2006 Minnesota Statutes

256B.04 DUTIES OF STATE AGENCY.
    Subdivision 1. General. The state agency shall supervise the administration of medical
assistance for eligible recipients by the county agencies hereunder.
    Subd. 1a. Comprehensive health services system. The commissioner shall carry out the
duties in this section with the participation of the boards of county commissioners, and with
full consideration for the interests of counties, to plan and implement a unified, accountable,
comprehensive health services system that:
(1) promotes accessible and quality health care for all Minnesotans;
(2) assures provision of adequate health care within limited state and county resources;
(3) avoids shifting funding burdens to county tax resources;
(4) provides statewide eligibility, benefit, and service expectations;
(5) manages care, develops risk management strategies, and contains cost in all health and
human services; and
(6) supports effective implementation of publicly funded health and human services for
all areas of the state.
    Subd. 1b. Contract for administrative services for American Indian children.
Notwithstanding subdivision 1, the commissioner may contract with federally recognized Indian
tribes with a reservation in Minnesota for the provision of early and periodic screening, diagnosis,
and treatment administrative services for American Indian children, according to Code of Federal
Regulations, title 42, section 441, subpart B, and Minnesota Rules, part 9505.1693 et seq., when
the tribe chooses to provide such services. For purposes of this subdivision, "American Indian"
has the meaning given to persons to whom services will be provided for in Code of Federal
Regulations, title 42, section 36.12. Notwithstanding Minnesota Rules, part 9505.1748, subpart 1,
the commissioner, the local agency, and the tribe may contract with any entity for the provision of
early and periodic screening, diagnosis, and treatment administrative services.
    Subd. 2. Rulemaking authority. Make uniform rules, not inconsistent with law, for carrying
out and enforcing the provisions hereof in an efficient, economical, and impartial manner, and to
the end that the medical assistance system may be administered uniformly throughout the state,
having regard for varying costs of medical care in different parts of the state and the conditions in
each case, and in all things to carry out the spirit and purpose of this program, which rules shall be
furnished immediately to all county agencies, and shall be binding on such county agencies.
    Subd. 3. Required forms. Prescribe the form of, print, and supply to the county agencies,
blanks for applications, reports, affidavits, and such other forms as it may deem necessary or
advisable.
    Subd. 4. Cooperation with federal agency. Cooperate with the federal Centers for Medicare
and Medicaid Services in any reasonable manner as may be necessary to qualify for federal aid in
connection with the medical assistance program, including the making of such reports in such
form and containing such information as the Department of Health, Education, and Welfare may,
from time to time, require, and comply with such provisions as such department may, from time
to time, find necessary to assure the correctness and verifications of such reports.
    Subd. 4a. Medicare prescription drug subsidy. The commissioner shall perform all duties
necessary to administer eligibility determinations for the Medicare Part D prescription drug
subsidy and facilitate the enrollment of eligible medical assistance recipients into Medicare
prescription drug plans as required by the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA), Public Law 108-173, and Code of Federal Regulations, title
42, sections 423.30 to 423.56 and 423.771 to 423.800.
    Subd. 5. Annual report required. The state agency within 60 days after the close of each
fiscal year, shall prepare and print for the fiscal year a report that includes a full account of the
operations and expenditure of funds under this chapter, a full account of the activities undertaken
in accordance with subdivision 10, adequate and complete statistics divided by counties about
all medical assistance provided in accordance with this chapter, and any other information it
may deem advisable.
    Subd. 6. Monthly statement. Prepare and release a summary statement monthly showing by
counties the amount paid hereunder and the total number of persons assisted.
    Subd. 7. Program safeguards. Establish and enforce safeguards to prevent unauthorized
disclosure or improper use of the information contained in applications, reports of investigations
and medical examinations, and correspondence in the individual case records of recipients
of medical assistance.
    Subd. 8. Information. Furnish information to acquaint needy persons and the public
generally with the plan for medical assistance of this state.
    Subd. 9. Reciprocal agreements. Cooperate with agencies in other states in establishing
reciprocal agreements to provide for payment of medical assistance to recipients who have moved
to another state, consistent with the provisions hereof and of Title XIX of the Social Security
Act of the United States of America.
    Subd. 10. Investigation of certain claims. Establish by rule general criteria and procedures
for the identification and prompt investigation of suspected medical assistance fraud, theft, abuse,
presentment of false or duplicate claims, presentment of claims for services not medically
necessary, or false statement or representation of material facts by a vendor of medical care,
and for the imposition of sanctions against a vendor of medical care. If it appears to the state
agency that a vendor of medical care may have acted in a manner warranting civil or criminal
proceedings, it shall so inform the attorney general in writing.
