HF2760 (Legislative Session 94 (2025-2026))
Reimbursement procedures for federally qualified health centers modified.
Related bill: SF1622
AI Generated Summary
Purpose of the Bill
The bill aims to modify reimbursement procedures for Federally Qualified Health Centers (FQHCs) in Minnesota. The focus is on updating and refining the way these health centers report costs and receive payments for services provided under the medical assistance program.
Main Provisions
- Reimbursement Process: FQHCs must submit detailed financial reports to receive payments. New FQHCs submit budget estimates for initial periods, whereas existing ones use actual costs and visit data.
- Essential Community Provider Designation: FQHCs and rural health clinics must apply for this status to continue cost-based payment. Failing to apply results in payments akin to non-FQHC providers after a period.
- Prospective Payment System: Clinics must choose annually between this system and an alternative payment methodology, which includes cost assessment based on Medicare principles.
- Payment Claims: After January 1, 2021, claims for services by FQHCs and rural health clinics will follow this structured annual election system.
Significant Changes to Existing Law
- Change of Scope Requests: The commissioner will consider requests that alter the scope of services provided by FQHCs, factoring in changes that cause a cost fluctuation of 2.5% or more.
- Encounter Payment Rates: Establishes an encounter rate equivalent to that set by the Indian Health Service for FQHCs that are also urban Indian organizations.
- Quality Workgroup: Formation of a workgroup to evaluate clinical and non-clinical quality measures at FQHCs and rural health clinics.
- Tribal FQHC Enrollment: Permits Tribal health centers to enroll as Tribal FQHCs, aligning their payment and procedural requirements with those of non-FQHC tribal facilities, while maintaining necessary federal compliance.
Relevant Terms
- Federally Qualified Health Center (FQHC)
- Rural Health Clinic
- Medical Assistance Program
- Essential Community Provider
- Prospective Payment System
- Alternative Payment Methodology
- Indian Health Service
- Medicare Cost Principles
- Tribal Health Center
Bill text versions
- Introduction PDF file
Actions
| Date | Chamber | Where | Type | Name | Committee Name |
|---|---|---|---|---|---|
| March 23, 2025 | House | Floor | Action | Introduction and first reading, referred to | Health Finance and Policy |
| March 23, 2025 | House | Floor | Action | Introduction and first reading, referred to | Health Finance and Policy |
Citations
[
{
"analysis": {
"added": [
"Introduces provisions for an alternative payment methodology.",
"Defines encounter payment rates and change of scope requests for FQHCs and rural health clinics."
],
"removed": [],
"summary": "This bill modifies reimbursement procedures for federally qualified health centers under Minnesota Statutes section 256B.0625, subdivision 30.",
"modified": [
"Updates rules for FQHC cost reporting and payment systems.",
"Adjusts rules around essential community provider requirements and payments."
]
},
"citation": "256B.0625",
"subdivision": "subdivision 30"
},
{
"analysis": {
"added": [
"Details the timeline for applying as an essential community provider."
],
"removed": [],
"summary": "The legislation aligns medical assistance program requirements with section 62Q.19 subdivision 7 regarding designation as an essential community provider.",
"modified": [
"Clarifies conditions under which FQHCs and rural health clinics must apply for essential community provider designation."
]
},
"citation": "62Q.19",
"subdivision": "subdivision 7"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Mentions the tax required to be paid according to section 295.52 which supports additional reimbursement amounts for clinics.",
"modified": [
"Includes tax considerations in the calculation of payment rates."
]
},
"citation": "295.52",
"subdivision": ""
},
{
"analysis": {
"added": [
""
],
"removed": [],
"summary": "Incorporates an appeals process for FQHCs and rural health clinics in alignment with section 14.57.",
"modified": [
"Provides a framework for resolving disputes and appeals regarding payment rates."
]
},
"citation": "14.57",
"subdivision": ""
}
]