Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
Covered health services.
Health services covered by MinnesotaCare include the services
listed in Minnesota Statutes, section
256L.03.
Subp. 2.
Inpatient hospital
services.
A. Enrollees are covered for
medically necessary inpatient hospital services including acute care services,
mental health services, and chemical dependency services.
B. MinnesotaCare benefits for inpatient
hospital services for adult enrollees are limited to $10,000 per calendar year.
No benefit limit for inpatient hospital services applies to children.
C. To be reimbursed under MinnesotaCare for
inpatient hospital services provided to enrollees, eligible providers must
comply with:
(1) parts
9500.1090 to
9500.1140 and Minnesota Statutes,
sections
256.9685,
256.9686,
256.969, and
256.9695,
governing inpatient hospital payment rates for medical assistance;
(2) parts
9505.0170 and
9505.0475 and Minnesota Statutes,
section
256L.03,
subdivisions 1 to 5, establishing standards for services covered by medical
assistance;
(3) parts
9505.5000 to
9505.5030 and Minnesota Statutes,
section
256B.0625,
subdivision 25, requiring prior authorization for certain services;
and
(4) parts
9505.0540 and
9505.5035 to
9505.5105, governing second
surgical opinions.
Subp.
3.
Hospital admission certification.
Inpatient hospital admissions of enrollees, including admission
of a pregnant woman that results in the delivery of a newborn or a stillbirth
or an admission where the principal diagnosis or procedure is an inpatient
dental procedure, must be certified in accordance with the medical assistance
certification criteria in parts
9505.0501 to
9505.0540, except for
admissions:
A. approved under
Medicare; or
B. authorized under
parts
9530.6600 to
9530.6655.
Subp. 4.
Cost avoidance.
The commissioner shall use cost avoidance techniques to ensure
benefit coordination for enrollees, including items A to C.
A. MinnesotaCare coverage for covered health
services is secondary to other health coverage for which enrollees are
eligible, except for coverage under the consolidated chemical dependency
treatment fund.
B. Coverage by all
potential third-party payers must be exhausted before MinnesotaCare payment for
covered health services will be made. An eligible provider must attempt to
collect payment from potential third-party payers before billing the department
for a covered health service.
C.
Private accident and health care coverage must be used according to the rules
of the specific health plan. MinnesotaCare shall not pay for services that
would have been covered by the primary health coverage if the applicable rules
of that health coverage had been followed.
Subp. 5.
Lien.
When the department provides, pays for, or becomes liable for
covered health services, the department has a lien for the cost of care upon
any and all causes of action accruing to the enrollee, or to the enrollee's
legal representatives, as a result of the occurrence necessitating payment for
covered health services. All liens under this subpart are governed by Minnesota
Statutes, section
256.015.
Statutory Authority: MS s
256.9352;
256L.02
