Purpose

This bill strengthens protections for people who receive medical assistance when a provider can no longer continue services due to a serious problem with the provider's operations. It aims to keep people safe, ensure they still get medically necessary care, and guide a structured, orderly transition to another provider. It also creates new rules for payments during transitions and increases oversight to identify and fix systemic gaps.

Key concepts and definitions

• Serious operational event: events like sanctions, licensure actions, insolvency, bankruptcy, abandonment, or other failures that prevent a provider from safely operating and continuing to serve recipients.
• Complex transition: a special transition situation triggered by a serious operational event that could cause gaps in care or other harms unless managed carefully.
• Complex transition designation: criteria the state uses to label a transition as “complex” (examples include long-term services, behavioral health treatment, medically fragile recipients, limited regional capacity, or unstable placements).
• Lead agency: the county, Tribe, or managed care organization responsible for coordinating services for recipients.
• Recipient: a person enrolled in, or otherwise receiving, services under medical assistance.
• Direct recipient care costs: the portion of provider costs that goes to actually delivering care (excluding owner profits and related noncare transfers).

Main provisions and what the bill seeks to accomplish

• Provider duties during a serious operational event
  • When a provider can no longer continue services, the provider must notify the recipient, their contact person (if any), the lead agency, and the commissioner about 30 days before terminating services when practicable.
  • The provider must help the recipient transition to another provider and, when practicable, give the recipient a copy of relevant rights or protections 30 days before termination.
• Commissioner duties
  • The commissioner must inform the appropriate ombudspersons and lead agencies, and directly notify each affected recipient to protect welfare.
  • The commissioner must assist in transitioning the recipient to another provider of the recipient’s choice and ensure continuity of medically necessary services during the transition when the event is designated as complex.
• Lead agency duties
  • Lead agencies must reach out to affected recipients to ensure ongoing services and to confirm the recipient has free choice of provider if they transfer.
• Complex transition operations and planning
  • The commissioner must designate a serious operational event as a complex transition when specific conditions apply (long-term supports, critical treatment interruptions, medically fragile status, limited capacity, or placement stability needs).
  • A written complex transition operations plan must be prepared for each complex transition, covering: recipient identification and acuity, stabilization actions, medical record and treatment plan continuity, receiving provider capacity, transition timelines and transportation, and clear communication with recipients and families (including language access) and coordination with case managers and ombudsperson offices.
  • The commissioner may form a complex transition team with agency staff and other professionals to oversee safe transitions.
  • The commissioner must notify legislative committees within ten days of designating a complex transition and report within 90 days after recipient stabilization to identify gaps and make improvements.
• Continuity period and transition payments for complex transitions
  • A provider involved in a complex transition may continue to serve high-risk recipients for up to 180 days after the designation, but this continuity does not reinstate provider participation in medical assistance or remove the state’s sanction or enforcement authorities.
  • When a provider faces payment withholds or similar sanctions, there can be “good cause” allowances to avoid interrupting care during complex transitions.
  • Transition payments (when allowed) are limited to direct recipient care costs. Providers receiving transition payments must undergo independent financial monitoring and cannot distribute profits to owners during this period.
  • Transition payment amounts, when allowed, may be credited against the provider’s debts to the state where permissible by law.
  • Priority is given to alternative enrolled providers, court-appointed receivers, interim managers, or other substitute providers who take over care under an approved transition plan.
  • The provisions do not require payments that federal law prohibits.
• Statutory updates to recipient protection and related sections
  • Amendments to home care protections require providers to give the home care bill of rights at least 30 days before termination due to sanctions, and to assist in transitioning to another provider while protecting recipient rights when a serious operational event occurs.
  • When a provider can no longer serve, lead agencies must contact recipients to ensure continued care and free provider choice, and the commissioner or delegate may notify recipients directly if necessary to protect welfare.
  • If a provider’s participation is suspended or terminated, lead agencies and ombudspersons must be informed and must assist in transitioning recipients to other providers, while maintaining protections and eligibility rules.
• Sanctions information for participants upon termination of services
  • The commissioner may withhold payment, suspend, or terminate a provider’s enrollment for noncompliance, with an appeal right.
  • If a participant or employer fails to comply, they may be disenrolled from the budget model, with a process to contest the decision.
  • Agencies and providers must deliver a copy of participant protections to participants at least 30 days before termination due to sanctions or related actions, and notify recipients and their representatives if necessary to protect welfare.
  • The same notification and transition requirements apply to CFSS (care and services) agency providers, FMS (financial management services) providers, or consultation services providers when those providers face sanctions or enrollment actions.

Significant changes to existing law

• Adds a formal framework for “complex transitions” and a dedicated operations plan to manage transitions when a provider experiences a serious operational event.
• Establishes a 180-day continuity period during which a provider can continue services to high-risk recipients, while ensuring safety and ongoing care, without reinstating participation or altering enforcement authority.
• Creates structured transition payments and financial oversight to support continuity of care without enabling provider financial mismanagement, and prioritizes alternative providers during transitions.
• Expands notification, coordination, and oversight responsibilities among providers, lead agencies, the commissioner, and ombudsperson offices to protect recipient welfare.
• Applies similar protections and transition requirements across multiple program areas (general medical assistance, home care, CFSS, FMS, and related services).

Who is affected

• Recipients receiving medical assistance, especially those in long-term services and supports, behavioral health treatment, medically fragile conditions, or with placement stability concerns.
• Home care providers and CFSS/FMS providers who might experience sanctions or termination of participation.
• Lead agencies (counties/tribes/managed care organizations) and ombudsperson offices.
• The commissioner of human services and related state agencies involved in administering medical assistance and home-based services.

Implementation considerations

• Requires new processes for notifying recipients, coordinating with lead agencies, and developing complex transition plans within tight timelines.
• Introduces monitoring and reporting requirements (including a 90-day post-stabilization report to legislators) to identify systemic gaps and guide improvements.
• Establishes financial oversight during transitions to prevent misuse of transition funds and to safeguard against ongoing provider debt to the state.
• Ensures continuity of care for high-risk individuals even when a provider is undergoing sanctions or termination.

Plain-language takeaway

If a health or home-based care provider can no longer safely offer services, Minnesota’s proposed rules aim to: - Protect recipients by ensuring they know what’s happening and can move to another trusted provider. - Require careful planning and coordination among providers, lead agencies, and state officials. - Keep care flowing for medically fragile and high-need recipients during a transition, with temporary funding rules to support this process. - Gather lessons from each transition to improve the system for everyone.

Relevant Terms

serious operational event; complex transition; complex transition designation; complex transition operations plan; lead agency; recipient; direct recipient care costs; continuity period; continuity of medically necessary services; transitional payments; transition payments; good cause payments safeguards; ombudsperson; Home Care Bill of Rights; recipient protections; free choice of provider; stabilization actions; medical records continuity; receiving provider; transition timelines; transportation; handoff; health services alignment; managed care organization; county-based purchasing; CFSS; FMS; enrollment suspension; provider sanctions; legislative notification; recipient welfare.

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