    Subd. 11.[Repealed, 1997 c 7 art 2 s 67]
    Subd. 12. Limitation on services. Place limits on the types of services covered by medical
assistance, the frequency with which the same or similar services may be covered by medical
assistance for an individual recipient, and the amount paid for each covered service. The state
agency shall promulgate rules establishing maximum reimbursement rates for emergency and
nonemergency transportation.
The rules shall provide:
(a) An opportunity for all recognized transportation providers to be reimbursed for
nonemergency transportation consistent with the maximum rates established by the agency;
(b) Reimbursement of public and private nonprofit providers serving the disabled population
generally at reasonable maximum rates that reflect the cost of providing the service regardless of
the fare that might be charged by the provider for similar services to individuals other than those
receiving medical assistance or medical care under this chapter; and
(c) Reimbursement for each additional passenger carried on a single trip at a substantially
lower rate than the first passenger carried on that trip.
The commissioner shall encourage providers reimbursed under this chapter to coordinate
their operation with similar services that are operating in the same community. To the extent
practicable, the commissioner shall encourage eligible individuals to utilize less expensive
providers capable of serving their needs.
For the purpose of this subdivision and section 256B.02, subdivision 8, and effective on
January 1, 1981, "recognized provider of transportation services" means an operator of special
transportation service as defined in section 174.29 that has been issued a current certificate of
compliance with operating standards of the commissioner of transportation or, if those standards
do not apply to the operator, that the agency finds is able to provide the required transportation in
a safe and reliable manner. Until January 1, 1981, "recognized transportation provider" includes
an operator of special transportation service that the agency finds is able to provide the required
transportation in a safe and reliable manner.
    Subd. 13. Medical necessity review. Each person appointed by the commissioner to
participate in decisions whether medical care to be provided to eligible recipients is medically
necessary shall abstain from participation in those cases in which the appointee(a) has issued
treatment orders in the care of the patient or participated in the formulation or execution of the
patient's treatment plan or (b) has, or a member of the appointee's family has, an ownership
interest of five percent or more in the institution that provided or proposed to provide the services
being reviewed.
    Subd. 14. Competitive bidding. (a) When determined to be effective, economical, and
feasible, the commissioner may utilize volume purchase through competitive bidding and
negotiation under the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:
(1) eyeglasses;
(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation on
a short-term basis, until the vendor can obtain the necessary supply from the contract dealer;
(3) hearing aids and supplies; and
(4) durable medical equipment, including but not limited to:
(i) hospital beds;
(ii) commodes;
(iii) glide-about chairs;
(iv) patient lift apparatus;
(v) wheelchairs and accessories;
(vi) oxygen administration equipment;
(vii) respiratory therapy equipment;
(viii) electronic diagnostic, therapeutic and life support systems;
(5) special transportation services; and
(6) drugs.
(b) Rate changes under this chapter and chapters 256D and 256L do not affect contract
payments under this subdivision unless specifically identified.
    Subd. 15. Utilization review. (1) Establish on a statewide basis a new program to safeguard
against unnecessary or inappropriate use of medical assistance services, against excess payments,
against unnecessary or inappropriate hospital admissions or lengths of stay, and against
underutilization of services in prepaid health plans, long-term care facilities or any health care
delivery system subject to fixed rate reimbursement. In implementing the program, the state
agency shall utilize both prepayment and postpayment review systems to determine if utilization
is reasonable and necessary. The determination of whether services are reasonable and necessary
shall be made by the commissioner in consultation with a professional services advisory group or
health care consultant appointed by the commissioner.
(2) Contracts entered into for purposes of meeting the requirements of this subdivision shall
not be subject to the set-aside provisions of chapter 16C.
(3) A recipient aggrieved by the commissioner's termination of services or denial of future
services may appeal pursuant to section 256.045. A vendor aggrieved by the commissioner's
determination that services provided were not reasonable or necessary may appeal pursuant to the
contested case procedures of chapter 14. To appeal, the vendor shall notify the commissioner in
writing within 30 days of receiving the commissioner's notice. The appeal request shall specify
each disputed item, the reason for the dispute, an estimate of the dollar amount involved for each
disputed item, the computation that the vendor believes is correct, the authority in statute or
rule upon which the vendor relies for each disputed item, the name and address of the person
or firm with whom contacts may be made regarding the appeal, and other information required
by the commissioner.
(4) The commissioner may select providers to provide case management services to
recipients who use health care services inappropriately or to recipients who are eligible for other
managed care projects. The providers shall be selected based upon criteria that may include a
comparison with a peer group of providers related to the quality, quantity, or cost of health care
services delivered or a review of sanctions previously imposed by health care services programs
or the provider's professional licensing board.
    Subd. 16. Personal care services. (a) Notwithstanding any contrary language in this
paragraph, the commissioner of human services and the commissioner of health shall jointly
promulgate rules to be applied to the licensure of personal care services provided under the
medical assistance program. The rules shall consider standards for personal care services that
are based on the World Institute on Disability's recommendations regarding personal care
services. These rules shall at a minimum consider the standards and requirements adopted by
the commissioner of health under section 144A.45, which the commissioner of human services
determines are applicable to the provision of personal care services, in addition to other standards
or modifications which the commissioner of human services determines are appropriate.
