WeVote
Log In

Bill

WeVote Research Nonpartisan
Bill Summary · SF 5024

Summary of SF 5024 (2025-2026) – Minnesota

Overview

SF 5024 would require health carriers to offer reference-based pricing (RBP) health plans and establish a framework for pricing, provider participation, and consumer information. The bill also adds protections against open-ended promise-to-pay contracts and creates a provider “numbers” framework to disclose standardized pricing data. The act connects to existing statutes in chapters 62J and 62K and includes provisions for rulemaking and consumer information exchanges.

Status: Introduced and referred to the Commerce and Consumer Protection committee on April 9, 2026.

Author/Co-Sponsors: Sen. Gruenhagen, Sen. Hoffman, Sen. Lieske (co-sponsors)

1) Main purpose and intent

  • To expand access to a reference-based pricing model within Minnesota by requiring health carriers to offer reference-based pricing health plans in the individual, small-group, and large-group markets, subject to federal approvals.
  • To improve price transparency, reduce surprise medical billing, and promote competition by standardizing and publicly disclosing provider pricing data.
  • To prohibit open-ended promise-to-pay contracts, ensuring patients are informed of expected charges upfront.
  • To establish a provider-number framework to quantify and communicate pricing to consumers.

2) Key provisions and changes

A. Reference-Based Pricing Health Plans (Section 7)

  • Definition: A “reference-based pricing health plan” pays a set price for each service (rather than negotiating per-provider rates).
  • Carrier Obligation: Health carriers offering plans in the individual, small group, and large group markets must also offer an RBP health plan, assuming necessary federal approvals.
  • Provider Participation (Subd. 3):
    • Enrollees may access any provider who agrees to a reimbursement rate up to, but not greater than, the rate specified in the RBP plan.
    • All participating providers must be offered the same terms and conditions.
    • Carriers may require providers to meet reasonable data, utilization review, and quality assurance requirements.
    • Providers agreeing to participate must serve all enrollees if their rate is at or below the specified RBP rate.
  • Reimbursement Rates (Subd. 4):
    • Rates must be based on a percentage of the Department of Human Services’ (DHS) most recent Medical Assistance fee-for-service (MA FFS) schedules.
    • For services without a MA FFS reference, rates must be negotiated using other market-fee schedules.
    • If the RBP rate is at least 190% above MA FFS and the plan is offered in all Minnesota counties, the plan is exempt from certain geographic and network adequacy requirements.
    • Participating providers accept the RBP rate as payment in full.
  • Conditions (Subd. 5):
    • Providers cannot be compelled to participate in an RBP plan as a condition of participation in other health plans or arrangements.
    • Carriers are not required to cover services not included in the enrollee’s plan.
    • Plans may impose cost-sharing (co-pays, deductibles, coinsurance) and reasonable referral/prior authorization requirements.
    • All chiropractic services and items for enrollees aged 21 or younger must be covered.

B. Prohibition on Open-Ended Promise-to-Pay Contracts (Section 2)

  • Prohibits any health care provider from requesting or enforcing open-ended promise-to-pay contracts.
  • Such contracts are void and unenforceable if executed after July 1, 2026, for services rendered on or after that date.
  • If allowed, providers may require patients to sign agreements acknowledging financial responsibility only if:
    • The agreement includes the provider’s number (see Provider Numbers, Section 4),
    • Identifies services that may not be covered by insurance, and
    • Discloses estimated patient responsibility based on the provider’s number and the patient’s coverage.

C. Provider Number Framework (Sections 3–4)

  • Provider Numbers (Subd. 4): By January 1, 2028 (and annually thereafter), the Department of Health must publish a provider number for each provider. This number is calculated by a formula that ties standard charges to the provider’s baseline charges, reflecting a standardized pricing metric.
  • Separate numbers must be published for facility-based charges (hospital/facility) and professional services.
  • Providers must prominently display their number where patients can easily see it (including on websites).

D. Consumer Health Information Exchanges (Section 5)

  • Authorized privately operated online platforms may aggregate data from providers and the commissioner of health to display provider numbers, price data, quality metrics, and patient reviews.
  • Exchanges must be privately owned and operated (not by providers, health systems, plans, or manufacturers).
  • The commissioner must register exchanges that meet security, independence, non-bias, privacy, and public-access requirements.

E. Rulemaking (Section 6)

  • The commissioner of health must promulgate rules implementing:
    • The provider-number framework and price-disclosure goals (including a simple, universal pricing system and the elimination of surprise bills).
    • Standards for privately operated consumer health information exchanges (data submission, independence, privacy, and consumer access).

3) Who/what is affected

  • Health carriers: Required to offer reference-based pricing health plans in addition to existing products; subject to pricing and network rules.
  • Providers: May participate in RBP plans; must accept RBP rates as payment in full if they participate; disclose pricing data via provider numbers; display numbers publicly.
  • Enrollees/consumers: Benefit from price transparency, standardized pricing, and potential reduction in surprise bills; can compare providers via exchanges.
  • Hospitals/health facilities and professional medical/dental practices: Affected by pricing standards and the need to display provider numbers; potential impact on negotiating leverage and reimbursement rates.
  • Consumer health information exchanges: New regulatory framework to collect and display price and quality data.
  • Department of Health: Responsible for calculating and publishing provider numbers and implementing rulemakings.

4) Procedural and timeline aspects

  • Effective date and federal approvals: The RBP requirement applies “upon any necessary federal approval.”
  • Open-ended contracts: Prohibition takes effect for services rendered on or after July 1, 2026; contracts signed earlier are governed by the transitional provisions.
  • Provider numbers: Calculations and public posting begin by January 1, 2028, with annual updates thereafter.
  • Rulemaking: The Department of Health would adopt rules to implement the provider-number framework, pricing system, and consumer-exchange standards, as described in Section 6.

Potential impact considerations

  • Could increase price transparency and reduce hidden costs for consumers.
  • May influence provider pricing strategies and payer negotiations through standardized reference-based rates.
  • Creation of a regulated framework for consumer data exchanges may affect how price and quality information is shared with the public.
  • Geographic and network-availability considerations may shift for plans with high RBP rates (≥190% of MA FFS).

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

Sign in to ask a question.