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Chapter 9505
Topics
Part 9505.0015
9505.0015 DEFINITIONS.
Subpart 1.
Applicability.
For the purposes of parts 9505.0010 to 9505.0140, the following terms have the meanings given to them in this part.
Subp. 3.
Applicant.
"Applicant" means a person who submits a written application to the local agency for a determination of eligibility for medical assistance.
Subp. 4.
Application.
"Application" means the applicant's written request for medical assistance as provided in part 9505.0085.
Subp. 5.
Application date.
"Application date" means the day on which a local agency or a designated representative of the commissioner receives, during normal working hours, a written request for medical assistance consisting of at least the name of the applicant, a means to locate the applicant, and signature of the applicant, provided the completed application form required in part 9505.0085 is submitted to the local agency within 30 days of the written request.
Subp. 6.
Asset.
"Asset" means any property that is owned and has monetary value. Examples of assets are negotiable instruments including cash or bonds, real and personal property, and rights that a person has in tangible or intangible property.
Subp. 8.
Authorized representative.
"Authorized representative" means an individual authorized by the applicant or recipient to apply for medical assistance or perform duties required of the applicant or recipient by parts 9505.0010 to 9505.0140 on that person's behalf.
Subp. 9.
Commissioner.
"Commissioner" means the commissioner of human services or the commissioner's designated representative.
Subp. 11.
County of service.
"County of service" means the county where the applicant or recipient resides. However, if the applicant or recipient resides in a state hospital, the county of service is the county of financial responsibility.
Subp. 13.
Earned income.
"Earned income" means wages, salary, commission, or other benefits received by a person as monetary compensation from employment or self-employment.
Subp. 14.
Eligibility factors.
"Eligibility factors" means all the conditions, limits, standards, and required actions in parts 9505.0010 to 9505.0120 that the applicant or recipient must satisfy in order to be eligible for medical assistance.
Subp. 16.
General assistance medical care or GAMC.
"General assistance medical care" or "GAMC" means the program established under Minnesota Statutes, section 256D.02, subdivision 4a.
Subp. 17.
Gross earned income.
"Gross earned income" means all earned income before any deduction, disregard, or exclusion.
Subp. 18.
Gross income.
"Gross income" means all earned and unearned income before any deduction, disregard, or exclusion.
Subp. 19.
Health maintenance organization.
"Health maintenance organization" means a corporation as defined in Minnesota Statutes, section 62D.02, subdivision 4.
Subp. 20.
Health services.
"Health services" means the services and supplies furnished to a recipient by a provider for a health related purpose as specified in Minnesota Statutes, sections 256B.02, subdivision 8 and 256B.0625.
Subp. 21.
Hospital.
"Hospital" means an acute care institution licensed under Minnesota Statutes, sections 144.50 to 144.58, defined in Minnesota Statutes, section 144.696, subdivision 3, and maintained primarily for the treatment and care of persons with disorders other than tuberculosis or mental diseases.
Subp. 22.
Income.
"Income" means cash or other benefits, whether earned or unearned, received by or available to an applicant or recipient and not determined to be an asset under parts 9505.0058 to 9505.0064 or part 9505.0065.
Subp. 23.
In-kind income.
"In-kind income" means a benefit other than cash that provides food, shelter, clothing, transportation, or health service and is not determined to be an asset under parts 9505.0058 to 9505.0064 or part 9505.0065.
Subp. 24.
Inpatient.
"Inpatient" means a person who has been admitted to an inpatient hospital and has not yet been formally discharged. Inpatient applies to a person absent from a hospital on a pass ordered by a physician. For purposes of this definition, a person absent from the hospital against medical advice is not an inpatient during the absence.
Subp. 25.
Life estate.
"Life estate" means an interest in real property with the right of use or enjoyment limited to the life or lives of one or more human beings that is not terminable at any fixed or computable period of time.
Subp. 27.
Local agency.
"Local agency" means a county or multicounty agency that is authorized under Minnesota Statutes, sections 393.01, subdivision 7 and 393.07, subdivision 2, as the agency responsible for determining eligibility for the medical assistance program. "Local agency" is used in parts 9505.0010 to 9505.0140 to refer to the local agency of the county of service unless otherwise specified.
