STATE OF
MINNESOTA
NINETY-THIRD
SESSION - 2023
_____________________
SEVENTY-SEVENTH
DAY
Saint Paul, Minnesota, Monday, May 22, 2023
The House of Representatives convened at
11:00 a.m. and was called to order by Melissa Hortman, Speaker of the House.
Prayer was offered by Pastor Ryan Braley,
Central Lutheran Church, Elk River, Minnesota.
The members of the House gave the pledge
of allegiance to the flag of the United States of America.
The roll was called and the following
members were present:
Acomb
Agbaje
Altendorf
Anderson, P. E.
Anderson, P. H.
Backer
Bahner
Bakeberg
Baker
Becker-Finn
Bennett
Berg
Bierman
Bliss
Brand
Burkel
Carroll
Cha
Clardy
Coulter
Curran
Daniels
Daudt
Davids
Davis
Demuth
Dotseth
Edelson
Elkins
Engen
Feist
Finke
Fischer
Fogelman
Franson
Frazier
Frederick
Freiberg
Garofalo
Gillman
Gomez
Greenman
Hansen, R.
Hanson, J.
Harder
Hassan
Heintzeman
Hemmingsen-Jaeger
Her
Hicks
Hill
Hollins
Hornstein
Howard
Hudella
Hudson
Huot
Hussein
Igo
Jacob
Johnson
Jordan
Joy
Keeler
Kiel
Klevorn
Knudsen
Koegel
Kotyza-Witthuhn
Kozlowski
Koznick
Kraft
Kresha
Lee, F.
Lee, K.
Liebling
Lillie
Lislegard
Long
McDonald
Mekeland
Moller
Mueller
Murphy
Myers
Nadeau
Nash
Nelson, M.
Nelson, N.
Neu Brindley
Newton
Niska
Noor
Norris
Novotny
O'Driscoll
Olson, B.
Olson, L.
O'Neill
Pelowski
Pérez-Vega
Perryman
Petersburg
Pfarr
Pinto
Pryor
Pursell
Quam
Rehm
Reyer
Richardson
Robbins
Schomacker
Schultz
Scott
Sencer-Mura
Skraba
Smith
Stephenson
Swedzinski
Tabke
Torkelson
Urdahl
Vang
West
Wiener
Wiens
Witte
Wolgamott
Xiong
Youakim
Zeleznikar
Spk. Hortman
A quorum was present.
Grossell was excused.
The Chief Clerk proceeded to read the
Journal of the preceding day. There
being no objection, further reading of the Journal was dispensed with and the
Journal was approved as corrected by the Chief Clerk.
Long moved that the House recess subject to the call of the
Chair. The motion prevailed.
RECESS
RECONVENED
The House reconvened and was called to
order by the Speaker.
CALENDAR FOR
THE DAY
S. F. No. 3307 was reported
to the House.
Becker-Finn moved to amend S. F. No. 3307 as follows:
Page 1, delete sections 1 and 2 and insert:
"Section 1. [CORR23-01] Laws 2023, chapter 13, article 1, section 7, is amended to read:
Sec. 7. Minnesota Statutes 2022, section 171.06, is amended by adding a subdivision to read:
Subd. 11. Noncompliant license or identification card; secondary documents. (a) For purposes of a noncompliant driver's license or identification card, a secondary document under Minnesota Rules, part 7410.0400, subpart 3, or successor rules, includes:
(1) a second primary document listed under subdivision 10, paragraph (a);
(2) a notice of action on or proof of submission of a completed Application for Asylum and for Withholding of Removal issued by the United States Department of Homeland Security, Form I-589;
(3) a Certificate of Eligibility for Nonimmigrant Student Status issued by the United States Department of Homeland Security, Form I-20;
(4) a Certificate of Eligibility for Exchange Visitor Status issued by the United States Department of State, Form DS-2019;
(5) a Deferred Action for Childhood Arrival approval notice issued by the United States Department of Homeland Security;
(6) an employment authorization document issued by the United States Department of Homeland Security, Form I-688, Form I-688A, Form I-688B, or Form I-766;
(7) a document issued by
the Social Security Administration Internal Revenue Service with
an individual taxpayer identification number;
(8) a Social Security card;
(9) a Supplemental Security Income award statement issued no more than 12 months before the application;
(10) an unexpired Selective Service card;
(11) military orders that are still in effect at the time of application;
(12) a Minnesota unemployment insurance benefit statement issued no more than 90 days before the application;
(13) a valid identification card for health benefits or an assistance or social services program;
(14) a Minnesota vehicle certificate of title issued no more than 12 months before the application;
(15) mortgage documents for the applicant's residence;
(16) a filed property deed or title for the applicant's residence;
(17) a Minnesota property tax statement for the current or prior calendar year, or a proposed Minnesota property tax notice for the current year, that shows the applicant's principal residential address both on the mailing portion and the portion stating what property is being taxed;
(18) a certified copy of a divorce decree or dissolution of marriage that specifies the applicant's name or name change, issued by a court; and
(19) any of the following documents issued by a foreign jurisdiction:
(i) a driver's license that is current or has been expired for five years or less;
(ii) a high school, college, or university student identification card with a certified transcript from the school;
(iii) an official high school, college, or university transcript that includes the applicant's date of birth and a photograph of the applicant at the age the record was issued;
(iv) a federal electoral card issued on or after January 1, 1991, that contains the applicant's photograph;
(v) a certified copy of the applicant's certificate of marriage; and
(vi) a certified copy of a court order or judgment from a court of competent jurisdiction that contains the applicant's name and date of birth.
(b) Submission of more than one secondary document is not required under this subdivision.
Sec. 2. [CORR23-03A] Laws 2023, chapter 37, article 6, section 14, is amended to read:
Sec. 14. WORKGROUP
ON EXPEDITING RENTAL ASSISTANCE.
Subdivision 1. Creation; duties. A workgroup is created to study how to expedite both the processing of applications for rental assistance and for emergency rental assistance and the distribution of rental assistance funds to landlords, in order to identify what processes, procedures, and technological or personnel resources would be
necessary to enable the state or county agencies responsible for administering government rental assistance funds, including the family homelessness prevention and assistance program, the emergency assistance program, and emergency general assistance, to meet the following goals:
(1) within two weeks of receiving a completed application for rental assistance, make and issue a determination on the application; and
(2) within 30 days of receiving a completed application for rental assistance, issue payment on an approved rental application to the landlord.
Subd. 2. Membership. The workgroup shall consist of the following:
(1) the commissioner of the Minnesota Housing Finance Agency or a designee;
(2) the commissioner of the Department of Human Services or designee;
(3) a representative from the Minnesota Multi Housing Association;
(4) a representative from Mid-Minnesota Legal Aid;
(5) a representative from HOME Line;
(6) a representative from the United Way;
(7) a representative from the Salvation Army;
(8) a representative from the Community Action Partnership;
(9) a representative from Community Mediation Minnesota;
(10) a representative from the Family Housing Fund;
(11) four county administrators of emergency rental assistance, including two county administrators who work for metropolitan counties, as defined by Minnesota Statutes, section 473.121, subdivision 4, and two county administrators who work for nonmetropolitan counties, with one member from each category appointed by the speaker of the house of representatives and one from each category appointed by the senate majority leader;
(12) one member from the house of representatives appointed by the speaker of the house; and
(13) one member from the senate appointed by the senate majority leader.
Subd. 3. Facilitation;
organization; meetings. (a) The
Management Analysis Division of Minnesota Management and Budget shall
facilitate the workgroup and convene the first meeting by July September
15, 2023.
(b) The workgroup must meet at regular intervals as often as necessary to accomplish the goals enumerated under subdivision 1.
(c) Meetings of the workgroup are subject to the Minnesota Open Meeting Law under Minnesota Statutes, chapter 13D.
Subd. 4. External consultation. The workgroup shall consult with other individuals and organizations that have expertise and experience that may assist the workgroup in fulfilling its responsibilities, including entities engaging in additional external stakeholder input from those with lived experience and administrators of emergency assistance not named to the workgroup, including Minnesota's Tribal nations.
Subd. 5. Report
required. The workgroup shall submit
a final report by February 1 29, 2024, to the chairs and ranking
minority members of the legislative committees with jurisdiction over housing
finance and policy. The report shall
include draft legislation required to implement the proposed legislation.
Subd. 6. Expiration. The workgroup expires upon submission
of the final report in subdivision 5, or February 28, 2024, whichever is
later.
Sec. 3. [CORR23-03B] Laws 2023, chapter 37, article 6, section 14, the effective date, is amended to read:
EFFECTIVE DATE. This section
is effective the day following final enactment and expires March 1, 2024
the day following sine die adjournment of both bodies of the 93rd regular
legislative session.
Sec. 4. [CORR23-04] Laws 2023, chapter 37, article 2, section 8, subdivision 2, is amended to read:
Subd. 2. Eligible organizations. To be eligible for a grant under this section an organization must:
(1) be a nonprofit organization that is tax exempt under section 501(c)(3) of the Internal Revenue Code that has been doing business in the state for at least ten years as demonstrated by registration or filing of organizational documents with the secretary of state;
(2) have its primary operations located in the state;
(3) be experiencing significant detrimental financial impact due to recent economic and social conditions, including but not limited to decreased operating revenue due to loss of rental income or increased operating expenses due to inflation in utility expenses, insurance, or other expenses;
(4) have supportive services options available for the individuals and families residing in a portion of the rental housing it provides to low-income populations; and
(5) provide, as of December 31, 2022, housing units in the state that it owns or controls consisting of any of the following:
(i) at least 1,000 units of naturally occurring affordable housing. For purposes of this item, "naturally occurring affordable housing" means multiunit rental housing developments that have not received financing from the federal low-income housing tax credit program for which the majority of the units have agreements in place to be affordable to individuals or families with incomes at or below 60 percent of the area median income as determined by the United States Department of Housing and Urban Development, adjusted for family size, and that do not receive project- or other place-based rental subsidies from the federal government;
(ii) rental housing units, not including naturally occurring affordable housing, of which 50 percent of the total number of units are rented to individuals or families whose annual incomes, according to the most recent income certification as of December 31, 2022, are at or below 30 percent of the area median income as determined by the United States Department of Housing and Urban Development, adjusted for family size; or
(iii) at least 250 units of permanent supportive housing, as defined in Minnesota Statutes, section 462A.36, subdivision 1, paragraph (e).
Sec. 5. [CORR23-06] 2023 H. F. No. 2310, article 4, if enacted during the 2023 regular legislative session, is amended to add:
Sec. 113. EFFECTIVE
DATE.
H. F. No. 2310,
article 4, sections 22 and 29 to 34, are effective January 1, 2024.
EFFECTIVE DATE. This
section is effective at the time H. F. No. 2310, article 4,
sections 22 and 29 to 34, are effective and only if H. F. No. 2310
is enacted in the 2023 regular legislative session.
Sec. 6. [CORR23-07] 2023 H. F. No. 2497, article 1, if enacted during the 2023 regular legislative session, is amended to add a section to read:
Sec. 10. Minnesota Statutes 2022, section 126C.05, subdivision 1, is amended to read:
Subdivision 1. Pupil unit. Pupil units for each Minnesota resident pupil under the age of 21 or who meets the requirements of section 120A.20, subdivision 1, paragraph (c), in average daily membership enrolled in the district of residence, in another district under sections 123A.05 to 123A.08, 124D.03, 124D.08, or 124D.68; in a charter school under chapter 124E; or for whom the resident district pays tuition under section 123A.18, 123A.22, 123A.30, 123A.32, 123A.44, 123A.488, 123B.88, subdivision 4, 124D.04, 124D.05, 125A.03 to 125A.24, 125A.51, or 125A.65, shall be counted according to this subdivision.
(a) A prekindergarten pupil with a disability who is enrolled in a program approved by the commissioner and has an individualized education program is counted as the ratio of the number of hours of assessment and education service to 825 times 1.0 with a minimum average daily membership of 0.28, but not more than 1.0 pupil unit.
(b) A prekindergarten pupil who is assessed but determined not to be disabled is counted as the ratio of the number of hours of assessment service to 825 times 1.0.
(c) A kindergarten pupil
with a disability who is enrolled in a program approved by the commissioner is
counted as the ratio of the number of hours of assessment and education
services required in the fiscal year by the pupil's individualized education
program to 875, but not more than one.
(d) (c) A
prekindergarten pupil who is not included in paragraph (a) or (b) and is
enrolled in an approved voluntary prekindergarten program under section
124D.151 is counted as the ratio of the number of hours of instruction to 850
times 1.0, but not more than 0.6 pupil units.
(e) (d) A
kindergarten pupil who is not included in paragraph (c) is counted as
1.0 pupil unit if the pupil is enrolled in a free all-day, every day
kindergarten program available to all kindergarten pupils at the pupil's school
that meets the minimum hours requirement in section 120A.41, or is counted as
.55 pupil unit, if the pupil is not enrolled in a free all-day, every day
kindergarten program available to all kindergarten pupils at the pupil's
school.
(f) (e) A pupil
who is in any of grades 1 to 6 is counted as 1.0 pupil unit.
(g) (f) A pupil
who is in any of grades 7 to 12 is counted as 1.2 pupil units.
(h) (g) A pupil
who is in the postsecondary enrollment options program is counted as 1.2 pupil
units.
(i) For fiscal years
2018 through 2023, (h) A prekindergarten pupil who:
(1) is not included in
paragraph (a), (b), or (d) (c);
(2) is enrolled in a school readiness plus program under Laws 2017, First Special Session chapter 5, article 8, section 9; and
(3) has one or more of the risk factors specified by the eligibility requirements for a school readiness plus program,
is counted as the ratio of the number of hours of instruction to 850 times 1.0, but not more than 0.6 pupil units. A pupil qualifying under this paragraph must be counted in the same manner as a voluntary prekindergarten student for all general education and other school funding formulas.
EFFECTIVE DATE. This
section is effective for fiscal year 2024 and later.
Sec. 7. [CORR23-09] 2023 H. F. No. 1830, article 2, section 16, if enacted, is amended to read:
Sec. 16. Minnesota Statutes 2022, section 3.855, is amended by adding a subdivision to read:
Subd. 6. Information required; collective bargaining agreements, memoranda of understanding, and interest arbitration awards. Within 14 days after the implementation of a collective bargaining agreement, memorandum of understanding, or receipt of an interest arbitration award, the commissioner of management and budget must submit to the Legislative Coordinating Commission the following:
(1) a copy of the collective bargaining agreement showing changes from previous agreements and a copy of the executed agreement;
(2) a copy of any memorandum
of understanding that has a fiscal impact, or interest, or
arbitration award;
(3) a comparison of biennial
compensation costs under the current agreement to the projected biennial
compensation costs under the new agreement, memorandum of understanding, or
interest, or arbitration award; and
(4) a comparison of biennial
compensation costs under the current agreement to the projected biennial
compensation costs for the following biennium under the new agreement,
memorandum of understanding, or interest, or arbitration award.
Sec. 8. [CORR23-10] Laws 2023, chapter 52, article 6, section 10, subdivision 2, is amended to read:
Subd. 2. Prosecutor-initiated sentence adjustment. The prosecutor for the jurisdiction responsible for the prosecution of an individual convicted of a crime may commence a proceeding to adjust the sentence of that individual at any time after the initial sentencing provided the prosecutor does not seek to increase the period of confinement or, if the individual is serving a stayed sentence, increase the period of supervision.
Sec. 9. [CORR23-11] 2023 H. F. No. 1830, article 7, section 10, if enacted, is amended to read:
Sec. 10. Minnesota Statutes 2022, section 16B.98, is amended by adding a subdivision to read:
Subd. 14. Administrative costs. Unless amounts are otherwise appropriated for administrative costs, a state agency may retain up to five percent of the amount appropriated to the agency for grants enacted by the legislature and formula grants and up to ten percent for competitively awarded grants. This subdivision applies to appropriations made for new grant programs enacted on or after the effective date of this subdivision. This subdivision does not apply to grants funded with an appropriation of proceeds from the sale of state general obligation bonds.
EFFECTIVE DATE. This section is effective July 1, 2023, and applies to grants issued on or after that date."
Renumber the sections in sequence and correct the internal references
Amend the title accordingly
Becker-Finn moved to amend the Becker-Finn amendment to S. F. No. 3307 as follows:
Page 8, after line 28, insert:
"Sec. 11. [CORR23-02A] Minnesota Statutes 2022, section 268.057, subdivision 7, is amended to read:
Subd. 7. Credit adjustments, refunds. (a) If an employer makes an application for a credit adjustment of any amount paid under this chapter or section 116L.20 within four years of the date that the payment was due, in a manner and format prescribed by the commissioner, and the commissioner determines that the payment or any portion was erroneous, the commissioner must make an adjustment and issue a credit without interest. If a credit cannot be used, the commissioner must refund, without interest, the amount erroneously paid. The commissioner, on the commissioner's own motion, may make a credit adjustment or refund under this subdivision.
Any refund returned to the commissioner is considered unclaimed property under chapter 345.
(b) If a credit adjustment or
refund is denied in whole or in part, a determination of denial must be sent to
the employer by mail or electronic transmission. The determination of denial is final unless
an employer files an appeal within 20 45 calendar days after
sending. Proceedings on the appeal are
conducted in accordance with section 268.105.
EFFECTIVE DATE. This
section is effective for determinations issued on or after May 5, 2024.
Sec. 12. [CORR23-02B] Laws 2023, chapter 33, section 18, is amended to read:
Sec. 18. Minnesota Statutes 2022, section 268.105, subdivision 2, is amended to read:
Subd. 2. Request
for reconsideration. (a) Any party,
or the commissioner, may within 20 45 calendar days of the
sending of the unemployment law judge's decision under subdivision 1a, file a
request for reconsideration asking the judge to reconsider that decision.
(b) Upon a request for reconsideration having been filed, the chief unemployment law judge must send a notice, by mail or electronic transmission, to all parties that a request for reconsideration has been filed. The notice must inform the parties:
(1) that reconsideration is the procedure for the unemployment law judge to correct any factual or legal mistake in the decision, or to order an additional hearing when appropriate;
(2) of the opportunity to provide comment on the request for reconsideration, and the right under subdivision 5 to obtain a copy of any recorded testimony and exhibits offered or received into evidence at the hearing;
(3) that providing specific comments as to a perceived factual or legal mistake in the decision, or a perceived mistake in procedure during the hearing, will assist the unemployment law judge in deciding the request for reconsideration;
(4) of the right to obtain any comments and submissions provided by any other party regarding the request for reconsideration; and
(5) of the provisions of paragraph (c) regarding additional evidence.
This paragraph does not apply if paragraph (d) is applicable. Sending the notice does not mean the unemployment law judge has decided the request for reconsideration was timely filed.
(c) In deciding a request for reconsideration, the unemployment law judge must not consider any evidence that was not submitted at the hearing, except for purposes of determining whether to order an additional hearing.
The unemployment law judge must order an additional hearing if a party shows that evidence which was not submitted at the hearing:
(1) would likely change the outcome of the decision and there was good cause for not having previously submitted that evidence; or
(2) would show that the evidence that was submitted at the hearing was likely false and that the likely false evidence had an effect on the outcome of the decision.
"Good cause" for purposes of this paragraph is a reason that would have prevented a reasonable person acting with due diligence from submitting the evidence.
(d) If the party who filed the request for reconsideration failed to participate in the hearing, the unemployment law judge must issue an order setting aside the decision and ordering an additional hearing if the party who failed to participate had good cause for failing to do so. The party who failed to participate in the hearing must be informed of the requirement to show good cause for failing to participate. If the unemployment law judge determines that good cause for failure to participate has not been shown, the judge must state that in the decision issued under paragraph (f).
Submission of a written statement at the hearing does not constitute participation for purposes of this paragraph.
"Good cause" for purposes of this paragraph is a reason that would have prevented a reasonable person acting with due diligence from participating in the hearing.
(e) A request for reconsideration must be decided by the unemployment law judge who issued the decision under subdivision 1a unless that judge:
(1) is no longer employed by the department;
(2) is on an extended or indefinite leave; or
(3) has been removed from the proceedings by the chief unemployment law judge.
(f) If a request for reconsideration is timely filed, the unemployment law judge must issue:
(1) a decision affirming the findings of fact, reasons for decision, and decision issued under subdivision 1a;
(2) a decision modifying the findings of fact, reasons for decision, and decision under subdivision 1a; or
(3) an order setting aside the findings of fact, reasons for decision, and decision issued under subdivision 1a, and ordering an additional hearing.
The unemployment law judge must issue a decision dismissing the request for reconsideration as untimely if the judge decides the request for reconsideration was not filed within 45 calendar days after the sending of the decision under subdivision 1a.
The unemployment law judge must send to all parties, by mail or electronic transmission, the decision or order issued under this subdivision. A decision affirming or modifying the previously issued findings of fact, reasons for decision, and decision, or a decision dismissing the request for reconsideration as untimely, is the final decision on the matter and is binding on the parties unless judicial review is sought under subdivision 7.
Sec. 13. [CORR23-05] Laws 2023, chapter 52, article 2, section 3, subdivision 8, is amended to read:
|
Subd. 8. Office
of Justice Programs |
|
94,758,000 |
|
80,434,000 |
|
Appropriations by Fund |
||
|
General |
94,662,000 |
80,338,000 |
|
State Government Special Revenue |
96,000 |
96,000 |
(a) Domestic and Sexual Violence Housing
$1,500,000 each year is to establish a Domestic Violence Housing First grant program to provide resources for survivors of violence to access safe and stable housing and for staff to provide mobile advocacy and expertise in housing resources in their community and a Minnesota Domestic and Sexual Violence Transitional Housing program to develop and support medium to long term transitional housing for survivors of domestic and sexual violence with supportive services. The base for this appropriation is $1,000,000 beginning in fiscal year 2026.
(b) Federal Victims of Crime Funding Gap
$11,000,000 each year is to fund services for victims of domestic violence, sexual assault, child abuse, and other crimes. This is a onetime appropriation.
(c) Office for Missing and Murdered Black Women and Girls
$1,248,000 each year is to establish and maintain the Minnesota Office for Missing and Murdered Black Women and Girls.
(d) Increased Staffing
$667,000 the first year and $1,334,000 the second year are to increase staffing in the Office of Justice Programs for grant monitoring and compliance; provide training and technical assistance to grantees and potential grantees; conduct community outreach and engagement to improve the experiences and outcomes of applicants, grant recipients, and crime victims
throughout Minnesota; expand the Minnesota Statistical Analysis Center; and increase staffing for the crime victim reimbursement program and the Crime Victim Justice Unit.
(e) Office of Restorative Practices
$500,000 each year is to establish and maintain the Office of Restorative Practices.
(f) Crossover and Dual-Status Youth Model Grants
$1,000,000 each year is to provide grants to local units of government to initiate or expand crossover youth practices model and dual-status youth programs that provide services for youth who are involved with or at risk of becoming involved with both the child welfare and juvenile justice systems, in accordance with the Robert F. Kennedy National Resource Center for Juvenile Justice model. This is a onetime appropriation.
(g) Restorative Practices Initiatives Grants
$4,000,000 each year is for grants to establish and support restorative practices initiatives pursuant to Minnesota Statutes, section 299A.95, subdivision 6. The base for this appropriation is $2,500,000 beginning in fiscal year 2026.
(h) Ramsey County Youth Treatment Homes Acquisition and Betterment
$5,000,000 the first year is for a grant to Ramsey County to establish, with input from community stakeholders, including impacted youth and families, up to seven intensive trauma‑informed therapeutic treatment homes in Ramsey County that are licensed by the Department of Human Services, that are culturally specific, that are community-based, and that can be secured. These residential spaces must provide intensive treatment and intentional healing for youth as ordered by the court as part of the disposition of a case in juvenile court.
(i) Ramsey County Violence Prevention
$5,000,000 the first year is for a grant to Ramsey County to award grants to develop new and further enhance existing community‑based organizational support through violence prevention and community wellness grants. Grantees must use the money to create family support groups and resources to support families during the time a young person is placed out of home following a juvenile delinquency adjudication and support the family through the period of postplacement reentry; create community-based respite options for conflict or crisis de-escalation to prevent incarceration or further systems involvement for
families; or establish additional meaningful employment opportunities for systems-involved youth. This appropriation is available through June 30, 2027.
(j) Office for Missing and Murdered Indigenous Relatives
$274,000 each year is for increased staff and operating costs of the Office for Missing and Murdered Indigenous Relatives, the Missing and Murdered Indigenous Relatives Advisory Board, and the Gaagige-Mikwendaagoziwag reward advisory group.
(k) Youth Intervention Programs
$3,525,000 the first year and $3,526,000 the second year are for youth intervention programs under Minnesota Statutes, section 299A.73. The base for this appropriation is $3,526,000 in fiscal year 2026 and $3,525,000 in fiscal year 2027.
(l) Community Crime Intervention and Prevention Grants
$750,000 each year is for community crime intervention and prevention program grants, authorized under Minnesota Statutes, section 299A.296. This is a onetime appropriation.
(m) Resources for Victims of Crime
$1,000,000 each year is for general crime victim grants to meet the needs of victims of crime not covered by domestic violence, sexual assault, or child abuse services. This is a onetime appropriation.
(n) Prosecutor Training
$100,000 each year is for a grant to the Minnesota County Attorneys Association to be used for prosecutorial and law enforcement training, including trial school training and train‑the‑trainer courses. All training funded with grant proceeds must contain blocks of instruction on racial disparities in the criminal justice system, collateral consequences to criminal convictions, and trauma-informed responses to victims. This is a onetime appropriation.
