2007 Minnesota Statutes

256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE PROGRAMS.
    (a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a health
maintenance organization, as defined in chapter 62D, must participate as a provider or contractor
in the medical assistance program, general assistance medical care program, and MinnesotaCare
as a condition of participating as a provider in health insurance plans and programs or contractor
for state employees established under section 43A.18, the public employees insurance program
under section 43A.316, for health insurance plans offered to local statutory or home rule charter
city, county, and school district employees, the workers' compensation system under section
176.135, and insurance plans provided through the Minnesota Comprehensive Health Association
under sections 62E.01 to 62E.19. The limitations on insurance plans offered to local government
employees shall not be applicable in geographic areas where provider participation is limited by
managed care contracts with the Department of Human Services.
    (b) For providers other than health maintenance organizations, participation in the medical
assistance program means that:
     (1) the provider accepts new medical assistance, general assistance medical care, and
MinnesotaCare patients;
    (2) for providers other than dental service providers, at least 20 percent of the provider's
patients are covered by medical assistance, general assistance medical care, and MinnesotaCare
as their primary source of coverage; or
    (3) for dental service providers, at least ten percent of the provider's patients are covered
by medical assistance, general assistance medical care, and MinnesotaCare as their primary
source of coverage, or the provider accepts new medical assistance and MinnesotaCare patients
who are children with special health care needs. For purposes of this section, "children with
special health care needs" means children up to age 18 who: (i) require health and related services
beyond that required by children generally; and (ii) have or are at risk for a chronic physical,
developmental, behavioral, or emotional condition, including: bleeding and coagulation disorders;
immunodeficiency disorders; cancer; endocrinopathy; developmental disabilities; epilepsy,
cerebral palsy, and other neurological diseases; visual impairment or deafness; Down syndrome
and other genetic disorders; autism; fetal alcohol syndrome; and other conditions designated by the
commissioner after consultation with representatives of pediatric dental providers and consumers.
    (c) Patients seen on a volunteer basis by the provider at a location other than the provider's
usual place of practice may be considered in meeting the participation requirement in this
section. The commissioner shall establish participation requirements for health maintenance
organizations. The commissioner shall provide lists of participating medical assistance providers
on a quarterly basis to the commissioner of employee relations, the commissioner of labor and
industry, and the commissioner of commerce. Each of the commissioners shall develop and
implement procedures to exclude as participating providers in the program or programs under
their jurisdiction those providers who do not participate in the medical assistance program.
The commissioner of employee relations shall implement this section through contracts with
participating health and dental carriers.
History: 1992 c 549 art 4 s 13; 1993 c 13 art 2 s 7; 1993 c 247 art 4 s 9; 1993 c 339 s 14;
1993 c 345 art 9 s 14; 1995 c 248 art 10 s 16; 1997 c 203 art 4 s 33,72; 1999 c 177 s 87; 1Sp2001
c 9 art 2 s 43; 2002 c 275 s 3; 2002 c 379 art 1 s 113; 2007 c 147 art 5 s 12