MN SF2616

Modifies payment methodology for enteral nutrition and supplies beginning July 1, 2023, using the 50th percentile of usual and customary charges submitted to the commissioner.

Requires the commissioner to base 50th percentile calculations on at least 100 paid claim lines from at least 10 different providers; falls back to 20 claim lines from 5 providers if insufficient data exists.

For July 1, 2023 through December 31, 2023, rate increases cannot exceed 50 percent of the previous rate per product code and combination.

Beginning January 1, 2024, payment rates must be updated annually based on the previous calendar year's data, capped at 50 percent increase per code and product combination.

For products or supplies without sufficient data, payment defaults to manufacturer's suggested retail price minus 20 percent, or if unavailable, actual acquisition cost plus 20 percent.