HF4719

Purpose

• The bill aims to increase reimbursement rates under Minnesota Medical Assistance (MA) for certain mental health testing and assessment services. It would align these payments with Medicare rates and change who gets paid what, with the goal of improving access to mental health care for MA enrollees.

Key Provisions

• Add Subdivision 5 to Minnesota Statutes 2025 Supplement section 256B.761:
  • Effective date: For services rendered on or after January 1, 2027, or when federal approval is obtained (whichever is later).
  • Payment rate: The commissioner must pay 100 percent of the total published Medicare payment rate (as defined by 42 C.F.R. 438.6) for:
  • Neuropsychological assessments (256B.0671, subd. 8)
  • Neuropsychological testing (256B.0671, subd. 9)
  • Psychological testing (256B.0671, subd. 10)
  • Reimbursement by managed care and county-based purchasing plans: Must reimburse providers at least at the same rate as fee-for-service for these services.
  • Monitoring: The commissioner must monitor how this rate change affects enrollee access to mental health services.
  • Federal approval contingency: If federal approval is not received for this provision in a contract year, capitation rates paid to managed care and county-based purchasing plans must be adjusted to reflect the removal of this provision.
  • Provider-contract consequences: Contracts between plans and providers must allow recovery of payments from providers if capitation rates are adjusted; such recoveries may not exceed the amount of the rate increase attributable to this provision.
  • Expiration: This subdivision expires on the effective date of Laws 2025, First Special Session, chapter 3, article 8, section 29.
• Sec. 2 Repealer:
  • Repeals Minnesota Statutes 2024 section 256B.0625, subdivision 38.
  • Background from repealed text (for context): Previously, payments for mental health services by certain professionals followed a tiered structure:
  • Master’s-prepared mental health professionals: 80% of the rate paid to doctoral-prepared professionals.
  • Master’s-prepared professionals employed by community mental health centers: 100% of the doctoral rate.
  • Physician assistants: 80.4% of the base rate paid to psychiatrists.

Significant Changes to Existing Law

• Removes the prior, lower-pay structure for master’s-prepared mental health professionals and related categories, replacing it with a single standard tied to 100% of the Medicare payment rate for specified testing services.
• Establishes Medicare-based pricing for neuropsychological and psychological testing, rather than the previous master’s/doctorate-based pay scales.
• Creates a built-in mechanism to adjust capitation rates if federal approval is not granted, protecting state costs and payer contracts.
• Adds a monitoring requirement to assess how higher testing-rate payments affect access to mental health services.

Implementation, Oversight, and Dates

• Implementation depends on federal approval and the stated January 1, 2027 date (or the later federal approval date).
• The state must monitor enrollee access and adjust capitation rates if federal approval does not occur in a given contract year.

Relevant Terms - Medical Assistance (MA) - mental health services - reimbursement rates - 100 percent of Medicare payment rate - total published Medicare payment rate - 42 C.F.R. 438.6 - neuropsychological assessments - neuropsychological testing - psychological testing - 256B.0671 subd. 8, 9, 10 - managed care organizations (MCOs) - county-based purchasing plans (CBPs) - fee-for-service rate (FFS rate) - capitation rates - federal approval - enrollee access - master’s-prepared mental health professionals - doctoral-prepared professionals - community mental health centers - physician assistants - base rate paid to psychiatrists - repeal of 256B.0625, subd. 38