Subp. 28.
Long-term care facility.
"Long-term care facility" means a residential facility certified by the Minnesota Department of Health as a skilled nursing facility or as an intermediate care facility including an intermediate care facility for persons with developmental disabilities.
Subp. 31.
Medical assistance or MA.
"Medical assistance" or "MA" means the program established under title XIX of the Social Security Act and Minnesota Statutes, chapter 256B.
Subp. 32.
Medicare.
"Medicare" means the health insurance program for the aged and disabled under title XVIII of the Social Security Act.
Subp. 33.
Minnesota supplemental aid or MSA.
"Minnesota supplemental aid" or "MSA" means the program established under Minnesota Statutes, sections 256D.33 to 256D.54.
Subp. 34.
Net income.
"Net income" means the income remaining after applicable disregards, exclusions, and deductions are subtracted from gross income.
Subp. 38.
Prior authorization.
"Prior authorization" means the written approval and issuance of an authorization number by the department to a provider before the provision of a covered health service, as specified in part 9505.5010.
Subp. 39.
Provider.
"Provider" means a vendor as specified in Minnesota Statutes, section 256B.02, subdivision 7, that has signed an agreement approved by the department for the provision of health services to a recipient.
Subp. 40.
Real property.
"Real property" means land and all buildings, structures, and improvements or other fixtures on it, all rights and privileges belonging or appertaining to it, all manufactured homes attached to it on permanent foundations, and all trees, mines, minerals, quarries, and fossils on or under it.
Subp. 41.
Recipient.
"Recipient" means a person who has been determined by the local agency to be eligible for the medical assistance program.
Subp. 42.
Residence.
"Residence" means the place a person uses, and intends to continue to use for the indefinite future, as his or her primary dwelling place.
Subp. 44.
Spenddown.
"Spenddown" means the process by which a person who has income in excess of the income standard allowed under part 9505.0065, subpart 1 becomes eligible for medical assistance as a result of incurring medical expenses that are not covered by a liable third party and that reduce the excess income to zero.
Subp. 45.
State medical review team.
"State medical review team" means those physicians and social workers who are under contract with the department to review a medical and social history to determine a person's disability within the scope of the regulations of the Social Security Administration.
Subp. 46.
Third-party payer.
"Third-party payer" refers to a person, entity, agency, or government program other than Medicare or the medical assistance program, that has a probable obligation to pay all or part of the costs of a recipient's health services. Examples are an insurance company, health maintenance organization, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), workers' compensation, and defendants in legal actions arising out of an accidental or intentional tort.
Subp. 47.
Title XIX state plan.
"Title XIX state plan" refers to the document submitted for approval to the Centers for Medicare and Medicaid Services defining the conditions of medical assistance program eligibility and services authorized by title XIX of the Social Security Act and Minnesota Statutes, chapter 256B.
Subp. 48.
Unearned income.
"Unearned income" means income other than earned income as defined in subpart 13.
Subp. 49.
Wrongfully obtaining assistance.
"Wrongfully obtaining assistance" means:
A.
action by an applicant or recipient of willfully or intentionally withholding, concealing, or misrepresenting information which results in a person's receipt of medical assistance in excess of the amount for which he or she is eligible under the program and the eligibility basis claimed by the applicant or recipient;
B.
receipt of real or personal property by an individual without providing reasonable compensation and for the known purpose of creating an applicant's or recipient's eligibility for medical assistance; or
C.
action by an individual of conspiring with or knowingly aiding or abetting an applicant or recipient to wrongfully obtain medical assistance.
Statutory Authority:
MS s 256B.04; L 2000 c 340 s 17
History:
11 SR 1069; 12 SR 1148; L 1988 c 689 art 2 s 268; 26 SR 977; L 2002 c 277 s 32; L 2005 c 56 s 2
Published Electronically:
August 12, 2013
Official Publication of the State of Minnesota
Revisor of Statutes