HF3964

Purpose

• Extend and reinforce requirements that health plan companies credential and contract with mental health providers.
• Improve timely access to mental health services, especially for underserved communities and rural areas.
• Update the credentialing framework to ensure more providers can participate in existing mental health networks.

Main Provisions

• Continuity of credentialing for certain providers:

  • If a health plan has initially credentialed providers who work for or with an entity that is:
  • authorized to bill under section 256B.0625 subdivision 5,
  • a mental health clinic certified under section 245I.20,
  • designated an essential community provider under section 62Q.19,
  • and under contract to provide mental health services,
  • then the health plan must continue to credential at least the same number of providers from that entity as long as those providers meet the plan’s credentialing standards.

• Temporary credentialing and contracting (July 1, 2023 to June 30, 2025):

  • Health plans must credential and contract with any mental health provider who meets credential requirements.
  • The plan may waive non–quality-related credentialing requirements to improve access for underserved communities or rural areas.
  • The contract with such providers must include:
  • payment rates that are usual and customary for the services,
  • a statement that the provider is accepting new patients,
  • evidence that the provider is not already under contract with the plan (or, if already under contract, that the plan has been notified of termination of that contract).

• Non-discrimination in credentialing:

  • A health plan may not refuse to credential these providers simply because there are already enough providers of that type in the network or enough mental health providers overall.

Changes to Existing Law

• The bill amends Minnesota Statutes 2024 section 62Q.096 to read as 62Q.096CREDENTIALING OF PROVIDERS, expanding the scope and requirements for credentialing mental health providers within health plan networks.

Implementation and Scope

• Applies to health plan companies operating in Minnesota.
• Focuses on providers of mental health services and specific qualifying entities (mental health clinics, essential community providers, and related billable entities).

Potential Impacts

• Increased access to mental health services for residents, particularly in underserved and rural areas.
• More providers may be included in health plan networks due to temporary credentialing provisions.
• Health plans may incur changes in credentialing processes and contracting timelines.

Relevant Terms - credentialing of providers - health plan company - mental health services - provider network - mental health clinic certified under section 245I.20 - essential community provider under section 62Q.19 - authorized to bill under section 256B.0625 subdivision 5 - contract - payment rates usual and customary - accepting new patients - unduly restricting credentialing (non-discrimination) - July 1, 2023 to June 30, 2025 - waive credentialing requirements - underserved communities - rural areas - Minnesota Statutes 2024 section 62Q.096 (amended to 62Q.096CREDENTIALING OF PROVIDERS) - providers of mental health services - contract termination notice - tax identification number (as referenced in contract terms)