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SF3117 (Legislative Session 94 (2025-2026))

Commissioner of human services revalidation of providers enrolled in Minnesota health programs every three years requirement

Related bill: HF2957

AI Generated Summary

Purpose of the Bill

This bill aims to enhance the oversight and integrity of providers enrolled in Minnesota’s health care programs by requiring regular revalidation, setting compliance standards, and enforcing actions against non-compliance.

Main Provisions

  • Revalidation of Providers: The bill mandates that the commissioner of human services revalidate every enrolled provider at least once every three years. Personal care assistance agencies must also be revalidated every three years.
  • Notification and Compliance: Providers will receive a 30-day notice before their revalidation is due, with detailed instructions and a list of necessary submission materials.
  • Penalties for Non-Compliance: If a provider fails to submit the required materials by the due date, they will receive a notification and have an added 30 days to comply. Failure to remedy deficiencies results in a 60-day notice of termination and suspension of billing privileges.
  • Background Checks and Risk Management: Providers designated as high-risk must undergo background checks, including criminal background checks if required. The commissioner can suspend billings for non-compliance and deny billings for high-risk designations.
  • Surety Bonds Requirement: Certain medical suppliers, particularly durable medical equipment providers, must purchase a surety bond as a condition for enrollment and revalidation to prevent fraud.

Significant Changes to Existing Law

  • Revalidation Frequency: Changes the revalidation period from five years to three years for all providers.
  • Provider Compliance Officer Requirement: Providers must now appoint a compliance officer responsible for ensuring adherence to medical assistance laws and managing claims and compliance activities.
  • Enhanced Penalties and Risk Management: Introduces stricter penalties for documentation and compliance failures, including potential revocation of enrollment for up to one year.
  • Surety Bonds for High-Risk Providers: Establishes new surety bond requirements for high-risk providers or those suspected of non-compliance to safeguard against financial risks to Medicaid.

Relevant Terms

  • Provider enrollment
  • Revalidation
  • Background study
  • Compliance officer
  • Surety bond
  • High-risk provider
  • Durable medical equipment

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
March 31, 2025SenateFloorActionIntroduction and first reading
March 31, 2025SenateFloorActionReferred toHealth and Human Services

Citations

 
[
  {
    "analysis": {
      "added": [
        "Revalidation period changed to every three years from previously unspecified."
      ],
      "removed": [],
      "summary": "This bill requires the commissioner of human services to revalidate providers enrolled in Minnesota health care programs every three years, amending section 256B.04, subdivision 21.",
      "modified": [
        "Condition for provider file to be terminated if revalidation is incomplete after an extended period."
      ]
    },
    "citation": "256B.04",
    "subdivision": "subdivision 21"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Background study requirements include review of databases as described in section 245C.08, subdivision 1.",
      "modified": []
    },
    "citation": "245C.08",
    "subdivision": "subdivision 1"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "The authority to sanction a provider under the provisions of section 256B.064 is not limited by conditions for documentation access.",
      "modified": []
    },
    "citation": "256B.064",
    "subdivision": ""
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Surety bond requirements do not apply if the provider maintains a surety bond under section 256B.0659.",
      "modified": []
    },
    "citation": "256B.0659",
    "subdivision": ""
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "The requirements for purchasing a surety bond do not apply if the provider maintains a surety bond under section 256B.85.",
      "modified": []
    },
    "citation": "256B.85",
    "subdivision": ""
  }
]

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