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SF2542 (Legislative Session 94 (2025-2026))

Enteral nutrition equipment and supplies payment methodologies modification; establishing payment rates for certain medical equipment and supplies

Related bill: HF2299

AI Generated Summary

The bill S.F. No. 2542 proposes modifications to Minnesota’s human services payment methodologies for enteral nutrition equipment and supplies, as well as adjustments to certain medical equipment and supply payment rates. It includes amendments to Minnesota Statutes 2024, section 256B.766.

Key Provisions:

  1. Temporary Payment Rates for Enteral Nutrition and Supplies (July 1, 2023 – June 30, 2027):

    • Payment is based on the 50th percentile of usual and customary charges per product code, using charge data submitted to the state.
    • If sufficient data is not available, rates will remain at the June 30, 2023 levels.
    • Rate increases under this methodology are capped at 150% of the previous fiscal year's rate.

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

    • Payments are annually updated on January 1.
    • If sufficient data is available, payments are based on the 50th percentile of previous year's charges per product code.
    • If data is unavailable:
      • Payments will be Manufacturer’s Suggested Retail Price (MSRP) minus 20%.
      • If MSRP is not available, payments will be based on actual acquisition cost plus 20%.

  3. Other Changes to Medical Equipment Payments:

    • Manufacturers’ Suggested Retail Price (MSRP) Methodology: The Minnesota Department of Human Services will establish payments for medical supplies like enteral formula, low-profile feeding tubes, and feeding tube extension sets on an annual basis.
    • Exemptions: Certain categories like physician services, inpatient hospital services, and prescription drugs remain exempt from these changes.

This bill aims to standardize and adjust payment rates for enteral nutrition products and medical equipment, ensuring more transparent and data-based reimbursement methodologies.

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
March 12, 2025HouseFloorActionIntroduction and first reading
March 12, 2025SenateFloorActionIntroduction and first reading
March 12, 2025HouseFloorActionReferred toHuman Services
March 12, 2025SenateFloorActionReferred toHuman Services

Citations

 
[
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section involves changes in the payment reductions for basic care services as of July 1, 2009.",
      "modified": [
        "Total payments for basic care services shall be reduced by three percent, with a variation to 4.5 percent between July 1, 2009, through June 30, 2011, before other calculations."
      ]
    },
    "citation": "256B.766",
    "subdivision": "subdivision 1"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This legislation references the specific criteria for adjustments in the payment for durable medical equipment and supplies.",
      "modified": [
        "Increases payments by 90 percent for prosthetics and orthotics to hospitals meeting certain criteria."
      ]
    },
    "citation": "62Q.19",
    "subdivision": "subdivision 1"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section of the U.S. Code refers to the federal financial participation and repayment obligations for ventilators.",
      "modified": [
        "State must repay excess federal financial participation for ventilators."
      ]
    },
    "citation": "42 U.S. Code § 1396b(i)(27)",
    "subdivision": ""
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Ensures that payment rates for certain medical equipment adhere to federal upper payment limits.",
      "modified": [
        "Ensures Medicare rate pays for durable medical equipment, prosthetics, orthotics, or supplies."
      ]
    },
    "citation": "Social Security Act § 1903(i)(27)",
    "subdivision": ""
  }
]

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