hospital buildings or as determined by the Centers

for Medicare and Medicaid Services, that is owned by a hospital licensed under chapter

144, or a health system that operates one or more hospitals licensed under chapter 144, and

is primarily engaged in providing diagnostic and therapeutic care, including medical history,

physical examinations, assessment of health status, and treatment monitoring. Provider-based

clinic does not include clinics that are exclusively providing laboratory, x-ray, testing,

therapy, pharmacy, or educational services.

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Subd. 2.

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Unique NPI.

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(a) Provider-based clinics must apply for, obtain, and use on all

claims for reimbursement or payment for health services provided at the provider-based

clinic a unique NPI that is distinct from the hospital's NPI.

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(b) The provider-based clinic's unique NPI must be included on all claims for

reimbursement or payment for health services provided at the provider-based clinic,

regardless of whether the claim is filed or submitted by or through a central office of the

hospital, a health care clearinghouse, or any other intermediary.

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Sec. 2.

Minnesota Statutes 2024, section 62U.04, is amended by adding a subdivision to

read:

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Subd. 14.

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Unique National Provider Identifier (NPI).

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Data submitted under this section

relating to a provider-based clinic, as defined in section 62J.825, and which includes an

NPI, as defined in section 62J.825, must include the provider-based clinic's unique NPI that

is distinct from the hospital's NPI.

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EFFECTIVE DATE.

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This section is effective January 1, 2027.

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