Subdivision 1.[Repealed, 1987 c 363 s 14
Subd. 2.[Repealed, 1987 c 363 s 14
Subd. 3.[Repealed, 1987 c 363 s 14
Subd. 4. Medical institution.
"Medical institution" means any licensed medical facility that
receives a license from the Minnesota Health Department or Department of Human Services or
appropriate licensing authority of this state, any other state, or a Canadian province.
Subd. 5. State agency.
"State agency" means the commissioner of human services.
Subd. 6. County agency.
"County agency" means a local social service agency operating
under and pursuant to the provisions of chapter 393.
Subd. 7. Vendor of medical care.
(a) "Vendor of medical care" means any person or persons
furnishing, within the scope of the vendor's respective license, any or all of the following goods or
services: medical, surgical, hospital, ambulatory surgical center services, optical, visual, dental and
nursing services; drugs and medical supplies; appliances; laboratory, diagnostic, and therapeutic
services; nursing home and convalescent care; screening and health assessment services provided
by public health nurses as defined in section
145A.02, subdivision 18
; health care services
provided at the residence of the patient if the services are performed by a public health nurse and
the nurse indicates in a statement submitted under oath that the services were actually provided;
and such other medical services or supplies provided or prescribed by persons authorized by
state law to give such services and supplies. The term includes, but is not limited to, directors
and officers of corporations or members of partnerships who, either individually or jointly with
another or others, have the legal control, supervision, or responsibility of submitting claims for
reimbursement to the medical assistance program. The term only includes directors and officers
of corporations who personally receive a portion of the distributed assets upon liquidation or
dissolution, and their liability is limited to the portion of the claim that bears the same proportion
to the total claim as their share of the distributed assets bears to the total distributed assets.
(b) "Vendor of medical care" also includes any person who is credentialed as a health
professional under standards set by the governing body of a federally recognized Indian tribe
authorized under an agreement with the federal government according to United States Code,
title 25, section 450f, to provide health services to its members, and who through a tribal facility
provides covered services to American Indian people within a contract health service delivery area
of a Minnesota reservation, as defined under Code of Federal Regulations, title 42, section
(c) A federally recognized Indian tribe that intends to implement standards for credentialing
health professionals must submit the standards to the commissioner of human services, along
with evidence of meeting, exceeding, or being exempt from corresponding state standards. The
commissioner shall maintain a copy of the standards and supporting evidence, and shall use
those standards to enroll tribal-approved health professionals as medical assistance providers.
For purposes of this section, "Indian" and "Indian tribe" mean persons or entities that meet the
definition in United States Code, title 25, section 450b.
Subd. 8. Medical assistance; medical care.
"Medical assistance" or "medical care" means
payment of part or all of the cost of the care and services identified in section
eligible individuals whose income and resources are insufficient to meet all of this cost.
256B.0625, subdivision 1
256B.0625, subd 2
256B.0625, subd 3
256B.0625, subd 4
256B.0625, subd 5
256B.0625, subd 6
256B.0625, subd 7
256B.0625, subd 8
256B.0625, subd 9
256B.0625, subd 10
256B.0625, subd 11
256B.0625, subd 12
256B.0625, subd 13
256B.0625, subd 14
256B.0625, subd 15
256B.0625, subd 16
256B.0625, subd 17
256B.0625, subd 18
256B.0625, subd 19
256B.0625, subd 20
256B.0625, subd 21
256B.0625, subd 22
256B.0625, subd 23
256B.0625, subd 24
256B.0625, subd 25
Subd. 9. Private health care coverage.
"Private health care coverage" means any plan
regulated by chapter 62A, 62C or 64B. Private health care coverage also includes any self-insured
plan providing health care benefits, pharmacy benefit manager, service benefit plan, managed
care organization, and other parties that are by contract legally responsible for payment of a
claim for a health care item or service for an individual receiving medical benefits under chapter
256B, 256D, or 256L.
Subd. 10. Automobile accident coverage.
"Automobile accident coverage" means any
plan, or that portion of a plan, regulated under chapter 65B, which provides benefits for medical
expenses incurred in an automobile accident.
Subd. 11. Related condition.
"Related condition" means that condition defined in section
252.27, subdivision 1a
Subd. 12. Third-party payer.
"Third-party payer" means a person, entity, or agency or
government program that has a probable obligation to pay all or part of the costs of a medical
assistance recipient's health services. Third-party payer includes an entity under contract with the
recipient to cover all or part of the recipient's medical costs.
Subd. 13. Prepaid health plan.
"Prepaid health plan" means a vendor who receives a
capitation payment and assumes financial risk for the provision of medical assistance services
under a contract with the commissioner.
Subd. 14. Group health plan.
"Group health plan" means any plan of, or contributed to
by, an employer, including a self-insured plan, to provide health care directly or otherwise to the
employer's employees, former employees, or the families of the employees or former employees,
and includes continuation coverage pursuant to title XXII of the Public Health Service Act,
section 4980B of the Internal Revenue Code of 1986, or title VI of the Employee Retirement
Income Security Act of 1974.
Subd. 15. Cost-effective.
"Cost-effective" means that the amount paid by the state for
premiums, coinsurance, deductibles, other cost-sharing obligations under a health insurance plan,
and other administrative costs is likely to be less than the amount paid for an equivalent set of
services paid by medical assistance.
History: Ex1967 c 16 s 2; 1969 c 395 s 1; 1973 c 717 s 17; 1975 c 247 s 9; 1975 c 384 s 1;
1975 c 437 art 2 s 3; 1976 c 173 s 56; 1976 c 236 s 1; 1976 c 312 s 1; 1978 c 508 s 2; 1978 c 560
s 10; 1981 c 360 art 2 s 26,54; 1Sp1981 c 2 s 12; 1Sp1981 c 4 art 4 s 22; 3Sp1981 c 2 art 1 s 31;
1982 c 562 s 2; 1983 c 151 s 1,2; 1983 c 312 art 1 s 27; art 5 s 10; art 9 s 4; 1984 c 654 art 5 s
58; 1985 c 21 s 52-54; 1985 c 49 s 41; 1985 c 252 s 19,20; 1Sp1985 c 3 s 19; 1986 c 394 s 17;
1986 c 444; 1987 c 370 art 1 s 3; art 2 s 4; 1987 c 374 s 1; 1987 c 309 s 24; 1987 c 403 art 2 s
73,74; art 5 s 16; 1988 c 689 art 2 s 141,268; 1992 c 464 art 1 s 55; 1992 c 513 art 7 s 31,32;
1994 c 631 s 31; 2002 c 275 s 2; 2004 c 198 s 17; 1Sp2005 c 4 art 8 s 17; 2006 c 282 art 17 s 24