SF3190

SF3190 (Legislative Session 94 (2025-2026))

Medical capitation payment withhold related to verification of coverage establishment

AI Generated Summary

Purpose of the Bill

The bill aims to establish a capitation payment withhold connected to the verification of coverage through human services in Minnesota. This proposes changes affecting how managed care plans handle medical assistance payments.

Main Provisions

Verification of Coverage: Starting January 1, 2026, managed care plans must submit a "verification of coverage" form for each enrollee to the commissioner. This form includes details like the enrollee's name, address, the chosen managed care plan, and the enrollee's attestation of information accuracy. The intent is to ensure that enrollee information is accurate and to verify active engagement with healthcare plans.
Payment Withhold: The state will withhold a percentage (two percent) of capitation payments from managed care plans to ensure compliance with the new form submission requirement. These withheld funds will be returned only if the managed care plans submit the completed forms by the specified deadline.
Timelines and Consequences: All completed forms must be submitted by February 28, 2026. If a form isn’t submitted on time, the state will not return the withheld funds, will stop making payments for that enrollee as of April 2026, and will disenroll the individual from medical assistance, although the enrollee has the option to appeal this action.

Significant Changes to Existing Law

Managed Care Payments: Modifies how capitation payments are processed by withholding funds linked to compliance with new verification requirements and sets the terms for their return.
Disenrollment Procedures: Introduces measures for disenrolling recipients from medical assistance if verification forms are not submitted, thus affecting eligibility and continuity of healthcare service.

Relevant Terms

capitation payment, verification of coverage, managed care plans, medical assistance, enrollee disenrollment, healthcare compliance, payment withhold.

Bill text versions

Introduction PDF file

Actions

Date	Chamber	Where	Type	Name	Committee Name
March 31, 2025	Senate	Floor	Action	Introduction and first reading
March 31, 2025	Senate	Floor	Action	Referred to	Health and Human Services

Citations

[
  {
    "analysis": {
      "added": [
        "A new capitation payment withhold connected to the verification of coverage form filled by enrollees."
      ],
      "removed": [],
      "summary": "The bill modifies managed care contracts under section 256B.69, subdivision 5a to include a capitation payment withhold related to verification of coverage.",
      "modified": [
        "Adjustment of percentages withheld and criteria for returning withheld funds."
      ]
    },
    "citation": "256B.69",
    "subdivision": "subdivision 5a"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This bill references payments under section 256B.692 in relation to county-based purchasing plans.",
      "modified": [
        "Adjusts manner of handling withheld funds and verification requirements."
      ]
    },
    "citation": "256B.692",
    "subdivision": ""
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "The bill exempts contracts from set-aside and preference provisions under section 16C.16, subdivisions 6 and 7.",
      "modified": [
        "Exemption for managed care plans from specific contract set-aside and preference requirements."
      ]
    },
    "citation": "16C.16",
    "subdivision": "subdivisions 6 and 7"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "The reference to section 62D.044 relates to admitted assets for managed care plans or county-based purchasing plans.",
      "modified": [
        "Allows inclusion of withheld amounts as admitted assets."
      ]
    },
    "citation": "62D.044",
    "subdivision": ""
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "The bill ensures privacy of nonpublic data by referencing section 13.02.",
      "modified": [
        "Clarification on access to subcontractor documentation while maintaining data privacy."
      ]
    },
    "citation": "13.02",
    "subdivision": ""
  }
]