The Minnesota County Attorneys Association must report to the chairs and ranking minority members of the legislative committees with jurisdiction over public safety policy and finance on the training provided with grant proceeds, including a description of each training and the number of prosecutors and law enforcement officers who received training. The report is due by February 15, 2025. The report may include trainings scheduled to be completed after the date of submission with an estimate of expected participants.
(o) Minnesota Heals
$500,000 each year is for the Minnesota Heals grant program. This is a onetime appropriation.
(p) Sexual Assault Exam Costs
$3,967,000 the first year and $3,767,000 the second year are to reimburse qualified health care providers for the expenses associated with medical examinations administered to victims of criminal sexual conduct as required under Minnesota Statutes, section 609.35, and for costs to administer the program. The base for this appropriation is $3,771,000 in fiscal year 2026 and $3,776,000 in fiscal year 2027.
(q) First Responder Mental Health Curriculum
$75,000 each year is for a grant to the Adler graduate school. The grantee must use the grant to develop a curriculum for a 24-week certificate to train licensed therapists to understand the nuances, culture, and stressors of the work environments of first responders to allow those therapists to provide effective treatment to first responders in distress. The grantee must collaborate with first responders who are familiar with the psychological, cultural, and professional issues of their field to develop the curriculum and promote it upon completion.
The grantee may provide the program online.
The grantee must seek to recruit additional participants from outside the 11-county metropolitan area.
The grantee must create a resource directory to provide law enforcement agencies with names of counselors who complete the program and other resources to support law enforcement professionals with overall wellness. The grantee shall collaborate with the Department of Public Safety and law enforcement organizations to promote the directory. This is a onetime appropriation.
(r) Pathways to Policing
$400,000 each year is for reimbursement grants to state and local law enforcement agencies that operate pathway to policing programs. Applicants for reimbursement grants may receive up to 50 percent of the cost of compensating and training program participants. Reimbursement grants shall be proportionally allocated based on the number of grant applications approved by the commissioner. This is a onetime appropriation.
(s) Direct Assistance to Crime Victim Survivors
$5,000,000 each year is to provide grants for direct services and advocacy for victims of sexual assault, general crime, domestic violence, and child abuse. Funding must support the direct needs of organizations serving victims of crime by providing: direct client assistance to crime victims; competitive wages for direct service staff; hotel stays and other housing-related supports and services; culturally responsive programming; prevention programming, including domestic abuse transformation and restorative justice programming; and for other needs of organizations and crime victim survivors. Services funded must include services for victims of crime in underserved communities most impacted by violence and reflect the ethnic, racial, economic, cultural, and geographic diversity of the state. The office shall prioritize culturally specific programs, or organizations led and staffed by persons of color that primarily serve communities of color, when allocating funds.
(t) Racially Diverse Youth
$250,000 each year is for grants to organizations to address racial disparity of youth using shelter services in the Rochester and St. Cloud regional areas. Of this amount, $125,000 each year is to address this issue in the Rochester area and $125,000 each year is to address this issue in the St. Cloud area. A grant recipient shall establish and operate a pilot program connected to shelter services to engage in community intervention outreach, mobile case management, family reunification, aftercare, and follow up when family members are released from shelter services. A pilot program must specifically address the high number of racially diverse youth that enter shelters in the regions. This is a onetime appropriation.
(u) Violence Prevention Project Research Center
$500,000 each year is for a grant to the Violence Prevention Project Research Center, operating as a 501(c)(3) organization, for research focused on reducing violence in society that uses data and analysis to improve criminal justice-related policy and practice in Minnesota. Research must place an emphasis on issues related to deaths and injuries involving firearms. This is a onetime appropriation.
Beginning January 15, 2025, the Violence Prevention Project Research Center must submit an annual report to the chairs and ranking minority members of the legislative committees with jurisdiction over public safety policy and finance on its work and findings. The report must include a description of the data reviewed, an analysis of that data, and recommendations to improve criminal justice-related policy and practice in Minnesota with specific recommendations to address deaths and injuries involving firearms.
(v) Report on Approaches to Address Illicit Drug Use in Minnesota
$118,000 each year is to enter into an agreement with Rise Research LLC for a study and set of reports on illicit drug use in Minnesota describing current responses to that use, reviewing alternative approaches utilized in other jurisdictions, and making policy and funding recommendations for a holistic and effective response to illicit drug use and the illicit drug trade. The agreement must establish a budget and schedule with clear deliverables. This appropriation is onetime.
The study must include a review of current policies, practices, and funding; identification of alternative approaches utilized effectively in other jurisdictions; and policy and funding recommendations for a response to illicit drug use and the illicit drug trade that reduces and, where possible, prevents harm and expands individual and community health, safety, and autonomy. Recommendations must consider impacts on public safety, racial equity, accessibility of health and ancillary supportive social services, and the intersections between drug policy and mental health, housing and homelessness, overdose and infectious disease, child welfare, and employment.
Rise Research may subcontract and coordinate with other organizations or individuals to conduct research, provide analysis, and prepare the reports required by this section.
Rise Research shall submit reports to the chairs and ranking minority members of the legislative committees with jurisdiction over public safety finance and policy, human services finance and policy, health finance and policy, and judiciary finance and policy. Rise Research shall submit an initial report by February 15, 2024, and a final report by March 1, 2025.
(w) Legal Representation for Children
$150,000 each year is for a grant to an organization that provides legal representation for children in need of protection or services and children in out-of-home placement. The grant is contingent upon a match in an equal amount from nonstate funds. The match may be in kind, including the value of volunteer attorney time, in cash, or a combination of the two. These appropriations are in addition to any other appropriations for the legal representation of children. This appropriation is onetime.
(x) Pretrial Release Study and Report
$250,000 each year are for a grant to the Minnesota Justice Research Center to study and report on pretrial release practices in Minnesota and other jurisdictions, including but not limited to the use of bail as a condition of pretrial release. This appropriation is onetime.
(y) Intensive Comprehensive Peace Officer Education and Training Program
$5,000,000 the first year is to implement the intensive comprehensive peace officer education and training program described in Minnesota Statutes, section 626.8516. This appropriation is available through June 30, 2027.
(z) Youth Services Office
$250,000 each year is to operate the Youth Services Office."
The
motion prevailed and the amendment to the amendment was adopted.
The
question recurred on the Becker-Finn amendment, as amended, to
S. F. No. 3307. The
motion prevailed and the amendment, as amended, was adopted.
S. F. No. 3307, A bill for an act relating to legislative enactments; correcting miscellaneous oversights, inconsistencies, ambiguities, unintended results, and technical errors; amending Laws 2023, chapter 5, sections 1; 2.
The bill was read for the third time, as
amended, and placed upon its final passage.
The question was taken on the passage of
the bill and the roll was called. There
were 132 yeas and 0 nays as follows:
Those who voted in the affirmative were:
Acomb
Agbaje
Altendorf
Anderson, P. E.
Anderson, P. H.
Backer
Bahner
Bakeberg
Baker
Becker-Finn
Bennett
Berg
Bierman
Bliss
Brand
Burkel
Carroll
Cha
Clardy
Coulter
Curran
Daniels
Daudt
Davids
Davis
Demuth
Dotseth
Edelson
Elkins
Engen
Feist
Finke
Fischer
Fogelman
Franson
Frazier
Frederick
Freiberg
Garofalo
Gillman
Gomez
Greenman
Hansen, R.
Hanson, J.
Harder
Hassan
Heintzeman
Hemmingsen-Jaeger
Her
Hicks
Hill
Hollins
Hornstein
Howard
Hudella
Hudson
Huot
Hussein
Igo
Jacob
Johnson
Jordan
Joy
Keeler
Kiel
Klevorn
Knudsen
Koegel
Kotyza-Witthuhn
Kozlowski
Koznick
Kraft
Kresha
Lee, F.
Lee, K.
Liebling
Lillie
Lislegard
Long
McDonald
Mekeland
Moller
Mueller
Murphy
Myers
Nadeau
Nash
Nelson, M.
Nelson, N.
Neu Brindley
Newton
Niska
Noor
Norris
Novotny
O'Driscoll
Olson, B.
Olson, L.
O'Neill
Pelowski
Pérez-Vega
Perryman
Petersburg
Pfarr
Pinto
Pryor
Pursell
Rehm
Reyer
Richardson
Robbins
Schomacker
Schultz
Scott
Sencer-Mura
Skraba
Smith
Stephenson
Swedzinski
Tabke
Torkelson
Urdahl
Vang
West
Wiener
Wiens
Witte
Wolgamott
Xiong
Youakim
Zeleznikar
Spk. Hortman
The bill was
passed, as amended, and its title agreed to.
There being no objection, the order of
business reverted to Messages from the Senate.
MESSAGES FROM THE SENATE
The following
messages were received from the Senate:
Madam Speaker:
I hereby announce that the Senate has concurred in and adopted the report of the Conference Committee on:
H. F. No. 2887, A bill for an act relating to transportation; establishing a budget for transportation; appropriating money for transportation purposes, including Department of Transportation, Department of Public Safety, and Metropolitan Council activities; modifying prior appropriations; authorizing the sale and issuance of state bonds; modifying various policy and finance provisions; establishing metropolitan region sales and use tax; requiring Metropolitan Council to implement and enforce transit safety measures; authorizing administrative citations; establishing criminal penalties; establishing an advisory committee, a task force, and a working group; establishing pilot programs; requiring a study; requiring reports; transferring money; amending Minnesota Statutes 2022, sections 13.69, subdivision 1; 43A.17, by adding a subdivision; 151.37, subdivision 12; 161.088, subdivisions 1, 2, 4, 5, as amended, by adding subdivisions; 161.45, subdivisions 1, 2; 161.46, subdivision 2; 163.051, subdivision 1; 168.002, by adding a subdivision; 168.012, by adding a subdivision; 168.013, subdivision 1a; 168.326; 168.327, subdivisions 1, 2, 3, by adding a subdivision; 168.33, subdivision 7; 168.345, subdivision 2; 168.54, subdivision 5; 168A.29, by adding a subdivision; 169.09, subdivision 13, by adding a subdivision; 169.14, by adding a subdivision; 169.345, subdivision 2; 169.475, subdivisions 2, 3; 169.8261; 169.865, subdivision 1a; 171.01, by adding subdivisions; 171.06, subdivisions 2, 3, as amended, 7, by adding subdivisions; 171.061, subdivision 4; 171.0705, by adding a subdivision; 171.13, subdivisions 1, 1a; 171.26; 174.01, by adding a subdivision; 174.03, subdivision 1c; 174.634; 219.015, subdivision 2; 219.1651; 221.0269, by adding a subdivision; 222.37, subdivision 1; 256.9752, by adding a subdivision; 270C.15; 297A.94; 297A.99, subdivision 1; 297A.993, by adding a subdivision; 297B.02, subdivision 1; 297B.03; 297B.09; 299A.01, by adding a subdivision; 299A.705, subdivision 1; 299D.03, subdivision 5; 299F.60, subdivision 1; 299J.16, subdivision 1; 357.021, subdivisions 6, 7; 473.146, subdivision 1, by adding a subdivision; 473.39, by adding a subdivision; 473.859, by adding a subdivision; 609.855, subdivisions 1, 3, 7, by adding a subdivision; Laws 2021, First Special Session chapter 5, article 1, sections 2, subdivision 2; 4, subdivision 4; article 4, section 143; Laws 2022, chapter 39, section 2; proposing coding for new law in Minnesota Statutes, chapters 4; 160; 161; 168; 169; 171; 174; 297A; 473; proposing coding for new law as Minnesota Statutes, chapter 168E; repealing Minnesota Statutes 2022, sections 168.121, subdivision 5; 168.1282, subdivision 5; 168.1294, subdivision 5; 168.1299, subdivision 4; 168.345, subdivision 1; 299A.705, subdivision 2; 360.915, subdivision 5.
The Senate has repassed said bill in accordance with the recommendation and report of the Conference Committee. Said House File is herewith returned to the House.
Thomas S. Bottern, Secretary of the Senate
Madam Speaker:
I hereby announce that the Senate has concurred in and adopted the report of the Conference Committee on:
S. F. No. 2995.
The Senate has repassed said bill in accordance with the recommendation and report of the Conference Committee. Said Senate File is herewith transmitted to the House.
Thomas S. Bottern, Secretary of the Senate
CONFERENCE COMMITTEE REPORT ON S. F. No. 2995
A bill for an act relating to state government; modifying provisions governing child care, child safety and permanency, child support, economic assistance, deep poverty, housing and homelessness, behavioral health, the medical education and research cost account, MinnesotaCare, medical assistance, background studies, and human services licensing; establishing the Department of Children, Youth, and Families; making technical and conforming changes; establishing requirements for hospital nurse staffing committees and hospital nurse workload committees; modifying requirements of hospital core staffing plans; modifying requirements related to hospital preparedness and incident response action plans to acts of violence; modifying eligibility for the health professional education loan forgiveness program; establishing the Health Care Affordability Board and Health Care Affordability Advisory Council; establishing prescription contraceptive supply requirement; requiring health plan coverage of prescription contraceptives, certain services provided by a pharmacist, infertility treatment, treatment of rare diseases and conditions, and biomarker testing; modifying managed care withhold requirements; establishing filing requirements for a health plan's prescription drug formulary and for items and services provided by medical and dental practices; establishing notice and disclosure requirements for certain health care transactions; extending moratorium on certain conversion transactions; requiring disclosure of facility fees for telehealth; modifying provisions relating to the eligibility of undocumented children for MinnesotaCare and of children for medical assistance; prohibiting a medical assistance benefit plan from including cost-sharing provisions; authorizing a MinnesotaCare buy-in option; assessing alternative payment methods in rural health care; assessing feasibility for a health care provider directory; requiring compliance with the No Surprises Act in billing; modifying prescription drug price provisions and continuity of care provisions; compiling health encounter data; modifying all-payer claims data provisions; establishing certain advisory councils, committees, public awareness campaigns, apprenticeship programs, and grant programs; modifying lead testing and remediation requirements; establishing Minnesota One Health Microbial Stewardship Collaborative and cultural communications program; providing for clinical health care training; establishing a climate resiliency program; changing assisted living provisions; establishing a program to monitor long COVID, a 988 suicide crisis lifeline, school-based health centers, Healthy Beginnings, Healthy Families Act, and Comprehensive and Collaborative Resource and Referral System for Children; establishing a moratorium on green burials; regulating submerged closed-loop exchanger systems; establishing a tobacco use prevention account; amending provisions relating to adoptee birth records access; establishing Office of African American Health; establishing Office of American Indian Health; changing certain health board fees; establishing easy enrollment health insurance outreach program; establishing a state-funded cost-sharing reduction program for eligible persons enrolled in certain qualified health plans; setting certain fees; requiring reports; authorizing attorney general and commissioner of health review and enforcement of certain health care transactions; authorizing rulemaking; transferring money; allocating funds for a specific purpose; making forecast adjustments; appropriating money for the Department of Human Services, Department of Health, health-related boards, emergency medical services regulatory board, ombudsperson for families, ombudsperson for American Indian families, Office of the Foster Youth Ombudsperson, Rare Disease Advisory Council, Department of Revenue, Department of Management and Budget, Department of Children, Youth and Families, Department of Commerce, and Health Care Affordability Board; amending Minnesota Statutes 2022, sections 4.045; 10.65, subdivision 2; 13.10, subdivision 5; 13.46,
subdivision 4; 13.465, subdivision 8; 15.01; 15.06, subdivision 1; 15A.0815, subdivision 2; 16A.151, subdivision 2; 43A.08, subdivision 1a; 62A.02, subdivision 1; 62A.045; 62A.15, subdivision 4, by adding a subdivision; 62A.30, by adding subdivisions; 62A.673, subdivision 2; 62J.497, subdivisions 1, 3; 62J.692, subdivisions 1, 3, 4, 5, 8; 62J.824; 62J.84, subdivisions 2, 3, 4, 6, 7, 8, 9, by adding subdivisions; 62K.10, subdivision 4; 62K.15; 62U.04, subdivisions 4, 5, 5a, 11, by adding subdivisions; 62U.10, subdivision 7; 103I.005, subdivisions 17a, 20a, by adding a subdivision; 103I.208, subdivision 2; 119B.011, subdivisions 2, 5, 13, 19a; 119B.025, subdivision 4; 119B.03, subdivision 4a; 119B.125, subdivisions 1, 1a, 1b, 2, 3, 4, 6, 7; 119B.13, subdivisions 1, 6; 119B.16, subdivisions 1a, 1c, 3; 119B.161, subdivisions 2, 3; 119B.19, subdivision 7; 121A.335, subdivisions 3, 5, by adding a subdivision; 144.05, by adding a subdivision; 144.122; 144.1501, subdivisions 1, 2, 3, 4, 5; 144.1506, subdivision 4; 144.218, subdivisions 1, 2; 144.225, subdivision 2; 144.2252; 144.226, subdivisions 3, 4; 144.566; 144.608, subdivision 1; 144.651, by adding a subdivision; 144.653, subdivision 5; 144.7055; 144.7067, subdivision 1; 144.9501, subdivision 9; 144E.001, subdivision 1, by adding a subdivision; 144E.35; 145.4716, subdivision 3; 145.87, subdivision 4; 145.924; 145A.131, subdivisions 1, 2, 5; 145A.14, by adding a subdivision; 147A.08; 148.56, subdivision 1; 148B.392, subdivision 2; 150A.08, subdivisions 1, 5; 150A.091, by adding a subdivision; 150A.13, subdivision 10; 151.065, subdivisions 1, 2, 3, 4, 6; 151.071, subdivision 2; 151.555; 151.74, subdivisions 3, 4; 152.126, subdivisions 4, 5, 6, 9; 245.095; 245.4663, subdivision 4; 245.4889, subdivision 1; 245.735, subdivisions 3, 6, by adding a subdivision; 245A.02, subdivision 2c; 245A.04, subdivisions 1, 7a; 245A.05; 245A.055, subdivision 2; 245A.06, subdivisions 1, 2, 4; 245A.07, subdivision 3; 245A.16, by adding a subdivision; 245A.50, subdivisions 3, 4, 5, 6, 9; 245C.02, subdivision 13e, by adding subdivisions; 245C.03, subdivisions 1, 1a; 245C.031, subdivision 1; 245C.04, subdivision 1; 245C.05, subdivisions 1, 2c, 4; 245C.08, subdivision 1; 245C.10, subdivisions 2, 2a, 3, 4, 5, 6, 8, 9, 9a, 10, 11, 12, 13, 14, 15, 16, 17, 20, 21; 245C.15, subdivision 2, by adding a subdivision; 245C.17, subdivisions 2, 3, 6; 245C.21, subdivisions 1a, 2; 245C.22, subdivision 7; 245C.23, subdivisions 1, 2; 245C.24, subdivision 2; 245C.30, subdivision 2; 245C.32, subdivision 2; 245E.06, subdivision 3; 245G.03, subdivision 1; 245H.01, subdivision 3, by adding a subdivision; 245H.03, subdivisions 2, 4; 245H.06, subdivisions 1, 2; 245H.07, subdivisions 1, 2; 245I.011, subdivision 3; 245I.20, subdivisions 10, 13, 14, 16; 254B.02, subdivision 5; 256.01, by adding a subdivision; 256.014, subdivisions 1, 2; 256.046, subdivision 3; 256.0471, subdivision 1; 256.962, subdivision 5; 256.9655, by adding a subdivision; 256.969, subdivisions 2b, 9, 25, by adding a subdivision; 256.983, subdivision 5; 256B.04, by adding a subdivision; 256B.055, subdivision 17; 256B.056, subdivision 7; 256B.0625, subdivisions 9, 13, 13c, 13f, 13g, 28b, 30, 31, 34, 49, by adding subdivisions; 256B.0631, subdivision 2, by adding a subdivision; 256B.0941, by adding a subdivision; 256B.196, subdivision 2; 256B.69, subdivisions 4, 5a, 6d, 28, 36, by adding subdivisions; 256B.692, subdivision 1; 256B.75; 256B.758; 256B.76, as amended; 256B.761; 256B.764; 256D.01, subdivision 1a; 256D.024, subdivision 1; 256D.03, by adding a subdivision; 256D.06, subdivision 5; 256D.44, subdivision 5; 256D.63, subdivision 2; 256E.34, subdivision 4; 256E.35, subdivisions 1, 2, 3, 4a, 6, 7; 256I.03, subdivisions 7, 13; 256I.04, subdivision 1; 256I.06, subdivisions 6, 8, by adding a subdivision; 256J.08, subdivisions 71, 79; 256J.11, subdivision 1; 256J.21, subdivisions 3, 4; 256J.26, subdivision 1; 256J.33, subdivisions 1, 2; 256J.35; 256J.37, subdivisions 3, 3a; 256J.425, subdivisions 1, 4, 5, 7; 256J.46, subdivisions 1, 2, 2a; 256J.95, subdivision 19; 256L.03, subdivision 5; 256L.04, subdivisions 7a, 10, by adding a subdivision; 256L.07, subdivision 1; 256L.15, subdivision 2; 256N.26, subdivision 12; 256P.01, by adding subdivisions; 256P.02, subdivision 2, by adding subdivisions; 256P.04, subdivisions 4, 8; 256P.06, subdivision 3, by adding a subdivision; 256P.07, subdivisions 1, 2, 3, 4, 6, 7, by adding subdivisions; 259.83, subdivisions 1, 1a, 1b, by adding a subdivision; 260.761, subdivision 2, as amended; 260C.007, subdivisions 6, 14; 260C.317, subdivision 4; 260C.80, subdivision 1; 260E.01; 260E.02, subdivision 1; 260E.03, subdivision 22, by adding subdivisions; 260E.09; 260E.14, subdivisions 2, 5; 260E.17, subdivision 1; 260E.18; 260E.20, subdivision 2; 260E.24, subdivisions 2, 7; 260E.33, subdivision 1; 260E.35, subdivision 6; 270B.14, subdivision 1, by adding a subdivision; 297F.10, subdivision 1; 403.161, subdivisions 1, 3, 5, 6, 7; 403.162, subdivisions 1, 2, 5; 518A.31; 518A.32, subdivisions 3, 4; 518A.34; 518A.41; 518A.42, subdivisions 1, 3; 518A.65; 518A.77; 524.5-118; 609B.425, subdivision 2; 609B.435, subdivision 2; Laws 2017, First Special Session chapter 6, article 5, section 11, as amended; Laws 2021, First Special Session chapter 7, article 6, section 26; article 16, sections 2, subdivision 32, as amended; 3, subdivision 2, as amended; article 17, section 5, subdivision 1; proposing coding for new law in Minnesota Statutes, chapters 62A; 62D; 62J; 62Q; 62V; 103I; 119B; 144; 144E; 145; 148; 245; 245C; 256B; 256E; 256K; 256N; 256P; 260; 290; proposing coding for new law as Minnesota Statutes, chapter 143; repealing
Minnesota Statutes 2022, sections 62J.692, subdivisions 4a, 7, 7a; 119B.03, subdivision 4; 137.38, subdivision 1; 144.059, subdivision 10; 144.212, subdivision 11; 245C.02, subdivision 14b; 245C.031, subdivisions 5, 6, 7; 245C.032; 245C.11, subdivision 3; 245C.30, subdivision 1a; 256.8799; 256.9864; 256B.0631, subdivisions 1, 2, 3; 256B.69, subdivision 5c; 256J.08, subdivisions 10, 53, 61, 62, 81, 83; 256J.30, subdivisions 5, 7, 8; 256J.33, subdivisions 3, 4, 5; 256J.34, subdivisions 1, 2, 3, 4; 256J.37, subdivision 10; 256J.425, subdivision 6; 259.83, subdivision 3; 259.89; 260C.637.
May 21, 2023
The Honorable Bobby Joe Champion
President of the Senate
The Honorable Melissa Hortman
Speaker of the House of Representatives
We, the undersigned conferees for S. F. No. 2995 report that we have agreed upon the items in dispute and recommend as follows:
That the House recede from its amendments and that S. F. No. 2995 be further amended as follows:
Delete everything after the enacting clause and insert:
"ARTICLE 1
HEALTH CARE
Section 1. Minnesota Statutes 2022, section 256.01, is amended by adding a subdivision to read:
Subd. 43. Education
on contraceptive options. The
commissioner shall require hospitals and primary care providers serving medical
assistance and MinnesotaCare enrollees to develop and implement protocols to
provide enrollees, when appropriate, with comprehensive and scientifically
accurate information on the full range of contraceptive options, in a medically
ethical, culturally competent, and noncoercive manner. The information provided must be designed to
assist enrollees in identifying the contraceptive method that best meets their
needs and the needs of their families. The
protocol must specify the enrollee categories to which this requirement will be
applied, the process to be used, and the information and resources to be
provided. Hospitals and providers must
make this protocol available to the commissioner upon request.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 2. Minnesota Statutes 2022, section 256.0471, subdivision 1, is amended to read:
Subdivision 1. Qualifying
overpayment. Any overpayment for
assistance granted under chapter 119B, the MFIP program formerly
codified under sections 256.031 to 256.0361, and the AFDC program
formerly codified under sections 256.72 to 256.871; for assistance granted
under chapters 256B for state-funded medical assistance 119B,
256D, 256I, 256J, and 256K, and 256L; for assistance
granted pursuant to section 256.045, subdivision 10, for state-funded medical
assistance and state-funded MinnesotaCare under chapters 256B and 256L;
and for assistance granted under the Supplemental Nutrition Assistance
Program (SNAP), except agency error claims, become a judgment by operation of
law 90 days after the notice of overpayment is personally served upon the
recipient in a manner that is sufficient under rule 4.03(a) of the Rules of
Civil Procedure for district courts, or by certified
mail, return receipt requested. This
judgment shall be entitled to full faith and credit in this and any other
state.
EFFECTIVE DATE. This
section is effective July 1, 2023.
