SF1497

Purpose

To raise reimbursement for certain heart-monitoring services and formalize payment rules for diagnostic testing facilities under Minnesota’s health programs. The bill adds a new subdivision to existing law to specify longterm ambulatory electrocardiogram monitoring and changes how providers are paid.

Main Provisions

• Creates a new subdivision (Subd.1a) under Minn. Stat. 256B.76 defining longterm ambulatory electrocardiogram monitoring services.
• Defines these services as the use of external cardiac patch monitoring devices worn for 48 hours or longer, plus the interpretation of the collected data to detect heart rhythm problems.
• Specifies that these monitoring services are used to identify arrhythmias that can lead to stroke, cardiac arrest, or other related health problems if not diagnosed.
• Requires the state commissioner to reimburse diagnostic testing facilities that provide these services at 100 percent of the Medicare Physician Fee Schedule rate or higher.
• Applies to the reimbursement policy beginning January 1, 2026, or upon federal approval if that comes first.

Definitions and Scope

• Longterm ambulatory electrocardiogram monitoring services: external patch-style heart monitors worn for at least 48 hours with data interpretation to detect arrhythmias.
• External cardiac patch monitoring devices: the wearable monitoring technology used to collect heart rhythm data outside a clinical setting.
• 48 hours or greater: the minimum duration for the monitoring period covered by the reimbursement.
• Arhythmias and related health risks: conditions or data interpretations tied to potential stroke, cardiac arrest, or other complications if not diagnosed.

Reimbursement Details

• Reimbursement rate: 100 percent of the Medicare Physician Fee Schedule rate for these services, or a higher rate if applicable.
• Payer/coverage: applies to diagnostic testing facilities providing longterm ambulatory EKG monitoring services under the relevant Minnesota program.

Effective Date

• January 1, 2026, or the later date if federal approval is required.

Significance and Changes to Law

• Adds a new Subdivision (Subd.1a) to Minnesota Statutes 256B.76, expanding the scope of reimbursable longterm ambulatory ECG monitoring.
• Establishes a clear, full Medicare-rate-based payment standard for these services, potentially increasing provider reimbursement and affecting how these tests are billed and paid under state programs.
• Aligns state reimbursement with federal medicine payment frameworks for this specific monitoring service.

Implementation Considerations

• The change depends on the commissioner implementing the new subdivision and ensuring compliance with the Medicare rate calculation.
• The effective date is contingent on federal approval if required, which could influence timing and planning for diagnostic testing facilities.

Relevant Terms - longterm ambulatory electrocardiogram monitoring services - external cardiac patch monitoring devices - wear for 48 hours or greater - interpretation of data - heart arrhythmias - stroke - cardiac arrest - comorbidities - medical complications - Medicare Physician Fee Schedule rate - diagnostic testing facilities - commissioner - Minnesota Statutes 2024 section 256B.76 - Subd.1a - reimbursement - January 1, 2026 - federal approval