HF 38

as introduced - 89th Legislature (2015 - 2016) Posted on 01/29/2015 04:25pm

A bill for an act
relating to human services; modifying ambulance provider procedures for
seeking payment for services not covered by medical assistance; amending
Minnesota Statutes 2014, section 256B.0625, subdivision 55.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2014, section 256B.0625, subdivision 55, is amended to
read:

Subd. 55.

Payment for noncovered services.

(a) Except when specifically
prohibited by the commissioner or federal law, a provider may seek payment from the
recipient for services not eligible for payment under the medical assistance program when
the provider, prior to delivering the service, reviews and considers all other available
covered alternatives with the recipient and obtains a signed acknowledgment from the
recipient of the potential of the recipient's liability. The signed acknowledgment must be
in a form approved by the commissioner. new text begin Ambulance providers licensed under chapter
144E are exempt from the requirement to obtain signed acknowledgement from the
recipient of the recipient's potential liability, unless all of the following criteria are met:
new text end

new text begin (1) the service being provided is a medical assistance-covered ambulance benefit;
new text end

new text begin (2) the provider believes that the service may be denied, in part or in full, as not
reasonable and necessary; and
new text end

new text begin (3) the ambulance service is being provided in a nonemergency situation.
new text end

(b) Conditions under which a provider must not request payment from the recipient
include, but are not limited to:

(1) a service that requires prior authorization, unless authorization has been denied
as not medically necessary and all other therapeutic alternatives have been reviewed;

(2) a service for which payment has been denied for reasons relating to billing
requirements;

(3) standard shipping or delivery and setup of medical equipment or medical supplies;

(4) services that are included in the recipient's long term care per diem;

(5) the recipient is enrolled in the Restricted Recipient Program and the provider is
one of a provider type designated for the recipient's health care services; and

(6) the noncovered service is a prescription drug identified by the commissioner as
having the potential for abuse and overuse, except where payment by the recipient is
specifically approved by the commissioner on the date of service based upon compelling
evidence supplied by the prescribing provider that establishes medical necessity for that
particular drug.

(c) The payment requested from recipients for noncovered services under this
subdivision must not exceed the provider's usual and customary charge for the actual service
received by the recipient. A recipient must not be billed for the difference between what
medical assistance paid for the service or would pay for a less costly alternative service.