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245.4933 MEDICAL ASSISTANCE PROVIDER STATUS.
    Subdivision 1. Requirements to become a prepaid medical provider. (a) In order for a
local children's mental health collaborative to become a prepaid provider of medical assistance
services and be eligible to receive medical assistance reimbursement, the collaborative must:
(1) enter into a contract with the commissioner of human services to provide mental health
services including inpatient, outpatient, medication management, services under the rehabilitation
option, and related physician services;
(2) meet the applicable federal requirements;
(3) either carry stop-loss insurance or enter into a risk-sharing agreement with the
commissioner of human services; and
(4) provide medically necessary medical assistance mental health services to children in the
target population who enroll in the local children's mental health collaborative.
(b) Upon execution of the provider contract with the commissioner of human services the
local children's mental health collaborative may:
(1) provide mental health services which are not medical assistance state plan services in
addition to the state plan services described in the contract with the commissioner of human
services; and
(2) enter into subcontracts which meet the requirements of Code of Federal Regulations, title
42, section 434.6, with other providers of mental health services including prepaid health plans
established under section 256B.69.
    Subd. 2. Children enrolled in a prepaid health plan. A children's mental health
collaborative may serve children in the collaborative's target population who are enrolled in a
prepaid health plan under contract with the commissioner of human services by contracting with
one or more such health plans to provide medical assistance or MinnesotaCare mental health
services to children enrolled in the health plan. The collaborative and the health plan shall work
cooperatively to ensure the integration of physical and mental health services.
    Subd. 3. Children who become enrolled in a prepaid health plan. A children's mental
health collaborative may provide prepaid medical assistance or MinnesotaCare mental health
services to children who are not enrolled in prepaid health plans until those children are
enrolled. Publication of a request for proposals in the State Register shall serve as notice to
the collaborative of the commissioner's intent to execute contracts for medical assistance and
MinnesotaCare services. In order to become or continue to be a provider of medical assistance
or MinnesotaCare services the collaborative may contract with one or more such prepaid
health plans after the collaborative's target population is enrolled in a prepaid health plan. The
collaborative and the health plan shall work cooperatively to ensure the integration of physical
and mental health services.
    Subd. 4. Commissioner's duties. (a) The commissioner of human services shall provide
to each children's mental health collaborative that is considering whether to become a prepaid
provider of mental health services the commissioner's best estimate of a capitated payment rate
prior to an actuarial study based upon the collaborative's operational target population. The
capitated payment rate shall be adjusted annually, if necessary, for changes in the operational
target population.
(b) The commissioner shall negotiate risk adjustment and reinsurance mechanisms with
children's mental health collaboratives that become medical assistance providers including those
that subcontract with prepaid health plans.
    Subd. 5. Noncontracting collaboratives. A local children's mental health collaborative that
does not become a prepaid provider of medical assistance or MinnesotaCare services may provide
services through individual members of a noncontracting collaborative who have a medical
assistance provider agreement to eligible recipients who are not enrolled in the health plan.
    Subd. 6. Individualized rehabilitation services. A children's mental health collaborative
with an integrated service system approved by the Children's Cabinet may become a medical
assistance provider for the purpose of obtaining prior authorization for and providing
individualized rehabilitation services.
History: 1995 c 207 art 8 s 22; art 11 s 11

Official Publication of the State of Minnesota
Revisor of Statutes