1998 Minnesota Statutes

     256L.03 Covered health services. 

    Subdivision 1.    Covered health services.  "Covered 
 health services" means the health services reimbursed under 
 chapter 256B, with the exception of inpatient hospital services, 
 special education services, private duty nursing services, adult 
 dental care services other than preventive services, orthodontic 
 services, nonemergency medical transportation services, personal 
 care assistant and case management services, nursing home or 
 intermediate care facilities services, inpatient mental health 
 services, and chemical dependency services.  Effective July 1, 
 1998, adult dental care for nonpreventive services with the 
 exception of orthodontic services is available to persons who 
 qualify under section 256L.04, subdivisions 1 to 7, with family 
 gross income equal to or less than 175 percent of the federal 
 poverty guidelines.  Outpatient mental health services covered 
 under the MinnesotaCare program are limited to diagnostic 
 assessments, psychological testing, explanation of findings, 
 medication management by a physician, day treatment, partial 
 hospitalization, and individual, family, and group psychotherapy.

    No public funds shall be used for coverage of abortion 
 under MinnesotaCare except where the life of the female would be 
 endangered or substantial and irreversible impairment of a major 
 bodily function would result if the fetus were carried to term; 
 or where the pregnancy is the result of rape or incest. 

    Covered health services shall be expanded as provided in 
 this section. 

    Subd. 1a.    Covered services for pregnant women and 
 children under MinnesotaCare health care reform waiver.  
 Beginning January 1, 1999, children and pregnant women are 
 eligible for coverage of all services that are eligible for 
 reimbursement under the medical assistance program according to 
 chapter 256B, except that abortion services under MinnesotaCare 
 shall be limited as provided under subdivision 1.  Pregnant 
 women and children are exempt from the provisions of subdivision 
 5, regarding copayments.  Pregnant women and children who are 
 lawfully residing in the United States but who are not 
 "qualified noncitizens" under title IV of the Personal 
 Responsibility and Work Opportunity Reconciliation Act of 1996, 
 Public Law Number 104-193, Statutes at Large, volume 110, page 
 2105, are eligible for coverage of all services provided under 
 the medical assistance program according to chapter 256B. 

    Subd. 1b.    Pregnant women; eligibility for full medical 
 assistance services.  Beginning January 1, 1999, a woman who 
 is enrolled in MinnesotaCare when her pregnancy is diagnosed is 
 eligible for coverage of all services provided under the medical 
 assistance program according to chapter 256B retroactive to the 
 date the pregnancy is medically diagnosed.  Copayments totaling 
 $30 or more, paid after the date the pregnancy is diagnosed, 
 shall be refunded. 

    Subd. 2.    Alcohol and drug dependency.  Beginning July 
 1, 1993, covered health services shall include individual 
 outpatient treatment of alcohol or drug dependency by a 
 qualified health professional or outpatient program.  

    Persons who may need chemical dependency services under the 
 provisions of this chapter shall be assessed by a local agency 
 as defined under section 254B.01, and under the assessment 
 provisions of section 254A.03, subdivision 3.  A local agency or 
 managed care plan under contract with the department of human 
 services must place a person in need of chemical dependency 
 services as provided in Minnesota Rules, parts 9530.6600 to 
 9530.6660.  Persons who are recipients of medical benefits under 
 the provisions of this chapter and who are financially eligible 
 for consolidated chemical dependency treatment fund services 
 provided under the provisions of chapter 254B shall receive 
 chemical dependency treatment services under the provisions of 
 chapter 254B only if: 

    (1) they have exhausted the chemical dependency benefits 
 offered under this chapter; or 

    (2) an assessment indicates that they need a level of care 
 not provided under the provisions of this chapter. 

    Recipients of covered health services under the children's 
 health plan, as provided in Minnesota Statutes 1990, section 
 256.936, and as amended by Laws 1991, chapter 292, article 4, 
 section 17, and recipients of covered health services enrolled 
 in the children's health plan or the MinnesotaCare program after 
 October 1, 1992, pursuant to Laws 1992, chapter 549, article 4, 
 sections 5 and 17, are eligible to receive alcohol and drug 
 dependency benefits under this subdivision. 