Sec. 3. Minnesota Statutes 2022, section 256.9655, is amended by adding a subdivision to read:
Subd. 3. Prompt
payment required. (a) In
paying claims under medical assistance, the commissioner shall comply with Code
of Federal Regulations, title 42, section 447.45.
(b) If the commissioner
does not pay or deny a clean claim within the period provided in paragraph (a),
the commissioner must pay interest on the claim for the period beginning on the
day after the required payment date specified
in paragraph (a) and ending on the date on which the commissioner makes the
payment or denies the claim.
(c) The rate of interest
paid by the commissioner under this subdivision must be 1.5 percent per month
or any part of a month.
EFFECTIVE DATE. This
section is effective the day following final enactment.
Sec. 4. Minnesota Statutes 2022, section 256.969, subdivision 2b, is amended to read:
Subd. 2b. Hospital payment rates. (a) For discharges occurring on or after November 1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according to the following:
(1) critical access hospitals as defined by Medicare shall be paid using a cost-based methodology;
(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology under subdivision 25;
(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation distinct parts as defined by Medicare shall be paid according to the methodology under subdivision 12; and
(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.
(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not be rebased, except that a Minnesota long-term hospital shall be rebased effective January 1, 2011, based on its most recent Medicare cost report ending on or before September 1, 2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on December 31, 2010. For rate setting periods after November 1, 2014, in which the base years are updated, a Minnesota long-term hospital's base year shall remain within the same period as other hospitals.
(c) Effective for discharges occurring on and after November 1, 2014, payment rates for hospital inpatient services provided by hospitals located in Minnesota or the local trade area, except for the hospitals paid under the methodologies described in paragraph (a), clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a manner similar to Medicare. The base year or years for the rates effective November 1, 2014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral, ensuring that the total aggregate payments under the rebased system are equal to the total aggregate payments that were made for the same number and types of services in the base year. Separate budget neutrality calculations shall be determined for payments made to critical access hospitals and payments made to hospitals paid under the DRG system. Only the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being rebased during the entire base period shall be incorporated into the budget neutrality calculation.
(d) For discharges occurring on or after November 1, 2014, through the next rebasing that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph (a), clause (4), shall include adjustments to the projected rates that result in no greater than a five percent increase or decrease from the base year payments for any hospital. Any adjustments to the rates made by the commissioner under this paragraph and paragraph (e) shall maintain budget neutrality as described in paragraph (c).
(e) For discharges occurring on or after November 1, 2014, the commissioner may make additional adjustments to the rebased rates, and when evaluating whether additional adjustments should be made, the commissioner shall consider the impact of the rates on the following:
(1) pediatric services;
(2) behavioral health services;
(3) trauma services as defined by the National Uniform Billing Committee;
(4) transplant services;
(5) obstetric services, newborn services, and behavioral health services provided by hospitals outside the seven‑county metropolitan area;
(6) outlier admissions;
(7) low-volume providers; and
(8) services provided by small rural hospitals that are not critical access hospitals.
(f) Hospital payment rates established under paragraph (c) must incorporate the following:
(1) for hospitals paid under the DRG methodology, the base year payment rate per admission is standardized by the applicable Medicare wage index and adjusted by the hospital's disproportionate population adjustment;
(2) for critical access hospitals, payment rates for discharges between November 1, 2014, and June 30, 2015, shall be set to the same rate of payment that applied for discharges on October 31, 2014;
(3) the cost and charge data used to establish hospital payment rates must only reflect inpatient services covered by medical assistance; and
(4) in determining hospital payment rates for discharges occurring on or after the rate year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per discharge shall be based on the cost-finding methods and allowable costs of the Medicare program in effect during the base year or years. In determining hospital payment rates for discharges in subsequent base years, the per discharge rates shall be based on the cost‑finding methods and allowable costs of the Medicare program in effect during the base year or years.
(g) The commissioner shall validate the rates effective November 1, 2014, by applying the rates established under paragraph (c), and any adjustments made to the rates under paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the total aggregate payments for the same number and types of services under the rebased rates are equal to the total aggregate payments made during calendar year 2013.
(h) Effective for discharges occurring on or after July 1, 2017, and every two years thereafter, payment rates under this section shall be rebased to reflect only those changes in hospital costs between the existing base year or years and the next base year or years. In any year that inpatient claims volume falls below the threshold required to ensure a statistically valid sample of claims, the commissioner may combine claims data from two consecutive years to serve as the base year. Years in which inpatient claims volume is reduced or altered due to a pandemic or other public health emergency shall not be used as a base year or part of a base year if the base year includes more than one year. Changes in costs between base years shall be measured using the lower of the hospital cost index defined in subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per claim. The commissioner
shall establish the base year for each rebasing period considering the most recent year or years for which filed Medicare cost reports are available, except that the base years for the rebasing effective July 1, 2023, are calendar years 2018 and 2019. The estimated change in the average payment per hospital discharge resulting from a scheduled rebasing must be calculated and made available to the legislature by January 15 of each year in which rebasing is scheduled to occur, and must include by hospital the differential in payment rates compared to the individual hospital's costs.
(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates for critical access hospitals located in Minnesota or the local trade area shall be determined using a new cost-based methodology. The commissioner shall establish within the methodology tiers of payment designed to promote efficiency and cost‑effectiveness. Payment rates for hospitals under this paragraph shall be set at a level that does not exceed the total cost for critical access hospitals as reflected in base year cost reports. Until the next rebasing that occurs, the new methodology shall result in no greater than a five percent decrease from the base year payments for any hospital, except a hospital that had payments that were greater than 100 percent of the hospital's costs in the base year shall have their rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and after July 1, 2016, covered under this paragraph shall be increased by the inflation factor in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the following criteria:
(1) hospitals that had payments at or below 80 percent of their costs in the base year shall have a rate set that equals 85 percent of their base year costs;
(2) hospitals that had payments that were above 80 percent, up to and including 90 percent of their costs in the base year shall have a rate set that equals 95 percent of their base year costs; and
(3) hospitals that had payments that were above 90 percent of their costs in the base year shall have a rate set that equals 100 percent of their base year costs.
(j) The commissioner may refine the payment tiers and criteria for critical access hospitals to coincide with the next rebasing under paragraph (h). The factors used to develop the new methodology may include, but are not limited to:
(1) the ratio between the hospital's costs for treating medical assistance patients and the hospital's charges to the medical assistance program;
(2) the ratio between the hospital's costs for treating medical assistance patients and the hospital's payments received from the medical assistance program for the care of medical assistance patients;
(3) the ratio between the hospital's charges to the medical assistance program and the hospital's payments received from the medical assistance program for the care of medical assistance patients;
(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);
(5) the proportion of that hospital's costs that are administrative and trends in administrative costs; and
(6) geographic location.
EFFECTIVE DATE. This
section is effective July 1, 2023.
Sec. 5. Minnesota Statutes 2022, section 256.969, subdivision 9, is amended to read:
Subd. 9. Disproportionate numbers of low-income patients served. (a) For admissions occurring on or after July 1, 1993, the medical assistance disproportionate population adjustment shall comply with federal law and shall be paid to a hospital, excluding regional treatment centers and facilities of the federal Indian Health Service, with a medical assistance inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined as follows:
(1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic mean for all hospitals excluding regional treatment centers and facilities of the federal Indian Health Service but less than or equal to one standard deviation above the mean, the adjustment must be determined by multiplying the total of the operating and property payment rates by the difference between the hospital's actual medical assistance inpatient utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers and facilities of the federal Indian Health Service; and
(2) for a hospital with a medical assistance inpatient utilization rate above one standard deviation above the mean, the adjustment must be determined by multiplying the adjustment that would be determined under clause (1) for that hospital by 1.1. The commissioner shall report annually on the number of hospitals likely to receive the adjustment authorized by this paragraph. The commissioner shall specifically report on the adjustments received by public hospitals and public hospital corporations located in cities of the first class.
(b) Certified public expenditures made by Hennepin County Medical Center shall be considered Medicaid disproportionate share hospital payments. Hennepin County and Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning July 1, 2005, or another date specified by the commissioner, that may qualify for reimbursement under federal law. Based on these reports, the commissioner shall apply for federal matching funds.
(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective retroactively from July 1, 2005, or the earliest effective date approved by the Centers for Medicare and Medicaid Services.
(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid in accordance with a new methodology using 2012 as the base year. Annual payments made under this paragraph shall equal the total amount of payments made for 2012. A licensed children's hospital shall receive only a single DSH factor for children's hospitals. Other DSH factors may be combined to arrive at a single factor for each hospital that is eligible for DSH payments. The new methodology shall make payments only to hospitals located in Minnesota and include the following factors:
(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000 fee-for-service discharges in the base year shall receive a factor of 0.7880;
(2) a hospital that has in effect for the initial rate year a contract with the commissioner to provide extended psychiatric inpatient services under section 256.9693 shall receive a factor of 0.0160;
(3) a hospital that has received medical assistance payment for at least 20 transplant services in the base year shall receive a factor of 0.0435;
(4) a hospital that has a medical assistance utilization rate in the base year between 20 percent up to one standard deviation above the statewide mean utilization rate shall receive a factor of 0.0468;
(5) a hospital that has a medical assistance utilization rate in the base year that is at least one standard deviation above the statewide mean utilization rate but is less than two and one-half standard deviations above the mean shall receive a factor of 0.2300; and
(6) a hospital that is a
level one trauma center and that has a medical assistance utilization rate in
the base year that is at least two and one-half one-quarter
standard deviations above the statewide mean utilization rate shall receive a
factor of 0.3711.
(e) For the purposes of determining eligibility for the disproportionate share hospital factors in paragraph (d), clauses (1) to (6), the medical assistance utilization rate and discharge thresholds shall be measured using only one year when a two-year base period is used.
(f) Any payments or portion of payments made to a hospital under this subdivision that are subsequently returned to the commissioner because the payments are found to exceed the hospital-specific DSH limit for that hospital shall be redistributed, proportionate to the number of fee-for-service discharges, to other DSH-eligible non-children's hospitals that have a medical assistance utilization rate that is at least one standard deviation above the mean.
(g) An additional payment adjustment shall be established by the commissioner under this subdivision for a hospital that provides high levels of administering high-cost drugs to enrollees in fee-for-service medical assistance. The commissioner shall consider factors including fee-for-service medical assistance utilization rates and payments made for drugs purchased through the 340B drug purchasing program and administered to fee-for-service enrollees. If any part of this adjustment exceeds a hospital's hospital-specific disproportionate share hospital limit, the commissioner shall make a payment to the hospital that equals the nonfederal share of the amount that exceeds the limit. The total nonfederal share of the amount of the payment adjustment under this paragraph shall not exceed $1,500,000.
Sec. 6. Minnesota Statutes 2022, section 256.969, subdivision 25, is amended to read:
Subd. 25. Long-term hospital rates. (a) Long-term hospitals shall be paid on a per diem basis.
(b) For admissions occurring on or after April 1, 1995, a long-term hospital as designated by Medicare that does not have admissions in the base year shall have inpatient rates established at the average of other hospitals with the same designation. For subsequent rate-setting periods in which base years are updated, the hospital's base year shall be the first Medicare cost report filed with the long-term hospital designation and shall remain in effect until it falls within the same period as other hospitals.
(c) For admissions
occurring on or after July 1, 2023, long-term hospitals must be paid the higher
of a per diem amount computed using the methodology described in subdivision
2b, paragraph (i), or the per diem rate as of July 1, 2021.
EFFECTIVE DATE. This
section is effective July 1, 2023.
Sec. 7. Minnesota Statutes 2022, section 256.969, is amended by adding a subdivision to read:
Subd. 31. Long-acting
reversible contraceptives. (a)
The commissioner must provide separate reimbursement to hospitals for
long-acting reversible contraceptives provided immediately postpartum in the
inpatient hospital setting. This payment
must be in addition to the diagnostic related group reimbursement for labor and
delivery and shall be made consistent with section 256B.0625, subdivision 13e,
paragraph (e).
(b) The commissioner must
require managed care and county-based purchasing plans to comply with this
subdivision when providing services to medical assistance enrollees. If, for any contract year, federal approval
is not received for this paragraph, the commissioner must adjust the capitation
rates paid to managed care plans and
county-based purchasing plans
for that contract year to reflect the removal of this provision. Contracts between managed care plans and
county-based purchasing plans and providers to whom this paragraph applies must
allow recovery of payments from those providers if capitation rates are
adjusted in accordance with this paragraph.
Payment recoveries must not exceed the amount equal to any increase in
rates that results from this provision. This
paragraph expires if federal approval is not received for this paragraph at any
time.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 8. Minnesota Statutes 2022, section 256B.04, subdivision 14, is amended to read:
Subd. 14. Competitive bidding. (a) When determined to be effective, economical, and feasible, the commissioner may utilize volume purchase through competitive bidding and negotiation under the provisions of chapter 16C, to provide items under the medical assistance program including but not limited to the following:
(1) eyeglasses;
(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation on a short-term basis, until the vendor can obtain the necessary supply from the contract dealer;
(3) hearing aids and supplies;
(4) durable medical equipment, including but not limited to:
(i) hospital beds;
(ii) commodes;
(iii) glide-about chairs;
(iv) patient lift apparatus;
(v) wheelchairs and accessories;
(vi) oxygen administration equipment;
(vii) respiratory therapy equipment;
(viii) electronic diagnostic, therapeutic and life-support systems; and
(ix) allergen-reducing products as described in section 256B.0625, subdivision 67, paragraph (c) or (d);
(5) nonemergency medical
transportation level of need determinations, disbursement of public
transportation passes and tokens, and volunteer and recipient mileage and
parking reimbursements; and
(6) drugs.; and
(7) quitline services as
described in section 256B.0625, subdivision 68, paragraph (c).
(b) Rate changes and recipient cost-sharing under this chapter and chapter 256L do not affect contract payments under this subdivision unless specifically identified.
(c) The commissioner may not utilize volume purchase through competitive bidding and negotiation under the provisions of chapter 16C for special transportation services or incontinence products and related supplies.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 9. Minnesota Statutes 2022, section 256B.055, subdivision 17, is amended to read:
Subd. 17. Adults who were in foster care at the age of 18. (a) Medical assistance may be paid for a person under 26 years of age who was in foster care under the commissioner's responsibility on the date of attaining 18, 19, or 20 years of age, and who was enrolled in medical assistance under the state plan or a waiver of the plan while in foster care, in accordance with section 2004 of the Affordable Care Act.
(b) Medical assistance
may be paid for a person under 26 years of age who was in foster care and
enrolled in any state's Medicaid program as provided by Public Law 115-271,
section 1002.
(c) The commissioner
shall seek federal waiver approval under United States Code, title 42, section
1315, to include youth who were in a state's foster care program and who turned
age 18 prior to January 1, 2023, without regard to potential eligibility under
a Medicaid mandatory group.
EFFECTIVE DATE. This
section is effective the day following final enactment.
Sec. 10. Minnesota Statutes 2022, section 256B.0622, subdivision 8, is amended to read:
Subd. 8. Medical assistance payment for assertive community treatment and intensive residential treatment services. (a) Payment for intensive residential treatment services and assertive community treatment in this section shall be based on one daily rate per provider inclusive of the following services received by an eligible client in a given calendar day: all rehabilitative services under this section, staff travel time to provide rehabilitative services under this section, and nonresidential crisis stabilization services under section 256B.0624.
(b) Except as indicated in paragraph (c), payment will not be made to more than one entity for each client for services provided under this section on a given day. If services under this section are provided by a team that includes staff from more than one entity, the team must determine how to distribute the payment among the members.
(c) The commissioner shall determine one rate for each provider that will bill medical assistance for residential services under this section and one rate for each assertive community treatment provider. If a single entity provides both services, one rate is established for the entity's residential services and another rate for the entity's nonresidential services under this section. A provider is not eligible for payment under this section without authorization from the commissioner. The commissioner shall develop rates using the following criteria:
(1) the provider's cost for services shall include direct services costs, other program costs, and other costs determined as follows:
(i) the direct services costs must be determined using actual costs of salaries, benefits, payroll taxes, and training of direct service staff and service-related transportation;
(ii) other program costs not included in item (i) must be determined as a specified percentage of the direct services costs as determined by item (i). The percentage used shall be determined by the commissioner based upon the average of percentages that represent the relationship of other program costs to direct services costs among the entities that provide similar services;
(iii) physical plant costs calculated based on the percentage of space within the program that is entirely devoted to treatment and programming. This does not include administrative or residential space;
(iv) assertive community treatment physical plant costs must be reimbursed as part of the costs described in item (ii); and
(v) subject to federal approval, up to an additional five percent of the total rate may be added to the program rate as a quality incentive based upon the entity meeting performance criteria specified by the commissioner;
(2) actual cost is defined as costs which are allowable, allocable, and reasonable, and consistent with federal reimbursement requirements under Code of Federal Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and Office of Management and Budget Circular Number A-122, relating to nonprofit entities;
(3) the number of service units;
(4) the degree to which clients will receive services other than services under this section; and
(5) the costs of other services that will be separately reimbursed.
(d) The rate for intensive residential treatment services and assertive community treatment must exclude room and board, as defined in section 256I.03, subdivision 6, and services not covered under this section, such as partial hospitalization, home care, and inpatient services.
(e) Physician services that are not separately billed may be included in the rate to the extent that a psychiatrist, or other health care professional providing physician services within their scope of practice, is a member of the intensive residential treatment services treatment team. Physician services, whether billed separately or included in the rate, may be delivered by telehealth. For purposes of this paragraph, "telehealth" has the meaning given to "mental health telehealth" in section 256B.0625, subdivision 46, when telehealth is used to provide intensive residential treatment services.
(f) When services under this section are provided by an assertive community treatment provider, case management functions must be an integral part of the team.
(g) The rate for a provider must not exceed the rate charged by that provider for the same service to other payors.
(h) The rates for existing programs must be established prospectively based upon the expenditures and utilization over a prior 12-month period using the criteria established in paragraph (c). The rates for new programs must be established based upon estimated expenditures and estimated utilization using the criteria established in paragraph (c).
(i) Effective for the
rate years beginning on and after January 1, 2024, rates for assertive
community treatment, adult residential crisis stabilization services, and
intensive residential treatment services must be annually adjusted for
inflation using the Centers for Medicare and Medicaid Services Medicare
Economic Index, as forecasted in the fourth quarter of the calendar year before
the rate year. The inflation adjustment
must be based on the 12-month period from the midpoint of the previous rate
year to the midpoint of the rate year for which the rate is being determined.
(i) (j) Entities
who discontinue providing services must be subject to a settle-up process
whereby actual costs and reimbursement for the previous 12 months are compared. In the event that the entity was paid more
than the entity's actual costs plus any applicable performance-related funding
due the provider, the excess payment must be reimbursed to the department. If a provider's revenue is less than actual
allowed costs due to lower utilization than projected, the commissioner may
reimburse the provider to recover its actual allowable costs. The resulting adjustments by the commissioner
must be proportional to the percent of total units of service reimbursed by the
commissioner and must reflect a difference of greater than five percent.
(j) (k) A provider may request of the commissioner a review of any rate-setting decision made under this subdivision.
EFFECTIVE DATE. This
section is effective January 1, 2024, or upon federal approval, whichever is
later. The commissioner of human
services shall notify the revisor of statutes when federal approval is
obtained.
Sec. 11. Minnesota Statutes 2022, section 256B.0625, subdivision 9, is amended to read:
Subd. 9. Dental services. (a) Medical assistance covers medically necessary dental services.
(b) Medical assistance
dental coverage for nonpregnant adults is limited to the following services:
(1) comprehensive exams,
limited to once every five years;
(2) periodic exams,
limited to one per year;
(3) limited exams;
(4) bitewing x-rays,
limited to one per year;
(5) periapical x-rays;
(6) panoramic x-rays,
limited to one every five years except (1) when medically necessary for the
diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2)
once every two years for patients who cannot cooperate for intraoral film due to
a developmental disability or medical condition that does not allow for
intraoral film placement;
(7) prophylaxis, limited
to one per year;
(8) application of
fluoride varnish, limited to one per year;
(9) posterior fillings,
all at the amalgam rate;
(10) anterior fillings;
(11) endodontics, limited
to root canals on the anterior and premolars only;
(12) removable
prostheses, each dental arch limited to one every six years;
(13) oral surgery,
limited to extractions, biopsies, and incision and drainage of abscesses;
(14) palliative treatment
and sedative fillings for relief of pain;
(15) full-mouth
debridement, limited to one every five years; and
(16) nonsurgical
treatment for periodontal disease, including scaling and root planing once
every two years for each quadrant, and routine periodontal maintenance
procedures.
(c) In addition to the
services specified in paragraph (b), medical assistance covers the following
services for adults, if provided in an outpatient hospital setting or
freestanding ambulatory surgical center as part of outpatient dental surgery:
(1) periodontics, limited
to periodontal scaling and root planing once every two years;
(2) general anesthesia; and
(3) full-mouth survey
once every five years.
(d) Medical assistance
covers medically necessary dental services for children and pregnant women. (b) The following guidelines apply to
dental services:
(1) posterior fillings are paid at the amalgam rate;
(2) application of sealants
are covered once every five years per permanent molar for children only;
and
(3) application of fluoride
varnish is covered once every six months; and.
(4) orthodontia is
eligible for coverage for children only.
(e) (c) In
addition to the services specified in paragraphs paragraph (b) and
(c), medical assistance covers the following services for adults:
(1) house calls or extended care facility calls for on-site delivery of covered services;
(2) behavioral management when additional staff time is required to accommodate behavioral challenges and sedation is not used;
(3) oral or IV sedation, if the covered dental service cannot be performed safely without it or would otherwise require the service to be performed under general anesthesia in a hospital or surgical center; and
(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but no more than four times per year.
(f) (d) The
commissioner shall not require prior authorization for the services included in
paragraph (e) (c), clauses (1) to (3), and shall prohibit managed
care and county-based purchasing plans from requiring prior authorization for
the services included in paragraph (e) (c), clauses (1) to (3),
when provided under sections 256B.69, 256B.692, and 256L.12.
EFFECTIVE DATE. This
section is effective January 1, 2024, or upon federal approval, whichever is
later. The commissioner of human
services shall notify the revisor of statutes when federal approval is
obtained.
Sec. 12. Minnesota Statutes 2022, section 256B.0625, subdivision 13, is amended to read:
Subd. 13. Drugs. (a) Medical assistance covers drugs, except for fertility drugs when specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed by a licensed pharmacist, by a physician enrolled in the medical assistance program as a dispensing physician, or by a physician, a physician assistant, or an advanced practice registered nurse employed by or under contract with a community health board as defined in section 145A.02, subdivision 5, for the purposes of communicable disease control.
(b) The dispensed quantity
of a prescription drug must not exceed a 34-day supply, unless
authorized by the commissioner or as provided in paragraph (h) or the
drug appears on the 90-day supply list published by the commissioner. The 90-day supply list shall be published by
the commissioner on the department's website.
The commissioner may add to, delete from, and otherwise modify the
90-day supply list after providing public notice and the opportunity for a
15-day public comment period. The 90-day
supply list may include cost-effective generic drugs and shall not include
controlled substances.
(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical ingredient" is defined as a substance that is represented for use in a drug and when used in the manufacturing, processing, or packaging of a drug becomes an active ingredient of the drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and excipients which are included in the medical assistance formulary. Medical assistance covers selected active pharmaceutical ingredients and excipients used in compounded prescriptions when the compounded combination is specifically approved by the commissioner or when a commercially available product:
(1) is not a therapeutic option for the patient;
(2) does not exist in the same combination of active ingredients in the same strengths as the compounded prescription; and
(3) cannot be used in place of the active pharmaceutical ingredient in the compounded prescription.
(d) Medical assistance covers the following over-the-counter drugs when prescribed by a licensed practitioner or by a licensed pharmacist who meets standards established by the commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults with documented vitamin deficiencies, vitamins for children under the age of seven and pregnant or nursing women, and any other over-the-counter drug identified by the commissioner, in consultation with the Formulary Committee, as necessary, appropriate, and cost-effective for the treatment of certain specified chronic diseases, conditions, or disorders, and this determination shall not be subject to the requirements of chapter 14. A pharmacist may prescribe over-the-counter medications as provided under this paragraph for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter drugs under this paragraph, licensed pharmacists must consult with the recipient to determine necessity, provide drug counseling, review drug therapy for potential adverse interactions, and make referrals as needed to other health care professionals.
(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible for drug coverage as defined in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these individuals, medical assistance may cover drugs from the drug classes listed in United States Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to 13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall not be covered.
(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing Program and dispensed by 340B covered entities and ambulatory pharmacies under common ownership of the 340B covered entity. Medical assistance does not cover drugs acquired through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section 151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed pharmacist in accordance with section 151.37, subdivision 16.
(h) Medical assistance
coverage for a prescription contraceptive must provide a 12-month supply for
any prescription contraceptive if a 12-month supply is prescribed by the
prescribing health care provider. The
prescribing health care provider must determine the appropriate duration for
which to prescribe the prescription contraceptives, up to 12 months. For purposes of this paragraph,
"prescription contraceptive" means any drug or device that requires a
prescription and is approved by the Food and Drug Administration to prevent
pregnancy.
