SF4311 (Legislative Session 94 (2025-2026))
Site visits requirement for all enrolled medical assistance providers
Related bill: HF4258
AI Generated Summary
- Purpose
- Strengthen oversight of medical assistance providers by expanding enrollment requirements, adding site visits, and increasing screening to prevent fraud, waste, and abuse.
Update funding and processes for provider screening and enforcement to align with federal rules and Minnesota needs.
Key provisions and what the bill does
Provider enrollment and site visits
- Requires enrollment of all provider locations where direct services are provided.
- Mandates site visits for enrollment, reenrollment, and revalidation of providers.
- Establishes background checks (in line with 42 CFR 455 subpart 1 E) including fingerprint-based checks when required.
- Allows background study to be satisfied by a prior fingerprint-based check that reviews specified databases.
- Revalidates providers at least every five years (three years for certain types: personal care assistance CFSS providers, CFSS financial management providers, and EIDBI agencies; and more frequently for high-risk providers as designated by the commissioner).
- Requires timely responses to enrollment information requests (60 days) and sets procedures for deficiencies and termination if not remedied.
Compliance and oversight
- Creates mandatory compliance programs for certain provider types, including core CMS elements (policies, training, response to improper conduct, monitoring, and reporting).
- Requires compliance officers for certain providers (e.g., providers licensed as home care or assisted living with specific designations) to oversee adherence to laws, prevent improper claims, train staff, and report overpayments.
- Allows suspension of a provider’s ability to bill for noncompliance, with no right to an administrative appeal in some cases.
- Authorizes unannounced CMS onsite inspections of provider locations before enrollment, reenrollment, and revalidation; requires disclosure of designated risk status in a public provider manual.
- Enables withholding of payment for high-risk providers for 90 days after initial enrollment.
- Allows revocation of enrollment for patterns of missing documentation or failure to provide access to requested documentation.
- Adds conflict of interest and protection provisions to ensure providers with Medicare/Medicaid terminations in other states face enrollment actions in Minnesota (with certain pediatric-focused exemptions).
High-risk designation and criminal background checks
- Designates some providers as moderate/high risk by CMS or the commissioner and requires consent to criminal background checks (including fingerprinting where required).
DMEPOS surety bond requirement
- Requires durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) providers to obtain a surety bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment.
- Bond amounts: initial 50,000; if Medicaid revenue in the prior year is up to 300,000, bond remains 50,000; if over 300,000, bond increases to 100,000.
- Bond naming and recovery provisions: Minnesota DHS is the obligee; bond allows recovery of costs/fees; action to recover must be within six years of a final agency decision.
- Certain providers are exempt from the bond (e.g., federally qualified health centers, home health agencies, Indian Health Service, pharmacies, rural health clinics).
Application fees and funding
- Creates an application fee for enrollment to fund provider screening activities ( deposited in a provider screening account in the special revenue fund).
- Initial fee schedule and CPI-based adjustments: base amount for 2013, with adjustments for 2014 and subsequent years; fees apply to initial enrollments, new practice locations, reenrollment, and revalidation as applicable.
- Fees not charged to certain providers (e.g., those already enrolled in Medicare or enrolled in another state with documentation of payment, and some grouping/billing scenarios).
- The provider screening account funds costs of screening activities described in the bill and related federal requirements.
Related enrollment conditions and protections
- Enables denials or terminations for incomplete applications; 60-day response window; 30-day notice and a further 30-day extension to comply; 60-day notice to terminate if still noncompliant.
- Electronic correspondence to providers (MNITS mailbox) for most notices, with exceptions for background studies.
- Certain protections and exemptions when a provider has limited or pediatric-focused practices or when other statutory criteria apply.
- The list of provider types designated limited/moderate/high-risk and the criteria are published in the Minnesota Health Care Program Provider Manual; these designations are not subject to typical administrative appeals.
Significant changes to existing law
Expands mandatory site visits to all enrolled medical assistance providers and requires revalidation on a defined schedule (five years generally, three years for specific provider types and high-risk categories).
Introduces formal, ongoing compliance programs and a designated compliance officer for many providers.
Tightens enforcement with pre-enrollment, reenrollment, and revalidation unannounced on-site inspections by CMS or its agents and state authorities.
Establishes a mandatory, ongoing background check framework (including fingerprinting where required) and explicit high-risk designations guiding oversight intensity.
Adds a new financial mechanism (provider screening fees) and a bonding requirement for DMEPOS suppliers to ensure financial accountability and fund screening activities.
Creates stronger billing suspensions and a tighter path to revocation for noncompliant providers, with limited or no administrative appeal in some cases.
Requires disclosures and compliance measures linked to federal CMS standards (42 CFR 455 and CMS core elements) and integrates these with Minnesota’s own provider oversight processes.
Relevant terms - medical assistance providers, provider enrollment, site visits, provider-controlled location, background study, fingerprint-based background check, 42 CFR 455 subpart 1 E, revalidation, high-risk, compliance officer, compliance program, CMS, Centers for Medicare and Medicaid Services, unannounced onsite inspections, MNITS, provider manual, provider screening account, application fee, DMEPOS, surety bond, obligee, suspension of billing, termination of enrollment, pattern of noncompliance, overpayment, recovery of overpayment, EIDBI, CFSS, CFSS provider agency, CFSS financial management provider, home care provider, licensed, residential care/assisted living, 245A/144A/144G, 245C, 256B.04, 42 CFR, medical assistance fraud waste abuse.
