2005 Minnesota Statutes

     256L.035 Limited benefits coverage for certain single 
  adults and households without children. 

    (a) "Covered health services" for individuals under section 
 256L.04, subdivision 7, with income above 75 percent, but not 
 exceeding 175 percent, of the federal poverty guideline means: 

    (1) inpatient hospitalization benefits with a ten percent 
 co-payment up to $1,000 and subject to an annual limitation of 
 $10,000; 

    (2) physician services provided during an inpatient stay; 
 and 

    (3) physician services not provided during an inpatient 
 stay; outpatient hospital services; freestanding ambulatory 
 surgical center services; chiropractic services; lab and 
 diagnostic services; diabetic supplies and equipment; and 
 prescription drugs; subject to the following co-payments: 

    (i) $50 co-pay per emergency room visit; 

    (ii) $3 co-pay per prescription drug; and 

    (iii) $5 co-pay per nonpreventive visit. 

 The services covered under this section may be provided by a 
 physician, physician ancillary, chiropractor, psychologist, or 
 licensed independent clinical social worker if the services are 
 within the scope of practice of that health care professional.  

    For purposes of this section, "a visit" means an episode of 
 service which is required because of a recipient's symptoms, 
 diagnosis, or established illness, and which is delivered in an 
 ambulatory setting by any health care provider identified in 
 this paragraph. 

    Enrollees are responsible for all co-payments in this 
 section. 

    (b) Reimbursement to the providers shall be reduced by the 
 amount of the co-payment, except that reimbursement for 
 prescription drugs shall not be reduced once a recipient has 
 reached the $20 per month maximum for prescription drug 
 co-payments.  The provider collects the co-payment from the 
 recipient.  Providers may not deny services to recipients who 
 are unable to pay the co-payment, except as provided in 
 paragraph (c). 

    (c) If it is the routine business practice of a provider to 
 refuse service to an individual with uncollected debt, the 
 provider may include uncollected co-payments under this 
 section.  A provider must give advance notice to a recipient 
 with uncollected debt before services can be denied. 

    HIST: 1Sp2003 c 14 art 12 s 72; 2004 c 198 s 18; 1Sp2005 c 4 
 art 8 s 60