HF4892

Purpose

• Establish two new uncompensated care relief programs to provide financial help to providers that experience a disproportionate amount of uncompensated care.
• Target hospitals (qualifying hospitals) and community-based safety net providers (like certain clinics and health centers).
• Create a framework for identifying qualifying uncompensated episodes of care, applying for payments, calculating distributions, and issuing payments, with rulemaking authority for implementation details.

Key Entities and Definitions

• Qualifying hospital: a hospital licensed in Minnesota, listed in the state's Medicare cost reports, that serves residents and is located in Minnesota.
• Qualifying community-based safety net provider: federally qualified health center, certified community behavioral health clinic, or community mental health center that serves underserved populations.
• Qualifying uncompensated episode of care: services paid under medical assistance provided to an individual during one encounter or episode, when the individual is not enrolled in Medical Assistance (Medicaid), MinnesotaCare, or Medicare and has no other health coverage; the individual is ineligible for Medicaid/MinnesotaCare for the date of service after any retroactive eligibility determination; the total potential reimbursement under Medicaid methodologies would be between a minimum and maximum dollar amount (see Subdivisions below for exact ranges).
• Medical Assistance, MinnesotaCare, Medicare: public or state-run health coverage programs referenced for determining eligibility and payment applicability.

Main Provisions: Hospital Uncompensated Care Relief Program

• Establishment: The Commissioner of Health must create a Hospital Uncompensated Care Relief Program to aid hospitals with disproportionate uncompensated care.
• Eligibility and qualifying episodes:
  • An episode must involve services that would have been reimbursed under Medical Assistance but for the patient’s lack of coverage or ineligibility.
  • The reimbursable amount must fall within a specified range (at least $5,000 but not more than $50,000) if paid under Medical Assistance payment methods.
• Applications and reporting:
  • Qualifying hospitals must submit documentation identifying qualifying uncompensated episodes within defined reporting periods.
  • Reporting periods: January 1–June 30 and July 1–December 31.
  • Deadlines for documentation: September 15 for the January–June period; March 15 of the following year for the July–December period.
  • Documentation must be submitted in a format required by the Commissioner and may require supporting materials.
• Payment calculations:
  • The Commissioner determines each qualifying hospital’s share of the total value of qualifying uncompensated episodes.
  • Payments are distributed proportionally based on each hospital’s share of the statewide total.
  • Payment cap: no hospital may receive more than 10% of the money available for a given reporting period.
  • If funds remain after the cap, the remaining money is redistributed among hospitals that have not reached the cap, proportional to their shares.
  • The Commissioner may set rules to reconcile adjustments, corrected claims, or late submissions in a future period.
• Distribution timing:
  • Half of the annual appropriation for this program is allocated to each reporting period.
  • For January–June, payments are due no later than November 1 of the same year.
  • For July–December, payments are due no later than May 1 of the following year.

Main Provisions: Community-Based Safety Net Provider Uncompensated Care Relief Program

• Establishment: The Commissioner of Health must create a Community-Based Safety Net Provider Uncompensated Care Relief Program to aid qualifying providers with disproportionate uncompensated care.
• Eligibility and qualifying episodes:
  • Qualifying providers include federally qualified health centers, certified community behavioral health clinics, and community mental health centers.
  • Qualifying uncompensated episodes follow the same general criteria as the hospital program, including lack of coverage and potential MA/MinnesotaCare reimbursement thresholds (specific dollar range defined in this section).
• Applications and reporting:
  • Providers must submit documentation identifying qualifying uncompensated episodes within the same two reporting periods (Jan–Jun and Jul–Dec) and meet corresponding deadlines (Sept 15 and Mar 15 of the following year, respectively).
• Payment calculations:
  • Payments are distributed proportionally based on each provider’s share of the total qualifying uncompensated episodes.
  • A cap of 10% per provider per reporting period applies.
  • If funds remain after caps, redistribution occurs among providers not yet at the limit, in proportion to their shares.
  • Rulemaking authority to address adjustments, corrected claims, or late submissions.
• Distribution timing:
  • Half of the annual appropriation is allocated to each reporting period.
  • Distribution deadlines mirror the hospital program: no later than November 1 for Jan–Jun, and no later than May 1 for Jul–Dec.

Changes to Existing Law (Rural EMS Uncompensated Care Pool)

• The bill amends an existing appropriation for the Rural EMS Uncompensated Care Pool Payment Program (specific appropriations listed for fiscal years 2026–2027 and beyond) and clarifies availability through June 30, 2029.
• It sets base funding levels for later fiscal years and indicates certain fund bases (General Fund and Health Care Access Fund) that support these appropriations.
• The distribution provisions for this Rural EMS pool align with the general approach used in the new programs (period-based allocations with distinct deadlines), while acknowledging ongoing statutory framework referenced as Minnesota Statutes section 144E.55.

Administrative and Fiscal Details

• Rulemaking: The Commissioner may establish rules to implement and reconcile reporting processes, adjust for corrected or late submissions, and manage other administrative details.
• Appropriations and funding:
  • Section 4 specifies appropriations from the General Fund for fiscal year 2027 to fund the hospital and community-based safety net provider uncompensated care relief programs.
  • The bill outlines how the funds are allocated across the two reporting periods and related timing.

Significant Changes to Existing Law

• Creates two new uncompensated care relief programs (for hospitals and for community-based safety net providers) to address disproportionate uncompensated care.
• Introduces explicit eligibility criteria, reporting, calculation, caps, and redistribution rules for fair distribution of funds.
• Adds a formal framework for timing and sequencing of payments across two semiannual reporting periods.
• Adjusts and clarifies funding for the Rural EMS Uncompensated Care Pool, including available years and base funding, with alignment to the new framework.
• Provides rulemaking authority to implement details and ensure adjustments can be handled in future periods.

Relevant Terms - uncompensated care relief program - hospital - qualifying hospital - qualifying uncompensated episode of care - medical assistance - MinnesotaCare - Medicare - reporting period - documentation - proportional distribution - payment cap (10 percent) - redistribution - rulemaking - community-based safety net provider - federally qualified health center (FQHC) - certified community behavioral health clinic (CCBHC) - community mental health center (CMHC) - qualifying uncompensated episode of care (CBNP context) - Rural EMS Uncompensated Care Pool - appropriation - general fund - health care access fund