SF3117

Purpose of the Bill

The bill aims to enhance the oversight and security of Minnesota's health care programs by mandating regular revalidation of providers and enforcing stricter compliance protocols.

Main Provisions

• Revalidation of Providers: The bill requires providers enrolled in Minnesota health care programs to undergo revalidation every three years, instead of the previous five years. Personal care assistance agencies are specifically mentioned for this three-year revalidation process.
• Compliance Requirements: Providers must be notified 30 days before their revalidation deadline and submit all required materials. If they fail to do so, they are given additional time to comply before potential termination of their enrollment.
• Suspensions and Appeals: The bill grants the commissioner authority to suspend a provider's billing capabilities for non-compliance, without the right to appeal such suspensions.
• High-Risk Provider Scrutiny: High-risk providers may face unannounced inspections and a hold on payments within the first 90 days of claims submissions. Additional background checks, including fingerprinting, are required for these providers.
• Documentation and Compliance: Providers must maintain documentation of medical orders and may face penalties for failing to do so. Compliance officers in certain licensed entities are tasked with reporting violations and overseeing internal adherence to regulations.
• Surety Bonds for Medical Suppliers: Durable medical equipment providers must purchase surety bonds to deter fraudulent activities, with specific bonding amounts based on Medicaid revenue. Exceptions apply to some medical suppliers like pharmacies and rural health clinics.

Significant Changes to Existing Law

• The revalidation period for providers is shortened from five to three years, increasing the frequency of checks and ensuring up-to-date provider information.
• Introduction of mandatory surety bonds for certain medical equipment suppliers, depending on their Medicaid revenue and risk category.
• The bill implements stricter sanctions on providers who fail to maintain necessary compliance, including more severe penalties for documentation failures and non-compliance with revalidation processes.

Relevant Terms

• Revalidation
• Provider Enrollment
• Personal Care Assistance
• Compliance Officer
• Surety Bond
• High-risk Provider
• Background Checks
• Durable Medical Equipment (DME)
• Medical Assistance
• Fraud Prevention