Minnesota Administrative Rules
Agency 196 - Human Services Department
Chapter 9505 - HEALTH CARE PROGRAMS
MEDICAL ASSISTANCE PAYMENTS
Part 9505.0300 - INPATIENT HOSPITAL SERVICES

Subpart 1. Definition.

"Inpatient hospital service" means a health service provided to a recipient who is an inpatient.

Subp. 2. Eligibility for participation in medical assistance program; general.

To be eligible for participation in the medical assistance program, a hospital must meet the conditions of items A to C.

Subp. 3. Payment limitation.

Payment for inpatient hospital services to a recipient shall be made according to parts 9500.1090 to 9500.1140. Inpatient hospital services that are medically necessary for treatment of the recipient's condition are not eligible for a separate payment but are included within the payment rate established under parts 9500.1090 to 9500.1155. An example of a medically necessary service is a private room that the recipient's physician certifies as medically necessary.

Subp. 4. Eligibility for participation in medical assistance; emergency.

A hospital service provided to a recipient in an emergency is eligible for medical assistance payment regardless of whether the hospital providing the service is qualified to participate in Medicare. Urgent care services do not qualify for medical assistance payment under this subpart. For the purposes of this subpart, "urgent care" means acute, episodic care similar to services provided in a physician directed clinic.

Subp. 5. Excluded services.

Inpatient hospital admission and services are not eligible for payment under the medical assistance program if they are not medically necessary under parts 9505.0501 to 9505.0545; if they are for alcohol detoxification that is not medically necessary to treat an emergency; if they are denied a required prior authorization; or if they are surgical procedures requiring a second surgical opinion that has failed to be approved by a second or third surgical opinion.