This bill proposes modifications to payment methodologies for enteral nutrition equipment and supplies under Minnesota's Medical Assistance program. It amends Minnesota Statutes 2024, section 256B.766, to revise the process for establishing payment rates for medical equipment and supplies.

Key provisions of the bill include:

1. Temporary Payment Rates for Enteral Nutrition and Supplies (2023-2027):

   • From July 1, 2023, through June 30, 2027, payments for enteral nutrition and supplies will be determined based on the 50th percentile of the usual and customary charge submitted to the commissioner.
     
   • A cap ensures that increases in rates do not exceed 150% of the previous fiscal year’s rate for each product code.
     
   • If sufficient data are not available, the payment rate will default to the rate in effect as of June 30, 2023.

2. Permanent Payment Methodology for Enteral Nutrition and Supplies (Effective July 1, 2027):

   • Starting July 1, 2027, and updating annually on January 1, payment rates will follow a similar methodology, using the 50th percentile of the usual and customary charge from the prior calendar year.
     
   • If sufficient data are unavailable:
     
     • Payments will be based on the manufacturer’s suggested retail price minus 20%.
       
     • If no manufacturer’s suggested retail price is available, payments will be set at actual acquisition cost plus 20%.

3. Other Payment Methodology Updates:

   • The bill maintains and updates previous adjustments to reimbursement rates for various medical equipment and supplies.
     
   • It includes provisions preventing reductions due to Medicare competitive bidding.
     
   • Adjustments to rates for ventilators, durable medical equipment, and other services are also reiterated or clarified.

The bill seeks to ensure more accurate and equitable reimbursement for enteral nutrition supplies and other medical equipment by using actual provider-submitted charges and manufacturer pricing methodologies.