Prescription contraceptive
does not include an emergency contraceptive drug approved to prevent pregnancy
when administered after sexual contact. For
purposes of this paragraph, "health plan" has the meaning provided in
section 62Q.01, subdivision 3.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 13. Minnesota Statutes 2022, section 256B.0625, subdivision 13c, is amended to read:
Subd. 13c. Formulary
Committee. The commissioner, after
receiving recommendations from professional medical associations and
professional pharmacy associations, and consumer groups shall designate a
Formulary Committee to carry out duties as described in subdivisions 13 to 13g. The Formulary Committee shall be comprised of
four at least five licensed physicians actively engaged in the
practice of medicine in Minnesota, one of whom must be actively engaged in
the treatment of persons with mental illness is an actively practicing
psychiatrist, one of whom specializes in the diagnosis and treatment of rare
diseases, one of whom specializes in pediatrics, and one of whom actively
treats persons with disabilities; at least three licensed pharmacists
actively engaged in the practice of pharmacy in Minnesota, one of whom
practices outside the metropolitan counties listed in section 473.121,
subdivision 4, one of whom practices in the metropolitan counties listed in
section 473.121, subdivision 4, and one of whom is a practicing hospital
pharmacist; and one at least two consumer representative
representatives, all of whom must have a personal or professional connection
to medical assistance; and one representative designated by the
Minnesota Rare Disease Advisory Council established under section 256.4835;
the remainder to be made up of health care professionals who are licensed in
their field and have recognized knowledge in the clinically appropriate
prescribing, dispensing, and monitoring of covered outpatient drugs. Members of the Formulary Committee shall not
be employed by the Department of Human Services or have a personal interest
in a pharmaceutical company, pharmacy benefits manager, health plan company, or
their affiliate organizations, but the committee shall be staffed by an
employee of the department who shall serve as an ex officio, nonvoting member
of the committee. For the purposes of
this subdivision, "personal interest" means that a person owns at
least five percent of the voting interest or equity interest in the entity, the
equity interest owned by a person represents at least five percent of that person's
net worth, or more than five percent of a person's gross income for the
preceding year was derived from the entity.
A committee member must notify the committee of any potential conflict
of interest and recuse themselves from any communications, discussion, or vote
on any matter where a conflict of interest exists. A conflict of interest alone, without a
personal interest, does not preclude an applicant from serving as a member of
the Formulary Committee. Members may be
removed from the committee for cause after a recommendation for removal by a
majority of the committee membership. For
the purposes of this subdivision, "cause" does not include offering a
differing or dissenting clinical opinion on a drug or drug class. The department's medical director shall also
serve as an ex officio, nonvoting member for the committee. Committee members shall serve three-year
terms and may be reappointed twice by the commissioner. The committee members shall vote on a
chair and vice chair from among their membership. The chair shall preside over all committee
meetings, and the vice chair shall preside over the meetings if the chair is
not present. The Formulary Committee
shall meet at least twice three times per year. The commissioner may require more frequent
Formulary Committee meetings as needed. An
honorarium of $100 per meeting and reimbursement for mileage shall be paid to
each committee member in attendance. The
Formulary Committee expires June 30, 2023 2027. The Formulary Committee is subject to the
Open Meeting Law under chapter 13D. For
purposes of establishing a quorum to transact business, vacant committee member
positions do not count in the calculation as long as at least 60 percent of the
committee member positions are filled.
EFFECTIVE DATE. This
section is effective the day following final enactment.
Sec. 14. Minnesota Statutes 2022, section 256B.0625, subdivision 13e, is amended to read:
Subd. 13e. Payment rates. (a) The basis for determining the amount of payment shall be the lower of the ingredient costs of the drugs plus the professional dispensing fee; or the usual and customary price charged to the public. The usual and customary price means the lowest price charged by the provider to a patient who pays for the
prescription by cash, check, or charge account and includes prices the pharmacy charges to a patient enrolled in a prescription savings club or prescription discount club administered by the pharmacy or pharmacy chain. The amount of payment basis must be reduced to reflect all discount amounts applied to the charge by any third-party provider/insurer agreement or contract for submitted charges to medical assistance programs. The net submitted charge may not be greater than the patient liability for the service. The professional dispensing fee shall be $10.77 for prescriptions filled with legend drugs meeting the definition of "covered outpatient drugs" according to United States Code, title 42, section 1396r-8(k)(2). The dispensing fee for intravenous solutions that must be compounded by the pharmacist shall be $10.77 per claim. The professional dispensing fee for prescriptions filled with over-the-counter drugs meeting the definition of covered outpatient drugs shall be $10.77 for dispensed quantities equal to or greater than the number of units contained in the manufacturer's original package. The professional dispensing fee shall be prorated based on the percentage of the package dispensed when the pharmacy dispenses a quantity less than the number of units contained in the manufacturer's original package. The pharmacy dispensing fee for prescribed over‑the-counter drugs not meeting the definition of covered outpatient drugs shall be $3.65 for quantities equal to or greater than the number of units contained in the manufacturer's original package and shall be prorated based on the percentage of the package dispensed when the pharmacy dispenses a quantity less than the number of units contained in the manufacturer's original package. The National Average Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost of a drug. For drugs for which a NADAC is not reported, the commissioner shall estimate the ingredient cost at the wholesale acquisition cost minus two percent. The ingredient cost of a drug for a provider participating in the federal 340B Drug Pricing Program shall be either the 340B Drug Pricing Program ceiling price established by the Health Resources and Services Administration or NADAC, whichever is lower. Wholesale acquisition cost is defined as the manufacturer's list price for a drug or biological to wholesalers or direct purchasers in the United States, not including prompt pay or other discounts, rebates, or reductions in price, for the most recent month for which information is available, as reported in wholesale price guides or other publications of drug or biological pricing data. The maximum allowable cost of a multisource drug may be set by the commissioner and it shall be comparable to the actual acquisition cost of the drug product and no higher than the NADAC of the generic product. Establishment of the amount of payment for drugs shall not be subject to the requirements of the Administrative Procedure Act.
(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using an automated drug distribution system meeting the requirements of section 151.58, or a packaging system meeting the packaging standards set forth in Minnesota Rules, part 6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ retrospective billing for prescription drugs dispensed to long-term care facility residents. A retrospectively billing pharmacy must submit a claim only for the quantity of medication used by the enrolled recipient during the defined billing period. A retrospectively billing pharmacy must use a billing period not less than one calendar month or 30 days.
(c) A pharmacy provider using packaging that meets the standards set forth in Minnesota Rules, part 6800.2700, is required to credit the department for the actual acquisition cost of all unused drugs that are eligible for reuse, unless the pharmacy is using retrospective billing. The commissioner may permit the drug clozapine to be dispensed in a quantity that is less than a 30-day supply.
(d) If a pharmacy dispenses a multisource drug, the ingredient cost shall be the NADAC of the generic product or the maximum allowable cost established by the commissioner unless prior authorization for the brand name product has been granted according to the criteria established by the Drug Formulary Committee as required by subdivision 13f, paragraph (a), and the prescriber has indicated "dispense as written" on the prescription in a manner consistent with section 151.21, subdivision 2.
(e) The basis for determining the amount of payment for drugs administered in an outpatient setting shall be the lower of the usual and customary cost submitted by the provider, 106 percent of the average sales price as determined by the United States Department of Health and Human Services pursuant to title XVIII, section 1847a of the federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost set by the
commissioner. If average sales price is unavailable, the amount of payment must be lower of the usual and customary cost submitted by the provider, the wholesale acquisition cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner. The commissioner shall discount the payment rate for drugs obtained through the federal 340B Drug Pricing Program by 28.6 percent. The payment for drugs administered in an outpatient setting shall be made to the administering facility or practitioner. A retail or specialty pharmacy dispensing a drug for administration in an outpatient setting is not eligible for direct reimbursement.
(f) The commissioner may establish maximum allowable cost rates for specialty pharmacy products that are lower than the ingredient cost formulas specified in paragraph (a). The commissioner may require individuals enrolled in the health care programs administered by the department to obtain specialty pharmacy products from providers with whom the commissioner has negotiated lower reimbursement rates. Specialty pharmacy products are defined as those used by a small number of recipients or recipients with complex and chronic diseases that require expensive and challenging drug regimens. Examples of these conditions include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of cancer. Specialty pharmaceutical products include injectable and infusion therapies, biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies that require complex care. The commissioner shall consult with the Formulary Committee to develop a list of specialty pharmacy products subject to maximum allowable cost reimbursement. In consulting with the Formulary Committee in developing this list, the commissioner shall take into consideration the population served by specialty pharmacy products, the current delivery system and standard of care in the state, and access to care issues. The commissioner shall have the discretion to adjust the maximum allowable cost to prevent access to care issues.
(g) Home infusion therapy services provided by home infusion therapy pharmacies must be paid at rates according to subdivision 8d.
(h) The commissioner shall contract
with a vendor to conduct a cost of dispensing survey for all pharmacies that
are physically located in the state of Minnesota that dispense outpatient drugs
under medical assistance. The
commissioner shall ensure that the vendor has prior experience in conducting
cost of dispensing surveys. Each
pharmacy enrolled with the department to dispense outpatient prescription drugs
to fee-for-service members must respond to the cost of dispensing survey. The commissioner may sanction a pharmacy
under section 256B.064 for failure to respond.
The commissioner shall require the vendor to measure a single statewide
cost of dispensing for specialty prescription drugs and a single statewide cost
of dispensing for nonspecialty prescription drugs for all responding pharmacies
to measure the mean, mean weighted by total prescription volume, mean weighted
by medical assistance prescription volume, median, median weighted by total
prescription volume, and median weighted by total medical assistance
prescription volume. The commissioner
shall post a copy of the final cost of dispensing survey report on the
department's website. The initial survey
must be completed no later than January 1, 2021, and repeated every three years. The commissioner shall provide a summary of
the results of each cost of dispensing survey and provide recommendations for
any changes to the dispensing fee to the chairs and ranking members of the
legislative committees with jurisdiction over medical assistance pharmacy
reimbursement. Notwithstanding
section 256.01, subdivision 42, this paragraph does not expire.
(i) The commissioner shall increase the ingredient cost reimbursement calculated in paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to the wholesale drug distributor tax under section 295.52.
EFFECTIVE DATE. This
section is effective the day following final enactment.
Sec. 15. Minnesota Statutes 2022, section 256B.0625, subdivision 13f, is amended to read:
Subd. 13f. Prior authorization. (a) The Formulary Committee shall review and recommend drugs which require prior authorization. The Formulary Committee shall establish general criteria to be used for the prior authorization of brand-name drugs for which generically equivalent drugs are available, but the committee is not required to review each brand-name drug for which a generically equivalent drug is available.
(b) Prior authorization may be required by the commissioner before certain formulary drugs are eligible for payment. The Formulary Committee may recommend drugs for prior authorization directly to the commissioner. The commissioner may also request that the Formulary Committee review a drug for prior authorization. Before the commissioner may require prior authorization for a drug:
(1) the commissioner must provide information to the Formulary Committee on the impact that placing the drug on prior authorization may have on the quality of patient care and on program costs, information regarding whether the drug is subject to clinical abuse or misuse, and relevant data from the state Medicaid program if such data is available;
(2) the Formulary Committee must review the drug, taking into account medical and clinical data and the information provided by the commissioner; and
(3) the Formulary Committee must hold a public forum and receive public comment for an additional 15 days.
The commissioner must provide a 15-day notice period before implementing the prior authorization.
(c) Except as provided in subdivision 13j, prior authorization shall not be required or utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if:
(1) there is no generically equivalent drug available; and
(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
(3) the drug is part of the recipient's current course of treatment.
This paragraph applies to any multistate preferred drug list or supplemental drug rebate program established or administered by the commissioner. Prior authorization shall automatically be granted for 60 days for brand name drugs prescribed for treatment of mental illness within 60 days of when a generically equivalent drug becomes available, provided that the brand name drug was part of the recipient's course of treatment at the time the generically equivalent drug became available.
(d) Prior authorization
must not be required for liquid methadone if only one version of liquid
methadone is available. If more than one
version of liquid methadone is available, the commissioner shall ensure that at
least one version of liquid methadone is available without prior authorization.
(e) Prior authorization may be required for an oral liquid form of a drug, except as described in paragraph (d). A prior authorization request under this paragraph must be automatically approved within 24 hours if the drug is being prescribed for a Food and Drug Administration-approved condition for a patient who utilizes an enteral tube for feedings or medication administration, even if the patient has current or prior claims for pills for that condition. If more than one version of the oral liquid form of a drug is available, the commissioner may select the version that is able to be approved for a Food and Drug Administration-approved condition for a patient who utilizes an enteral tube for feedings or medication administration. This paragraph applies to any multistate preferred drug list or supplemental drug rebate program established or administered by the commissioner. The commissioner shall design and implement a streamlined prior authorization form for patients who utilize an enteral tube for feedings or medication administration and are prescribed an oral liquid form of a drug. The commissioner may require prior authorization for brand name drugs whenever a generically equivalent product is available, even if the prescriber specifically indicates "dispense as written-brand necessary" on the prescription as required by section 151.21, subdivision 2.
(e) (f) Notwithstanding this subdivision, the commissioner may automatically require prior authorization, for a period not to exceed 180 days, for any drug that is approved by the United States Food and Drug Administration on or after July 1, 2005. The 180-day period begins no later than the first day that a drug is available for shipment to pharmacies within the state. The Formulary Committee shall recommend to the commissioner general criteria to be used for the prior authorization of the drugs, but the committee is not required to review each individual drug. In order to continue prior authorizations for a drug after the 180-day period has expired, the commissioner must follow the provisions of this subdivision.
(f) (g) Prior
authorization under this subdivision shall comply with section 62Q.184.
(g) (h) Any
step therapy protocol requirements established by the commissioner must comply
with section 62Q.1841.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 16. Minnesota Statutes 2022, section 256B.0625, subdivision 13g, is amended to read:
Subd. 13g. Preferred
drug list. (a) The commissioner
shall adopt and implement a preferred drug list by January 1, 2004. The commissioner may enter into a contract
with a vendor for the purpose of participating in a preferred drug list and
supplemental rebate program. The
terms of the contract with the vendor must be publicly disclosed on the website
of the Department of Human Services.
The commissioner shall ensure that any contract meets all federal
requirements and maximizes federal financial participation. The commissioner shall publish the preferred
drug list annually in the State Register and shall maintain an accurate and
up-to-date list on the agency website. The
commissioner shall implement and maintain an accurate archive of previous
versions of the preferred drug list, and make this archive available to the
public on the website of the Department of Human Services beginning January 1,
2024.
(b) The commissioner may add
to, delete from, and otherwise modify the preferred drug list, after consulting
with the Formulary Committee and appropriate medical specialists and,
providing public notice and the opportunity for public comment, and
complying with the requirements of paragraph (f).
(c) The commissioner shall adopt and administer the preferred drug list as part of the administration of the supplemental drug rebate program. Reimbursement for prescription drugs not on the preferred drug list may be subject to prior authorization.
(d) For purposes of this
subdivision, the following terms have the meanings given:
(1) "appropriate
medical specialist" means a medical professional who prescribes the
relevant class of drug as part of their practice; and
(2) "preferred drug list" means a list of prescription drugs within designated therapeutic classes selected by the commissioner, for which prior authorization based on the identity of the drug or class is not required.
(e) The commissioner shall seek any federal waivers or approvals necessary to implement this subdivision.
(f) Notwithstanding
paragraph (b), Before the commissioner may delete a drug from the preferred
drug list or modify the inclusion of a drug on the preferred drug list, the
commissioner shall consider any implications that the deletion or modification
may have on state public health policies or initiatives and any impact that the
deletion or modification may have on increasing health disparities in the state. Prior to deleting a drug or modifying the
inclusion of a drug, the commissioner shall also conduct a public hearing. The commissioner shall provide adequate
notice to the public and the commissioner of health prior to the hearing that
specifies the drug that the commissioner
is proposing to delete or
modify, and shall disclose any public medical or clinical analysis that
the commissioner has relied on in proposing the deletion or modification,
and evidence that the commissioner has evaluated the impact of the proposed
deletion or modification on public health and health disparities. Notwithstanding section 331A.05, a public
notice of a Formulary Committee meeting must be published at least 30 days in
advance of the meeting. The list of
drugs to be discussed at the meeting must be announced at least 30 days before
the meeting and must include the name and class of drug, the proposed action,
and the proposed prior authorization requirements, if applicable.
Sec. 17. Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision to read:
Subd. 13k. Value-based
purchasing arrangements. (a)
The commissioner may enter into a value-based purchasing arrangement under
medical assistance or MinnesotaCare, by written arrangement with a drug
manufacturer based on agreed-upon metrics.
The commissioner may contract with a vendor to implement and administer
the value-based purchasing arrangement. A
value-based purchasing arrangement may include but is not limited to rebates,
discounts, price reductions, risk sharing, reimbursements, guarantees, shared
savings payments, withholds, or bonuses.
A value-based purchasing arrangement must provide at least the same
value or discount in the aggregate as would
claiming the mandatory federal drug rebate under the Federal Social Security
Act, section 1927.
(b) Nothing in this section shall be interpreted as requiring a drug manufacturer or the commissioner to enter into an arrangement as described in paragraph (a).
(c) Nothing in this section shall be interpreted as altering or modifying medical assistance coverage requirements under the federal Social Security Act, section 1927.
(d) If the commissioner
determines that a state plan amendment is necessary before implementing a
value-based purchasing arrangement, the commissioner shall request the
amendment and may delay implementing this provision until the amendment is
approved.
EFFECTIVE DATE. This
section is effective July 1, 2023.
Sec. 18. Minnesota Statutes 2022, section 256B.0625, subdivision 16, is amended to read:
Subd. 16. Abortion
services. Medical assistance covers
abortion services, but only if one of the following conditions is met: determined
to be medically necessary by the treating provider and delivered in accordance
with all applicable Minnesota laws.
(a) The abortion is a
medical necessity. "Medical
necessity" means (1) the signed written statement of two physicians
indicating the abortion is medically necessary to prevent the death of the
mother, and (2) the patient has given her consent to the abortion in writing
unless the patient is physically or legally incapable of providing informed
consent to the procedure, in which case consent will be given as otherwise
provided by law;
(b) The pregnancy is the
result of criminal sexual conduct as defined in section 609.342, subdivision 1,
clauses (a), (b), (c)(i) and (ii), and (e), and subdivision 1a, clauses (a),
(b), (c)(i) and (ii), and (d), and the incident is reported within 48 hours
after the incident occurs to a valid law enforcement agency for investigation,
unless the victim is physically unable to report the criminal sexual conduct,
in which case the report shall be made within 48 hours after the victim becomes
physically able to report the criminal sexual conduct; or
(c) The pregnancy is the
result of incest, but only if the incident and relative are reported to a valid
law enforcement agency for investigation prior to the abortion.
EFFECTIVE DATE. This
section is effective the day following final enactment.
Sec. 19. Minnesota Statutes 2022, section 256B.0625, subdivision 28b, is amended to read:
Subd. 28b. Doula
services. Medical assistance covers
doula services provided by a certified doula as defined in section 148.995,
subdivision 2, of the mother's choice. For
purposes of this section, "doula services" means childbirth education
and support services, including emotional and physical support provided during
pregnancy, labor, birth, and postpartum.
The commissioner shall enroll doula agencies and individual treating
doulas to provide direct reimbursement.
EFFECTIVE DATE. This
section is effective January 1, 2024, or upon federal approval, whichever is
later. The commissioner of human
services shall notify the revisor of statutes when federal approval is
obtained.
Sec. 20. Minnesota Statutes 2022, section 256B.0625, subdivision 30, is amended to read:
Subd. 30. Other clinic services. (a) Medical assistance covers rural health clinic services, federally qualified health center services, nonprofit community health clinic services, and public health clinic services. Rural health clinic services and federally qualified health center services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and (C). Payment for rural health clinic and federally qualified health center services shall be made according to applicable federal law and regulation.
(b) A federally qualified health center (FQHC) that is beginning initial operation shall submit an estimate of budgeted costs and visits for the initial reporting period in the form and detail required by the commissioner. An FQHC that is already in operation shall submit an initial report using actual costs and visits for the initial reporting period. Within 90 days of the end of its reporting period, an FQHC shall submit, in the form and detail required by the commissioner, a report of its operations, including allowable costs actually incurred for the period and the actual number of visits for services furnished during the period, and other information required by the commissioner. FQHCs that file Medicare cost reports shall provide the commissioner with a copy of the most recent Medicare cost report filed with the Medicare program intermediary for the reporting year which support the costs claimed on their cost report to the state.
(c) In order to continue cost-based payment under the medical assistance program according to paragraphs (a) and (b), an FQHC or rural health clinic must apply for designation as an essential community provider within six months of final adoption of rules by the Department of Health according to section 62Q.19, subdivision 7. For those FQHCs and rural health clinics that have applied for essential community provider status within the six-month time prescribed, medical assistance payments will continue to be made according to paragraphs (a) and (b) for the first three years after application. For FQHCs and rural health clinics that either do not apply within the time specified above or who have had essential community provider status for three years, medical assistance payments for health services provided by these entities shall be according to the same rates and conditions applicable to the same service provided by health care providers that are not FQHCs or rural health clinics.
(d) Effective July 1, 1999, the provisions of paragraph (c) requiring an FQHC or a rural health clinic to make application for an essential community provider designation in order to have cost-based payments made according to paragraphs (a) and (b) no longer apply.
(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
(f) Effective January 1, 2001, through December 31, 2020, each FQHC and rural health clinic may elect to be paid either under the prospective payment system established in United States Code, title 42, section 1396a(aa), or under an alternative payment methodology consistent with the requirements of United States Code, title 42, section 1396a(aa), and approved by the Centers for Medicare and Medicaid Services. The alternative payment methodology shall be 100 percent of cost as determined according to Medicare cost principles.
(g) Effective for services provided on or after January 1, 2021, all claims for payment of clinic services provided by FQHCs and rural health clinics shall be paid by the commissioner, according to an annual election by the FQHC or rural health clinic, under the current prospective payment system described in paragraph (f) or the alternative payment methodology described in paragraph (l), or, upon federal approval, for FQHCs that are also urban Indian organizations under Title V of the federal Indian Health Improvement Act, as provided under paragraph (k).
(h) For purposes of this section, "nonprofit community clinic" is a clinic that:
(1) has nonprofit status as specified in chapter 317A;
(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
(3) is established to provide health services to low-income population groups, uninsured, high-risk and special needs populations, underserved and other special needs populations;
(4) employs professional staff at least one-half of which are familiar with the cultural background of their clients;
(5) charges for services on a sliding fee scale designed to provide assistance to low-income clients based on current poverty income guidelines and family size; and
(6) does not restrict access or services because of a client's financial limitations or public assistance status and provides no-cost care as needed.
(i) Effective for services provided on or after January 1, 2015, all claims for payment of clinic services provided by FQHCs and rural health clinics shall be paid by the commissioner. the commissioner shall determine the most feasible method for paying claims from the following options:
(1) FQHCs and rural health clinics submit claims directly to the commissioner for payment, and the commissioner provides claims information for recipients enrolled in a managed care or county-based purchasing plan to the plan, on a regular basis; or
(2) FQHCs and rural health clinics submit claims for recipients enrolled in a managed care or county-based purchasing plan to the plan, and those claims are submitted by the plan to the commissioner for payment to the clinic.
(j) For clinic services provided prior to January 1, 2015, the commissioner shall calculate and pay monthly the proposed managed care supplemental payments to clinics, and clinics shall conduct a timely review of the payment calculation data in order to finalize all supplemental payments in accordance with federal law. Any issues arising from a clinic's review must be reported to the commissioner by January 1, 2017. Upon final agreement between the commissioner and a clinic on issues identified under this subdivision, and in accordance with United States Code, title 42, section 1396a(bb), no supplemental payments for managed care plan or county-based purchasing plan claims for services provided prior to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are unable to resolve issues under this subdivision, the parties shall submit the dispute to the arbitration process under section 14.57.
(k) The commissioner
shall seek a federal waiver, authorized under section 1115 of the Social
Security Act, to obtain federal financial participation at the 100 percent
federal matching percentage available to facilities of the Indian Health
Service or tribal organization in accordance with section 1905(b) of the Social
Security Act for expenditures made to organizations dually certified under
Title V of the Indian Health Care Improvement Act, Public Law 94-437, and as a
federally qualified health center under paragraph (a) that
provides services to American
Indian and Alaskan Native individuals eligible for services under this
subdivision.
(k) The commissioner
shall establish an encounter payment rate that is equivalent to the all
inclusive rate (AIR) payment established by the Indian Health Service and
published in the Federal Register. The
encounter rate must be updated annually and must reflect the changes in the AIR
established by the Indian Health Service each calendar year. FQHCs that are also urban Indian
organizations under Title V of the federal Indian Health Improvement Act may
elect to be paid: (1) at the encounter
rate established under this paragraph; (2) under the alternative payment
methodology described in paragraph (l); or (3) under the federally required
prospective payment system described in paragraph (f). FQHCs that elect to be paid at the encounter
rate established under this paragraph must continue to meet all state and
federal requirements related to FQHCs and urban Indian organizations, and must
maintain their statuses as FQHCs and urban Indian organizations.
