HF4651

Purpose

• The bill aims to strengthen and modernize the way Minnesota manages and guards against improper use or waste in the Medical Assistance (MA) program. It seeks to improve oversight, provider enrollment rules, and the overall program integrity through new entities, updated processes, audits, and funding.

Main Provisions

• Create a Medical Assistance Program Integrity Advisory Board to guide and inform MA program integrity efforts.
• Direct the commissioner of human services to develop and adopt provider enrollment standards for MA, including criteria for enrollment and ongoing verification.
• Modernize the program integrity system, including improvements to technology, data analytics, and enforcement approaches (program integrity interventions).
• Require the commissioner to conduct audits of the MA program and to produce reports detailing findings and actions taken.
• Provide funding to support these program integrity enhancements (appropriations).
• Amend existing Minnesota Statutes to implement these changes:
  • Add subdivisions to Minnesota Statutes 2024 section 245.095.
  • Add subdivisions to Minnesota Statutes 2024 section 256B.064 (subdivisions 1b, 1d, 2, 3, 4, 5).
  • Add subdivisions to Minnesota Statutes 2025 Supplement section 15.013.

Changes to Existing Law

• Introduces new program integrity requirements specifically for the MA program, distinct from other programs.
• Establishes a formal advisory board to shape policies and standards for program integrity, including provider enrollment.
• Reforms the infrastructure and methods used to detect and prevent improper MA payments, with an emphasis on data-driven interventions and timely audits.
• Creates explicit statutory changes to multiple sections to reflect these new procedures and oversight mechanisms.

Implementation and Funding

• Requires the commissioner of human services to implement the advisory board, enrollment standards, and modernized integrity measures.
• Requires regular audits and reporting to document findings, recommendations, and actions.
• Allocates state funding to support these new activities and ongoing program integrity efforts.

Exemption

• The bill adds an exemption to Minnesota Statutes 2025 Supplement section 15.013, stating that this section does not apply to the MA program administered by the commissioner of human services. This carve-out clarifies that MA program operations are subject to separate MA-specific integrity provisions and standards.

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Relevant Terms - medical assistance program - program integrity - advisory board - provider enrollment standards - audits - program integrity infrastructure - program integrity interventions - commissioner of human services - appropriations / funding - Minnesota Statutes 2024 245.095 - Minnesota Statutes 256B.064 - Minnesota Statutes 2025 Supplement 15.013 - enhancements to data analytics and enforcement - MA program administration