1998 Minnesota Statutes

     256B.74 Special payments. 

    Subdivision 1.    Hospital reimbursement.  Effective for 
 services rendered on or after July 1, 1991, the commissioner 
 shall reimburse outpatient hospital facility fees at 80 percent 
 of calendar year 1990 submitted charges, not to exceed the 
 Medicare upper payment limit.  Services excepted from this 
 payment methodology are emergency room facility fees, clinic 
 facility fees, and those services for which there is a federal 
 maximum allowable payment. 

    Subd. 2.    Physician reimbursement.  The commissioner 
 shall make payments for physician services rendered on or after 
 July 1, 1992, as follows: 

    (a) Payments for level one Health Care Finance 
 Administration's common procedural coding system (HCPCS) codes 
 titled "office and other outpatient medical services," 
 "preventive medicine new and established patient," "delivery, 
 antepartum and postpartum care," Caesarean delivery, and 
 pharmacologic management provided to psychiatric patients and 
 HCPCS level three codes for enhanced services for prenatal high 
 risk shall be calculated at the lower of (1) submitted charges, 
 or (2) the median charges in 1989 minus 20 percent.  If the 
 median minus 20 percent results in a decrease to rates in effect 
 June 30, 1991, for obstetrical and prenatal services, the rate 
 on those codes in effect on June 30, 1991, shall be increased by 
 an additional five percent. 

    (b) Payments for level one HCPCS codes titled "critical 
 care" initial or subsequent visits only shall be calculated at 
 the lower of (1) submitted charges, or (2) the median charges in 
 1989 minus 30 percent. 

    (c) Payments for all other services shall be calculated at 
 the lower of (1) submitted charges, or (2) the median charges in 
 1989 minus 40 percent. 

    (d) In addition to the payment rates in paragraphs (a) to 
 (c), rates for obstetrical services shall be adjusted by the ten 
 percent increase in Laws 1988, chapter 689, article 1, section 
 2, subdivision 5, and rates for obstetrical and pediatric 
 services shall be adjusted by the 15 percent increase in Laws 
 1990, chapter 568, article 1, section 2, subdivision 7. 

    Subd. 3.    Nursing facility reimbursement.  For rate 
 years beginning on or after July 1, 1991, the maximum efficiency 
 incentive per diem payment established annually under section 
 256B.431, subdivision 2b, paragraph (d), shall be increased to 
 $2.10 effective July 1, 1991, and $2.20 effective July 1, 1992, 
 and shall be indexed for inflation annually beginning July 1, 
 1993, using Data Resources, Inc., forecast for change in the 
 nursing home market basket. 

    Subd. 4.    Personal needs allowance.  The commissioner 
 shall provide cost of living increases in the personal needs 
 allowance under section 256B.35, subdivision 1. 

    Subd. 5.    Dentists.  The commissioner shall increase 
 reimbursement to dentists for services rendered on or after July 
 1, 1992, by 20 percent for preventative services and five 
 percent for all other services. 

    Subd. 6.    Health plans.  Effective for services 
 rendered after July 1, 1991, the commissioner shall adjust the 
 monthly medical assistance capitation rate cell established in 
 contract by the amount necessary to accommodate the equivalent 
 value of the reimbursement increase established under 
 subdivisions 1, 2, and 5. 

    Subd. 7.    Administrative cost.  The commissioner may 
 expend up to $1,700,000 for the administrative costs associated 
 with sections 256.9657 and 256B.74. 

    Subd. 8. Repealed, 1992 c 513 art 7 s 135 

    Subd. 9. Repealed, 1992 c 513 art 7 s 135 

    Subd. 10.    Implementation; rulemaking.  The 
 commissioner shall implement sections 256.9657 and 256B.74 on 
 July 1, 1991, without complying with the rulemaking requirements 
 of the Administrative Procedure Act.  The commissioner may adopt 
 rules to implement Laws 1991, chapter 292, article 4.  Rules 
 adopted to implement Laws 1991, chapter 292, article 4, 
 supersede any provisions adopted under the exemption from 
 rulemaking requirements in this section.  

    HIST: 1991 c 292 art 4 s 67; 1992 c 464 art 1 s 30; 1992 c 513 
 art 7 s 123,124; 1996 c 305 art 2 s 53