Minnesota Administrative Rules

9505.5210 DEFINITIONS.

Subpart 1.

Applicability.

For the purposes of parts 9505.5200 to 9505.5240, the terms in this part have the meanings given them.

Subp. 2.

Capitation rate.

"Capitation rate" means a method of payment for health care services under which a monthly per person rate is paid on a prospective basis to a health plan.

Subp. 3.

Commissioner.

"Commissioner" means the commissioner of the Department of Human Services or the commissioner's designated representative.

Subp. 4.

Department.

"Department" means the Department of Human Services.

Subp. 5.

Department health care programs.

"Department health care programs" means:

A.

general assistance medical care;

B.

medical assistance; and

C.

MinnesotaCare.

Subp. 6.

Fee-for-service.

"Fee-for-service" means a method of payment for health services under which a specific amount is paid for each type of health service provided a recipient.

Subp. 7.

General assistance medical care.

"General assistance medical care" has the meaning given in Minnesota Statutes, section 256D.02, subdivision 4a.

Subp. 8.

Geographic area.

"Geographic area" means a portion of a county, a county, or multiple counties as designated by the commissioner for purposes of providing department health care programs through a prepaid contract.

Subp. 9.

Health maintenance organization or HMO.

"Health maintenance organization" or "HMO" means an organization specified in Minnesota Statutes, section 62D.02, subdivision 4.

Subp. 10.

Health plan.

"Health plan" means a health maintenance organization or other organization that contracts with the department to provide health services to recipients under a prepaid contract.

Subp. 11.

Health services.

"Health services" means the goods and services eligible for payment under a department health care program.

Subp. 12.

Medical assistance.

"Medical assistance" means the program authorized under title XIX of the Social Security Act and Minnesota Statutes, chapter 256B.

Subp. 13.

MinnesotaCare.

"MinnesotaCare" means the program authorized under Minnesota Statutes, sections 256L.01 to 256L.12.

Subp. 14.

Other state health care programs.

"Other state health care programs" means:

A.

health insurance plans for state employees covered under Minnesota Statutes, section 43A.18;

B.

the workers' compensation system established under Minnesota Statutes, section 176.135;

C.

the public employees insurance program authorized under Minnesota Statutes, section 43A.316;

D.

insurance plans provided through the Minnesota comprehensive health association under Minnesota Statutes, sections 62E.01 to 62E.16; and

E.

health insurance plans offered to local statutory or home rule charter city, county, and school district employees.

Subp. 15.

Prepaid contract.

"Prepaid contract" means a contract between the department and a health plan under which health services are provided recipients for a capitation rate.

Subp. 16.

Provider.

"Provider" means a vendor other than a health maintenance organization that has signed an agreement approved by the department for the provision of health services to a recipient.

Subp. 17.

Recipient.

"Recipient" means a person who is determined by the state or local agency to be eligible to receive health services under a department health care program.

Subp. 18.

Vendor.

"Vendor" means a vendor of medical care, other than a health maintenance organization, as defined in Minnesota Statutes, section 256B.02, subdivision 7.

Statutory Authority:

MS s 256B.0644

History:

18 SR 2651

Published Electronically:

August 12, 2008