Bill > SF2542

This bill modifies payment methodologies for medical equipment and supplies, particularly focusing on enteral nutrition equipment and supplies. The legislation establishes a new approach to determining payment rates for these items, primarily using the 50th percentile of usual and customary charges submitted to the commissioner. For dates of service from July 1, 2023, through June 30, 2027, payments will be calculated based on claim data, with increases capped at 150 percent of the previous year's rate. If sufficient claim data exists (defined as at least 100 paid claim lines from ten different providers, or at least 20 claim lines from five providers), the payment will be set at the 50th percentile of charges. If insufficient data is available, the payment will remain at the June 30, 2023 rate. After July 1, 2027, the methodology will be similar, but if no sufficient data exists, payments will be based on the manufacturer's suggested retail price minus 20 percent, or the actual acquisition cost plus 20 percent. The bill also includes provisions for annual updates to these rates starting January 1 and establishes specific guidelines for calculating payments for various medical supplies and equipment.

Government Affairs

https://www.revisor.mn.gov/bills/bill.php?b=Senate&f=SF2542&ssn=0&y=2025