(l) All claims for payment of clinic services provided by FQHCs and rural health clinics, that have elected to be paid under this paragraph, shall be paid by the commissioner according to the following requirements:
(1) the commissioner shall establish a single medical and single dental organization encounter rate for each FQHC and rural health clinic when applicable;
(2) each FQHC and rural health clinic is eligible for same day reimbursement of one medical and one dental organization encounter rate if eligible medical and dental visits are provided on the same day;
(3) the commissioner shall reimburse FQHCs and rural health clinics, in accordance with current applicable Medicare cost principles, their allowable costs, including direct patient care costs and patient-related support services. Nonallowable costs include, but are not limited to:
(i) general social services and administrative costs;
(ii) retail pharmacy;
(iii) patient incentives, food, housing assistance, and utility assistance;
(iv) external lab and x-ray;
(v) navigation services;
(vi) health care taxes;
(vii) advertising, public relations, and marketing;
(viii) office entertainment costs, food, alcohol, and gifts;
(ix) contributions and donations;
(x) bad debts or losses on awards or contracts;
(xi) fines, penalties, damages, or other settlements;
(xii) fundraising, investment management, and associated administrative costs;
(xiii) research and associated administrative costs;
(xiv) nonpaid workers;
(xv) lobbying;
(xvi) scholarships and student aid; and
(xvii) nonmedical assistance covered services;
(4) the commissioner shall review the list of nonallowable costs in the years between the rebasing process established in clause (5), in consultation with the Minnesota Association of Community Health Centers, FQHCs, and rural health clinics. The commissioner shall publish the list and any updates in the Minnesota health care programs provider manual;
(5) the initial applicable base year organization encounter rates for FQHCs and rural health clinics shall be computed for services delivered on or after January 1, 2021, and:
(i) must be determined using each FQHC's and rural health clinic's Medicare cost reports from 2017 and 2018;
(ii) must be according to current applicable Medicare cost principles as applicable to FQHCs and rural health clinics without the application of productivity screens and upper payment limits or the Medicare prospective payment system FQHC aggregate mean upper payment limit;
(iii) must be subsequently rebased every two years thereafter using the Medicare cost reports that are three and four years prior to the rebasing year. Years in which organizational cost or claims volume is reduced or altered due to a pandemic, disease, or other public health emergency shall not be used as part of a base year when the base year includes more than one year. The commissioner may use the Medicare cost reports of a year unaffected by a pandemic, disease, or other public health emergency, or previous two consecutive years, inflated to the base year as established under item (iv);
(iv) must be inflated to the base year using the inflation factor described in clause (6); and
(v) the commissioner must provide for a 60-day appeals process under section 14.57;
(6) the commissioner shall annually inflate the applicable organization encounter rates for FQHCs and rural health clinics from the base year payment rate to the effective date by using the CMS FQHC Market Basket inflator established under United States Code, title 42, section 1395m(o), less productivity;
(7) FQHCs and rural health clinics that have elected the alternative payment methodology under this paragraph shall submit all necessary documentation required by the commissioner to compute the rebased organization encounter rates no later than six months following the date the applicable Medicare cost reports are due to the Centers for Medicare and Medicaid Services;
(8) the commissioner shall reimburse FQHCs and rural health clinics an additional amount relative to their medical and dental organization encounter rates that is attributable to the tax required to be paid according to section 295.52, if applicable;
(9) FQHCs and rural health clinics may submit change of scope requests to the commissioner if the change of scope would result in an increase or decrease of 2.5 percent or higher in the medical or dental organization encounter rate currently received by the FQHC or rural health clinic;
(10) for FQHCs and rural health clinics seeking a change in scope with the commissioner under clause (9) that requires the approval of the scope change by the federal Health Resources Services Administration:
(i) FQHCs and rural health clinics shall submit the change of scope request, including the start date of services, to the commissioner within seven business days of submission of the scope change to the federal Health Resources Services Administration;
(ii) the commissioner shall establish the effective date of the payment change as the federal Health Resources Services Administration date of approval of the FQHC's or rural health clinic's scope change request, or the effective start date of services, whichever is later; and
(iii) within 45 days of one year after the effective date established in item (ii), the commissioner shall conduct a retroactive review to determine if the actual costs established under clause (3) or encounters result in an increase or decrease of 2.5 percent or higher in the medical or dental organization encounter rate, and if this is the case, the commissioner shall revise the rate accordingly and shall adjust payments retrospectively to the effective date established in item (ii);
(11) for change of scope requests that do not require federal Health Resources Services Administration approval, the FQHC and rural health clinic shall submit the request to the commissioner before implementing the change, and the effective date of the change is the date the commissioner received the FQHC's or rural health clinic's request, or the effective start date of the service, whichever is later. The commissioner shall provide a response to the FQHC's or rural health clinic's request within 45 days of submission and provide a final approval within 120 days of submission. This timeline may be waived at the mutual agreement of the commissioner and the FQHC or rural health clinic if more information is needed to evaluate the request;
(12) the commissioner, when establishing organization encounter rates for new FQHCs and rural health clinics, shall consider the patient caseload of existing FQHCs and rural health clinics in a 60-mile radius for organizations established outside of the seven-county metropolitan area, and in a 30-mile radius for organizations in the seven‑county metropolitan area. If this information is not available, the commissioner may use Medicare cost reports or audited financial statements to establish base rates;
(13) the commissioner shall establish a quality measures workgroup that includes representatives from the Minnesota Association of Community Health Centers, FQHCs, and rural health clinics, to evaluate clinical and nonclinical measures; and
(14) the commissioner shall not disallow or reduce costs that are related to an FQHC's or rural health clinic's participation in health care educational programs to the extent that the costs are not accounted for in the alternative payment methodology encounter rate established in this paragraph.
(m) Effective July 1,
2023, an enrolled Indian health service facility or a Tribal health center
operating under a 638 contract or compact may elect to also enroll as a Tribal
FQHC. Requirements that otherwise apply
to an FQHC covered in this subdivision do not apply to a Tribal FQHC enrolled
under this paragraph, except that any requirements necessary to comply with
federal regulations do apply to a Tribal FQHC.
The commissioner shall establish an alternative payment method for a
Tribal FQHC enrolled under this paragraph that uses the same method and rates
applicable to a Tribal facility or health center that does not enroll as a
Tribal FQHC.
EFFECTIVE DATE. This
section is effective January 1, 2026, or upon federal approval, whichever is
later, except that paragraph (m) is effective July 1, 2023, or upon federal
approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
Sec. 21. Minnesota Statutes 2022, section 256B.0625, subdivision 31, is amended to read:
Subd. 31. Medical supplies and equipment. (a) Medical assistance covers medical supplies and equipment. Separate payment outside of the facility's payment rate shall be made for wheelchairs and wheelchair accessories for recipients who are residents of intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions and limitations as coverage for recipients who do not reside in institutions. A wheelchair purchased outside of the facility's payment rate is the property of the recipient.
(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies must enroll as a Medicare provider.
(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment requirement if:
(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic, or medical supply;
(2) the vendor serves ten or fewer medical assistance recipients per year;
(3) the commissioner finds that other vendors are not available to provide same or similar durable medical equipment, prosthetics, orthotics, or medical supplies; and
(4) the vendor complies with all screening requirements in this chapter and Code of Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare and Medicaid Services approved national accreditation organization as complying with the Medicare program's supplier and quality standards and the vendor serves primarily pediatric patients.
(d) Durable medical equipment means a device or equipment that:
(1) can withstand repeated use;
(2) is generally not useful in the absence of an illness, injury, or disability; and
(3) is provided to correct or accommodate a physiological disorder or physical condition or is generally used primarily for a medical purpose.
(e) Electronic tablets may be considered durable medical equipment if the electronic tablet will be used as an augmentative and alternative communication system as defined under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must be locked in order to prevent use not related to communication.
(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be locked to prevent use not as an augmentative communication device, a recipient of waiver services may use an electronic tablet for a use not related to communication when the recipient has been authorized under the waiver to receive one or more additional applications that can be loaded onto the electronic tablet, such that allowing the additional use prevents the purchase of a separate electronic tablet with waiver funds.
(g) An order or prescription for medical supplies, equipment, or appliances must meet the requirements in Code of Federal Regulations, title 42, part 440.70.
(h) Allergen-reducing products provided according to subdivision 67, paragraph (c) or (d), shall be considered durable medical equipment.
(i) Seizure detection
devices are covered as durable medical equipment under this subdivision if:
(1) the seizure detection
device is medically appropriate based on the recipient's medical condition or
status; and
(2) the recipient's
health care provider has identified that a seizure detection device would:
(i) likely assist in
reducing bodily harm to or death of the recipient as a result of the recipient
experiencing a seizure; or
(ii) provide data to the
health care provider necessary to appropriately diagnose or treat a health
condition of the recipient that causes the seizure activity.
(j) For purposes of
paragraph (i), "seizure detection device" means a United States Food
and Drug Administration-approved monitoring device and related service or
subscription supporting the prescribed use of the device, including technology
that provides ongoing patient monitoring and alert services that detect seizure
activity and transmit notification of the seizure activity to a caregiver for
appropriate medical response or collects data of the seizure activity of the
recipient that can be used by a health care provider to diagnose or
appropriately treat a health care condition that causes the seizure activity. The medical assistance reimbursement rate for
a subscription supporting the prescribed use of a seizure detection device is
60 percent of the rate for monthly remote monitoring under the medical
assistance telemonitoring benefit.
EFFECTIVE DATE. This
section is effective January 1, 2024, or upon federal approval, whichever is
later. The commissioner of human
services shall notify the revisor of statutes when federal approval is
obtained.
Sec. 22. Minnesota Statutes 2022, section 256B.0625, subdivision 34, is amended to read:
Subd. 34. Indian
health services facilities. (a)
Medical assistance payments and MinnesotaCare payments to facilities of the
Indian health service and facilities operated by a Tribe or Tribal organization
under funding authorized by United States Code, title 25, sections 450f to
450n, or title III of the Indian Self-Determination and Education Assistance
Act, Public Law 93-638, for enrollees who are eligible for federal financial
participation, shall be at the option of the facility in accordance with the
rate published by the United States Assistant Secretary for Health under the
authority of United States Code, title 42, sections 248(a) and 249(b). MinnesotaCare payments for enrollees who are
not eligible for federal financial participation at facilities of the Indian
health service and facilities operated by a Tribe or Tribal organization for
the provision of outpatient medical services must be in accordance with the
medical assistance rates paid for the same services when provided in a facility
other than a facility of the Indian health service or a facility operated by a
Tribe or Tribal organization.
(b) Effective upon
federal approval, the medical assistance payments to a dually certified
facility as defined in subdivision 30, paragraph (j), shall be the encounter
rate described in paragraph (a) or a rate that is substantially equivalent for
services provided to American Indians and Alaskan Native populations. The rate established under this paragraph for
dually certified facilities shall not apply to MinnesotaCare payments.
EFFECTIVE DATE. This
section is effective the day following final enactment.
Sec. 23. Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision to read:
Subd. 68. Tobacco
and nicotine cessation. (a)
Medical assistance covers tobacco and nicotine cessation services, drugs to
treat tobacco and nicotine addiction or dependence, and drugs to help
individuals discontinue use of tobacco and nicotine products. Medical assistance must cover services and
drugs as provided in this subdivision consistent with evidence-based or
evidence-informed best practices.
(b) Medical assistance must
cover in-person individual and group tobacco and nicotine cessation education
and counseling services if provided by a health care practitioner whose scope
of practice encompasses tobacco and nicotine cessation education and counseling. Service providers include but are not limited
to the following:
(1) mental health
practitioners under section 245.462, subdivision 17;
(2) mental health
professionals under section 245.462, subdivision 18;
(3) mental health
certified peer specialists under section 256B.0615;
(4) alcohol and drug
counselors licensed under chapter 148F;
(5) recovery peers as
defined in section 245F.02, subdivision 21;
(6) certified tobacco
treatment specialists;
(7) community health
workers;
(8) physicians;
(9) physician
assistants;
(10) advanced practice
registered nurses; or
(11) other licensed or
nonlicensed professionals or paraprofessionals with training in providing
tobacco and nicotine cessation education and counseling services.
(c) Medical assistance
covers telephone cessation counseling services provided through a quitline. Notwithstanding section 256B.0625,
subdivision 3b, quitline services may be provided through audio-only
communications. The commissioner of
human services may utilize volume purchasing for quitline services consistent
with section 256B.04, subdivision 14.
(d) Medical assistance
must cover all prescription and over-the-counter pharmacotherapy drugs approved
by the United States Food and Drug Administration for cessation of tobacco and
nicotine use or treatment of tobacco and nicotine dependence, and that are
subject to a Medicaid drug rebate agreement.
(e) Services covered
under this subdivision may be provided by telemedicine.
(f) The commissioner
must not:
(1) restrict or limit
the type, duration, or frequency of tobacco and nicotine cessation services;
(2) prohibit the
simultaneous use of multiple cessation services, including but not limited to
simultaneous use of counseling and drugs;
(3) require counseling
before receiving drugs or as a condition of receiving drugs;
(4) limit
pharmacotherapy drug dosage amounts for a dosing regimen for treatment of a
medically accepted indication as defined in United States Code, title 14,
section 1396r-8(K)(6); limit dosing frequency; or impose duration limits;
(5) prohibit simultaneous use
of multiple drugs, including prescription and over-the-counter drugs;
(6) require or authorize
step therapy; or
(7) require or utilize
prior authorization for any tobacco and nicotine cessation services and drugs
covered under this subdivision.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 24. Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision to read:
Subd. 69. Biomarker
testing. Medical assistance
covers biomarker testing to diagnose, treat, manage, and monitor illness or
disease. Medical assistance coverage
must meet the requirements that would otherwise apply to a health plan under
section 62Q.473.
EFFECTIVE DATE. This
section is effective January 1, 2025, or upon federal approval, whichever is
later. The commissioner of human
services shall notify the revisor of statutes when federal approval is
obtained.
Sec. 25. Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision to read:
Subd. 70. Recuperative
care services. Medical
assistance covers recuperative care services according to section 256B.0701.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 26. Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision to read:
Subd. 71. Coverage
of services for the diagnosis, monitoring, and treatment of rare diseases. (a) Medical assistance covers services
related to the diagnosis, monitoring, and treatment of a rare disease or
condition. Medical assistance coverage
for these services must meet the requirements in section 62Q.451, subdivisions
1 to 3 and 6. Providers must still meet
all applicable program requirements.
(b) Coverage for a service must not be denied solely on the basis that it was provided by, referred for, or ordered by an out-of-network provider.
(c) Any prior authorization requirements for a service that is provided by, referred for, or ordered by an out-of-network provider must be the same as any prior authorization requirements for a service that is provided by, referred for, or ordered by an in-network provider.
(d) Nothing in this subdivision requires medical assistance to cover additional services.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 27. [256B.0701]
RECUPERATIVE CARE SERVICES.
Subdivision 1. Definitions. (a) For purposes of this section, the following terms have the meanings given.
(b) "Provider"
means a recuperative care provider as defined by the standards established by
the National Institute for Medical Respite Care.
(c) "Recuperative
care" means a model of care that prevents hospitalization or that provides
postacute medical care and support services for recipients experiencing
homelessness who are too ill or frail to recover from a physical illness or injury
while living in a shelter or are otherwise unhoused but who are not sick enough
to be hospitalized or remain hospitalized, or to need other levels of care.
Subd. 2. Recuperative
care settings. Recuperative
care may be provided in any setting, including but not limited to homeless
shelters, congregate care settings, single room occupancy settings, or
supportive housing, so long as the provider of recuperative care or provider of
housing is able to provide to the recipient within the designated setting, at a
minimum:
(1) 24-hour access to a
bed and bathroom;
(2) access to three
meals a day;
(3) availability to
environmental services;
(4) access to a
telephone;
(5) a secure place to
store belongings; and
(6) staff available
within the setting to provide a wellness check as needed, but at a minimum, at
least once every 24 hours.
Subd. 3. Eligibility. To be eligible for recuperative care
service, a recipient must:
(1) not be a child;
(2) be experiencing
homelessness;
(3) be in need of
short-term acute medical care for a period of no more than 60 days;
(4) meet clinical
criteria, as established by the commissioner, that indicates that the recipient
needs recuperative care; and
(5) not have behavioral
health needs that are greater than what can be managed by the provider within
the setting.
Subd. 4. Total
payment rates. Total payment
rates for recuperative care consist of the recuperative care services rate and
the recuperative care facility rate.
Subd. 5. Recuperative
care services rate. The
recuperative care services rate is for the services provided to the recipient
and must be a bundled daily per diem payment of at least $300 per day. Services provided within the bundled payment
may include but are not limited to:
(1) basic nursing care,
including:
(i) monitoring a
patient's physical health and pain level;
(ii) providing wound
care;
(iii) medication
support;
(iv) patient education;
(v) immunization review
and update; and
(vi) establishing
clinical goals for the recuperative care period and discharge plan;
(2) care coordination,
including:
(i) initial assessment of
medical, behavioral, and social needs;
(ii) development of a
care plan;
(iii) support and
referral assistance for legal services, housing, community social services,
case management, health care benefits, health and other eligible benefits, and
transportation needs and services; and
(iv) monitoring and
follow-up to ensure that the care plan is effectively implemented to address
the medical, behavioral, and social needs;
(3) basic behavioral
needs, including counseling and peer support, that can be provided in the
recuperative care setting; and
(4) services provided by
a community health worker as defined under section 256B.0625, subdivision 49.
Subd. 6. Recuperative
care facility rate. (a) The
recuperative care facility rate is for facility costs and must be paid from
state money in an amount equal to the medical assistance room and board rate at
the time the recuperative care services were provided. The eligibility standards in chapter 256I do
not apply to the recuperative care facility rate. The recuperative care facility rate is only
paid when the recuperative care services rate is paid to a provider. Providers may opt to only receive the recuperative
care services rate.
(b) Before a recipient is discharged from a recuperative care setting, the provider must ensure that the recipient's medical condition is stabilized or that the recipient is being discharged to a setting that is able to meet that recipient's needs.
Subd. 7. Extended
stay. If a recipient requires
care exceeding the 60-day limit described in subdivision 3, the provider may
request in a format prescribed by the commissioner an extension to continue
payments until the recipient is discharged.
Subd. 8. Report. (a) The commissioner must submit an
initial report on coverage of recuperative care services to the chairs and
ranking minority members of the legislative committees having jurisdiction over
health and human services finance and policy by February 1, 2025, and a final
report by February 1, 2027. The reports
must include but are not limited to:
(1) a list of the
recuperative care services in Minnesota and the number of recipients;
(2) the estimated return
on investment, including health care savings due to reduced hospitalizations;
(3) follow-up
information, if available, on whether recipients' hospital visits decreased
since recuperative care services were provided compared to before the services
were provided; and
(4) any other information
that can be used to determine the effectiveness of the program and its funding,
including recommendations for improvements to the program.
(b) This subdivision
expires upon submission of the final report.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 28. Minnesota Statutes 2022, section 256B.0941, subdivision 3, is amended to read:
Subd. 3. Per diem rate. (a) The commissioner must establish one per diem rate per provider for psychiatric residential treatment facility services for individuals 21 years of age or younger. The rate for a provider must not exceed the rate charged by that provider for the same service to other payers. Payment must not be made to more than one entity for each individual for services provided under this section on a given day. The commissioner must set rates prospectively for the annual rate period. The commissioner must require providers to submit annual cost reports on a uniform cost reporting form and must use submitted cost reports to inform the rate-setting process. The cost reporting must be done according to federal requirements for Medicare cost reports.
(b) The following are included in the rate:
(1) costs necessary for licensure and accreditation, meeting all staffing standards for participation, meeting all service standards for participation, meeting all requirements for active treatment, maintaining medical records, conducting utilization review, meeting inspection of care, and discharge planning. The direct services costs must be determined using the actual cost of salaries, benefits, payroll taxes, and training of direct services staff and service‑related transportation; and
(2) payment for room and board provided by facilities meeting all accreditation and licensing requirements for participation.
(c) A facility may submit a claim for payment outside of the per diem for professional services arranged by and provided at the facility by an appropriately licensed professional who is enrolled as a provider with Minnesota health care programs. Arranged services may be billed by either the facility or the licensed professional. These services must be included in the individual plan of care and are subject to prior authorization.
(d) Medicaid must reimburse for concurrent services as approved by the commissioner to support continuity of care and successful discharge from the facility. "Concurrent services" means services provided by another entity or provider while the individual is admitted to a psychiatric residential treatment facility. Payment for concurrent services may be limited and these services are subject to prior authorization by the state's medical review agent. Concurrent services may include targeted case management, assertive community treatment, clinical care consultation, team consultation, and treatment planning.
(e) Payment rates under this subdivision must not include the costs of providing the following services:
(1) educational services;
(2) acute medical care or specialty services for other medical conditions;
(3) dental services; and
(4) pharmacy drug costs.
(f) For purposes of this section, "actual cost" means costs that are allowable, allocable, reasonable, and consistent with federal reimbursement requirements in Code of Federal Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and the Office of Management and Budget Circular Number A-122, relating to nonprofit entities.
(g) The commissioner shall
annually adjust psychiatric residential treatment facility services per diem
rates to reflect the change in the Centers for Medicare and Medicaid Services
Inpatient Psychiatric Facility Market Basket.
The commissioner shall use the indices as forecasted for the midpoint of
the prior rate year to the midpoint of the current rate year.
EFFECTIVE DATE. This
section is effective January 1, 2024, or upon federal approval, whichever is
later. The commissioner of human
services shall notify the revisor of statutes when federal approval is
obtained.
Sec. 29. Minnesota Statutes 2022, section 256B.0947, subdivision 7, is amended to read:
Subd. 7. Medical assistance payment and rate setting. (a) Payment for services in this section must be based on one daily encounter rate per provider inclusive of the following services received by an eligible client in a given calendar day: all rehabilitative services, supports, and ancillary activities under this section, staff travel time to provide rehabilitative services under this section, and crisis response services under section 256B.0624.
(b) Payment must not be made to more than one entity for each client for services provided under this section on a given day. If services under this section are provided by a team that includes staff from more than one entity, the team shall determine how to distribute the payment among the members.
(c) The commissioner shall establish regional cost-based rates for entities that will bill medical assistance for nonresidential intensive rehabilitative mental health services. In developing these rates, the commissioner shall consider:
(1) the cost for similar services in the health care trade area;
(2) actual costs incurred by entities providing the services;
(3) the intensity and frequency of services to be provided to each client;
(4) the degree to which clients will receive services other than services under this section; and
(5) the costs of other services that will be separately reimbursed.
(d) The rate for a provider must not exceed the rate charged by that provider for the same service to other payers.
(e) Effective for the
rate years beginning on and after January 1, 2024, rates must be annually
adjusted for inflation using the Centers for Medicare and Medicaid Services
Medicare Economic Index, as forecasted in the fourth quarter of the calendar
year before the rate year. The inflation
adjustment must be based on the 12-month period from the midpoint of the
previous rate year to the midpoint of the rate year for which the rate is being
determined.
EFFECTIVE DATE. This
section is effective January 1, 2024, or upon federal approval, whichever is
later. The commissioner of human
services shall notify the revisor of statutes when federal approval is
obtained.
Sec. 30. Minnesota Statutes 2022, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a. Managed care contracts. (a) Managed care contracts under this section and section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner may issue separate contracts with requirements specific to services to medical assistance recipients age 65 and older.
(b) A prepaid health plan providing covered health services for eligible persons pursuant to chapters 256B and 256L is responsible for complying with the terms of its contract with the commissioner. Requirements applicable to managed care programs under chapters 256B and 256L established after the effective date of a contract with the commissioner take effect when the contract is next issued or renewed.
(c) The commissioner shall withhold five percent of managed care plan payments under this section and county‑based purchasing plan payments under section 256B.692 for the prepaid medical assistance program pending completion of performance targets. Each performance target must be quantifiable, objective, measurable, and reasonably attainable, except in the case of a performance target based on a federal or state law or rule. Criteria for assessment of each performance target must be outlined in writing prior to the contract effective date. Clinical or utilization performance targets and their related criteria must consider evidence-based research and reasonable interventions when available or applicable to the populations served, and must be developed with input from external clinical experts and stakeholders, including managed care plans, county-based purchasing plans, and providers. The managed care or county-based purchasing plan must demonstrate, to the commissioner's satisfaction, that the data submitted regarding attainment of the performance target is accurate. The commissioner shall periodically change the administrative measures used as performance targets in order to improve plan performance across a broader range of administrative services. The performance targets must include measurement of plan efforts to contain spending on health care services and administrative activities. The commissioner may adopt plan‑specific performance targets that take into account factors affecting only one plan, including characteristics of the plan's enrollee population. The withheld funds must be returned no sooner than July of the following year if performance targets in the contract are achieved. The commissioner may exclude special demonstration projects under subdivision 23.
(d) The commissioner shall require that managed care plans:
(1) use the assessment and authorization processes, forms, timelines, standards, documentation, and data reporting requirements, protocols, billing processes, and policies consistent with medical assistance fee-for-service or the Department of Human Services contract requirements for all personal care assistance services under section 256B.0659 and community first services and supports under section 256B.85; and
(2) by January 30 of each year that follows a rate increase for any aspect of services under section 256B.0659 or 256B.85, inform the commissioner and the chairs and ranking minority members of the legislative committees with jurisdiction over rates determined under section 256B.851 of the amount of the rate increase that is paid to each personal care assistance provider agency with which the plan has a contract.
(e) Effective for
services rendered on or after January 1, 2012, the commissioner shall include
as part of the performance targets described in paragraph (c) a reduction in
the health plan's emergency department utilization rate for medical assistance
and MinnesotaCare enrollees, as determined by the commissioner. For 2012, the reduction shall be based on the
health plan's utilization in 2009. To
earn the return of the withhold each subsequent year, the managed care plan or
county-based purchasing plan must achieve a qualifying reduction of no less
than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs
described in subdivisions 23 and 28, compared to the previous measurement year
until the final performance target is reached.
When measuring performance, the commissioner must consider the
difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with
the managed care or county-based purchasing plan to account for differences
that they agree are significant.
The withheld funds must
be returned no sooner than July 1 and no later than July 31 of the following
calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the
utilization rate was achieved. The
commissioner shall structure the withhold so that the commissioner returns a
portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this
paragraph shall continue for each consecutive contract period until the plan's
emergency room utilization rate for state health care program enrollees is
reduced by 25 percent of the plan's emergency room utilization rate for medical
assistance and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the health
plans in meeting this performance target and shall accept payment withholds
that may be returned to the hospitals if the performance target is achieved.
