This bill amends Minnesota Statutes 2024, section 256B.69, subdivision 5a, to establish a new medical assistance capitation payment withhold related to the verification of coverage for managed care plans. The commissioner will withhold two percent of the capitation payment for each medical assistance enrollee starting January 1, 2026, and the withheld funds will be returned only if the managed care plan submits a completed verification of coverage form by February 28, 2026. The form must include the enrollee's name, address, and the name of the selected plan, along with a signature attesting to the accuracy of the information. If the form is not submitted by the deadline, the commissioner will not return the withheld funds, will cease capitation payments for that enrollee, and will disenroll the enrollee from medical assistance.

Additionally, the bill modifies existing withholding percentages for managed care plan payments. It deletes the previous withholding rates of 4.5 percent and 3 percent for services rendered in 2013 and 2014, respectively, and establishes a new withholding rate of five percent pending performance targets. The bill also includes provisions for the commissioner to periodically change administrative measures used as performance targets and requires managed care plans to comply with specific assessment and reporting processes. Overall, the bill aims to enhance accountability and ensure that managed care plans meet performance standards while also implementing a verification process for enrollees.

Statutes affected:
Introduction: 256B.69