To be eligible for medical assistance payments, a prepaid health plan must:
have a contract with the department; and
provide a recipient, either directly or through arrangements with other providers, the health services specified in the contract between the prepaid health plan and the department.
Health services provided by a prepaid health plan according to the contract in subpart 1, item A, must be comparable in scope, quantity, and duration to the requirements of parts 9505.0170 to 9505.0475. However, prior authorization, admission certification, and second surgical opinion requirements do not apply except that a prepaid health plan may impose similar requirements.
MS s 256B.04
12 SR 624
August 12, 2008