HF4719
Medical assistance reimbursement rates increased for mental health services.
Legislative Session 94 (2025-2026)
Related bill: SF4933
AI Generated Summary
Purpose
- The bill aims to increase reimbursement rates under Minnesota Medical Assistance (MA) for certain mental health testing and assessment services. It would align these payments with Medicare rates and change who gets paid what, with the goal of improving access to mental health care for MA enrollees.
Key Provisions
- Add Subdivision 5 to Minnesota Statutes 2025 Supplement section 256B.761:
- Effective date: For services rendered on or after January 1, 2027, or when federal approval is obtained (whichever is later).
- Payment rate: The commissioner must pay 100 percent of the total published Medicare payment rate (as defined by 42 C.F.R. 438.6) for:
- Neuropsychological assessments (256B.0671, subd. 8)
- Neuropsychological testing (256B.0671, subd. 9)
- Psychological testing (256B.0671, subd. 10)
- Reimbursement by managed care and county-based purchasing plans: Must reimburse providers at least at the same rate as fee-for-service for these services.
- Monitoring: The commissioner must monitor how this rate change affects enrollee access to mental health services.
- Federal approval contingency: If federal approval is not received for this provision in a contract year, capitation rates paid to managed care and county-based purchasing plans must be adjusted to reflect the removal of this provision.
- Provider-contract consequences: Contracts between plans and providers must allow recovery of payments from providers if capitation rates are adjusted; such recoveries may not exceed the amount of the rate increase attributable to this provision.
- Expiration: This subdivision expires on the effective date of Laws 2025, First Special Session, chapter 3, article 8, section 29.
- Sec. 2 Repealer:
- Repeals Minnesota Statutes 2024 section 256B.0625, subdivision 38.
- Background from repealed text (for context): Previously, payments for mental health services by certain professionals followed a tiered structure:
- Master’s-prepared mental health professionals: 80% of the rate paid to doctoral-prepared professionals.
- Master’s-prepared professionals employed by community mental health centers: 100% of the doctoral rate.
- Physician assistants: 80.4% of the base rate paid to psychiatrists.
Significant Changes to Existing Law
- Removes the prior, lower-pay structure for master’s-prepared mental health professionals and related categories, replacing it with a single standard tied to 100% of the Medicare payment rate for specified testing services.
- Establishes Medicare-based pricing for neuropsychological and psychological testing, rather than the previous master’s/doctorate-based pay scales.
- Creates a built-in mechanism to adjust capitation rates if federal approval is not granted, protecting state costs and payer contracts.
- Adds a monitoring requirement to assess how higher testing-rate payments affect access to mental health services.
Implementation, Oversight, and Dates
- Implementation depends on federal approval and the stated January 1, 2027 date (or the later federal approval date).
- The state must monitor enrollee access and adjust capitation rates if federal approval does not occur in a given contract year.
Relevant Terms - Medical Assistance (MA) - mental health services - reimbursement rates - 100 percent of Medicare payment rate - total published Medicare payment rate - 42 C.F.R. 438.6 - neuropsychological assessments - neuropsychological testing - psychological testing - 256B.0671 subd. 8, 9, 10 - managed care organizations (MCOs) - county-based purchasing plans (CBPs) - fee-for-service rate (FFS rate) - capitation rates - federal approval - enrollee access - master’s-prepared mental health professionals - doctoral-prepared professionals - community mental health centers - physician assistants - base rate paid to psychiatrists - repeal of 256B.0625, subd. 38
Bill text versions
- Introduction PDF PDF file
Actions
| Date | Chamber | Where | Type | Name | Committee Name |
|---|---|---|---|---|---|
| March 26, 2026 | House | Action | Introduction and first reading, referred to | Health Finance and Policy | |
| April 07, 2026 | House | Action | Authors added |
Citations
[
{
"analysis": {
"added": [
"A new Subd.5: Psychological testing and assessment rates.",
"For services rendered on or after January 1, 2027 (or upon federal approval, whichever is later): the commissioner must pay 100 percent of the total published Medicare payment rate (42 C.F.R. § 438.6) for neuropsychological assessments (256B.0671 subd.8), neuropsychological testing (256B.0671 subd.9), and psychological testing (256B.0671 subd.10).",
"Managed care and county-based purchasing plans must reimburse providers at least the fee-for-service rate for these services.",
"The commissioner must monitor the effect of this rate adjustment on enrollee access to mental health services.",
"If federal approval is not received for this paragraph in any contract year, capitation rates must be adjusted to reflect the removal of this paragraph.",
"Contracts between managed care and county-based purchasing plans and providers must allow recovery of payments if capitation rates are adjusted, with recoveries not exceeding the increase in rates."
],
"removed": [],
"summary": "This bill adds Subd.5 to Minnesota Statutes 2025 Supplement section 256B.761 to establish updated reimbursement rates for psychological testing and assessment services under medical assistance.",
"modified": []
},
"citation": "Minnesota Statutes 2025 Supplement section 256B.761",
"subdivision": "Subd.5"
},
{
"analysis": {
"added": [
"Repeal of Subd.38 (payments for mental health services under the MA program)."
],
"removed": [
"Subd.38: Payments for mental health services provision by masters-prepared mental health professionals (80% of the rate paid to doctoral-prepared professionals).",
"Subd.38: Payments for mental health services provided by masters-prepared mental health professionals employed by community mental health centers (100% of the rate paid to doctoral-prepared professionals).",
"Subd.38: Payments for mental health services provided by physician assistants (80.4% of the base rate paid to psychiatrists)."
],
"summary": "This bill repeals Minnesota Statutes 2024 section 256B.0625, subdivision 38, which previously established payments for mental health services.",
"modified": []
},
"citation": "Minnesota Statutes 2024 section 256B.0625",
"subdivision": "Subd.38"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "This bill references 256B.0671 Subd.8 as the basis for neuropsychological assessments included in the rate adjustments under Subd.5.",
"modified": [
"Cross-reference to 256B.0671 Subd.8; no substantive modification to Subd.8 itself."
]
},
"citation": "Minnesota Statutes 2025 Supplement section 256B.0671",
"subdivision": "Subd.8"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "This bill references 256B.0671 Subd.9 as the basis for neuropsychological testing included in the rate adjustments under Subd.5.",
"modified": [
"Cross-reference to 256B.0671 Subd.9; no substantive modification to Subd.9 itself."
]
},
"citation": "Minnesota Statutes 2025 Supplement section 256B.0671",
"subdivision": "Subd.9"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "This bill references 256B.0671 Subd.10 as the basis for psychological testing included in the rate adjustments under Subd.5.",
"modified": [
"Cross-reference to 256B.0671 Subd.10; no substantive modification to Subd.10 itself."
]
},
"citation": "Minnesota Statutes 2025 Supplement section 256B.0671",
"subdivision": "Subd.10"
},
{
"analysis": {
"added": [
"Reference to Medicare rate as defined by 42 C.F.R. § 438.6 for specified psychological services."
],
"removed": [],
"summary": "The rate applied under Subd.5 uses the total published Medicare payment rate as defined in 42 C.F.R. § 438.6.",
"modified": [
"Acknowledges federal framework for Medicare payments guiding MA reimbursement for the specified neuropsychological and psychological services."
]
},
"citation": "Code of Federal Regulations title 42 section 438.6",
"subdivision": ""
}
]Progress through the legislative process
In Committee