Minnesota Administrative Rules

9500.1129 PAYMENT LIMITATIONS.

Subpart 1.

Charge limitation.

A.

The department will limit payment, including third party and recipient liability, for services provided by an out-of-area hospital to allowable charges for the admission.

B.

Payments, in addition to third party and recipient liability, for discharges occurring during a rate year may not exceed, in aggregate, the allowable charges for the same period of time to the hospital. This limitation will exclude payments made under part 9500.1121 and Medicare crossover claims. The limitation will be calculated separately for general assistance medical care and medical assistance and separately from other services for a rehabilitation distinct part.

Subp. 2.

Transfers.

A discharging hospital is not eligible for a transfer payment for services provided to a discharged patient if the admission to the discharging hospital was not due to an emergency, as defined in part 9505.0505, subpart 12, and the discharging hospital knew or had reason to know at the time of admission that the inpatient hospital services were outside the scope of the hospital's available services and the transfer to another hospital resulted because of the patient's need for those services.

Statutory Authority:

MS s 256.9685; 256.9695

History:

18 SR 1115; 26 SR 976

Published Electronically:

October 16, 2013