MEDICAL ASSISTANCE

Administration, Minn. Rules 9505.0011, 9505.0135, 9505.0195

Appeals

Applicants, denial of eligibility, Minn. Rules 9505.0100

Generally, Minn. Rules 9505.0130

Prior authorization, Minn. Rules 9505.5105

Recipients, denial of inpatient hospital services, Minn. Rules 9505.0545

Suspended providers, Minn. Rules 9505.0475

Applicants

Appeals by, Minn. Rules 9505.0100, 9505.0130

Authorization by, eligibility verification, Minn. Rules 9505.0095

Defined, Minn. Rules 9505.0015

Notice given

Applications, withdrawal, Minn. Rules 9505.0090

Change in eligibility, Minn. Rules 9505.0115

Third-party payer coverage, Minn. Rules 9505.0071

Notice received, eligibility, Minn. Rules 9505.0090, 9505.0100, 9505.0125

Rights, Minn. Rules 9505.0085

Applications

Applicants, rights, Minn. Rules 9505.0085

Defined, Minn. Rules 9505.0015

Local social services agencies, Minn. Rules 9505.0085, 9505.0090

State hospital residents, Minn. Rules 9505.0105

Vendor participation, Minn. Rules 9505.0195

Assets, income, treatment, Minn. Rules 9505.0065

Assignment of benefits

Applicants and recipients, Minn. Rules 9505.0071

Providers, responsibility, Minn. Rules 9505.0070

Authorized representatives, applications, Minn. Rules 9505.0085

Benefits, transitional, revenue recapture, exemption, notice, Minn. Rules 8165.0300

Billing

Business agents, Minn. Rules 9505.0455

Medicare billing requirements, compliance, Minn. Rules 9505.0440

Pharmacy services, Minn. Rules 9505.0340

Provider responsibility, Minn. Rules 9505.0470

Requirements, generally, Minn. Rules 9505.0225, 9505.0450

Third party claims, Minn. Rules 9505.0070

Case management, Minn. Rules 9505.0322

Certification, hospices, Minn. Rules 4664.0320

Chemical dependency treatment services, see Treatment under CHEMICALLY DEPENDENT PERSONS

Claims

False claims, Minn. Rules 9505.0460

Generally, Minn. Rules 9505.0450

Provider responsibility, Minn. Rules 9505.0470

Third party liability, Minn. Rules 9505.0070, 9505.0071

Claims against estates, local social services agencies, duties, Minn. Rules 9505.0135

Contested cases, providers, participation, ineligibility, Minn. Rules 9505.0195

Contracts

Competitive bids

Generally, Minn. Rules 9505.0200, 9505.0445

Hearing aids, Minn. Rules 9505.0287

Medical equipment and supplies, performance agreements, Minn. Rules 9505.0365

Provider agreements, Minn. Rules 9505.0175, 9505.0195

Coordination

Hospice services, coordination, Minn. Rules 9505.0446

Mental health services, Minn. Rules 9505.0322

MinnesotaCare, Minn. Rules 9506.0050

Coverage

Ambulance services, Minn. Rules 9505.0315

Ambulatory surgical center services, Minn. Rules 9505.0240

Chiropractic services, Minn. Rules 9505.0245

Clinic services, Minn. Rules 9505.0250, 9505.0395

Community health clinic services, Minn. Rules 9505.0250, 9505.0255

Community mental health clinic services, Minn. Rules 9505.0260

Dental services, Minn. Rules 9505.0250, 9505.0270, 9505.0380

Early and periodic screening, diagnosis, and treatment (EPSDT), Minn. Rules 9505.0380