Bill text versions
- Introduction PDF PDF file
Actions
| Date | Chamber | Where | Type | Name | Committee Name |
|---|---|---|---|---|---|
| March 11, 2026 | Senate | Action | Introduction and first reading | ||
| March 11, 2026 | Senate | Action | Referred to | Health and Human Services |
Citations
[
{
"analysis": {
"added": [
"Provider enrollment and screening requirements forProvider-controlled locations.",
"Background study requirements including a fingerprint-based study and review of state databases (245C.08, subd. 1).",
"Revalidation of providers at defined intervals (generally at least every five years; specific provider groups at least every three years; high-risk providers at the commissioner’s discretion).",
"Procedures related to suspension and billing restrictions for noncompliance."
],
"removed": [],
"summary": "Amends Minn. Stat. 256B.04, subd. 21 to require enrollment and background screening of medical assistance providers in line with federal enrollment standards (42 C.F.R. §455 Subpart 1 E), including provider-controlled locations and revalidation schedules.",
"modified": [
"Links Minnesota’s enrollment/screening framework to federal standards (42 C.F.R. §455 Subpart 1 E) and state background checks (245C.08)."
]
},
"citation": "256B.04",
"subdivision": "21"
},
{
"analysis": {
"added": [
"Application fees for provider enrollment and ongoing screening.",
"Establishment of a provider screening account funded by fees."
],
"removed": [],
"summary": "Adds and funds provider screening and enrollment fees in Minn. Stat. 256B.04, subd. 22, to support background checks and screening activities in accordance with 42 C.F.R. §455 Subpart E.",
"modified": [
"Aligns state fee structure with federal screening requirements (42 C.F.R. §455 Subpart E) and CPI adjustments."
]
},
"citation": "256B.04",
"subdivision": "22"
},
{
"analysis": {
"added": [
"Background study process for providers and the option to satisfy via fingerprint-based background checks including data from 245C.08, subd. 1(a) clauses 1–5."
],
"removed": [],
"summary": "Background study framework under Minn. Stat. 245C.08, subd. 1, including potential satisfaction via fingerprint-based background checks and review of databases.",
"modified": [
"Integrates state background check processes with provider enrollment requirements."
]
},
"citation": "245C.08",
"subdivision": "1"
},
{
"analysis": {
"added": [
"References to compliance with federal enrollment background checks for providers."
],
"removed": [],
"summary": "Federal enrollment requirements related to background checks for providers under 42 C.F.R. §455 Subpart 1, E.",
"modified": [
"States alignment with federal background check standards in enrollment."
]
},
"citation": "42 CFR 455 subpart 1 E",
"subdivision": ""
},
{
"analysis": {
"added": [
"Publication of provider risk classifications in the Minnesota Health Care Program Provider Manual."
],
"removed": [],
"summary": "CMS designation of provider types and criteria for high-risk categorization per 42 C.F.R. §424.518; state manual to list and classify risk levels.",
"modified": [
"Incorporates CMS risk designations into state enrollment policy; criteria not subject to ch. 14."
]
},
"citation": "42 CFR 424.518",
"subdivision": ""
},
{
"analysis": {
"added": [
"Authority for unannounced onsite inspections of provider locations by CMS or its agents."
],
"removed": [],
"summary": "Unannounced onsite inspections authorized for high-risk providers per 42 C.F.R. §455.452.",
"modified": [
"Federally enabled oversight mechanism for provider compliance."
]
},
"citation": "42 CFR 455.452",
"subdivision": ""
},
{
"analysis": {
"added": [
"Mandatory surety bonds for certain providers; specified bond amounts based on revenue; exceptions for certain providers."
],
"removed": [],
"summary": "Surety bond requirements for certain medical assistance providers per 42 C.F.R. §455.450.",
"modified": [
"Provides recovery mechanism and sanctions potential via bond enforcement."
]
},
"citation": "42 CFR 455.450",
"subdivision": ""
},
{
"analysis": {
"added": [
"Fees deposited into the provider screening account; CPI-based adjustments; applicability to enrollment/reenrollment and related activities."
],
"removed": [],
"summary": "Provider screening costs funded through the provider screening account under 42 C.F.R. §455 Subpart E.",
"modified": [
"Ensures federal cost-sharing framework supports state screening activities."
]
},
"citation": "42 CFR 455 subpart E",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Reference to 256B.064 regarding sanctions; cross-reference indicating continued authority to sanction under existing provisions.",
"modified": [
"Clarifies alignment with sanction provisions in 256B.064."
]
},
"citation": "256B.064",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "References to bonding requirements that interact with providers’ surety bond obligations; cross-reference to existing bonding provisions.",
"modified": [
"Ensures consistency with existing bond requirements in 256B.051."
]
},
"citation": "256B.051",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Cross-reference for bonds and related enforcement provisions under 256B.0659.",
"modified": [
"Maintains coherence with related bonding rules."
]
},
"citation": "256B.0659",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Cross-reference to 256B.0701 for provisions related to provider enrollment and bonding.",
"modified": [
"Ensures consistency with other bonding/enrollment requirements."
]
},
"citation": "256B.0701",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Cross-reference to 256B.85 regarding bonding-related provisions.",
"modified": [
"Keeps bonding provisions aligned with existing statutes."
]
},
"citation": "256B.85",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "References to Chapter 245A in context of provider licensing for home health providers.",
"modified": [
"No standalone changes; cross-reference to enrollment/licensing framework."
]
},
"citation": "245A",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "References to Chapter 144A for home health provider licensing.",
"modified": [
"No standalone changes; cross-reference to licensing framework."
]
},
"citation": "144A",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "References to Chapter 144G for assisted living facility licensing.",
"modified": [
"No standalone changes; cross-reference to licensing framework."
]
},
"citation": "144G",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Section 144A.484 requiring home care license specifics integrated into enrollment.",
"modified": [
"Cross-reference; not an independent new requirement."
]
},
"citation": "144A.484",
"subdivision": ""
}
]Progress through the legislative process
In Committee