(f) Effective for
services rendered on or after January 1, 2012, the commissioner shall include
as part of the performance targets described in paragraph (c) a reduction in
the plan's hospitalization admission rate for medical assistance and
MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than five percent of the plan's hospital admission rate
for medical assistance and MinnesotaCare enrollees, excluding enrollees in
programs described in subdivisions 23 and 28, compared to the previous calendar
year until the final performance target is reached. When measuring performance, the commissioner
must consider the difference in health risk in a managed care or county-based
purchasing plan's membership in the baseline year compared to the measurement
year, and work with the managed care or county-based purchasing plan to account
for differences that they agree are significant.
The withheld funds must
be returned no sooner than July 1 and no later than July 31 of the following
calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the
hospitalization rate was achieved. The
commissioner shall structure the withhold so that the commissioner returns a
portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described
in this paragraph shall continue until there is a 25 percent reduction in the
hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner.
The hospital admissions in this performance target do not include the
admissions applicable to the subsequent hospital admission performance target
under paragraph (g). Hospitals shall
cooperate with the plans in meeting this performance target and shall accept
payment withholds that may be returned to the hospitals if the performance
target is achieved.
(g) Effective for
services rendered on or after January 1, 2012, the commissioner shall include
as part of the performance targets described in paragraph (c) a reduction in
the plan's hospitalization admission rates for subsequent hospitalizations
within 30 days of a previous hospitalization of a patient regardless of the
reason, for medical assistance and MinnesotaCare enrollees, as determined by
the commissioner. To earn the return of
the withhold each year, the managed care plan or county-based purchasing plan
must achieve a qualifying reduction of the subsequent hospitalization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs
described in subdivisions 23 and 28, of no less than five percent compared to
the previous calendar year until the final performance target is reached.
The withheld funds must
be returned no sooner than July 1 and no later than July 31 of the following
calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying
reduction in the subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts
commensurate with achieved reductions in utilization less than the targeted
amount.
The withhold described
in this paragraph must continue for each consecutive contract period until the
plan's subsequent hospitalization rate for medical assistance and MinnesotaCare
enrollees, excluding enrollees in programs described in subdivisions 23 and 28,
is reduced by 25 percent of the plan's subsequent hospitalization rate for
calendar year 2011. Hospitals shall
cooperate with the plans in meeting this performance target and shall accept
payment withholds that must be returned to the hospitals if the performance
target is achieved.
(h) (e) Effective for services rendered on or after January 1, 2013, through December 31, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments under this section and county-based purchasing plan payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following year. The commissioner may exclude special demonstration projects under subdivision 23.
(i) (f)
Effective for services rendered on or after January 1, 2014, the commissioner
shall withhold three percent of managed care plan payments under this section
and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The
withheld funds must be returned no sooner than July 1 and no later than July 31
of the following year. The commissioner
may exclude special demonstration projects under subdivision 23.
(j) (g) A
managed care plan or a county-based purchasing plan under section 256B.692 may
include as admitted assets under section 62D.044 any amount withheld under this
section that is reasonably expected to be returned.
(k) (h) Contracts
between the commissioner and a prepaid health plan are exempt from the
set-aside and preference provisions of section 16C.16, subdivisions 6,
paragraph (a), and 7.
(l) (i) The
return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).
(m) (j) Managed
care plans and county-based purchasing plans shall maintain current and fully
executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care
programs. Subcontractor agreements
determined to be material, as defined by the commissioner after taking into
account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of
offer, acceptance, consideration, payment terms, scope, duration of the
contract, and how the subcontractor services relate to state public health care
programs. Upon request, the commissioner
shall have access to all subcontractor documentation under this paragraph. Nothing in this paragraph shall allow release
of information that is nonpublic data pursuant to section 13.02.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 31. Minnesota Statutes 2022, section 256B.69, is amended by adding a subdivision to read:
Subd. 19a. Limitation
on reimbursement; rare disease services provided in Minnesota by out-of-network
providers. (a) If a managed
care or county-based purchasing plan has an established contractual payment
under medical assistance with an out-of-network provider for a service provided
in Minnesota related to the diagnosis, monitoring, and treatment of a rare
disease or condition, the provider must accept the established contractual
payment for that service as payment in full.
(b) If a plan does not
have an established contractual payment under medical assistance with an
out-of-network provider for a service provided in Minnesota related to the
diagnosis, monitoring, and treatment of a rare disease or condition, the
provider must accept the provider's established rate for uninsured patients for
that service as payment in full. If the
provider does not have an established rate for uninsured patients for that
service, the provider must accept the fee-for-service rate.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 32. Minnesota Statutes 2022, section 256B.69, is amended by adding a subdivision to read:
Subd. 19b. Limitation
on reimbursement; rare disease services provided outside of Minnesota by an out‑of-network
provider. (a) If a managed
care or county-based purchasing plan has an established contractual payment
under medical assistance with an out-of-network provider for a service provided
in another state related to diagnosis, monitoring, and treatment of a rare
disease or condition, the plan must pay the established contractual payment for
that service.
(b) If a plan does not have an established contractual payment under medical assistance with an out-of-network provider for a service provided in another state related to diagnosis, monitoring, and treatment of a rare disease or condition, the plan must pay the provider's established rate for uninsured patients for that service. If the provider does not have an established rate for uninsured patients for that service, the plan must pay the provider the fee-for-service rate in that state.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 33. Minnesota Statutes 2022, section 256B.758, is amended to read:
256B.758 REIMBURSEMENT FOR DOULA SERVICES.
(a) Effective for services provided on or after July 1, 2019, through December 31, 2023, payments for doula services provided by a certified doula shall be $47 per prenatal or postpartum visit and $488 for attending and providing doula services at a birth.
(b) Effective for
services provided on or after January 1, 2024, payments for doula services
provided by a certified doula are $100 per
prenatal or postpartum visit and $1,400 for attending and providing doula
services at birth.
EFFECTIVE DATE. This
section is effective January 1, 2024.
Sec. 34. Minnesota Statutes 2022, section 256B.76, subdivision 1, as amended by Laws 2023, chapter 25, section 145, is amended to read:
Subdivision 1. Physician and professional services reimbursement. (a) Effective for services rendered on or after October 1, 1992, the commissioner shall make payments for physician services as follows:
(1) payment for level one Centers for Medicare and Medicaid Services' common procedural coding system codes titled "office and other outpatient services," "preventive medicine new and established patient," "delivery, antepartum, and postpartum care," "critical care," cesarean delivery and pharmacologic management provided to psychiatric patients, and level three codes for enhanced services for prenatal high risk, shall be paid at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992;
(2) payments for all other services shall be paid at the lower of (i) submitted charges, or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th percentile of 1989, less the percent in aggregate necessary to equal the above increases except that payment rates for home health agency services shall be the rates in effect on September 30, 1992.
(b) Effective for services rendered on or after January 1, 2000, payment rates for physician and professional services shall be increased by three percent over the rates in effect on December 31, 1999, except for home health agency and family planning agency services. The increases in this paragraph shall be implemented January 1, 2000, for managed care.
(c) Effective for services rendered on or after July 1, 2009, payment rates for physician and professional services shall be reduced by five percent, except that for the period July 1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent for the medical assistance and general assistance medical care programs, over the rates in effect on June 30, 2009. This reduction and the reductions in paragraph (d) do not apply to office or other outpatient visits, preventive medicine visits and family planning visits billed by physicians, advanced practice registered nurses, or physician assistants in a family planning agency or in one of the following primary care practices: general practice, general internal medicine, general pediatrics, general geriatrics, and family medicine. This reduction and the reductions in paragraph (d) do not apply to federally qualified health centers, rural health centers, and Indian health services. Effective October 1, 2009, payments made to managed care plans and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reduction described in this paragraph.
(d) Effective for services rendered on or after July 1, 2010, payment rates for physician and professional services shall be reduced an additional seven percent over the five percent reduction in rates described in paragraph (c). This additional reduction does not apply to physical therapy services, occupational therapy services, and speech pathology and related services provided on or after July 1, 2010. This additional reduction does not apply to physician services billed by a psychiatrist or an advanced practice registered nurse with a specialty in mental health. Effective October 1, 2010, payments made to managed care plans and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reduction described in this paragraph.
(e) Effective for services rendered on or after September 1, 2011, through June 30, 2013, payment rates for physician and professional services shall be reduced three percent from the rates in effect on August 31, 2011. This reduction does not apply to physical therapy services, occupational therapy services, and speech pathology and related services.
(f) Effective for services rendered on or after September 1, 2014, payment rates for physician and professional services, including physical therapy, occupational therapy, speech pathology, and mental health services shall be increased by five percent from the rates in effect on August 31, 2014. In calculating this rate increase, the commissioner shall not include in the base rate for August 31, 2014, the rate increase provided under section 256B.76, subdivision 7. This increase does not apply to federally qualified health centers, rural health centers, and Indian health services. Payments made to managed care plans and county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.
(g) Effective for services rendered on or after July 1, 2015, payment rates for physical therapy, occupational therapy, and speech pathology and related services provided by a hospital meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause (4), shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments made to managed care plans and county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.
(h) Any ratables effective before July 1, 2015, do not apply to early intensive developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.
(i) The commissioner may reimburse physicians and other licensed professionals for costs incurred to pay the fee for testing newborns who are medical assistance enrollees for heritable and congenital disorders under section 144.125, subdivision 1, paragraph (c), when the sample is collected outside of an inpatient hospital or freestanding birth center and the cost is not recognized by another payment source.
Sec. 35. Minnesota Statutes 2022, section 256B.761, is amended to read:
256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
(a) Effective for services rendered on or after July 1, 2001, payment for medication management provided to psychiatric patients, outpatient mental health services, day treatment services, home-based mental health services, and family community support services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of 1999 charges.
(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health services provided by an entity that operates: (1) a Medicare-certified comprehensive outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993, with at least 33 percent of the clients receiving rehabilitation services in the most recent calendar year who are medical assistance recipients, will be increased by 38 percent, when those services are provided within the comprehensive outpatient rehabilitation facility and provided to residents of nursing facilities owned by the entity.
(c) In addition to rate increases otherwise provided, the commissioner may restructure coverage policy and rates to improve access to adult rehabilitative mental health services under section 256B.0623 and related mental health support services under section 256B.021, subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected state share of increased costs due to this paragraph is transferred from adult mental health grants under sections 245.4661 and 256E.12. The transfer for fiscal year 2016 is a permanent base adjustment for subsequent fiscal years. Payments made to managed care plans and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the rate changes described in this paragraph.
(d) Any ratables effective before July 1, 2015, do not apply to early intensive developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.
(e) Effective for
services rendered on or after January 1, 2024, payment rates for behavioral
health services included in the rate analysis required by Laws 2021, First
Special Session chapter 7, article 17, section 18, except for adult day
treatment services under section 256B.0671, subdivision 3; early intensive
developmental and behavioral intervention services under section 256B.0949; and
substance use disorder services under chapter 254B, must be increased by three
percent from the rates in effect on December 31, 2023. Effective for services rendered on or after
January 1, 2025, payment rates for behavioral health services included in the
rate analysis required by Laws 2021, First Special Session chapter 7, article
17, section 18, except for adult day treatment services under section
256B.0671, subdivision 3; early intensive developmental behavioral intervention
services under section 256B.0949; and substance use disorder services under
chapter 254B, must be annually adjusted according to the change from the
midpoint of the previous rate year to the midpoint of the rate year for which
the rate is being determined using the Centers for Medicare and Medicaid
Services Medicare Economic Index as forecasted in the fourth quarter of the
calendar year before the rate year. For
payments made in accordance with this paragraph, if and to the extent that the
commissioner identifies that the state has received federal financial
participation for behavioral health services in excess of the amount allowed
under United States Code, title 42, section 447.321, the state shall repay the
excess amount to the Centers for Medicare and Medicaid Services with state
money and maintain the full payment rate under this paragraph. This paragraph does not apply to federally
qualified health centers, rural health centers, Indian health services,
certified community behavioral health clinics, cost-based rates, and rates that
are negotiated with the county. This
paragraph expires upon legislative implementation of the new rate methodology
resulting from the rate analysis required by Laws 2021, First Special Session
chapter 7, article 17, section 18.
(f) Effective January 1,
2024, the commissioner shall increase capitation payments made to managed care
plans and county-based purchasing plans to reflect the behavioral health
service rate increase provided in paragraph (e). Managed care and county-based purchasing
plans must use the capitation rate increase provided under this paragraph to
increase payment rates to behavioral health services providers. The commissioner must monitor the
effect of this rate increase
on enrollee access to behavioral health services. If for any contract year federal approval is
not received for this paragraph, the commissioner must adjust the capitation
rates paid to managed care plans and county-based purchasing plans for that
contract year to reflect the removal of this provision. Contracts between managed care plans and
county-based purchasing plans and providers to whom this paragraph applies must
allow recovery of payments from those providers if capitation rates are
adjusted in accordance with this paragraph.
Payment recoveries must not exceed the amount equal to any increase in
rates that results from this provision.
EFFECTIVE DATE. This
section is effective January 1, 2024, or upon federal approval, whichever is
later. The commissioner of human
services shall notify the revisor of statutes when federal approval is
obtained.
Sec. 36. Minnesota Statutes 2022, section 256B.763, is amended to read:
256B.763 CRITICAL ACCESS MENTAL HEALTH RATE INCREASE.
Subdivision 1. Rate add-on. (a) For services defined in paragraph (b) and rendered on or after July 1, 2007, payment rates shall be increased by 23.7 percent over the rates in effect on January 1, 2006, for:
(1) psychiatrists and advanced practice registered nurses with a psychiatric specialty;
(2) community mental health centers under section 256B.0625, subdivision 5; and
(3) mental health clinics certified under section 245I.20, or hospital outpatient psychiatric departments that are designated as essential community providers under section 62Q.19.
(b) This increase applies to group skills training when provided as a component of children's therapeutic services and support, psychotherapy, medication management, evaluation and management, diagnostic assessment, explanation of findings, psychological testing, neuropsychological services, direction of behavioral aides, and inpatient consultation.
(c) This increase does not apply to rates that are governed by section 256B.0625, subdivision 30, or 256B.761, paragraph (b), other cost-based rates, rates that are negotiated with the county, rates that are established by the federal government, or rates that increased between January 1, 2004, and January 1, 2005.
(d) Payment rates shall be increased by 23.7 percent over the rates in effect on December 31, 2007, for:
(1) medication education services provided on or after January 1, 2008, by adult rehabilitative mental health services providers certified under section 256B.0623; and
(2) mental health behavioral aide services provided on or after January 1, 2008, by children's therapeutic services and support providers certified under section 256B.0943.
(e) For services defined in paragraph (b) and rendered on or after January 1, 2008, by children's therapeutic services and support providers certified under section 256B.0943 and not already included in paragraph (a), payment rates shall be increased by 23.7 percent over the rates in effect on December 31, 2007.
(f) Payment rates shall be increased by 2.3 percent over the rates in effect on December 31, 2007, for individual and family skills training provided on or after January 1, 2008, by children's therapeutic services and support providers certified under section 256B.0943.
(g) For services described in paragraphs (b), (d), and (f) and rendered on or after July 1, 2017, payment rates for mental health clinics certified under section 245I.20 that are not designated as essential community providers under section 62Q.19 shall be equal to payment rates for mental health clinics certified under section 245I.20 that are designated as essential community providers under section 62Q.19. In order to receive increased payment rates under this paragraph, a provider must demonstrate a commitment to serve low-income and underserved populations by:
(1) charging for services on a sliding-fee schedule based on current poverty income guidelines; and
(2) not restricting access or services because of a client's financial limitation.
(h) For services identified under this section that are rendered by providers identified under this section, managed care plans and county-based purchasing plans shall reimburse the providers at a rate that is at least equal to the fee-for-service payment rate. The commissioner shall monitor the effect of this requirement on the rate of access to the services delivered by mental health providers.
Subd. 2. Phaseout. The critical access mental health rate
add-on under this section must be reduced according to the following schedule:
(1) effective for
services provided on or after January 1, 2025, the rate add-on is reduced to
11.85 percent;
(2) effective for
services provided on or after January 1, 2026, the rate add-on is reduced to
5.92 percent; and
(3) effective for
services provided on or after January 1, 2027, the rate add-on is 0 percent.
EFFECTIVE DATE. This
section is effective January 1, 2024, or upon federal approval, whichever is
later. The commissioner of human
services shall notify the revisor of statutes when federal approval is
obtained.
Sec. 37. Minnesota Statutes 2022, section 256B.764, is amended to read:
256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.
(a) Effective for services rendered on or after July 1, 2007, payment rates for family planning services shall be increased by 25 percent over the rates in effect June 30, 2007, when these services are provided by a community clinic as defined in section 145.9268, subdivision 1.
(b) Effective for services rendered on or after July 1, 2013, payment rates for family planning services shall be increased by 20 percent over the rates in effect June 30, 2013, when these services are provided by a community clinic as defined in section 145.9268, subdivision 1. The commissioner shall adjust capitation rates to managed care and county-based purchasing plans to reflect this increase, and shall require plans to pass on the full amount of the rate increase to eligible community clinics, in the form of higher payment rates for family planning services.
(c) Effective for
services provided on or after January 1, 2024, payment rates for family
planning and abortion services shall be increased by 20 percent. This increase does not apply to federally
qualified health centers, rural health centers, or Indian health services.
Sec. 38. Minnesota Statutes 2022, section 256L.03, subdivision 1, is amended to read:
Subdivision 1. Covered health services. (a) "Covered health services" means the health services reimbursed under chapter 256B, with the exception of special education services, home care nursing services, adult dental care services other than services covered under section 256B.0625, subdivision 9, orthodontic services, nonemergency medical transportation services, personal care assistance and case management services, community first services and supports under section 256B.85, behavioral health home services under section 256B.0757, housing stabilization services under section 256B.051, and nursing home or intermediate care facilities services.
(b) No public funds shall be
used for coverage of abortion under MinnesotaCare except where the life of the
female would be endangered or substantial and irreversible impairment of a
major bodily function would result if the fetus were carried to term; or where
the pregnancy is the result of rape or incest.
(c) (b) Covered
health services shall be expanded as provided in this section.
(d) (c) For the
purposes of covered health services under this section, "child" means
an individual younger than 19 years of age.
EFFECTIVE DATE. This
section is effective the day following final enactment.
Sec. 39. Minnesota Statutes 2022, section 256L.03, subdivision 5, is amended to read:
Subd. 5. Cost-sharing. (a) Co-payments, coinsurance, and deductibles do not apply to children under the age of 21 and to American Indians as defined in Code of Federal Regulations, title 42, section 600.5.
(b) The commissioner shall
must adjust co-payments, coinsurance, and deductibles for covered
services in a manner sufficient to maintain the actuarial value of the benefit
to 94 percent. The cost-sharing changes
described in this paragraph do not apply to eligible recipients or services
exempt from cost-sharing under state law.
The cost‑sharing changes described in this paragraph shall not be
implemented prior to January 1, 2016.
(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations, title 42, sections 600.510 and 600.520.
(d) Co-payments,
coinsurance, and deductibles do not apply to additional diagnostic services or
testing that a health care provider determines an enrollee requires after a
mammogram, as specified under section 62A.30, subdivision 5.
(e) Cost-sharing must
not apply to drugs used for tobacco and nicotine cessation or to tobacco and
nicotine cessation services covered under section 256B.0625, subdivision 68.
(f) Co-payments,
coinsurance, and deductibles do not apply to pre-exposure prophylaxis (PrEP)
and postexposure prophylaxis (PEP) medications when used for the prevention or
treatment of the human immunodeficiency virus (HIV).
EFFECTIVE DATE. This
section is effective January 1, 2024, or upon federal approval, whichever is
later. The commissioner of human
services shall notify the revisor of statutes when federal approval is
obtained.
Sec. 40. Laws 2021, First Special Session chapter 7, article 1, section 36, as amended by Laws 2023, chapter 22, section 2, is amended to read:
Sec. 36. RESPONSE
TO COVID-19 PUBLIC HEALTH EMERGENCY.
(a) Notwithstanding Minnesota Statutes, section 256B.057, subdivision 9, or any other provision to the contrary, the commissioner shall not collect any unpaid premium for a coverage month that occurred during the COVID-19 public health emergency declared by the United States Secretary of Health and Human Services and through the month prior to an enrollee's first renewal following the resumption of medical assistance renewals after March 31, 2023.
(b) Notwithstanding any provision to the contrary, periodic data matching under Minnesota Statutes, section 256B.0561, subdivision 2, may be suspended for up to 12 months following the resumption of medical assistance and MinnesotaCare renewals after March 31, 2023.
(c) Notwithstanding any provision to the contrary, the requirement for the commissioner of human services to issue an annual report on periodic data matching under Minnesota Statutes, section 256B.0561, is suspended for one year following the last day of the COVID-19 public health emergency declared by the United States Secretary of Health and Human Services.
(d) For individuals
enrolled in medical assistance Minnesota health care programs as
of March 31, 2023, who are subject to the asset limits established by Minnesota
Statutes, section sections 256B.056, subdivision 3, paragraph
(a), and 256B.057, assets in excess of the limits established by
Minnesota Statutes, section 256B.056, subdivision 3, paragraph (a), therein
must be disregarded until the individual's second annual renewal occurring
following the resumption of renewals after March 31, 2023.
(e) The commissioner may temporarily adjust medical assistance eligibility verification requirements as needed to comply with federal guidance and ensure a timely renewal process for the period during which enrollees are subject to their first annual renewal following March 31, 2023. The commissioner must implement sufficient controls to monitor the effectiveness of verification adjustments and ensure program integrity.
(f) Notwithstanding any provision to the contrary, the commissioner of human services may temporarily extend the time frame permitted to take final administrative action on fair hearing requests from medical assistance and MinnesotaCare recipients under Minnesota Statutes, section 256.045, until the end of the 23rd month after the end of the month in which the public health emergency for COVID-19, as declared by the United States Secretary of Health and Human Services, ends. During this period, the commissioner must:
(1) not delay resolving expedited fair hearings described in Code of Federal Regulations, title 42, chapter IV, subchapter C, part 431, subpart E, section 431.224, paragraph (a);
(2) provide medical assistance benefits, pending the outcome of a fair hearing decision, to any medical assistance recipient, and provide MinnesotaCare benefits, pending the outcome of a fair hearing decision, to any MinnesotaCare recipient, who requests a fair hearing within the time provided under Minnesota Statutes, section 256.045, subdivision 3, paragraph (i), and regardless of whether the recipient has requested benefits pending the outcome of the recipient's fair hearing;
(3) reinstate medical assistance or MinnesotaCare benefits back to the date of action, if the recipient requests a fair hearing after the date of action and within the time provided under Minnesota Statutes, section 256.045, subdivision 3, paragraph (i);
(4) take final administrative action within the maximum 90 days permitted under Code of Federal Regulations, title 42, chapter IV, subchapter C, part 431, subpart E, section 431.244, paragraph (f)(1), for fair hearing requests where medical assistance or MinnesotaCare benefits cannot be provided pending the outcome of the fair hearing, such as a fair hearing challenging a denial of eligibility for an applicant;
(5) not recoup or recover from the recipient the cost of medical assistance or MinnesotaCare benefits provided pending final administrative action, even if the agency's action is sustained by the hearing decision; and
(6) not use this authority as justification to delay taking final action, and only exceed the 90 days permitted for taking final agency action under Code of Federal Regulations, title 42, section 431.244, paragraph (f)(1), to the extent to which the commissioner is unable to take timely final agency action on a given fair hearing request.
(g) Notwithstanding Minnesota Statutes, section 256L.06, subdivision 3; 256L.15, subdivision 2, or any other provision to the contrary, the commissioner must not collect any unpaid premium for a coverage month that occurred during the COVID-19 public health emergency declared by the United States Secretary of Health and Human Services.
(h) Notwithstanding Minnesota Statutes, sections 256L.06 and 256L.15, or any other provision to the contrary, the commissioner must waive MinnesotaCare premiums for all enrollees beginning May 1, 2023, through June 30, 2024.
(i) Notwithstanding any other law to the contrary, the commissioner shall, as required by the Centers for Medicare & Medicaid Services, suspend certain procedural terminations for medical assistance enrollees.
EFFECTIVE DATE. This
section is effective the day following final enactment.
Sec. 41. Laws 2021, First Special Session chapter 7, article 6, section 26, is amended to read:
Sec. 26. COMMISSIONER
OF HUMAN SERVICES; EXTENSION OF COVID-19 HUMAN SERVICES PROGRAM MODIFICATIONS.
Notwithstanding Laws 2020,
First Special Session chapter 7, section 1, subdivision 2, as amended by Laws
2020, Third Special Session chapter 1, section 3, when the peacetime emergency
declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, the following
modifications issued by the commissioner of human services pursuant to
Executive Orders 20-11 and 20-12, and including any amendments to the
modification issued before the peacetime emergency expires, shall remain in
effect until July 1, 2023 2025:
(1) CV16: expanding access to telemedicine services for Children's Health Insurance Program, Medical Assistance, and MinnesotaCare enrollees; and
(2) CV21: allowing telemedicine alternative for school-linked mental health services and intermediate school district mental health services.
Sec. 42. ELIGIBILITY
FOR DEFERRED ACTION FOR CHILDHOOD ARRIVAL ENROLLEES.
(a) The commissioner of
human services shall make federally funded medical assistance and federally
funded MinnesotaCare available to Minnesotans who are Deferred Action for
Childhood Arrival recipients considered lawfully present noncitizens in
accordance with regulations finalized by the Centers for Medicare and Medicaid
Services and who meet all other medical assistance and MinnesotaCare
eligibility criteria.