    Subd. 3.    Inpatient hospital services.  (a) Covered 
 health services shall include inpatient hospital services, 
 including inpatient hospital mental health services and 
 inpatient hospital and residential chemical dependency 
 treatment, subject to those limitations necessary to coordinate 
 the provision of these services with eligibility under the 
 medical assistance spenddown.  Prior to July 1, 1997, the 
 inpatient hospital benefit for adult enrollees is subject to an 
 annual benefit limit of $10,000.  The inpatient hospital benefit 
 for adult enrollees who qualify under section 256L.04, 
 subdivision 7, or who qualify under section 256L.04, 
 subdivisions 1 and 2, with family gross income that exceeds 175 
 percent of the federal poverty guidelines and who are not 
 pregnant, is subject to an annual limit of $10,000.  

    (b) Admissions for inpatient hospital services paid for 
 under section 256L.11, subdivision 3, must be certified as 
 medically necessary in accordance with Minnesota Rules, parts 
 9505.0500 to 9505.0540, except as provided in clauses (1) and 
 (2): 

    (1) all admissions must be certified, except those 
 authorized under rules established under section 254A.03, 
 subdivision 3, or approved under Medicare; and 

    (2) payment under section 256L.11, subdivision 3, shall be 
 reduced by five percent for admissions for which certification 
 is requested more than 30 days after the day of admission.  The 
 hospital may not seek payment from the enrollee for the amount 
 of the payment reduction under this clause. 

    Subd. 3a.    Interpreter services.  Covered services 
 include sign and spoken language interpreter services that 
 assist an enrollee in obtaining covered health care services. 

    Subd. 4.    Coordination with medical assistance.  The 
 commissioner shall coordinate the provision of hospital 
 inpatient services under the MinnesotaCare program with enrollee 
 eligibility under the medical assistance spenddown. 

    Subd. 5.    Copayments and coinsurance.  The 
 MinnesotaCare benefit plan shall include the following 
 copayments and coinsurance requirements:  

    (1) ten percent of the paid charges for inpatient hospital 
 services for adult enrollees, subject to an annual inpatient 
 out-of-pocket maximum of $1,000 per individual and $3,000 per 
 family; 

    (2) $3 per prescription for adult enrollees; 

    (3) $25 for eyeglasses for adult enrollees; and 

    (4) effective July 1, 1998, 50 percent of the 
 fee-for-service rate for adult dental care services other than 
 preventive care services for persons eligible under section 
 256L.04, subdivisions 1 to 7, with income equal to or less than 
 175 percent of the federal poverty guidelines. 

    Effective July 1, 1997, adult enrollees with family gross 
 income that exceeds 175 percent of the federal poverty 
 guidelines and who are not pregnant shall be financially 
 responsible for the coinsurance amount and amounts which exceed 
 the $10,000 inpatient hospital benefit limit. 

    When a MinnesotaCare enrollee becomes a member of a prepaid 
 health plan, or changes from one prepaid health plan to another 
 during a calendar year, any charges submitted towards the 
 $10,000 annual inpatient benefit limit, and any out-of-pocket 
 expenses incurred by the enrollee for inpatient services, that 
 were submitted or incurred prior to enrollment, or prior to the 
 change in health plans, shall be disregarded. 

    Subd. 6.    Lien.  When the state agency provides, pays 
 for, or becomes liable for covered health services, the agency 
 shall have a lien for the cost of the covered health services 
 upon any and all causes of action accruing to the enrollee, or 
 to the enrollee's legal representatives, as a result of the 
 occurrence that necessitated the payment for the covered health 
 services.  All liens under this section shall be subject to the 
 provisions of section 256.015.  For purposes of this 
 subdivision, "state agency" includes authorized agents of the 
 state agency. 

    HIST: 1986 c 444; 1992 c 549 art 4 s 4,19; 1992 c 603 s 31; 
 1993 c 247 art 4 s 2-4,11; 1993 c 345 art 9 s 3; 1993 c 366 s 
 26; 1994 c 625 art 8 s 50,51,72; 1995 c 207 art 6 s 12; 1995 c 
 234 art 6 s 4,5; 1997 c 225 art 1 s 1-3; 1998 c 407 art 5 s 
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