1.1 	A bill for an act
1.2 	relating to human services; modifying ambulance provider procedures for 
1.3 	seeking payment for services not covered by medical assistance;amending 
1.4 	Minnesota Statutes 2014, section 256B.0625, subdivision 55.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. Minnesota Statutes 2014, section 256B.0625, subdivision 55, is amended to 
1.7 	read:
1.8 		Subd. 55.Payment for noncovered services. (a) Except when specifically 
1.9 	prohibited by the commissioner or federal law, a provider may seek payment from the 
1.10 	recipient for services not eligible for payment under the medical assistance program when 
1.11 	the provider, prior to delivering the service, reviews and considers all other available 
1.12 	covered alternatives with the recipient and obtains a signed acknowledgment from the 
1.13 	recipient of the potential of the recipient's liability. The signed acknowledgment must be 
1.14 	in a form approved by the commissioner. Ambulance providers licensed under chapter 
1.15 	144E are exempt from the requirement to obtain signed acknowledgement from the 
1.16 	recipient of the recipient's potential liability, unless all of the following criteria are met:
1.17 	(1) the service being provided is a medical assistance-covered ambulance benefit;
1.18 	(2) the provider believes that the service may be denied, in part or in full, as not 
1.19 	reasonable and necessary; and
1.20 	(3) the ambulance service is being provided in a nonemergency situation.
1.21 	(b) Conditions under which a provider must not request payment from the recipient 
1.22 	include, but are not limited to:
1.23 	(1) a service that requires prior authorization, unless authorization has been denied 
1.24 	as not medically necessary and all other therapeutic alternatives have been reviewed;
2.1 	(2) a service for which payment has been denied for reasons relating to billing 
2.2 	requirements;
2.3 	(3) standard shipping or delivery and setup of medical equipment or medical supplies;
2.4 	(4) services that are included in the recipient's long term care per diem;
2.5 	(5) the recipient is enrolled in the Restricted Recipient Program and the provider is 
2.6 	one of a provider type designated for the recipient's health care services; and
2.7 	(6) the noncovered service is a prescription drug identified by the commissioner as 
2.8 	having the potential for abuse and overuse, except where payment by the recipient is 
2.9 	specifically approved by the commissioner on the date of service based upon compelling 
2.10 	evidence supplied by the prescribing provider that establishes medical necessity for that 
2.11 	particular drug.
2.12 	(c) The payment requested from recipients for noncovered services under this 
2.13 	subdivision must not exceed the provider's usual and customary charge for the actual service 
2.14 	received by the recipient. A recipient must not be billed for the difference between what 
2.15 	medical assistance paid for the service or would pay for a less costly alternative service.