Minnesota Administrative Rules

3050.2800 BOARD DETERMINATION OF REASONABLENESS.

Subpart 1.

Board consideration.

The board, in determining reasonableness, shall consider any and all of the following relative to a specific claim, or to a claim for compensation for a specific service:

A.

quantity of service proposed or provided;

B.

time span and duration of actual or proposed service;

C.

adherence of service provider to professional standards, with consideration to ethnic and cultural needs of a claimant;

D.

progress of treatment against standards presented to the board in the professional treatment plan, where a plan has been submitted;

E.

relationship of provider to claimant; and

F.

possible consequences of denial or reparations.

Subp. 2.

Utilization review.

Where the board is unable, due to multiple caregivers or complex treatment issues, to determine reasonableness, it may use the services of outside experts to assist in a determination. This review shall include, but is not limited to:

A.

review of clinical records;

B.

submission of a questionnaire to the claimant to elicit specific information; and

C.

interview or examination of the claimant.

Subp. 3.

Accessibility remodeling.

The board may use the services of outside consultants to assist in determining the reasonableness of remodeling to improve the accessibility of a living space for an injured victim. Accessibility remodeling projects must be approved by the board prior to payment.

Statutory Authority:

MS s 611A.56

History:

13 SR 661; 23 SR 519; 25 SR 1718

Published Electronically:

January 2, 2007