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Minnesota Legislature

Office of the Revisor of Statutes

256L.11 PROVIDER PAYMENT.
    Subdivision 1. Medical assistance rate to be used. Payment to providers under sections
256L.01 to 256L.11 shall be at the same rates and conditions established for medical assistance,
except as provided in subdivisions 2 to 6.
    Subd. 2. Payment of certain providers. Services provided by federally qualified health
centers, rural health clinics, and facilities of the Indian health service shall be paid for according
to the same rates and conditions applicable to the same service provided by providers that are not
federally qualified health centers, rural health clinics, or facilities of the Indian health service.
    Subd. 2a. Payment rates; services for families and children under the MinnesotaCare
health care reform waiver. Subdivision 2 shall not apply to services provided to families with
children who are eligible according to section 256L.04, subdivision 1, paragraph (a).
    Subd. 3. Inpatient hospital services. Inpatient hospital services provided under section
256L.03, subdivision 3, shall be paid for as provided in subdivisions 4 to 6.
    Subd. 4. Definition of medical assistance rate for inpatient hospital services. The
"medical assistance rate," as used in this section to apply to rates for providing inpatient hospital
services, means the rates established under sections 256.9685 to 256.9695 for providing inpatient
hospital services to medical assistance recipients who receive Minnesota family investment
program assistance.
    Subd. 5. Enrollees younger than 18. Payment for inpatient hospital services provided to
MinnesotaCare enrollees who are younger than 18 years old on the date of admission to the
inpatient hospital shall be at the medical assistance rate.
    Subd. 6. Enrollees 18 or older. Payment by the MinnesotaCare program for inpatient
hospital services provided to MinnesotaCare enrollees eligible 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, who are 18
years old or older on the date of admission to the inpatient hospital must be in accordance with
paragraphs (a) and (b). Payment for adults who are not pregnant and are eligible under section
256L.04, subdivisions 1 and 2, and whose incomes are equal to or less than 175 percent of the
federal poverty guidelines, shall be as provided for under paragraph (c).
(a) If the medical assistance rate minus any co-payment required under section 256L.03,
subdivision 4
, is less than or equal to the amount remaining in the enrollee's benefit limit
under section 256L.03, subdivision 3, payment must be the medical assistance rate minus any
co-payment required under section 256L.03, subdivision 4. The hospital must not seek payment
from the enrollee in addition to the co-payment. The MinnesotaCare payment plus the co-payment
must be treated as payment in full.
(b) If the medical assistance rate minus any co-payment required under section 256L.03,
subdivision 4
, is greater than the amount remaining in the enrollee's benefit limit under section
256L.03, subdivision 3, payment must be the lesser of:
(1) the amount remaining in the enrollee's benefit limit; or
(2) charges submitted for the inpatient hospital services less any co-payment established
under section 256L.03, subdivision 4.
The hospital may seek payment from the enrollee for the amount by which usual and
customary charges exceed the payment under this paragraph. If payment is reduced under section
256L.03, subdivision 3, paragraph (b), the hospital may not seek payment from the enrollee for
the amount of the reduction.
(c) For admissions occurring during the period of July 1, 1997, through June 30, 1998,
for adults who are not pregnant and are eligible under section 256L.04, subdivisions 1 and 2,
and whose incomes are equal to or less than 175 percent of the federal poverty guidelines, the
commissioner shall pay hospitals directly, up to the medical assistance payment rate, for inpatient
hospital benefits in excess of the $10,000 annual inpatient benefit limit.
    Subd. 7. Critical access dental providers. Effective for dental services provided to
MinnesotaCare enrollees on or after January 1, 2007, the commissioner shall increase payment
rates to dentists and dental clinics deemed by the commissioner to be critical access providers
under section 256B.76, paragraph (c), by 50 percent above the payment rate that would otherwise
be paid to the provider. The commissioner shall pay the prepaid health plans under contract with
the commissioner amounts sufficient to reflect this rate increase. The prepaid health plan must
pass this rate increase to providers who have been identified by the commissioner as critical
access dental providers under section 256B.76, paragraph (c).
History: 1993 c 345 art 9 s 9; 1994 c 625 art 8 s 57; 1995 c 234 art 6 s 21; 1997 c 225 art 1
s 15; 1998 c 407 art 5 s 37,47; 1999 c 159 s 106; 1Sp2001 c 9 art 2 s 66; 2002 c 379 art 1 s 113;
2006 c 282 art 16 s 13; 2007 c 147 art 5 s 31