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SF1966 (Legislative Session 94 (2025-2026))

Timelines modification for filing medical claims after recoupment

Related bill: HF1963

AI Generated Summary

This Minnesota Senate Bill (S.F. No. 1966) proposes modifications to various aspects of human services, particularly focusing on medical claims, financial responsibility for withdrawal management services, regulations for peer recovery support providers, and timelines for mental health diagnostic assessments.

Key highlights of the bill:

  1. Medical Claims Filing (Sec. 1):

    • Extends timelines for submitting medical claims after a payment recoupment by a health plan company or third-party administrator.
    • Allows health care providers additional time (up to 12 months) to file claims in cases of significant operational disruptions.

  2. Financial Responsibility for Withdrawal Management (Sec. 4):

    • Defines the county responsible for financing withdrawal management services in accordance with Section 256G.02, subdivision 4 of Minnesota Statutes.

  3. Regulations for Peer Recovery Support Providers (Sec. 2 & 3):

    • Introduces certification and accreditation requirements for recovery community organizations providing peer recovery support services.
    • Establishes compliance rules, including governance requirements, grievance policies, and non-retaliation clauses.
    • Implements closure planning requirements for peer recovery support providers.

  4. Changes to Mental Health and Substance Use Disorder Services (Sec. 3):

    • Updates rate structures for substance use disorder (SUD) treatment programs, including specific reimbursement rates based on the American Society of Addiction Medicine (ASAM) levels of care.
    • Establishes additional program eligibility criteria, including cultural responsiveness requirements and co-occurring disorder treatment standards.
    • Places limitations on telehealth-provided SUD services and sets maximum client-to-staff ratios for group services.
    • Enforces peer recovery support service billing review to ensure medical necessity and places limits on weekly billable service hours per client.

Overall, the bill refines administrative processes, adjusts timelines for claims processing, enforces stricter oversight on recovery support services, and enhances financial responsibility clarity for withdrawal management services.

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
February 26, 2025SenateFloorActionIntroduction and first reading
February 26, 2025HouseFloorActionIntroduction and first reading
February 26, 2025SenateFloorActionReferred toHuman Services
February 26, 2025HouseFloorActionReferred toHuman Services
March 05, 2025HouseFloorActionComm report: To pass and re-referred toCommerce and Consumer Protection
March 05, 2025SenateFloorActionComm report: To pass and re-referred toCommerce and Consumer Protection
April 02, 2025SenateFloorActionWithdrawn and re-referred toHuman Services

Citations

 
[
  {
    "analysis": {
      "added": [
        "Allows for an extension of claims submission by six months in cases of payment adjustment or recoupment."
      ],
      "removed": [
        ""
      ],
      "summary": "This bill amends the timelines for filing medical claims under section 62Q.75, subdivision 3.",
      "modified": [
        "Extends the submission requirement from six months to 12 months in disruption cases."
      ]
    },
    "citation": "62Q.75",
    "subdivision": "subdivision 3"
  },
  {
    "analysis": {
      "added": [
        "Adds requirements for recovery community organizations to become eligible vendors."
      ],
      "removed": [
        "Detoxification programs under certain rules are not eligible vendors."
      ],
      "summary": "This bill amends the criteria for eligibility of vendors providing substance use disorder services under section 254B.05, subdivision 1.",
      "modified": [
        "Modifies staffing credentials and care coordination services eligibility."
      ]
    },
    "citation": "254B.05",
    "subdivision": "subdivision 1"
  },
  {
    "analysis": {
      "added": [
        "Introduces higher rates for culturally specific or responsive programs."
      ],
      "removed": [
        ""
      ],
      "summary": "This bill revises rate requirements for substance use disorder services under section 254B.05, subdivision 5.",
      "modified": [
        "Updates ASAM level care specifications and base payment rates for certain services."
      ]
    },
    "citation": "254B.05",
    "subdivision": "subdivision 5"
  }
]

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