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HF2957 (Legislative Session 94 (2025-2026))

Commissioner of human services required to revalidate providers enrolled in Minnesota health care programs every three years.

Related bill: SF3117

AI Generated Summary

Purpose of the Bill

This legislation aims to strengthen the integrity of Minnesota's health care programs by enhancing the process of provider enrollment and revalidation. By requiring regular revalidation, the bill seeks to ensure compliance with federal and state regulations, reduce potential fraud, and improve service quality.

Main Provisions

  • Provider Revalidation: The bill mandates that providers enrolled in Minnesota health care programs must be revalidated every three years, with more frequent revalidation for certain agency types.
  • Documentation and Compliance: Providers must maintain proper documentation and are required to respond to any requests for additional information within specified timeframes. Failure to do so could result in the termination of their ability to bill.
  • Electronic Notifications: Providers will receive notifications and correspondence electronically where applicable, excluding those related to background studies.
  • High-Risk Providers: High-risk designation allows the commissioner to conduct unannounced inspections and withhold payments if necessary. Criminal background checks are required for providers with significant ownership interests when designated high-risk.
  • Surety Bond Requirements: Certain providers, particularly those dealing with durable medical equipment, must obtain surety bonds. The bond amount is determined based on the provider’s revenue and risk level.
  • Compliance Officers: Certain providers need to designate a compliance officer responsible for adhering to medical assistance laws and handling allegations of improper conduct.

Significant Changes to Existing Law

  • The revalidation period for health care providers is changed from five years to three years for most providers, with more stringent requirements for specific provider types.
  • Introduction of surety bond requirements for durable medical equipment providers, which were not explicitly mandated before.
  • Enhanced penalties and suspension mechanisms for providers failing to meet compliance and documentation requirements.

Relevant Terms

  • Provider Revalidation
  • Minnesota Health Care Programs
  • Compliance Officer
  • Background Study
  • High-Risk Providers
  • Surety Bond
  • Fraud and Abuse Prevention

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
March 31, 2025HouseFloorActionIntroduction and first reading, referred toHealth Finance and Policy

Citations

 
[
  {
    "analysis": {
      "added": [
        "Provisions for electronic notifications.",
        "Requirement to establish compliance programs for some providers."
      ],
      "removed": [],
      "summary": "The bill amends requirements for provider enrollment and revalidation, including compliance procedures and penalties under section 256B.04, subdivision 21.",
      "modified": [
        "Change of revalidation period from five years to three years for certain providers."
      ]
    },
    "citation": "256B.04",
    "subdivision": "subdivision 21"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Background study requirements for provider screenings under section 245C.08.",
      "modified": []
    },
    "citation": "245C.08",
    "subdivision": "subdivision 1, paragraph a, clauses 1 to 5"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Sanctions on providers lacking documentation for billing as guided by section 256B.064.",
      "modified": []
    },
    "citation": "256B.064",
    "subdivision": ""
  }
]

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