HF2604

Purpose of the Bill

The bill aims to amend existing statutes concerning the management of medical assistance payments in Minnesota. It focuses on introducing a mechanism to ensure accountability around capitation payments made to managed care plans.

Main Provisions

• Capitation Payment Withholding: The bill introduces a withholding of 2% of capitation payments for managed care plans providing medical assistance. This withholding takes effect for services provided between January 1, 2026, and December 31, 2026.
• Verification of Coverage Requirement: To have the withheld funds returned, plans must submit a verification of coverage form completed and signed by each enrollee. The form includes the enrollee's name, address, and selected managed care plan.
• Deadline for Form Submission: All forms must be submitted by February 27, 2026. Failure to submit the completed form results in the non-return of withheld funds for that enrollee, cessation of capitation payments, and potential disenrollment from medical assistance, though the enrollee can appeal.

Significant Changes to Existing Law

• Adjusts the percentage of capitation payment withholdings from previous levels.
• Introduces a new administrative requirement for enrollment verification aimed at ensuring accurate enrollee data.
• Establishes disenrollment conditions for non-compliance with the new verification requirements.

Relevant Terms

capitation payment, managed care plans, verification of coverage form, medical assistance, enrollee disenrollment, Minnesota statutes, withholding of funds, enrollee appeal.