(b) This section expires
June 30, 2025.
EFFECTIVE DATE. This
section is effective upon the effective date of final regulations published by
the Centers for Medicare and Medicaid Services.
The commissioner of human services shall notify the revisor of statutes
when the final regulations published by the Centers for Medicare and Medicaid
Services are effective.
Sec. 43. REPEALER.
(a) Minnesota Statutes
2022, section 256B.763, is repealed.
(b) Minnesota Rules,
part 9505.0235, is repealed.
EFFECTIVE DATE. Paragraph (a) is effective January 1, 2027. Paragraph (b) is effective the day following final enactment.
ARTICLE 2
HEALTH INSURANCE
Section 1. Minnesota Statutes 2022, section 62A.045, is amended to read:
62A.045 PAYMENTS ON BEHALF OF ENROLLEES IN GOVERNMENT HEALTH PROGRAMS.
(a) As a condition of doing
business in Minnesota or providing coverage to residents of Minnesota covered
by this section, each health insurer shall comply with the requirements of
for health insurers under the federal Deficit Reduction Act of 2005,
Public Law 109-171 and the federal Consolidated Appropriations Act of 2022,
Public Law 117-103, including any federal regulations adopted under that
act those acts, to the extent that it imposes they impose
a requirement that applies in this state and that is not also required by the
laws of this state. This section does
not require compliance with any provision of the federal act acts
prior to the effective date dates provided for that provision
those provisions in the federal act acts. The commissioner shall enforce this section.
For the purpose of this section, "health insurer" includes self-insured plans, group health plans (as defined in section 607(1) of the Employee Retirement Income Security Act of 1974), service benefit plans, managed care organizations, pharmacy benefit managers, or other parties that are by contract legally responsible to pay a claim for a health-care item or service for an individual receiving benefits under paragraph (b).
(b) No plan offered by a health insurer issued or renewed to provide coverage to a Minnesota resident shall contain any provision denying or reducing benefits because services are rendered to a person who is eligible for or receiving medical benefits pursuant to title XIX of the Social Security Act (Medicaid) in this or any other state; chapter 256 or 256B; or services pursuant to section 252.27; 256L.01 to 256L.10; 260B.331, subdivision 2; 260C.331, subdivision 2; or 393.07, subdivision 1 or 2. No health insurer providing benefits under plans covered by this section shall use eligibility for medical programs named in this section as an underwriting guideline or reason for nonacceptance of the risk.
(c) If payment for covered expenses has been made under state medical programs for health care items or services provided to an individual, and a third party has a legal liability to make payments, the rights of payment and appeal of an adverse coverage decision for the individual, or in the case of a child their responsible relative or caretaker, will be subrogated to the state agency. The state agency may assert its rights under this section within three years of the date the service was rendered. For purposes of this section, "state agency" includes prepaid health plans under contract with the commissioner according to sections 256B.69 and 256L.12; children's mental health collaboratives under section 245.493; demonstration projects for persons with disabilities under section 256B.77; nursing homes under the alternative payment demonstration project under section 256B.434; and county-based purchasing entities under section 256B.692.
(d) Notwithstanding any law to the contrary, when a person covered by a plan offered by a health insurer receives medical benefits according to any statute listed in this section, payment for covered services or notice of denial for services billed by the provider must be issued directly to the provider. If a person was receiving medical benefits through the Department of Human Services at the time a service was provided, the provider must indicate this benefit coverage on any claim forms submitted by the provider to the health insurer for those services. If the commissioner of human services notifies the health insurer that the commissioner has made payments to the provider, payment for benefits or notices of denials issued by the health insurer must be issued directly to the commissioner. Submission by the department to the health insurer of the claim on a Department of Human Services claim form is proper notice and shall be considered proof of payment of the claim to the provider and supersedes any contract requirements of the health insurer relating to the form of submission. Liability to the insured for coverage is satisfied to the extent that payments for those benefits are made by the health insurer to the provider or the commissioner as required by this section.
(e) When a state agency has acquired the rights of an individual eligible for medical programs named in this section and has health benefits coverage through a health insurer, the health insurer shall not impose requirements that are different from requirements applicable to an agent or assignee of any other individual covered.
(f) A health insurer must process a clean claim made by a state agency for covered expenses paid under state medical programs within 90 business days of the claim's submission. A health insurer must process all other claims made by a state agency for covered expenses paid under a state medical program within the timeline set forth in Code of Federal Regulations, title 42, section 447.45(d)(4).
(g) A health insurer may request a refund of a claim paid in error to the Department of Human Services within two years of the date the payment was made to the department. A request for a refund shall not be honored by the department if the health insurer makes the request after the time period has lapsed.
Sec. 2. Minnesota Statutes 2022, section 62A.30, is amended by adding a subdivision to read:
Subd. 5. Mammogram;
diagnostic services and testing. If
a health care provider determines an enrollee requires additional diagnostic
services or testing after a mammogram, a health plan must provide coverage for
the additional diagnostic services or testing with no cost-sharing, including
co-pay, deductible, or coinsurance.
EFFECTIVE DATE. This
section is effective January 1, 2024, and applies to health plans offered,
issued, or sold on or after that date.
Sec. 3. Minnesota Statutes 2022, section 62A.30, is amended by adding a subdivision to read:
Subd. 6. Application. If the application of subdivision 5
before an enrollee has met their health plan's deductible would result in: (1) health savings account ineligibility
under United States Code, title 26, section 223; or (2) catastrophic health
plan ineligibility under United States Code, title 42, section 18022(e), then
subdivision 5 shall apply to diagnostic services or testing only after the
enrollee has met their health plan's deductible.
EFFECTIVE DATE. This
section is effective January 1, 2024, and applies to health plans offered,
issued, or sold on or after that date.
Sec. 4. Minnesota Statutes 2022, section 62A.673, subdivision 2, is amended to read:
Subd. 2. Definitions. (a) For purposes of this section, the terms defined in this subdivision have the meanings given.
(b) "Distant site" means a site at which a health care provider is located while providing health care services or consultations by means of telehealth.
(c) "Health care provider" means a health care professional who is licensed or registered by the state to perform health care services within the provider's scope of practice and in accordance with state law. A health care provider includes a mental health professional under section 245I.04, subdivision 2; a mental health practitioner under section 245I.04, subdivision 4; a clinical trainee under section 245I.04, subdivision 6; a treatment coordinator under section 245G.11, subdivision 7; an alcohol and drug counselor under section 245G.11, subdivision 5; and a recovery peer under section 245G.11, subdivision 8.
(d) "Health carrier" has the meaning given in section 62A.011, subdivision 2.
(e) "Health plan" has the meaning given in section 62A.011, subdivision 3. Health plan includes dental plans as defined in section 62Q.76, subdivision 3, but does not include dental plans that provide indemnity-based benefits, regardless of expenses incurred, and are designed to pay benefits directly to the policy holder.
(f) "Originating site" means a site at which a patient is located at the time health care services are provided to the patient by means of telehealth. For purposes of store-and-forward technology, the originating site also means the location at which a health care provider transfers or transmits information to the distant site.
(g) "Store-and-forward technology" means the asynchronous electronic transfer or transmission of a patient's medical information or data from an originating site to a distant site for the purposes of diagnostic and therapeutic assistance in the care of a patient.
(h) "Telehealth"
means the delivery of health care services or consultations through the use of
real time two-way interactive audio and visual communications to provide or
support health care delivery and facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care. Telehealth includes the application of secure
video conferencing, store-and-forward technology, and synchronous interactions
between a patient located at an originating site and a health care provider
located at a distant site. Until July 1,
2023 2025, telehealth also includes audio-only communication
between a health care provider and a patient in accordance with subdivision 6,
paragraph (b). Telehealth does not
include communication between health care providers that consists solely of a
telephone conversation, email, or facsimile transmission. Telehealth does not include communication
between a health care provider and a patient that consists solely of an email
or facsimile transmission. Telehealth
does not include telemonitoring services as defined in paragraph (i).
(i) "Telemonitoring services" means the remote monitoring of clinical data related to the enrollee's vital signs or biometric data by a monitoring device or equipment that transmits the data electronically to a health care provider for analysis. Telemonitoring is intended to collect an enrollee's health-related data for the purpose of assisting a health care provider in assessing and monitoring the enrollee's medical condition or status.
Sec. 5. [62J.811]
PROVIDER BALANCE BILLING REQUIREMENTS.
Subdivision 1. Billing
requirements. (a) Each health
care provider and health facility shall comply with the federal Consolidated
Appropriations Act, 2021, Division BB also known as the "No Surprises
Act," including any federal regulations adopted under that act.
(b) For the purposes of this section, "provider" or "facility" means any health care provider or facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that is subject to relevant provisions of the No Surprises Act.
Subd. 2. Investigations
and compliance. (a) The
commissioner shall, to the extent practicable, seek the cooperation of health
care providers and facilities, and may provide any support and assistance as
available, in obtaining compliance with this section.
(b) The commissioner
shall determine the manner and processes for fulfilling any responsibilities
and taking any of the actions in paragraphs (c) to (f).
(c) A person who
believes a health care provider or facility has not complied with the
requirements of the No Surprises Act or this section may file a complaint with
the commissioner in the manner determined by the commissioner.
(d) The commissioner
shall conduct compliance reviews and investigate complaints filed under this
section in the manner determined by the commissioner to ascertain whether
health care providers and facilities are complying with this section.
(e) The commissioner may
report violations under this section to other relevant federal and state
departments and jurisdictions as appropriate, including the attorney general
and relevant licensing boards, and may also coordinate on investigations and
enforcement of this section with other relevant federal and state departments
and jurisdictions as appropriate, including the attorney general and relevant
licensing boards.
(f) A health care
provider or facility may contest whether the finding of facts constitute a
violation of this section according to the contested case proceeding in
sections 14.57 to 14.62, subject to appeal according to sections 14.63 to
14.68.
(g) Any data collected
by the commissioner as part of an active investigation or active compliance
review under this section are classified (1) if the data is not on individuals,
it is classified as protected nonpublic data pursuant to section 13.02 subdivision
13; or (2) if the data is on individuals, it is classified as confidential
pursuant to sections 13.02, subdivision 3.
Data describing the final disposition of an investigative or compliance
review are classified as public.
Subd. 3. Civil
penalty. (a) The
commissioner, in monitoring and enforcing this section, may levy a civil
monetary penalty against each health care provider or facility found to be in
violation of up to $100 for each violation, but may not exceed $25,000 for
identical violations during a calendar year.
(b) No civil monetary penalty shall be imposed under this section for
violations that occur prior to January 1, 2024.
Sec. 6. Minnesota Statutes 2022, section 62J.824, is amended to read:
62J.824 FACILITY FEE DISCLOSURE.
(a) Prior to the delivery of nonemergency services, a provider-based clinic that charges a facility fee shall provide notice to any patient, including patients served by telehealth as defined in section 62A.673, subdivision 2, paragraph (h), stating that the clinic is part of a hospital and the patient may receive a separate charge or billing for the facility component, which may result in a higher out-of-pocket expense.
(b) Each health care facility must post prominently in locations easily accessible to and visible by patients, including on its website, a statement that the provider-based clinic is part of a hospital and the patient may receive a separate charge or billing for the facility, which may result in a higher out-of-pocket expense.
(c) This section does not apply to laboratory services, imaging services, or other ancillary health services that are provided by staff who are not employed by the health care facility or clinic.
(d) For purposes of this section:
(1) "facility fee" means any separate charge or billing by a provider-based clinic in addition to a professional fee for physicians' services that is intended to cover building, electronic medical records systems, billing, and other administrative and operational expenses; and
(2) "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. This definition does not include clinics that are exclusively providing laboratory, x-ray, testing, therapy, pharmacy, or educational services and does not include facilities designated as rural health clinics.
Sec. 7. [62J.826]
MEDICAL AND DENTAL PRACTICES; CURRENT STANDARD CHARGES.
Subdivision 1. Definitions. (a) The definitions in this
subdivision apply to this section.
(b) "CDT code"
means a code value drawn from the Code on Dental Procedures and Nomenclature
published by the American Dental Association.
(c)
"Chargemaster" means the list of all individual items and services
maintained by a medical or dental practice for which the medical or dental
practice has established a charge.
(d)
"Commissioner" means the commissioner of health.
(e) "CPT code"
means a code value drawn from the Current Procedural Terminology published by
the American Medical Association.
(f) "Dental
service" means a service charged using a CDT code.
(g) "Diagnostic
laboratory testing" means a service charged using a CPT code within the
CPT code range of 80047 to 89398.
(h) "Diagnostic
radiology service" means a service charged using a CPT code within the CPT
code range of 70010 to 79999 and includes the provision of x-rays, computed
tomography scans, positron emission tomography scans, magnetic resonance imaging
scans, and mammographies.
(i) "Hospital"
means an acute care institution licensed under sections 144.50 to 144.58, but
does not include a health care institution conducted for those who rely
primarily upon treatment by prayer or spiritual means in accordance with the creed
or tenets of any church or denomination.
(j) "Medical or
dental practice" means a business that:
(1) earns revenue by
providing medical care or dental services to the public;
(2) issues payment
claims to health plan companies and other payers; and
(3) may be identified by
its federal tax identification number.
(k) "Outpatient
surgical center" means a health care facility other than a hospital offering
elective outpatient surgery under a license issued under sections 144.50 to
144.58.
(l) "Standard
charge" means the regular rate established by the medical or dental
practice for an item or service provided to a specific group of paying patients. This includes all of the following:
(1) the charge for an
individual item or service that is reflected on a medical or dental practice's
chargemaster, absent any discounts;
(2) the charge that a
medical or dental practice has negotiated with a third-party payer for an item
or service;
(3) the lowest charge
that a medical or dental practice has negotiated with all third-party payers
for an item or service;
(4) the highest charge that a
medical or dental practice has negotiated with all third-party payers for an
item or service; and
(5) the charge that
applies to an individual who pays cash, or cash equivalent, for an item or
service.
Subd. 2. Requirement;
current standard charges. The
following medical or dental practices must make available to the public a list
of their current standard charges for all items and services, as reflected in
the medical or dental practice's chargemaster, provided by the medical or
dental practice:
(1) hospitals;
(2) outpatient surgical
centers; and
(3) any other medical or
dental practice that has revenue of greater than $50,000,000 per year and that
derives the majority of its revenue by providing one or more of the following
services:
(i) diagnostic radiology
services;
(ii) diagnostic
laboratory testing;
(iii) orthopedic
surgical procedures, including joint arthroplasty procedures within the CPT
code range of 26990 to 27899;
(iv) ophthalmologic
surgical procedures, including cataract surgery coded using CPT code 66982 or
66984, or refractive correction surgery to improve visual acuity;
(v) anesthesia services
commonly provided as an ancillary to services provided at a hospital,
outpatient surgical center, or medical practice that provides orthopedic
surgical procedures or ophthalmologic surgical procedures;
(vi) oncology services,
including radiation oncology treatments within the CPT code range of 77261 to
77799 and drug infusions; or
(vii) dental services.
Subd. 3. Required
file format and content. (a)
A medical or dental practice that is subject to this section must make
available to the public current standard charges using the format and data
elements specified in the currently effective version of the Hospital Price
Transparency Sample Format (Tall) (CSV) and related data dictionary recommended
for hospitals by the Centers for Medicare and Medicaid Services (CMS). If CMS modifies or replaces the
specifications for this format, the form of this file must be modified or
replaced to conform with the new CMS specifications by the date specified by
CMS for compliance with its new specifications.
All prices included in the file must be expressed as dollar amounts. The data must be in the form of a comma
separated values file which can be directly imported, without further editing
or remediation, into a relational database table which has been designed to
receive these files. The medical or
dental practice must make the file available to the public in a manner
specified by the commissioner.
(b) A medical or dental
practice must test its file for compliance with paragraph (a) before making the
file available to the public.
(c) A hospital must
comply with this section no later than January 1, 2024. A medical or dental practice that meets the
requirements in subdivision 2, clause (3), or an outpatient surgical center
must comply with this section no later than January 1, 2025.
Sec. 8. Minnesota Statutes 2022, section 62J.84, subdivision 2, is amended to read:
Subd. 2. Definitions. (a) For purposes of this section, the terms defined in this subdivision have the meanings given.
(b) "Biosimilar" means a drug that is produced or distributed pursuant to a biologics license application approved under United States Code, title 42, section 262(K)(3).
(c) "Brand name drug" means a drug that is produced or distributed pursuant to:
(1) an original, a
new drug application approved under United States Code, title 21, section
355(c), except for a generic drug as defined under Code of Federal Regulations,
title 42, section 447.502; or
(2) a biologics license
application approved under United States Code, title 45 42,
section 262(a)(c).
(d) "Commissioner" means the commissioner of health.
(e) "Generic drug" means a drug that is marketed or distributed pursuant to:
(1) an abbreviated new drug application approved under United States Code, title 21, section 355(j);
(2) an authorized generic
as defined under Code of Federal Regulations, title 45 42,
section 447.502; or
(3) a drug that entered the market the year before 1962 and was not originally marketed under a new drug application.
(f) "Manufacturer" means a drug manufacturer licensed under section 151.252.
(g) "New prescription drug" or "new drug" means a prescription drug approved for marketing by the United States Food and Drug Administration (FDA) for which no previous wholesale acquisition cost has been established for comparison.
(h) "Patient assistance program" means a program that a manufacturer offers to the public in which a consumer may reduce the consumer's out-of-pocket costs for prescription drugs by using coupons, discount cards, prepaid gift cards, manufacturer debit cards, or by other means.
(i) "Prescription drug" or "drug" has the meaning provided in section 151.441, subdivision 8.
(j) "Price" means the wholesale acquisition cost as defined in United States Code, title 42, section 1395w‑3a(c)(6)(B).
(k) "30-day
supply" means the total daily dosage units of a prescription drug
recommended by the prescribing label approved by the FDA for 30 days. If the FDA-approved prescribing label
includes more than one recommended daily dosage, the 30-day supply is based on
the maximum recommended daily dosage on the FDA‑approved prescribing
label.
(l) "Course of
treatment" means the total dosage of a single prescription for a
prescription drug recommended by the FDA-approved prescribing label. If the FDA-approved prescribing label
includes more than one recommended dosage for a single course of treatment, the
course of treatment is the maximum recommended dosage on the FDA‑approved
prescribing label.
(m) "Drug product
family" means a group of one or more prescription drugs that share a
unique generic drug description or nontrade name and dosage form.
(n) "Individual
salable unit" means the smallest container of product introduced into
commerce by the manufacturer or repackager that is intended by the manufacturer
or repackager for individual sale to a dispenser.
(o) "National drug
code" means the three-segment code maintained by the federal Food and Drug
Administration that includes a labeler code, a product code, and a package code
for a drug product and that has been converted to an 11-digit format consisting
of five digits in the first segment, four digits in the second segment, and two
digits in the third segment. A
three-segment code shall be considered converted to an 11-digit format when, as
necessary, at least one "0" has been added to the front of each segment
containing less than the specified number of digits such that each segment
contains the specified number of digits.
(p) "Pharmacy"
or "pharmacy provider" means a community/outpatient pharmacy as
defined in Minnesota Rules, part 6800.0100, subpart 2, that is also licensed as
a pharmacy by the Board of Pharmacy under section 151.19.
(q) "Pharmacy
benefit manager" or "PBM" means an entity licensed to act as a
pharmacy benefit manager under section 62W.03.
(r) "Pricing
unit" means the smallest dispensable amount of a prescription drug product
that could be dispensed.
(s) "Rebate"
means a discount, chargeback, or other price concession that affects the price
of a prescription drug product, regardless of whether conferred through regular
aggregate payments, on a claim-by-claim basis at the point of sale, as part of
retrospective financial reconciliations, including reconciliations that also
reflect other contractual arrangements, or by any other method. "Rebate" does not mean a bona fide
service fee as defined in Code of Federal Regulations, title 42, section
447.502.
(t) "Reporting entity" means any manufacturer, pharmacy, pharmacy benefit manager, wholesale drug distributor, or any other entity required to submit data under this section.
(u) "Wholesale drug
distributor" or "wholesaler" means an entity that:
(1) is licensed to act
as a wholesale drug distributor under section 151.47; and
(2) distributes
prescription drugs, for which it is not the manufacturer, to persons or
entities, or both, other than a consumer or patient in the state.
Sec. 9. Minnesota Statutes 2022, section 62J.84, subdivision 3, is amended to read:
Subd. 3. Prescription drug price increases reporting. (a) Beginning January 1, 2022, a drug manufacturer must submit to the commissioner the information described in paragraph (b) for each prescription drug for which the price was $100 or greater for a 30-day supply or for a course of treatment lasting less than 30 days and:
(1) for brand name drugs where there is an increase of ten percent or greater in the price over the previous 12‑month period or an increase of 16 percent or greater in the price over the previous 24-month period; and
(2) for generic or biosimilar drugs where there is an increase of 50 percent or greater in the price over the previous 12-month period.
(b) For each of the drugs described in paragraph (a), the manufacturer shall submit to the commissioner no later than 60 days after the price increase goes into effect, in the form and manner prescribed by the commissioner, the following information, if applicable:
(1) the name description
and price of the drug and the net increase, expressed as a percentage;,
with the following listed separately:
(i) the national drug
code;
(ii) the product name;
(iii) the dosage form;
(iv) the strength; and
(v) the package size;
(2) the factors that contributed to the price increase;
(3) the name of any generic version of the prescription drug available on the market;
(4) the introductory price
of the prescription drug when it was approved for marketing by the Food and
Drug Administration and the net yearly increase, by calendar year, in the price
of the prescription drug during the previous five years introduced for
sale in the United States and the price of the drug on the last day of each of
the five calendar years preceding the price increase;
(5) the direct costs incurred during the previous 12-month period by the manufacturer that are associated with the prescription drug, listed separately:
(i) to manufacture the prescription drug;
(ii) to market the prescription drug, including advertising costs; and
(iii) to distribute the prescription drug;
(6) the total sales revenue for the prescription drug during the previous 12-month period;
(7) the manufacturer's net profit attributable to the prescription drug during the previous 12-month period;
(8) the total amount of financial assistance the manufacturer has provided through patient prescription assistance programs during the previous 12-month period, if applicable;
(9) any agreement between a manufacturer and another entity contingent upon any delay in offering to market a generic version of the prescription drug;
(10) the patent expiration date of the prescription drug if it is under patent;
(11) the name and location
of the company that manufactured the drug; and
(12) if a brand name
prescription drug, the ten highest prices price paid for
the prescription drug during the previous calendar year in any country other
than the ten countries, excluding the United States., that
charged the highest single price for the prescription drug; and
(13) if the prescription
drug was acquired by the manufacturer during the previous 12-month period, all
of the following information:
(i) price at
acquisition;
(ii) price in the
calendar year prior to acquisition;
(iii) name of the
company from which the drug was acquired;
(iv) date of
acquisition; and
(v) acquisition price.
(c) The manufacturer may submit any documentation necessary to support the information reported under this subdivision.
Sec. 10. Minnesota Statutes 2022, section 62J.84, subdivision 4, is amended to read:
Subd. 4. New prescription drug price reporting. (a) Beginning January 1, 2022, no later than 60 days after a manufacturer introduces a new prescription drug for sale in the United States that is a new brand name drug with a price that is greater than the tier threshold established by the Centers for Medicare and Medicaid Services for specialty drugs in the Medicare Part D program for a 30-day supply or for a course of treatment lasting fewer than 30 days or a new generic or biosimilar drug with a price that is greater than the tier threshold established by the Centers for Medicare and Medicaid Services for specialty drugs in the Medicare Part D program for a 30-day supply or for a course of treatment lasting fewer than 30 days and is not at least 15 percent lower than the referenced brand name drug when the generic or biosimilar drug is launched, the manufacturer must submit to the commissioner, in the form and manner prescribed by the commissioner, the following information, if applicable:
(1) the description of
the drug, with the following listed separately:
(i) the national drug
code;
(ii) the product name;
(iii) the dosage form;
(iv) the strength; and
(v) the package size;
(1) (2) the
price of the prescription drug;
(2) (3) whether
the Food and Drug Administration granted the new prescription drug a
breakthrough therapy designation or a priority review;
(3) (4) the direct costs incurred by the manufacturer that are associated with the prescription drug, listed separately:
(i) to manufacture the prescription drug;
(ii) to market the prescription drug, including advertising costs; and
(iii) to distribute the prescription drug; and
(4) (5) the
patent expiration date of the drug if it is under patent.
(b) The manufacturer may submit documentation necessary to support the information reported under this subdivision.
Sec. 11. Minnesota Statutes 2022, section 62J.84, subdivision 6, is amended to read:
Subd. 6. Public posting of prescription drug price information. (a) The commissioner shall post on the department's website, or may contract with a private entity or consortium that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the following information:
(1) a list of the
prescription drugs reported under subdivisions 3, 4, and 5, 11 to 14
and the manufacturers of those prescription drugs; and
(2) information reported to
the commissioner under subdivisions 3, 4, and 5 11 to 14.
(b) The information must be published in an easy-to-read format and in a manner that identifies the information that is disclosed on a per-drug basis and must not be aggregated in a manner that prevents the identification of the prescription drug.
(c) The commissioner shall
not post to the department's website or a private entity contracting with the
commissioner shall not post any information described in this section if the
information is not public data under section 13.02, subdivision 8a; or is trade
secret information under section 13.37, subdivision 1, paragraph (b); or is
trade secret information pursuant to the Defend Trade Secrets Act of 2016,
United States Code, title 18, section 1836, as amended. If a manufacturer reporting entity
believes information should be withheld from public disclosure pursuant to this
paragraph, the manufacturer reporting entity must clearly and
specifically identify that information and describe the legal basis in writing
when the manufacturer reporting entity submits the information
under this section. If the commissioner
disagrees with the manufacturer's reporting entity's request to
withhold information from public disclosure, the commissioner shall provide the
manufacturer reporting entity written notice that the information
will be publicly posted 30 days after the date of the notice.
