HF2604

HF2604 (Legislative Session 94 (2025-2026))

Medical assistance capitation payment withhold related to verification of coverage established.

Related bill: SF3115

AI Generated Summary

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.

Bill text versions

Introduction PDF file

Past committee meetings

Health Finance and Policy on: April 02, 2025 13:00

Actions

Date	Chamber	Where	Type	Name	Committee Name
March 19, 2025	House	Floor	Action	Introduction and first reading, referred to	Human Services Finance and Policy
March 23, 2025	House	Floor	Action	Motion to recall and re-refer, motion prevailed	Health Finance and Policy
March 23, 2025	House	Floor	Action	Motion to recall and re-refer, motion prevailed	Health Finance and Policy

Citations

[
  {
    "analysis": {
      "added": [
        "A new requirement for a five percent withhold of managed care plan payments pending performance target completion."
      ],
      "removed": [
        "Previous specific withholding percentages from years prior to 2026."
      ],
      "summary": "This bill modifies procedures related to managed care contracts under section 256B.69, subdivision 5a.",
      "modified": [
        "Clarification on procedures for returning withheld funds."
      ]
    },
    "citation": "256B.69"
  },
  {
    "analysis": {
      "added": [
        "Inclusion of new withholding procedures for managed care plan payments under county-based purchasing plans."
      ],
      "removed": [
        "Obsolete processes from previous years not applicable to the current bill."
      ],
      "summary": "References to managed care and county-based purchasing plans payment procedures are made under section 256B.692.",
      "modified": [
        "Defines criteria for verification of coverage forms to be submitted by enrollees."
      ]
    },
    "citation": "256B.692"
  },
  {
    "analysis": {
      "added": [
        "New annual reporting requirements for managed care plans regarding rate increases."
      ],
      "removed": [
        "Outdated compliance timelines for personal care assistance services."
      ],
      "summary": "This bill cites requirements for personal care assistance services under section 256B.0659.",
      "modified": [
        "Standardized assessment and authorization processes for personal care assistance services."
      ]
    },
    "citation": "256B.0659"
  },
  {
    "analysis": {
      "added": [
        "Annual reporting requirements for rate increases."
      ],
      "removed": [
        "Previous discretionary timelines and documentation standards."
      ],
      "summary": "This bill refers to community first services and supports under section 256B.85.",
      "modified": [
        "Alignment with fee-for-service contract requirements."
      ]
    },
    "citation": "256B.85"
  },
  {
    "analysis": {
      "added": [
        "Clarification of exemptions applicable to managed care contracts."
      ],
      "removed": [
        "No specific content removed related to this citation."
      ],
      "summary": "Exemption from set-aside provisions under section 16C.16 is noted.",
      "modified": [
        "Differential handling for various categories of contracts."
      ]
    },
    "citation": "16C.16"
  },
  {
    "analysis": {
      "added": [
        "Explicit references to nonpublic data limitations for certain information requests."
      ],
      "removed": [
        "No removal specifically related to this privacy citation."
      ],
      "summary": "This bill defers to privacy definitions under section 13.02.",
      "modified": [
        "Clarification on access to subcontractor data."
      ]
    },
    "citation": "13.02"
  }
]