MN HF2750

Removes enteral nutrition and supplies from the list of individually priced items effective July 1, 2023, establishing new payment methodologies based on percentile pricing of submitted charges.

Payment effective July 1, 2023, through December 31, 2023, shall be based on the 50th percentile of usual and customary charges from the previous fiscal year, with rate increases capped at 50 percent.

Payment effective January 1, 2024, and annually thereafter shall be based on the 50th percentile of usual and customary charges from the previous calendar year, with annual updates capped at 50 percent increases.

Commissioner must determine 50th percentile based on at least 100 paid claim lines from at least ten different providers; if insufficient data exists, the threshold drops to 20 claim lines from five providers.

For products or supplies lacking sufficient claim data, payment shall be based on manufacturer's suggested retail price minus 20 percent, or if unavailable, actual acquisition cost plus 20 percent.