Eyeglass services, Minn. Rules 9505.0277

Family planning services, Minn. Rules 9505.0280, 9505.0380

Generally, Minn. Rules 9505.0210, 9505.0220

Health care insurance premiums, Minn. Rules 9505.0430

Hearing aid services, Minn. Rules 9505.0287

Hospice care services, Minn. Rules 9505.0297

Inpatient hospital services, Minn. Rules 9505.0300

Laboratory services, Minn. Rules 9505.0305, 9505.0330

Lodging, Minn. Rules 9505.0140

Meals, Minn. Rules 9505.0140

Medical equipment and supplies, Minn. Rules 9505.0250

Medical transportation services, Minn. Rules 9505.0315

Noncovered services, Minn. Rules 9505.0220

Nurse midwife services, Minn. Rules 9505.0320

Nursing services

Home care, Minn. Rules 9505.0290, 9505.0295

Home care nursing services, Minn. Rules 9505.0360

Nutritional products, Minn. Rules 9505.0325

Occupational therapy services, Minn. Rules 9505.0390

Orthotic devices, Minn. Rules 9505.0365

Out-of-state providers, Minn. Rules 9505.0215

Outpatient hospital services, Minn. Rules 9505.0330

Personal care services, Minn. Rules 9505.0295

Pharmacy services, Minn. Rules 9505.0340

Physical therapy services, Minn. Rules 9505.0390

Physician services, Minn. Rules 9505.0345, 9505.0380

Podiatry services, Minn. Rules 9505.0350

Prenatal care services, Minn. Rules 9505.0353, 9505.0380

Prescription drugs, Minn. Rules 9505.0340, 9505.0345

Preventive health services, Minn. Rules 9505.0355, 9505.0380

Prosthetic devices, Minn. Rules 9505.0365

Public health clinic services, Minn. Rules 9505.0250, 9505.0380

Rehabilitative services, Minn. Rules 9505.0385, 9505.0386, 9505.0390, 9505.0410, 9505.0411

Respiratory therapy services, Minn. Rules 9505.0295

Rural health clinic services, Minn. Rules 9505.0250, 9505.0395

Screening teams, home health services, Minn. Rules 9505.0295

Services provided by affiliate, limitation, Minn. Rules 9505.0221

Sign language interpreters, Minn. Rules 9505.0140

Speech therapy services, Minn. Rules 9505.0390

Therapeutic services, Minn. Rules 9505.0385, 9505.0386, 9505.0390, 9505.0410, 9505.0411

Transportation, Minn. Rules 9505.0140, 9505.0315

Vision care services, Minn. Rules 9505.0277

X-ray services, Minn. Rules 9505.0305, 9505.0330

Day training services, Minn. Rules 9525.1200 to 9525.1330

Definitions

Disabled children, out-of-home care, parents' responsibility, Minn. Rules 9550.6210

Eligibility, Minn. Rules 9505.0015

Hospital admissions certification (public assistance), Minn. Rules 9505.0505

Inpatient hospital payment system (assistance payments), Minn. Rules 9500.1100

Intermediate care facilities, medical assistance payments, Minn. Rules 9553.0020

MinnesotaCare, Minn. Rules 9506.0010

Nursing facilities, medical assistance payments, Minn. Rules 9549.0020

Payments to vendors, Minn. Rules 9505.0175

Prepaid demonstration project, Minn. Rules 9500.1451

Public assistance payments, conditions, Minn. Rules 9505.5005

Surveillance and integrity review program (health services), Minn. Rules 9505.2165

Denial or termination, notice, Minn. Rules 9505.0125, 9505.0131

Developmental disability waiver, see under HOME AND COMMUNITY-BASED SERVICES WAIVERS

Diagnostic categories, inpatient hospital payment system, Minn. Rules 9500.1100

Eligibility

Administration, Minn. Rules 9505.0011

Appeals, Minn. Rules 9505.0130

Application of rules, Minn. Rules 9505.0010

Applications, Minn. Rules 9505.0085, 9505.0090

Definitions, Minn. Rules 9505.0015

Denial or termination, notice, Minn. Rules 9505.0125, 9505.0131

Developmentally disabled children, Minn. Rules 9525.1820

Foster care, children, Minn. Rules 9505.0055

Fraud, Minn. Rules 9505.0131

Hospice care services, Minn. Rules 9505.0297

Income eligibility standards, Minn. Rules 9505.0065

Mental health services, Minn. Rules 9505.0322

MinnesotaCare enrollees, Minn. Rules 9506.0050

Notice of decision, Minn. Rules 9505.0100

Periods of eligibility, determination, Minn. Rules 9505.0110

Persons detained by law, Minn. Rules 9505.0050

Redeterminations, Minn. Rules 9505.0115

Residency requirements, Minn. Rules 9505.0030

Residents of institutions for the treatment of mental diseases, Minn. Rules 9505.0045

Retroactive, Minn. Rules 9505.0110

Scope of rules, Minn. Rules 9505.0010

State hospital residents, Minn. Rules 9505.0105

Supplemental security income recipient, Minn. Rules 9505.0055

Verification, Minn. Rules 9505.0095

Federal aid

Administration, Minn. Rules 9505.0011

Allocation, calculation, Minn. Rules 9550.0330

Definitions, Minn. Rules 9550.0310

Disallowances, procedures, Minn. Rules 9550.0350

Hold harmless clause, Minn. Rules 9550.0360

Prior period adjustments, Minn. Rules 9550.0370

Purpose of rules, Minn. Rules 9550.0300

Reporting requirements, Minn. Rules 9550.0340

Forms, prior authorization, Minn. Rules 9505.5010

Formularies (drugs and medicine)

Defined, Minn. Rules 9505.0175

Requirements, Minn. Rules 9505.0340

Fraud, see Medical assistance under WELFARE FRAUD

Health maintenance organization, refusal to enroll recipients, Minn. Rules 4685.2500

