Purpose of the Bill

The primary goal of this bill is to enhance the oversight of healthcare providers participating in Minnesota health care programs by requiring a periodic revalidation process. This is intended to ensure compliance with medical assistance laws and regulations, prevent fraud, and maintain the integrity of the healthcare system.

Main Provisions

• Revalidation Requirement: Health care providers enrolled in Minnesota health care programs must undergo a revalidation process every three years, reduced from the previous requirement of five years.

• Notification and Compliance: Providers will receive a 30-day notice before their scheduled revalidation date. If they fail to submit the required materials by the due date, they will have an additional 30 days to comply. Failure to comply results in a 60-day termination notice and suspension of the ability to bill, without the right to appeal.

• Compliance Officer: Providers are required to designate an individual as a compliance officer responsible for ensuring adherence to medical assistance laws, training employees, responding to allegations of improper conduct, and reporting violations.

• Background Checks: High-risk providers or those with significant ownership stakes must consent to criminal background checks, including fingerprinting, as part of the enrollment and revalidation process.

• Surety Bond Requirements: Durable medical equipment providers must purchase a surety bond with specific conditions for enrollment and revalidation, particularly if they have significant Medicaid revenues or are deemed high-risk.

Significant Changes to Existing Law

• Shortened Revalidation Cycle: The bill changes the revalidation period for providers from five years to three years, enhancing regular oversight.

• Increased Enforcement and Sanctions: The bill strengthens the commissioner's ability to suspend a provider's billing privileges and enforce compliance without allowing administrative appeals for such decisions.

• Incorporation of Federal Standards: The bill mandates providers to adhere to standards set by the Centers for Medicare and Medicaid Services when establishing compliance programs.

Relevant Terms

• Revalidation
• Compliance officer
• Background checks
• Surety bond
• Medicaid fraud prevention
• Medical assistance compliance
• High-risk provider designation