(d) If the commissioner withholds any information from public disclosure pursuant to this subdivision, the commissioner shall post to the department's website a report describing the nature of the information and the commissioner's basis for withholding the information from disclosure.
(e) To the extent the information required to be posted under this subdivision is collected and made available to the public by another state, by the University of Minnesota, or through an online drug pricing reference and analytical tool, the commissioner may reference the availability of this drug price data from another source including, within existing appropriations, creating the ability of the public to access the data from the source for purposes of meeting the reporting requirements of this subdivision.
Sec. 12. Minnesota Statutes 2022, section 62J.84, subdivision 7, is amended to read:
Subd. 7. Consultation. (a) The commissioner may consult with a private entity or consortium that satisfies the standards of section 62U.04, subdivision 6, the University of Minnesota, or the commissioner of commerce, as appropriate, in issuing the form and format of the information reported under this section; in posting information pursuant to subdivision 6; and in taking any other action for the purpose of implementing this section.
(b) The commissioner may
consult with representatives of the manufacturers reporting entities
to establish a standard format for reporting information under this section and
may use existing reporting methodologies to establish a standard format to
minimize administrative burdens to the state and manufacturers reporting
entities.
Sec. 13. Minnesota Statutes 2022, section 62J.84, subdivision 8, is amended to read:
Subd. 8. Enforcement
and penalties. (a) A manufacturer
reporting entity may be subject to a civil penalty, as provided in
paragraph (b), for:
(1) failing to register
under subdivision 15;
(1) (2) failing
to submit timely reports or notices as required by this section;
(2) (3) failing
to provide information required under this section; or
(3) (4) providing
inaccurate or incomplete information under this section.
(b) The commissioner shall adopt a schedule of civil penalties, not to exceed $10,000 per day of violation, based on the severity of each violation.
(c) The commissioner shall impose civil penalties under this section as provided in section 144.99, subdivision 4.
(d) The commissioner may remit or mitigate civil penalties under this section upon terms and conditions the commissioner considers proper and consistent with public health and safety.
(e) Civil penalties collected under this section shall be deposited in the health care access fund.
Sec. 14. Minnesota Statutes 2022, section 62J.84, subdivision 9, is amended to read:
Subd. 9. Legislative report. (a) No later than May 15, 2022, and by January 15 of each year thereafter, the commissioner shall report to the chairs and ranking minority members of the legislative committees with jurisdiction over commerce and health and human services policy and finance on the implementation of this section, including but not limited to the effectiveness in addressing the following goals:
(1) promoting transparency in pharmaceutical pricing for the state and other payers;
(2) enhancing the understanding on pharmaceutical spending trends; and
(3) assisting the state and other payers in the management of pharmaceutical costs.
(b) The report must include
a summary of the information submitted to the commissioner under subdivisions
3, 4, and 5 11 to 14.
Sec. 15. Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:
Subd. 10. Notice
of prescription drugs of substantial public interest. (a) No later than January 31, 2024,
and quarterly thereafter, the commissioner shall produce and post on the
department's website a list of prescription drugs that the commissioner
determines to represent a substantial public interest and for which the commissioner
intends to request data under subdivisions 11 to 14, subject to paragraph (c). The commissioner shall base its inclusion of
prescription drugs on any information the commissioner determines is relevant
to providing greater consumer awareness of the factors contributing to the cost
of prescription drugs in the state, and the commissioner shall consider drug
product families that include prescription drugs:
(1) that triggered
reporting under subdivision 3 or 4 during the previous calendar quarter;
(2) for which average
claims paid amounts exceeded 125 percent of the price as of the claim incurred
date during the most recent calendar quarter for which claims paid amounts are
available; or
(3) that are identified
by members of the public during a public comment process.
(b) Not sooner than 30
days after publicly posting the list of prescription drugs under paragraph (a),
the department shall notify, via email, reporting entities registered with the
department of the requirement to report under subdivisions 11 to 14.
(c) The commissioner
must not designate more than 500 prescription drugs as having a substantial
public interest in any one notice.
Sec. 16. Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:
Subd. 11. Manufacturer
prescription drug substantial public interest reporting. (a) Beginning January 1, 2024, a
manufacturer must submit to the commissioner the information described in
paragraph (b) for any prescription drug:
(1) included in a
notification to report issued to the manufacturer by the department under
subdivision 10;
(2) which the
manufacturer manufactures or repackages;
(3) for which the
manufacturer sets the wholesale acquisition cost; and
(4) for which the
manufacturer has not submitted data under subdivision 3 during the 120-day
period prior to the date of the notification to report.
(b) For each of the
drugs described in paragraph (a), the manufacturer shall submit to the
commissioner no later than 60 days after the date of the notification to
report, in the form and manner prescribed by the commissioner, the following
information, if applicable:
(1) a description of the
drug with the following listed separately:
(i) the national drug
code;
(ii) the product name;
(iii) the dosage form;
(iv) the strength; and
(v) the package size;
(2) the price of the
drug product on the later of:
(i) the day one year
prior to the date of the notification to report;
(ii) the introduced to
market date; or
(iii) the acquisition
date;
(3) the price of the
drug product on the date of the notification to report;
(4) the introductory
price of the prescription drug when it was introduced for sale in the United
States and the price of the drug on the last day of each of the five calendar
years preceding the date of the notification to report;
(5) the direct costs
incurred during the 12-month period prior to the date of the notification to
report by the manufacturers that are associated with the prescription drug,
listed separately:
(i) to manufacture the
prescription drug;
(ii) to market the
prescription drug, including advertising costs; and
(iii) to distribute the
prescription drug;
(6) the number of units
of the prescription drug sold during the 12-month period prior to the date of
the notification to report;
(7) the total sales
revenue for the prescription drug during the 12-month period prior to the date
of the notification to report;
(8) the total rebate
payable amount accrued for the prescription drug during the 12-month period
prior to the date of the notification to report;
(9) the manufacturer's
net profit attributable to the prescription drug during the 12-month period
prior to the date of the notification to report;
(10) the total amount of
financial assistance the manufacturer has provided through patient prescription
assistance programs during the 12-month period prior to the date of the
notification to report, if applicable;
(11) any agreement
between a manufacturer and another entity contingent upon any delay in offering
to market a generic version of the prescription drug;
(12) the patent
expiration date of the prescription drug if the prescription drug is under
patent;
(13) the name and location of the company that manufactured the drug;
(14) if the prescription
drug is a brand name prescription drug, the ten countries other than the United
States that paid the highest prices for the prescription drug during the
previous calendar year and their prices; and
(15) if the prescription drug
was acquired by the manufacturer within a 12-month period prior to the date of
the notification to report, all of the following information:
(i) the price at
acquisition;
(ii) the price in the
calendar year prior to acquisition;
(iii) the name of the
company from which the drug was acquired;
(iv) the date of
acquisition; and
(v) the acquisition
price.
(c) The manufacturer may
submit any documentation necessary to support the information reported under
this subdivision.
Sec. 17. Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:
Subd. 12. Pharmacy
prescription drug substantial public interest reporting. (a) Beginning January 1, 2024, a
pharmacy must submit to the commissioner the information described in paragraph
(b) for any prescription drug included in a notification to report issued to
the pharmacy by the department under subdivision 10.
(b) For each of the
drugs described in paragraph (a), the pharmacy shall submit to the commissioner
no later than 60 days after the date of the notification to report, in the form
and manner prescribed by the commissioner, the following information, if applicable:
(1) a description of the
drug with the following listed separately:
(i) the national drug
code;
(ii) the product name;
(iii) the dosage form;
(iv) the strength; and
(v) the package size;
(2) the number of units
of the drug acquired during the 12-month period prior to the date of the
notification to report;
(3) the total spent
before rebates by the pharmacy to acquire the drug during the 12-month period
prior to the date of the notification to report;
(4) the total rebate
receivable amount accrued by the pharmacy for the drug during the 12-month
period prior to the date of the notification to report;
(5) the number of
pricing units of the drug dispensed by the pharmacy during the 12-month period
prior to the date of the notification to report;
(6) the total payment
receivable by the pharmacy for dispensing the drug including ingredient cost,
dispensing fee, and administrative fees during the 12-month period prior to the
date of the notification to report;
(7) the total rebate
payable amount accrued by the pharmacy for the drug during the 12-month period
prior to the date of the notification to report; and
(8) the average cash
price paid by consumers per pricing unit for prescriptions dispensed where no
claim was submitted to a health care service plan or health insurer during the
12-month period prior to the date of the notification to report.
(c) The pharmacy may
submit any documentation necessary to support the information reported under
this subdivision.
(d) The commissioner may
grant extensions, exemptions, or both to compliance with the requirements of
paragraphs (a) and (b) by small or independent pharmacies, if compliance with
paragraphs (a) and (b) would represent a hardship or undue burden to the
pharmacy. The commissioner may establish
procedures for small or independent pharmacies to request extensions or
exemptions under this paragraph.
Sec. 18. Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:
Subd. 13. PBM prescription drug substantial public interest reporting. (a) Beginning January 1, 2024, a PBM must submit to the commissioner the information described in paragraph (b) for any prescription drug included in a notification to report issued to the PBM by the department under subdivision 10.
(b) For each of the
drugs described in paragraph (a), the PBM shall submit to the commissioner no
later than 60 days after the date of the notification to report, in the
form and manner prescribed by the commissioner, the following information, if
applicable:
(1) a description of the
drug with the following listed separately:
(i) the national drug
code;
(ii) the product name;
(iii) the dosage form;
(iv) the strength; and
(v) the package size;
(2) the number of
pricing units of the drug product filled for which the PBM administered claims
during the 12‑month period prior to the date of the notification to
report;
(3) the total
reimbursement amount accrued and payable to pharmacies for pricing units of the
drug product filled for which the PBM
administered claims during the 12-month period prior to the date of the
notification to report;
(4) the total
reimbursement or administrative fee amount, or both, accrued and receivable
from payers for pricing units of the drug product filled for which the PBM
administered claims during the 12-month period prior to the date of the
notification to report;
(5) the total rebate
receivable amount accrued by the PBM for the drug product during the 12-month
period prior to the date of the notification to report; and
(6) the total rebate
payable amount accrued by the PBM for the drug product during the 12-month
period prior to the date of the notification to report.
(c) The PBM may submit
any documentation necessary to support the information reported under this
subdivision.
Sec. 19. Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:
Subd. 14. Wholesale drug distributor prescription drug substantial public interest reporting. (a) Beginning January 1, 2024, a wholesale drug distributor must submit to the commissioner the information described in paragraph (b) for any prescription drug included in a notification to report issued to the wholesale drug distributor by the department under subdivision 10.
(b) For each of the
drugs described in paragraph (a), the wholesale drug distributor shall submit
to the commissioner no later than 60 days after the date of the notification to
report, in the form and manner prescribed by the commissioner, the following
information, if applicable:
(1) a description of the
drug with the following listed separately:
(i) the national drug
code;
(ii) the product name;
(iii) the dosage form;
(iv) the strength; and
(v) the package size;
(2) the number of units
of the drug product acquired by the wholesale drug distributor during the
12-month period prior to the date of the notification to report;
(3) the total spent
before rebates by the wholesale drug distributor to acquire the drug product
during the 12‑month period prior to the date of the notification to
report;
(4) the total rebate
receivable amount accrued by the wholesale drug distributor for the drug
product during the 12-month period prior to the date of the notification to
report;
(5) the number of units
of the drug product sold by the wholesale drug distributor during the 12-month
period prior to the date of the notification to report;
(6) gross revenue from
sales in the United States generated by the wholesale drug distributor for this
drug product during the 12-month period prior to the date of the notification
to report; and
(7) total rebate payable
amount accrued by the wholesale drug distributor for the drug product during
the 12‑month period prior to the date of the notification to report.
(c) The wholesale drug
distributor may submit any documentation necessary to support the information
reported under this subdivision.
Sec. 20. Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:
Subd. 15. Registration
requirements. Beginning
January 1, 2024, a reporting entity subject to this chapter shall register with
the department in a form and manner prescribed by the commissioner.
Sec. 21. Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:
Subd. 16. Rulemaking. For the purposes of this section, the
commissioner may use the expedited rulemaking process under section 14.389.
Sec. 22. Minnesota Statutes 2022, section 62K.10, subdivision 4, is amended to read:
Subd. 4. Network adequacy. (a) Each designated provider network must include a sufficient number and type of providers, including providers that specialize in mental health and substance use disorder services, to ensure that covered services are available to all enrollees without unreasonable delay. In determining network adequacy, the commissioner of health shall consider availability of services, including the following:
(1) primary care physician services are available and accessible 24 hours per day, seven days per week, within the network area;
(2) a sufficient number of primary care physicians have hospital admitting privileges at one or more participating hospitals within the network area so that necessary admissions are made on a timely basis consistent with generally accepted practice parameters;
(3) specialty physician service is available through the network or contract arrangement;
(4) mental health and substance use disorder treatment providers, including but not limited to psychiatric residential treatment facilities, are available and accessible through the network or contract arrangement;
(5) to the extent that primary care services are provided through primary care providers other than physicians, and to the extent permitted under applicable scope of practice in state law for a given provider, these services shall be available and accessible; and
(6) the network has available, either directly or through arrangements, appropriate and sufficient personnel, physical resources, and equipment to meet the projected needs of enrollees for covered health care services.
(b) The commissioner may
establish sufficiency by referencing any reasonable criteria, which include but
are not limited to:
(1) ratios of providers
to enrollees by specialty;
(2) ratios of primary
care professionals to enrollees;
(3) geographic
accessibility of providers;
(4) waiting times for an
appointment with participating providers;
(5) hours of operation;
(6) the ability of the network
to meet the needs of enrollees that are:
(i) low-income persons;
(ii) children and adults
with serious, chronic, or complex health conditions, physical disabilities, or
mental illness; or
(iii) persons with
limited English proficiency and persons from underserved communities;
(7) other health care
service delivery system options, including telemedicine or telehealth, mobile
clinics, centers of excellence, and other ways of delivering care; and
(8) the volume of
technological and specialty care services available to serve the needs of
enrollees that need technologically advanced or specialty care services.
EFFECTIVE DATE; APPLICATION.
Paragraph (a) is effective July 1, 2023. Paragraph (b) is effective January 1, 2025,
and applies to health plans offered, issued, or renewed on or after that date. This section supercedes S. F. No. 2744,
article 2, section 39, if enacted in the 2023 legislative session.
Sec. 23. Minnesota Statutes 2022, section 62Q.01, is amended by adding a subdivision to read:
Subd. 6b. No
Surprises Act. "No
Surprises Act" means Division BB of the Consolidated Appropriations Act,
2021, which amended Title XXVII of the Public Health Service Act, Public Law
116-260, and any amendments to and any federal guidance or regulations issued
under this act.
Sec. 24. Minnesota Statutes 2022, section 62Q.021, is amended by adding a subdivision to read:
Subd. 3. Compliance
with 2021 federal law. Each
health plan company, health provider, and health facility shall comply with the
No Surprises Act, including any federal regulations adopted under the act, to
the extent that the act imposes requirements that apply in this state but are
not required under the laws of this state.
This subdivision does not require compliance with any provision of the
No Surprises Act before the effective date provided for that provision in the
No Surprises Act. The commissioner shall
enforce this subdivision.
Sec. 25. [62Q.451]
UNRESTRICTED ACCESS TO SERVICES FOR THE DIAGNOSIS, MONITORING, AND TREATMENT OF
RARE DISEASES.
Subdivision 1. Definitions. (a) For purposes of this section, the
following terms have the meanings given.
(b) "Rare disease or
condition" means any disease or condition:
(1) that affects fewer
than 200,000 persons in the United States and is chronic, serious,
life-altering, or life‑threatening;
(2) that affects more
than 200,000 persons in the United States and a drug for treatment has been
designated as a drug for a rare disease or condition pursuant to United States
Code, title 21, section 360bb;
(3) that is labeled as a
rare disease or condition on the Genetic and Rare Diseases Information Center
list created by the National Institutes of Health; or
(4) for which an
enrollee:
(i) has received two or
more clinical consultations from a primary care provider or specialty provider
that are specific to the presenting complaint;
(ii) has documentation in the
enrollee's medical record of a developmental delay through standardized
assessment, developmental regression, failure to thrive, or progressive
multisystemic involvement; and
(iii) had laboratory or
clinical testing that failed to provide a definitive diagnosis or resulted in
conflicting diagnoses.
A rare disease or condition does not include
an infectious disease that has widely available and known protocols for
diagnosis and treatment and that is commonly treated in a primary care setting,
even if it affects less than 200,000 persons in the United States.
Subd. 2. Unrestricted
access. (a) No health plan
company may restrict the choice of an enrollee as to where the enrollee
receives services from a licensed health care provider related to the
diagnosis, monitoring, and treatment of a rare disease or condition, including
but not limited to additional restrictions through any prior authorization,
preauthorization, prior approval, precertification process, increased fees, or
other methods.
(b) Any services provided
by, referred for, or ordered by an out-of-network provider for an enrollee who,
before receiving and being notified of a definitive diagnosis, satisfied the
requirements in subdivision 1, paragraph (b), clause (4), are governed by
paragraph (c), even if the subsequent definitive diagnosis does not meet the
definition of rare disease or condition in subdivision 1, paragraph (b), clause
(1), (2), or (3). Once the enrollee is
definitively diagnosed with a disease or condition that does not meet the
definition of rare disease or condition in subdivision 1, paragraph (b), clause
(1), (2), or (3), and notification of the diagnosis has been provided to both
the health plan and the enrollee, or a parent or guardian of a minor enrollee,
any services provided by, referred for, or ordered by an out‑of-network
provider related to the diagnosis are governed by paragraph (c) for up to 60
days, providing time for care to be transferred to a qualified in-network
provider and to schedule needed in-network appointments. After this 60-day period, subsequent services
provided by, referred for, or ordered by an out-of-network provider related to
the diagnosis are no longer governed by paragraph (c).
(c) Cost-sharing
requirements and benefit or services limitations for the diagnosis and
treatment of a rare disease or condition must not place a greater financial
burden on the enrollee or be more restrictive than those requirements for
in-network medical treatment.
(d) A health plan company must provide enrollees with written information on the content and application of this section and must train customer service representatives on the content and application of this section.
Subd. 3. Coverage; prior authorization. (a) Nothing in this section requires a health plan company to provide coverage for a medication, procedure or treatment, or laboratory or clinical testing, that is not covered under the enrollee's health plan.
(b) Coverage for a service must not be denied solely on the basis that it was provided by, referred for, or ordered by an out-of-network provider.
(c) Any prior authorization requirements for a service that is provided by, referred for, or ordered by an out-of-network provider must be the same as any prior authorization requirements for a service that is provided by, referred for, or ordered by an in-network provider.
(d) Subject to the
requirements of this section and chapter 62W, a health plan may require use of
a specialty pharmacy, as defined in section 62W.02, subdivision 20.
Subd. 4. Payments
to out-of-network providers for services provided in this state. (a) If a health plan company has an
established contractual payment under a health plan in the commercial insurance
market with an out-of-network provider for a service provided in Minnesota
related to the diagnosis, monitoring, and treatment of a rare disease or
condition, across any of the health plan's networks, then the provider shall
accept the established contractual payment for that service as payment in full.
(b) If a health plan company
does not have an established contractual payment under a health plan in the
commercial insurance market with an out-of-network provider for a service
provided in Minnesota related to the diagnosis, monitoring, and treatment of a
rare disease or condition, across any of the health plan's networks, then the
provider shall accept:
(1) the provider's
established rate for uninsured patients for that service as payment in full; or
(2) if the provider does
not have an established rate for uninsured patients for that service, then the
average commercial insurance rate the health plan company has paid for that
service in this state over the past 12 months as payment in full.
(d) If the payment
amount is determined under paragraph (b), clause (2), and the health plan
company has not paid for that service in this state within the past 12 months,
then the health plan company shall pay the lesser of the following:
(1) the average rate in
the commercial insurance market the health plan company paid for that service
across all states over the past 12 months; or
(2) the provider's
standard charge.
(e) This subdivision
does not apply to managed care organizations or county-based purchasing plans
when the plan provides coverage to public health care program enrollees under
chapters 256B or 256L.
Subd. 5. Payments
to out-of-network providers when services are provided outside of the state. (a) If a health plan company has an
established contractual payment under a health plan in the commercial insurance
market with an out-of-network provider for a service provided in another state
related to the diagnosis, monitoring, and treatment of a rare disease or
condition, across any of the health plan's networks in the state where the
service is provided, then the health plan company shall pay the established
contractual payment for that service.
(b) If a health plan
company does not have an established contractual payment under a health plan in
the commercial insurance market with an out-of-network provider for a service
provided in another state related to the diagnosis, monitoring, and treatment
of a rare disease or condition, across any of the health plan's networks in the
state where the service is provided, then the health plan company shall pay:
(1) the provider's
established rate for uninsured patients for that service; or
(2) if the provider does
not have an established rate for uninsured patients for that service, then the
average commercial insurance rate the health plan company has paid for that
service in the state where the service is provided over the past 12 months.
(c) If the payment
amount is determined under paragraph (b), clause (2), and the health plan
company has not paid for that service in the state where the service is
provided within the past 12 months, then the health plan company shall pay the
lesser of the following:
(1) the average
commercial insurance rate the health plan company has paid for that service
across all states over the last 12 months; or
(2) the provider's
standard charge.
(d) This subdivision
does not apply to managed care organizations or county-based purchasing plans
when the plan provides coverage to public health care program enrollees under
chapter 256B or 256L.
Subd. 6. Exclusion. This section does not apply to
medications obtained from a retail pharmacy as defined in section 62W.02,
subdivision 18.
EFFECTIVE DATE. This
section is effective January 1, 2024, and applies to health plans offered,
issued, or renewed on or after that date.
Sec. 26. [62Q.473]
BIOMARKER TESTING.
Subdivision 1. Definitions. (a) For the purposes of this section,
the terms defined in this subdivision have the meanings given.
(b)
"Biomarker" means a characteristic that is objectively measured and
evaluated as an indicator of normal biological processes, pathogenic processes,
or pharmacologic responses to a specific therapeutic intervention, including
but not limited to known gene-drug interactions for medications being
considered for use or already being administered. Biomarkers include but are not limited to
gene mutations, characteristics of genes, or protein expression.
(c) "Biomarker
testing" means the analysis of an individual's tissue, blood, or other
biospecimen for the presence of a biomarker.
Biomarker testing includes but is not limited to single-analyst tests;
multiplex panel tests; protein expression; and whole exome, whole genome, and
whole transcriptome sequencing.
(d) "Clinical
utility" means a test provides information that is used to formulate a
treatment or monitoring strategy that informs a patient's outcome and impacts
the clinical decision. The most
appropriate test may include information that is actionable and some
information that cannot be immediately used to formulate a clinical decision.
(e) "Consensus
statement" means a statement that: (1)
describes optimal clinical care outcomes, based on the best available evidence,
for a specific clinical circumstance; and (2) is developed by an independent,
multidisciplinary panel of experts that:
(i) uses a rigorous and validated development process that includes a
transparent methodology and reporting structure; and (ii) strictly adheres to
the panel's conflict of interest policy.
(f) "Nationally
recognized clinical practice guideline" means an evidence-based clinical
practice guideline that: (1) establishes
a standard of care informed by (i) a systematic review of evidence, and (ii) an
assessment of the risks and benefits of alternative care options; and (2) is
developed by an independent organization or medical professional society that: (i) uses a transparent methodology and
reporting structure; and (ii) adheres to a conflict of interest policy. Nationally recognized clinical practice
guideline includes recommendations to optimize patient care.
Subd. 2. Biomarker
testing; coverage required. (a)
A health plan must provide coverage for biomarker testing to diagnose, treat,
manage, and monitor illness or disease if the test provides clinical utility. For purposes of this section, a test's
clinical utility may be demonstrated by medical and scientific evidence,
including but not limited to:
(1) nationally
recognized clinical practice guidelines as defined in this section;
(2) consensus statements
as defined in this section;
(3) labeled indications
for a United States Food and Drug Administration (FDA) approved or FDA-cleared
test, indicated tests for an FDA-approved
drug, or adherence to warnings and precautions on FDA-approved drug labels; or
(4) Centers for Medicare
and Medicaid Services national coverage determinations or Medicare
Administrative Contractor local coverage determinations.
(b) Coverage under this
section must be provided in a manner that limits disruption of care, including
the need for multiple biopsies or biospecimen samples.
(c) Nothing in this
section prohibits a health plan company from requiring a prior authorization or
imposing other utilization controls when approving coverage for biomarker
testing.
EFFECTIVE DATE. This
section is effective January 1, 2025, and applies to health plans offered,
issued, or renewed on or after that date.
Sec. 27. [62Q.522]
COVERAGE OF CONTRACEPTIVE METHODS AND SERVICES.
Subdivision 1. Definitions. (a) The definitions in this
subdivision apply to this section.
(b) "Closely held
for-profit entity" means an entity that:
(1) is not a nonprofit
entity;
(2) has more than 50
percent of the value of its ownership interest owned directly or indirectly by
five or fewer owners; and
(3) has no publicly
traded ownership interest.
For purposes of this paragraph:
(i) ownership interests
owned by a corporation, partnership, limited liability company, estate, trust,
or similar entity are considered owned by that entity's shareholders, partners,
members, or beneficiaries in proportion to their interest held in the corporation,
partnership, limited liability company, estate, trust, or similar entity;