The commissioner of human services shall establish an advisory group including personal
care consumers and providers to provide advice regarding which standards or modifications
should be adopted. The advisory group membership must include not less than 15 members, of
which at least 60 percent must be consumers of personal care services and representatives of
recipients with various disabilities and diagnoses and ages. At least 51 percent of the members of
the advisory group must be recipients of personal care.
The commissioner of human services may contract with the commissioner of health to
enforce the jointly promulgated licensure rules for personal care service providers.
Prior to final promulgation of the joint rule the commissioner of human services shall report
preliminary findings along with any comments of the advisory group and a plan for monitoring
and enforcement by the Department of Health to the legislature by February 15, 1992.
Limits on the extent of personal care services that may be provided to an individual must be
based on the cost-effectiveness of the services in relation to the costs of inpatient hospital care,
nursing home care, and other available types of care. The rules must provide, at a minimum:
(1) that agencies be selected to contract with or employ and train staff to provide and
supervise the provision of personal care services;
(2) that agencies employ or contract with a qualified applicant that a qualified recipient
proposes to the agency as the recipient's choice of assistant;
(3) that agencies bill the medical assistance program for a personal care service by a personal
care assistant and supervision by a qualified professional supervising the personal care assistant
unless the recipient selects the fiscal agent option under section 256B.0627, subdivision 10;
(4) that agencies establish a grievance mechanism; and
(5) that agencies have a quality assurance program.
(b) The commissioner may waive the requirement for the provision of personal care services
through an agency in a particular county, when there are less than two agencies providing services
in that county and shall waive the requirement for personal care assistants required to join an
agency for the first time during 1993 when personal care services are provided under a relative
hardship waiver under Minnesota Statutes 1992, section 256B.0627, subdivision 4, paragraph (b),
clause (7), and at least two agencies providing personal care services have refused to employ or
contract with the independent personal care assistant.
    Subd. 17. Prenatal care outreach. (a) The commissioner of human services shall award a
grant to an eligible organization to conduct a statewide media campaign promoting early prenatal
care. The goals of the campaign are to increase public awareness of the importance of early
and continuous prenatal care and to inform the public about public and private funds available
for prenatal care.
(b) In order to receive a grant under this section, an applicant must:
(1) have experience conducting prenatal care outreach;
(2) have an established statewide constituency or service area; and
(3) demonstrate an ability to accomplish the purposes in this subdivision.
(c) Money received under this subdivision may be used for purchase of materials and
supplies, staff fees and salaries, consulting fees, and other goods and services necessary to
accomplish the goals of the campaign. Money may not be used for capital expenditures.
    Subd. 18. Applications for medical assistance. The state agency may take applications for
medical assistance and conduct eligibility determinations for MinnesotaCare enrollees.
    Subd. 19. Performance data reporting unit. The commissioner of human services shall
establish a performance data reporting unit that serves counties and the state. The department
shall support this unit and provide technical assistance and access to the data warehouse. The
performance data reporting unit, which will operate within the department's central office and
consist of both county and department staff, shall provide performance data reports to individual
counties, share expertise from counties and the department perspective, and participate in
joint planning to link with county databases and other county data sources in order to provide
information on services provided to public clients from state, federal, and county funding sources.
The performance data reporting unit shall provide counties both individual and group summary
level standard or unique reports on health care eligibility and services provided to clients for
whom they have financial responsibility.
History: Ex1967 c 16 s 4; 1976 c 273 s 1-3; 1977 c 185 s 1; 1977 c 347 s 39,40; 1978 c
560 s 11; Ex1979 c 1 s 46; 1980 c 349 s 3,4; 1982 c 640 s 3; 1983 c 312 art 5 s 11,12; 1984 c
640 s 32; 1985 c 248 s 70; 1Sp1985 c 9 art 2 s 37; 1986 c 444; 1987 c 378 s 15; 1987 c 403 art
2 s 77,78; 1988 c 532 s 13; 1989 c 282 art 3 s 41,42; 1990 c 568 art 3 s 21,22; 1991 c 292 art
7 s 8; 1Sp1993 c 1 art 5 s 28; 1995 c 233 art 2 s 56; 1995 c 234 art 6 s 34; 1997 c 7 art 1 s
101; 1997 c 203 art 4 s 18; 1998 c 386 art 2 s 78,79; 1998 c 407 art 5 s 2; 1999 c 245 art 4 s
26,27; 1Sp2001 c 9 art 2 s 14; 2002 c 277 s 32; 2002 c 379 art 1 s 113; 2005 c 56 s 1; 2005 c
98 art 2 s 1; 1Sp2005 c 4 art 8 s 18