Home and community-based waivered services, developmentally disabled persons, Minn. Rules 9525.1800 to 9525.1930

Income

Definitions, Minn. Rules 9505.0015

Eligibility standards, Minn. Rules 9505.0065

Intermediate care facilities, see Medical assistance payments under INTERMEDIATE CARE FACILITIES

Investigations

Surveillance and integrity review program (health services), Minn. Rules 9505.2200

Wrongfully obtained medical assistance, Minn. Rules 9505.0131

Liability, recipients, providers' failure to obtain prior authorization, Minn. Rules 9505.5010, 9505.5085

Medical equipment and supplies

Competitive bids, Minn. Rules 9505.0200

Home health services, coverage, Minn. Rules 9505.0295

Hospice care services, coverage, Minn. Rules 9505.0297

Payment exclusions and limitations, Minn. Rules 9505.0221, 9505.0300, 9505.0310

Payment rates, determination, Minn. Rules 9505.0445

Medical records

Case management services, Minn. Rules 9505.0322

Home health agency services, Minn. Rules 9505.0290

Rehabilitative and therapeutic services, Minn. Rules 9505.0412

Requirements, generally, Minn. Rules 9505.0205

Medical review agents

Definitions, Minn. Rules 9505.0505, 9505.5005

Reconsideration requests, Minn. Rules 9505.5078

Second medical opinions, duties, Minn. Rules 9505.5076

MFIP, see MINNESOTA FAMILY INVESTMENT PROGRAM (MFIP)

Notice

Prior authorization requests, Minn. Rules 9505.5020

Providers, sale or transfer of entity providing health services, Minn. Rules 9505.0195

Vendor participation, determination, Minn. Rules 9505.0195

Nursing home payment rates, workers' compensation medical services fees, payer liability, Minn. Rules 5221.0500

Overpayments, case management services, Minn. Rules 9505.0322

Parents' responsibility, children in out-of-home care

Appeals, Minn. Rules 9550.6235

Application of rules, Minn. Rules 9550.6200, 9550.6210

Collection of fee, Minn. Rules 9550.6240

Definitions, Minn. Rules 9550.6210

Determination, Minn. Rules 9550.6220, 9550.6225

Exclusion, Minn. Rules 9550.6200

Financial information, Minn. Rules 9550.6226

Health insurance, effect, Minn. Rules 9550.6225

Notice requirements, Minn. Rules 9550.6226, 9550.6229

Refusal or failure to pay, Minn. Rules 9550.6226

Review, Minn. Rules 9550.6226, 9550.6228

Variances, Minn. Rules 9550.6226, 9550.6230

Payments to vendors

Application of rules, Minn. Rules 9505.0170

Claims

False claims, Minn. Rules 9505.0460

Generally, Minn. Rules 9505.0450

Provider responsibility, Minn. Rules 9505.0470

Coverage, see same under this topic

Day training and habilitation services, Minn. Rules 9525.1200 to 9525.1330

Definitions, Minn. Rules 9505.0175

Hearing aid services, Minn. Rules 9505.0287

Home and community-based services for developmentally disabled persons, Minn. Rules 9525.1800 to 9525.1930

Intermediate care facilities, see Medical assistance payments under INTERMEDIATE CARE FACILITIES

