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SF2441 (Legislative Session 94 (2025-2026))

Prompt payment requirements to health care providers modification

AI Generated Summary

Purpose of the Bill

The bill aims to reform various aspects of health care contracts, payments, and provisions in Minnesota, ensuring fair practices in managed care organizations and health care provider interactions. It seeks to improve transparency, timeliness, and equity in payment and contract negotiations between health care providers and health plan companies.

Main Provisions

  • Non-Discrimination Against Providers: The bill prohibits health carriers from denying contracts with providers based on geographic location if the health plans are actively marketed in that area. Providers may need to meet standard quality assurance and utilization review criteria.
  • Contract Amendments: Health plan companies must disclose amendments or changes to existing contracts with providers at least 45-90 days before the changes take effect, with the possibility for providers to terminate contracts prior to amendments.
  • Prompt Payment and Interest on Claims: Health plan companies are required to process clean claims within 30 days, paying interest on delayed payments. Interest must be paid separately and regularly without providers needing to request it.
  • Claims Filing Timeline: The bill extends the time period for submitting claims from six to twelve months from the service date, with exceptions for disruptions that can extend this period further.
  • Durable Medical Equipment (DME) and Supplies: Expands coverage under medical assistance, adjusting rules for enrolling DME vendors and clarifying the definition and conditions for covering certain medical equipment.

Significant Changes to Existing Law

  • The bill amends several sections of Minnesota Statutes concerning health care, such as clarifying the claims process, enforcement of timely payment, provider contract negotiations, and geographic discrimination.
  • Introduces obligations on health carriers to maintain non-discriminative provider networks across geographic areas and mandates timely communication and negotiation with providers.
  • Implements structured timelines and interest rates for claims payments to promote accountability and efficiency.
  • Adjusts the rules for equipment vendors involving Medicare enrollment to ensure broader access to necessary medical equipment.

Relevant Terms

  • Health carriers, health care providers, geographic discrimination, managed care organizations, clean claims, durable medical equipment, Medicare enrollment, prompt payment, contract amendments, and fee-for-service.

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
March 12, 2025SenateFloorActionIntroduction and first reading
March 12, 2025SenateFloorActionReferred toCommerce and Consumer Protection

Citations

 
[
  {
    "analysis": {
      "added": [
        "A requirement for mutual written consent to waive disclosure requirements."
      ],
      "removed": [],
      "summary": "This bill modifies provider notification requirements under section 62Q.735, subdivision 2.",
      "modified": [
        "Notification period for amendments altering fee schedules increased from 45 to 90 days."
      ]
    },
    "citation": "62Q.735"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "The bill addresses negotiation practices between providers and health plan companies under section 62Q.736.",
      "modified": [
        "Clarification that designated contract negotiators must be accommodated in negotiations."
      ]
    },
    "citation": "62Q.736"
  },
  {
    "analysis": {
      "added": [
        "Interest payment specifications for late claim payments."
      ],
      "removed": [],
      "summary": "Amends claims payment timelines under section 62Q.75 and adds specifications to claims processing metrics.",
      "modified": [
        "Timeframe adjusted for initial submission of charges from six months to 12 months."
      ]
    },
    "citation": "62Q.75"
  },
  {
    "analysis": {
      "added": [
        "Clarifications on enrollment requirements and exceptions."
      ],
      "removed": [],
      "summary": "The bill amends coverage for medical supplies and equipment under section 256B.0625, subdivision 31.",
      "modified": [
        "Adjusts the scope of durable medical equipment to include electronic tablets under specific conditions."
      ]
    },
    "citation": "256B.0625"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "New subdivision added regarding provider payments in section 256B.69, but not cited as existing law.",
      "modified": []
    },
    "citation": "256B.69"
  }
]

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