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HF3056 (Legislative Session 94 (2025-2026))

Provider network adequacy provisions changed.

Related bill: SF3296

AI Generated Summary

Purpose of the Bill

This bill aims to update the rules regarding the network adequacy of healthcare providers in Minnesota. It focuses on how far individuals should need to travel for different types of healthcare services and the conditions under which healthcare providers can request exceptions to these rules.

Main Provisions

  • Travel Distance and Time Standards: It sets the maximum travel distance or time for healthcare services such as primary care, mental health, and general hospital services to either 30 miles or 30 minutes, whichever is less. This aligns with federal standards.
  • Waiver Conditions: Health carriers can apply for a waiver if they cannot meet these standards. The waiver process requires demonstration with specific data and description of corrective steps. Waivers can be approved if the carrier demonstrates an inability to meet standards due to a lack of providers and proposes the use of telehealth services for areas lacking specific types of providers.
  • Waiver Validity and Renewal: Waivers expire after one year. To renew, carriers must submit evidence of actions taken to address inadequacies and outline ongoing challenges.
  • Referral Centers: The bill explains that the new distance standards do not apply when a patient is referred to a referral center, which provides highly specialized medical care, like organ transplants.

Significant Changes

  • Repeal of Previous Standards: The bill repeals the portion of the law that allowed a maximum travel distance or time of 60 miles or 60 minutes for specialist services, focusing instead on the newly established 30-mile or 30-minute threshold for certain services.

Relevant Terms

  • Network adequacy
  • Travel distance standards
  • Primary care services
  • Mental health services
  • General hospital services
  • Waiver application
  • Telehealth services
  • Referral center
  • Specialized medical care

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
April 01, 2025HouseFloorActionIntroduction and first reading, referred toHealth Finance and Policy

Citations

 
[
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Amends standards for maximum travel distance or time for primary care and other services.",
      "modified": [
        "Clarifies that time and distance standards are the lesser of 30 miles or 30 minutes."
      ]
    },
    "citation": "62K.10",
    "subdivision": "subdivision 2"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Amends waiver application processes for network adequacy requirements.",
      "modified": [
        "Provides for conditions under which a health carrier can apply for a waiver if unable to meet network adequacy requirements."
      ]
    },
    "citation": "62K.10",
    "subdivision": "subdivision 5"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Amends the role of referral centers in network adequacy.",
      "modified": [
        "Specifies that subdivisions 2 and 3 do not apply if an enrollee is referred to a referral center."
      ]
    },
    "citation": "62K.10",
    "subdivision": "subdivision 6"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Referenced for defining 'telehealth' in network adequacy waivers.",
      "modified": []
    },
    "citation": "62A.673",
    "subdivision": "subdivision 2"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Federal law referenced for travel time and distance standards.",
      "modified": []
    },
    "citation": "Code of Federal Regulations title 45 section 155.1050",
    "subdivision": ""
  }
]

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