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9505.0355 PREVENTIVE HEALTH SERVICES.

Subpart 1.

Definition; preventive health service.

For the purposes of this part, "preventive health service" means a health service provided to a recipient to avoid or minimize the occurrence of illness, infection, disability, or other health condition. Examples are diabetes education, cardiac rehabilitation, weight loss programs, and nutrition counseling that meet the criteria established in part 9505.0210.

Subp. 2.

Covered preventive health services.

To be eligible for medical assistance payment, a preventive health service must:

A.

be provided to the recipient in person;

B.

affect the recipient's health condition rather than the recipient's physical environment;

C.

not be otherwise available to the recipient without cost as part of another program funded by a government or private agency;

D.

not be part of another covered service;

E.

be to minimize an illness, infection, or disability which will respond to treatment;

F.

be generally accepted by the provider's professional peer group as a safe and effective means to avoid or minimize the illness; and

G.

be ordered in writing by a physician and contained in the plan of care approved by the physician.

Subp. 3.

Payment limitations.

The services in items A and B are not eligible for medical assistance payment:

A.

service that is only for a vocational purpose or an educational purpose that is not health related; and

B.

service dealing with external, social, or environmental factors that do not directly address the recipient's physical or mental health.

Statutory Authority:

MS s 256B.04

History:

12 SR 624

Published Electronically:

August 12, 2008