SF1402 (Legislative Session 94 (2025-2026))
Medical assistance rate adjustments establishment for physician and professional services
Related bill: HF1005
AI Generated Summary
Senate File No. 1402 is a legislative bill that addresses health insurance and the way medical services are reimbursed in Minnesota. The bill proposes several important changes:
Adjustments to Payment Rates for Hospitals: Changes how hospitals in Minnesota are paid for inpatient services based on various methods like cost-based, per diem, and diagnosis-related group (DRG) methodologies. It also includes specific payment methods for types of hospitals such as critical access hospitals, long-term hospitals, and rehabilitation hospitals.
Rebasing of Hospital Rates: Starting November 1, 2014, hospital payment rates are set to be re-evaluated, or 'rebased', to reflect more current cost data. This involves using newer data to adjust payment rates to ensure they accurately reflect the cost of providing services. The rebasing is designed to be budget neutral, meaning it shouldn't increase the total spending on hospital payments overall.
Considerations for Specific Services: The commissioner may adjust rates to reflect the costs of specific types of services like pediatric, behavioral health, trauma, transplant, and obstetric services. The bill aims to ensure hospitals are fairly compensated for these services based on their costs and the complexity of care they provide.
Changes to Behavioral Health Home Services: Introduces a standard statewide reimbursement rate for behavioral health home services at no less than $425 per member per month, adjusted annually according to specific economic indices. Reviews and updates to this rate must occur every four years.
Payments for Obstetric and Gynecologic Services: Payment rates for obstetric and gynecologic services must be at least equal to 100% of the Medicare Physician Fee Schedule starting January 1, 2026. This change is aimed at ensuring these services are adequately funded.
Federal Approval and Adjustments: Several provisions in the bill require federal approval, and if not received, adjustments to payments might be necessary. This includes specific increases in capitation payments to managed care plans.
In summary, S.F. No. 1402 seeks to better align hospital payment systems with actual service costs, ensure sufficient funding for critical health services, and establish a more uniform payment structure across the state for behavioral health services. This is aimed at improving the financial stability of healthcare providers and ensuring more consistent quality of care across Minnesota.
Actions
| Date | Chamber | Where | Type | Name | Committee Name |
|---|---|---|---|---|---|
| February 12, 2025 | Senate | Floor | Action | Introduction and first reading | |
| February 12, 2025 | Senate | Floor | Action | Referred to | Health and Human Services |
| February 26, 2025 | Senate | Floor | Action | Authors added | |
| March 02, 2025 | Senate | Floor | Action | Comm report: To pass as amended and re-refer to | Taxes |
| March 02, 2025 | Senate | Floor | Action | Author stricken | |
| April 01, 2025 | Senate | Floor | Action | Comm report: No recommendation, re-referred to | Health and Human Services |
| April 01, 2025 | Senate | Floor | Action | Comm report: No recommendation, re-referred to | Health and Human Services |
Citations
[
{
"analysis": {
"added": [
"A new provision introduces an adjustment for behavioral health services."
],
"removed": [
"Prior restrictions on payment adjustments for specific hospital types removed."
],
"summary": "This section discusses hospital payment rates under section 256.969.",
"modified": [
"Hospital payment rates shall incorporate wage index and population adjustments."
]
},
"citation": "256.969"
},
{
"analysis": {
"added": [
"Subdivision added to implement a statewide reimbursement rate for behavioral health home services."
],
"removed": [
"Previous conditional expiration clauses no longer applicable after change."
],
"summary": "This bill amends payments related to health home services under section 256B.0757.",
"modified": [
"Payments for health home services to exclude behavioral health from 2028."
]
},
"citation": "256B.0757"
},
{
"analysis": {
"added": [
"Additional subdivisions clarify new rate implementations."
],
"removed": [
"Previous capped rates on certain services expunged."
],
"summary": "This section addresses rates for physician and professional services under section 256B.076.",
"modified": [
"Updated reimbursement scheme to align more closely with Medicare rates."
]
},
"citation": "256B.076"
},
{
"analysis": {
"added": [
"Clarification on periodic rate evaluation included."
],
"removed": [
"Obsolete references to outdated funding models removed."
],
"summary": "Reevaluating service rates with a focus on medical assistance eligibility under section 256B.761.",
"modified": [
"Service-specific enhancements added for payment increments."
]
},
"citation": "256B.761"
},
{
"analysis": {
"added": [
"New criteria added in prior sections replace repealed regulations."
],
"removed": [
"Elimination of subdivision governing specific medical assistance stipulations."
],
"summary": "Repealed section 256B.0625, subdivision 38, concerning medical assistance provisions.",
"modified": [
"None – this is a complete repeal without replacement subsection."
]
},
"citation": "256B.0625"
},
{
"analysis": {
"added": [
"Specific distribution clauses for qualifying hospitals under new payment structure."
],
"removed": [
"Legacy payment structures for educational distribution phased out."
],
"summary": "Medical education funding is addressed under section 62J.692.",
"modified": [
"Distribution methodology to ensure alignment with the medical education fund's objectives."
]
},
"citation": "62J.692"
}
]