Minnesota Administrative Rules

9525.1290 DAY SERVICE PROVIDER BILLING.

Subpart 1.

Billing requirements.

The day service provider must comply with the requirements in items A to E when submitting bills to the commissioner for reimbursement for the provision of day training and habilitation services.

A.

Bills must be submitted on forms supplied by the commissioner, which identify for each client:

(1)

the full-day or partial-day service rate as provided by part 9525.1270, subpart 1, multiplied by the number of days the client actually received day training and habilitation services from the day service provider; and

(2)

the transportation rate as approved under part 9525.1270, subpart 1, multiplied by the number of days the client was actually transported.

B.

The day service provider must not bill for days in which the client does not receive day training and habilitation or transportation services.

C.

The day service provider must not bill for more than one service rate and one transportation rate per client per day.

D.

Day service providers whose rates have been recommended under part 9525.1260, subpart 2 and approved under part 9525.1270, subpart 1, must submit bills to the commissioner using a procedural code available from the Health Care Programs Division.

E.

Each bill from the day service provider must be verified by the ICF/DD where the client resides before the bill is submitted to the commissioner. A signature by authorized ICF/DD personnel constitutes verification by the ICF/DD that the services were provided on the days and for the charges specified.

Subp. 2.

Payment.

The commissioner shall pay the day service provider for bills submitted under subpart 1 using the payment procedures in Minnesota Statutes, sections 256B.041 and 256B.501, subdivision 5, paragraph (f). No payment will be made by the commissioner for day training and habilitation services not authorized under subpart 1, item E.

Subp. 3.

Errors and duplicate payments.

If the day service provider becomes aware of a billing error that results in an overpayment or an underpayment to the day service provider or if the day service provider receives payment from another source for services which were also paid for by the medical assistance program, the day service provider shall promptly notify the commissioner and request an adjustment request form. Within one year of receipt of a completed adjustment request form, the commissioner shall:

A.

in the case of an overpayment, require the day service provider to repay an amount equal to the overpayment or adjust future payments to correct the error or eliminate the overpayment; or

B.

in the case of an underpayment, pay the day service provider an amount equal to the underpayment or adjust future payments to correct the error.

Statutory Authority:

MS s 256B.501

History:

10 SR 68; 11 SR 1612; L 2005 c 56 s 2

Published Electronically:

October 16, 2013