Program participation requirements, Minn. Rules 9505.0195

Provider choice, Minn. Rules 9505.0190

Rates, generally, Minn. Rules 9505.0445, 9505.0446

Recipients' responsibility, Minn. Rules 9505.0225

Record keeping, Minn. Rules 9505.0205

Recovery of payment, Minn. Rules 9505.0465

Services provided by affiliate, limitation, Minn. Rules 9505.0221

Third-party liability, Minn. Rules 9505.0070

Prepaid health plans, Minn. Rules 9505.0285

Prior authorization

Ambulatory aids, Minn. Rules 9505.0365

Appeals, Minn. Rules 9505.5105

Application of rules, Minn. Rules 9505.5000

Billing procedures, Minn. Rules 9505.0450

Chiropractic services, Minn. Rules 9505.0245

Criteria, Minn. Rules 9505.5030

Definitions, Minn. Rules 9505.0015, 9505.0175, 9505.5005

Denial, notice requirements, Minn. Rules 9505.0125

Dental services, Minn. Rules 9505.0270

Failure to comply, Minn. Rules 9505.5010, 9505.5085, 9505.5091

Home care nursing services, Minn. Rules 9505.0360

Human Services Department, duties, Minn. Rules 9505.5020

Medical equipment and supplies, Minn. Rules 9505.0310

Medically necessary health services, Minn. Rules 9505.0190

Out-of-state providers, Minn. Rules 9505.0215

Out-of-state service, Minn. Rules 9505.5025

Outpatient hospital services, Minn. Rules 9505.0330

Prepaid health plans, Minn. Rules 9505.0285

Procedures, Minn. Rules 9505.5010

Reconsideration requests, Minn. Rules 9505.5078

Weight reduction programs, Minn. Rules 9505.0345

Provider agreements

Defined, Minn. Rules 9505.0175

Prosthetic or orthotic devices, Minn. Rules 9505.0365

Requirements, Minn. Rules 9505.0195

Providers, see Vendors under this topic

Quality control review, cooperation, Minn. Rules 9505.0080

Recipients

Appeals by, Minn. Rules 9505.0130

Authorization by, health service records, access, Minn. Rules 9505.2185

Liability, providers' failure to obtain prior authorization, Minn. Rules 9505.5010, 9505.5085

Notice given

Change in eligibility, Minn. Rules 9505.0115

Third-party payer coverage, Minn. Rules 9505.0071

Notice received, denial or termination of eligibility, Minn. Rules 9505.0125, 9505.0131

Quality control review, cooperation, Minn. Rules 9505.0080

Records and record keeping

Applicants or recipients, right to review, Minn. Rules 9505.0130

Local social service agencies, Minn. Rules 9505.0135

Requirements, Minn. Rules 9505.0205

Residence

Defined

Eligibility, Minn. Rules 9505.0015

Home care services, Minn. Rules 9505.0290

Payments, Minn. Rules 9505.0175

Eligibility requirements, Minn. Rules 9505.0030

Schools and school districts, health screening, Minn. Rules 3530.4200

Scope of rules, Minn. Rules 9505.0010, 9505.0175

Screening teams

Defined, Minn. Rules 9505.0175

Home health services, coverage, Minn. Rules 9505.0295

Second medical opinions

Applicants, Minn. Rules 9505.5035

Application of rules, Minn. Rules 9505.5000

Definitions, Minn. Rules 9505.5005

Failure to obtain, Minn. Rules 9505.5080

Medical appropriateness criteria, Minn. Rules 9505.5046

Medical review agents, duties, Minn. Rules 9505.5076

Medicare recipients, Minn. Rules 9505.5041

Notice requirements, Minn. Rules 9505.5082

Physician advisers, duties, Minn. Rules 9505.5077

Physicians and surgeons, duties, Minn. Rules 9505.5075, 9505.5080

Procedures requiring, Minn. Rules 9505.0175, 9505.5035, 9505.5045

Semi-independent living services grants, Minn. Rules 9525.0900 to 9525.1020

Third party claims, Minn. Rules 9505.0070, 9505.0071

Utilization review, long-term care facilities, exemptions, Minn. Rules 9505.0420

Vendors

Billing, see same under this topic

Community health clinics, Minn. Rules 9505.0255

Defined, Minn. Rules 9505.0015, 9505.0175

Disclosure, health services restrictions or criteria, Minn. Rules 9505.0195

Eligible providers

Clinics, Minn. Rules 9505.0250

Community mental health centers, Minn. Rules 9505.0260

Family planning services, Minn. Rules 9505.0280

Home health agencies, Minn. Rules 9505.0290

Hospice care services, Minn. Rules 9505.0297

Laboratory and x-ray services, Minn. Rules 9505.0305

Mental health case management services, Minn. Rules 9505.0322

Pharmacy services, Minn. Rules 9505.0340

Prepaid health plans, Minn. Rules 9505.0285

Rehabilitative and therapeutic services to long-term care facility residents, Minn. Rules 9505.0410

Therapists, Minn. Rules 9505.0391

Notice received

Health service records, access to, Minn. Rules 9505.2185

Program participation applications, Minn. Rules 9505.0195

Out-of-state providers, Minn. Rules 9505.0215

Out-of-state vendors, Minn. Rules 9505.0195

Participation requirements, Minn. Rules 9505.0195, 9505.5200 to 9505.5240

Payments to vendors, see same under this topic

Physician services, supervision requirements, Minn. Rules 9505.0345

Recipients' choice of, Minn. Rules 9505.0190

Recipients' choice of provider, Minn. Rules 9505.0125

Record keeping requirements, Minn. Rules 9505.0205

Suspension, Minn. Rules 9505.0475

Third-party liability, Minn. Rules 9505.0070

Violations and penalties

Crime convictions, suspension, Minn. Rules 9505.0475

Nonprocessible claims, repeated submission, sanctions, Minn. Rules 9505.0450

Prior authorization, noncompliance, Minn. Rules 9505.5091

Provider agreements, noncompliance, Minn. Rules 9505.0195