HF4992

Purpose

This bill aims to reduce health care costs and improve price transparency for patients. It adds protections against certain billing practices, requires clearer pricing information, and introduces a new type of health plan based on fixed reference prices. It also sets up rules and systems to help consumers compare prices and quality across providers.

Main Provisions

• Hospital-acquired infections (HAI) and costs

  • Defines terms like health care facility and hospital-associated infection (HAI).
  • Prohibits health care facilities from charging patients or payers for the treatment costs of any HAI. This applies whether patients are insured, self-pay, or have other coverage.
  • The facility where the HAI was acquired must cover all related treatment costs, including extended hospital stays, procedures, medications, labs, imaging, rehab, and any subcontractor charges. If the original facility can’t treat the HAI, the hospital or facility is still financially responsible.

• Prohibition on open-ended promissory-to-pay contracts

  • Bans open-ended contracts that require a patient to pay for services without a clearly disclosed price.
  • Providers may not ask patients to sign such contracts.
  • All open-ended contracts signed before July 1, 2026 become unenforceable for services after that date.
  • Providers may require patients to sign agreements about financial responsibility only if they (a) disclose the provider’s assigned number, (b) identify services that may not be covered by insurance, and (c) disclose estimated patient responsibility based on the provider’s number and the patient’s insurance.

• Provider numbers and price transparency

  • Defines and uses a “provider number” to show how much of a baseline rate a provider charges.
  • Establishes a baseline (the allowable reimbursement amount under Minnesota’s Medical Assistance program) and a “standard charge” (the normal price charged by a practice).
  • Requires the state to publish two provider numbers by January 1, 2028: a facility number for hospital/facility charges and a professional services number for medical professional charges.
  • Providers must post these numbers prominently where patients can see them, including on websites.

• Consumer health information exchanges (CHIE)

  • Allows privately operated online platforms to collect and display provider data (prices, quality metrics, patient reviews) for consumers.
  • These exchanges must be privately owned and operated, with no ownership or control by health systems, health plans, pharmaceutical companies, or medical device makers.
  • The state must register these exchanges and require them to securely handle data, stay independent, display all provider data without bias, protect privacy, and keep basic search features free for consumers.

• Rulemaking

  • The health department must issue rules to implement the provider-number system and the CHIE requirements.
  • Rules should promote:
  • A simple, universal price system using a single number tied to the baseline rate.
  • Public disclosure of current prices to reveal hidden costs paid by private-pay patients.
  • A consumer-friendly marketplace where patients can compare prices, prices by provider, and choose providers.
  • Competition among providers and plans, and elimination of surprise billing and price gouging.
  • Rules for CHIE must support a framework for independent data, data submission, price and quality comparisons, and consumer privacy protections.

• Reference-based pricing health plan (RBPP)

  • Health carriers offering plans in individual, small, or large group markets must also offer a reference-based pricing plan.
  • Enrollees may access any provider who agrees to be paid up to the RBPP rate. If a provider’s rate is higher than this, the terms offered must be the same for all participating providers.
  • Carriers may require providers to meet data, quality, and review requirements.
  • Providers who participate must treat all enrollees if the rate is equal to or less than the RBPP rate.
  • Reimbursement rates for participating providers are based on a percentage of the Medicaid fee-for-service (MA FFS) rate. If a service lacks an MA FFS value, rates are negotiated using other major local fee schedules.
  • If a RBPP rate is at least 190% above the MA FFS rate and the plan is available in all Minnesota counties, the plan is exempt from certain geographic and network adequacy requirements.
  • Participating providers agree to accept the RBPP rate as payment in full.
  • Providers cannot be forced to join a RBPP plan as a condition of participation in other plans, and RBPP does not require coverage for non-covered services. RBPP plans may impose usual cost-sharing, referral, and prior-authorization requirements.
  • RBPP plans must cover chiropractic services for enrollees age 21 and under.

Implementation & Oversight

• The Minnesota Department of Health will publish provider numbers and oversee posting requirements. It will also set up rules for the price system and for CHIE operations.
• The rulemaking aims to create a transparent, consumer-friendly pricing environment, reduce hidden costs, and support competition and fair access to care.

Significant Changes to Existing Law

• Introduces a statewide, enforceable restriction on charging for HAI treatment, shifting financial responsibility to facilities.
• Bans open-ended promissory-to-pay contracts and requires clearer disclosures and a provider-number framework.
• Establishes a formal, public, two-number provider pricing system (facility and professional), with required postings.
• Creates a private, independent consumer health information exchange framework to compare prices and quality.
• Establishes a rule-based framework to promote price transparency and prevent surprise billing.
• Creates a mandatory RBPP option for health plans, with specific rules about rates, participation, and network requirements.

Implementation Timeline Highlights

• By January 1, 2028: the commissioner of health must publish provider numbers for each provider (facility and professional services).
• Ongoing rulemaking by the Health Department to implement the pricing numbers and CHIE requirements.

Potential Impacts

• Patients may see clearer, published price data and have easier access to price comparisons.
• Hospitals and clinics could face new pricing disclosure obligations and potential changes to billing practices.
• Health plans may offer a RBPP option, shifting how some services are priced and paid.
• The state aims to reduce surprise bills and hidden charges and to improve price competition across providers.

Relevant Terms - hospital-associated infection (HAI) - health care facility - provider number - chargemaster - standard charge - baseline (MA/Medicaid baseline) - CPT code - CDT code - open-ended promissory-to-pay contract - consumer health information exchanges (CHIE) - price transparency - reference-based pricing health plan (RBPP) - reimbursement rate - Medicaid fee-for-service (MA FFS) - geographic and network adequacy - patient cost sharing (copays, deductibles, coinsurance) - surprise medical billing - price gouging - data independence and privacy protections