Bill > HF3546

This bill establishes program integrity requirements for high-risk provider types under medical assistance, which is a government program that provides health coverage to low-income individuals and families. It clarifies definitions of "controlling individual" for licensed programs and services, ensuring that individuals with significant influence or ownership are identified. The bill also introduces new sections to Minnesota Statutes that categorize providers as "limited-risk," "moderate-risk," or "high-risk" based on federal criteria, and requires providers to enroll each location where they provide direct services. For high-risk providers, the bill mandates stricter oversight, including potential enrollment moratoriums, prepayment review of claims, and the possibility of payment withholding. It also requires certain providers, such as those in durable medical equipment, to obtain surety bonds to protect against fraud and abuse, and allows for unannounced on-site inspections of moderate and high-risk providers. Additionally, the bill updates requirements for compliance officers, background checks, and the revalidation process for providers, aiming to enhance program integrity and prevent fraud, waste, and abuse within the medical assistance program. Finally, it requires a report to the legislature on the effectiveness of these measures.

Labor and Employment

https://www.revisor.mn.gov/bills/94/2026/0/HF/3546/