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HF 808

A bill for an act relating to managed care organization chargebacks and third-party auditors.

2025-2026 Regular Session Introduced by Matt Rinker

HF 808 limits MCO chargebacks to 12 months after reimbursement and requires pre-negotiated auditor fees with no contingency pay, to reduce conflicts of interest.

Introduced, referred to Commerce.
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Bill Summary · HF 808

HF 808 — A bill relating to managed care organization chargebacks and third-party auditors

Overview

HF 808 would set limits and procedural requirements for how managed care organizations (MCOs) that administer Minnesota’s medical assistance program handle provider chargebacks and engage third-party auditors. The bill is introduced and referred to the Commerce committee as of March 6, 2025. Primary sponsor: Rinker.

Key Provisions

  • Section 249A.14 — Managed care organizations — chargebacks
    1) Chargeback timing

    • An MCO under contract with the Department to administer the Medical Assistance program may not issue a chargeback to a provider more than 12 months after the date the MCO provided reimbursement to the provider. 2) Auditor engagement and compensation
    • An MCO must negotiate a fee with a third-party auditor before the auditor initiates an audit of a provider on the MCO’s behalf.
    • An MCO may not base the auditor’s compensation on the percentage of chargebacks identified by the auditor (i.e., no contingency-based or success-fee arrangement tied to chargeback amounts).

  • Explanatory text

    • The accompanying explanation reiterates the above requirements: chargebacks must be issued within 12 months of reimbursement; audit fees must be negotiated beforehand; and compensation cannot be tied to the percentage of chargebacks found.

Affected Parties

  • Managed care organizations (MCOs) contracted with the Department to administer Minnesota’s Medical Assistance program.
  • Providers who receive reimbursements and may be subject to chargebacks.
  • Third-party auditors engaged by MCOs to conduct provider audits.

Procedural and Timeline Details

  • Effective as introduced: The bill establishes a 12-month cap on the window for issuing chargebacks after reimbursement.
  • Before any audit: MCOs must negotiate audit fees with third-party auditors prior to the audit start.
  • Compensation structure: Auditor compensation cannot be tied to the share or percentage of chargebacks identified.

Potential Impact and Considerations

  • Provider financial certainty: The 12-month chargeback limit gives providers a clearer, shorter window to address recoupments.
  • Audit fairness and independence: Requiring pre-negotiated fees and prohibiting contingency-based auditor pay may reduce potential conflicts of interest and incentives tied to outcome-based pay.
  • MCO operational changes: MCOs would need to adjust contracting practices with auditors and implement processes to ensure compliance with the 12-month deadline.

Additional notes

  • The content reflects the introduced version and summarized statutory language. The bill’s status indicates it is in early consideration (referred to Commerce) with sponsor Rinker.

Compiled from official sources — confirm details with the bill’s official record.

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