MINNESOTACARE

Accounting and bookkeeping, managed care health plans, financial risk capacity, Minn. Rules 9506.0400

Appeals

Application of rules, Minn. Rules 9506.0070, 9506.0400

Prior authorization, Minn. Rules 9505.5105

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

Applicants

Appeals, Minn. Rules 9506.0070

Defined, Minn. Rules 9506.0010

Eligibility, see same under this topic

Notice given, prepaid health plans, health plan selection, Minn. Rules 9506.0200

Notice received

Denial, suspension, reduction, or termination of eligibility, Minn. Rules 9506.0070

Prepaid health plans, health plan selection, Minn. Rules 9506.0200

Premiums, Minn. Rules 9506.0040

Requirements, generally, Minn. Rules 9506.0030

Applications, referral sources, Minn. Rules 9506.0030

Audits and examinations

Enrollees, eligibility, Minn. Rules 9506.0060

Managed care health plans, Minn. Rules 9506.0400

Billing, premiums, notices, Minn. Rules 9506.0040

Case management, Minn. Rules 9506.0400

Certificates and certification

Certificate of coverage, Minn. Rules 9506.0400

Inpatient hospital admissions, Minn. Rules 9506.0080

Change of health plan or primary care provider, prepaid health plans, Minn. Rules 9506.0200

Chemical dependency assessments, Minn. Rules 9506.0400

Complaints, Minn. Rules 9506.0070, 9506.0400

Contracts

Definitions, Minn. Rules 9506.0010

Managed care health plans, Minn. Rules 9506.0200 to 9506.0400

Coordination

Cost avoidance techniques, Minn. Rules 9506.0080

Generally, Minn. Rules 9506.0400

Medical assistance, Minn. Rules 9506.0050

Coverage

Beginning, determination, Minn. Rules 9506.0030

Certificate of coverage, Minn. Rules 9506.0400

Coordination with medical assistance, Minn. Rules 9506.0050

Definitions, Minn. Rules 9506.0010

Generally, Minn. Rules 9506.0080

Managed care health plans, Minn. Rules 9506.0300

Data

Access to data, Minn. Rules 9506.0090, 9506.0400

Welfare data on enrollees, classification, Minn. Rules 9506.0400

Deductibles, copayments, and coinsurance, Minn. Rules 9506.0090, 9506.0300

Definitions

Generally, Minn. Rules 9506.0010

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

Public assistance payments, conditions, Minn. Rules 9505.5005

State health care program participation, Minn. Rules 9505.5210

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

Eligibility

Application, Minn. Rules 9506.0030

Audits, Minn. Rules 9506.0060

Definitions, Minn. Rules 9506.0010

Denial, suspension, reduction, or termination, notice, Minn. Rules 9506.0070

Determination deadline, Minn. Rules 9506.0030

Generally, Minn. Rules 9506.0020

Medical assistance, coordination, Minn. Rules 9506.0050

Enrollees

Appeals, Minn. Rules 9506.0070

Audits, Minn. Rules 9506.0060

Change of health plan or primary care provider, prepaid health plans, Minn. Rules 9506.0200

Copayments, Minn. Rules 9506.0090

Defined, Minn. Rules 9506.0010

Eligibility, see same under this topic

Liability, Minn. Rules 9506.0300, 9506.0400

Notice given

Prepaid health plans, health plan selection, Minn. Rules 9506.0200

Requirements, generally, Minn. Rules 9506.0060

Notice received

Denial, suspension, reduction, or termination of eligibility, Minn. Rules 9506.0070

Inpatient hospital services, medical assistance eligibility, Minn. Rules 9506.0050

Managed care health plans, contract termination, Minn. Rules 9506.0400

Prepaid health plans, Minn. Rules 9506.0200

Premiums, Minn. Rules 9506.0040

Enrollment

Date, determination, Minn. Rules 9506.0030

Failure to pay premiums, effect, Minn. Rules 9506.0040

Family enrollment, Minn. Rules 9506.0020

Medical assistance eligibility, effect, Minn. Rules 9506.0050

Open enrollment period, prepaid health plans, Minn. Rules 9506.0200

Essential community providers, Minn. Rules 4688.0001 to 4688.0160

Families

Defined, Minn. Rules 9506.0010

Enrollment, Minn. Rules 9506.0020

Forms, prior authorization, Minn. Rules 9505.5010

Health plans, see Managed care health plans under this topic

Hospital inpatient services, see MinnesotaCare under INPATIENT HOSPITAL SERVICES

Identification cards, Minn. Rules 9506.0400

Immunization, Minn. Rules 9506.0400

Income

Eligibility requirements, Minn. Rules 9506.0020

Premiums, determination, Minn. Rules 9506.0040

Liability

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

State and enrollees held harmless, Minn. Rules 9506.0400

Third-party, Minn. Rules 9506.0400

Liens, Minn. Rules 9506.0080

Managed care health plans

Access to data, Minn. Rules 9506.0400

Complaint procedures, Minn. Rules 9506.0070, 9506.0400

Defined, Minn. Rules 9506.0010

Generally, Minn. Rules 9506.0200

Medical assistance or general assistance medical care eligible enrollee's continued participation, Minn. Rules 9506.0050

Payments, Minn. Rules 9506.0300

Requirements, generally, Minn. Rules 9506.0400

Medical records, Human Services Department, access, Minn. Rules 9506.0090

Medical review agents

Definitions, Minn. Rules 9505.0505, 9505.5005

Reconsideration requests, Minn. Rules 9505.5078

Second medical opinions, duties, Minn. Rules 9505.5076

Notice, prior authorization requests, Minn. Rules 9505.5020

Payments

Coordination with medical assistance, Minn. Rules 9506.0050

Generally, Minn. Rules 9506.0090

Managed care health plans, Minn. Rules 9506.0300

Premiums, Minn. Rules 9506.0040

Prepaid health plans, Minn. Rules 9506.0200

Prior authorization

Appeals, Minn. Rules 9505.5105

Application of rules, Minn. Rules 9505.5000

Criteria, Minn. Rules 9505.5030

Definitions, Minn. Rules 9505.5005

Failure to comply, Minn. Rules 9505.5085, 9505.5091

Human Services Department, duties, Minn. Rules 9505.5020

Out-of-state service, Minn. Rules 9505.5025

Procedures, Minn. Rules 9505.5010

Reconsideration requests, Minn. Rules 9505.5078

Providers

Change of primary care provider, prepaid health plans, Minn. Rules 9506.0200

Definitions, Minn. Rules 9506.0010

Payments, Minn. Rules 9506.0050, 9506.0090, 9506.0300

Quality assurance, Minn. Rules 9506.0060, 9506.0400

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

Residence

Definitions, Minn. Rules 9506.0010

Eligibility requirements, Minn. Rules 9506.0020

Scope of rules, Minn. Rules 9506.0010

Second medical opinions

Generally, Minn. Rules 9506.0400

Medical assistance

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

Spenddowns

Defined, Minn. Rules 9506.0010

Medical assistance, coordination, Minn. Rules 9506.0050

Requirements, generally, Minn. Rules 9506.0020

Surveillance and integrity review program (health services), Minn. Rules 9505.2160 to 9505.2245

Surveillance and utilization review, application of rules, Minn. Rules 9506.0100

Third party payers

Cost avoidance, Minn. Rules 9506.0080

Defined, Minn. Rules 9506.0010

Identification, Minn. Rules 9506.0020

Liability, Minn. Rules 9506.0400

Vendors

Participation requirements, Minn. Rules 9505.5200 to 9505.5240

State health care program participation, Minn. Rules 9505.5210, 9505.5220, 9505.5240