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HF3056 (Legislative Session 94 (2025-2026))

Provider network adequacy provisions changed.

Related bill: SF3296

AI Generated Summary

Purpose of the Bill

The bill aims to revise the rules related to provider network adequacy in Minnesota to ensure that health carriers maintain a sufficient network of healthcare providers within certain travel distances or times for enrollees. It makes changes to existing regulations to streamline the process and address gaps in provider networks.

Main Provisions

  1. Travel Distance or Time Standards:

    • The bill mandates that the maximum travel distance or time to access primary care services, mental health services, and general hospital services should be the lesser of 30 miles or 30 minutes.
    • Health carriers are required to comply with federal regulations to meet these adequacy standards.

  2. Waiver Process:

    • Health carriers can apply for a waiver if they cannot meet the travel distance or time standards.
    • The application must include specific data demonstrating infeasibility in particular service areas and a plan with timelines for addressing network inadequacies.
    • The waiver is valid for one year, after which a new application can be submitted, showing steps taken to address any inadequacies.

  3. Telehealth Provisions:

    • In cases where there are no available providers within the specified distance, health carriers can provide access to care through telehealth services.

  4. Referral Centers:

    • Exempt from the travel distance or time standards if patients are referred to highly specialized medical facilities, known as referral centers, for specific treatments like organ transplants.

  5. Fee Structure:

    • An application fee of $500 is required for each waiver related to provider types per county.

Significant Changes to Existing Law

  • The bill repeals the existing statute (Subdivision 3) which required the 60-mile or 60-minute travel standard for specialty services and other health services.
  • It introduces a more specific application and evaluation process for waivers, including telehealth options for areas with no available providers.
  • It modifies the criteria for referral centers by outlining which metrics can be considered when designating a facility as a referral center.

Relevant Terms

  • Provider Network Adequacy
  • Health Carriers
  • Travel Distance or Time Standards
  • Waiver Process
  • Telehealth Services
  • Referral Centers
  • Specialty Services
  • Health Finance and Policy

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
April 01, 2025HouseFloorActionIntroduction and first reading, referred toHealth Finance and Policy

Citations

 
[
  {
    "analysis": {
      "added": [
        "Clarification that distance shall be lesser of 30 miles or 30 minutes."
      ],
      "removed": [
        ""
      ],
      "summary": "This bill modifies travel distance and time standards for health services under section 62K.10.",
      "modified": [
        "Explicitly mentions primary care, mental health, and general hospital services."
      ]
    },
    "citation": "62K.10",
    "subdivision": "subdivision 2"
  },
  {
    "analysis": {
      "added": [
        "Clarifies application requirements and standards for waiver approvals."
      ],
      "removed": [
        ""
      ],
      "summary": "This bill modifies waiver application requirements for network adequacy standards.",
      "modified": [
        "Amends guidelines for evaluating and approving waiver applications."
      ]
    },
    "citation": "62K.10",
    "subdivision": "subdivision 5"
  },
  {
    "analysis": {
      "added": [
        "Defines criteria for designating a referral center based on volume and case severity."
      ],
      "removed": [
        ""
      ],
      "summary": "Changes in the referral centers applicability for health services under section 62K.10.",
      "modified": [
        "Clarifies that subdivisions 2 and 3 do not apply when referred to a center."
      ]
    },
    "citation": "62K.10",
    "subdivision": "subdivision 6"
  },
  {
    "analysis": {
      "added": [
        ""
      ],
      "removed": [
        ""
      ],
      "summary": "References federal law for time and distance standards for health service providers.",
      "modified": [
        ""
      ]
    },
    "citation": "45 CFR 155.1050",
    "subdivision": ""
  }
]

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