2006 Minnesota Statutes

256L.035 LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE ADULTS AND
HOUSEHOLDS WITHOUT CHILDREN.
(a) "Covered health services" for individuals under section 256L.04, subdivision 7, with
income above 75 percent, but not exceeding 175 percent, of the federal poverty guideline means:
(1) inpatient hospitalization benefits with a ten percent co-payment up to $1,000 and subject
to an annual limitation of $10,000;
(2) physician services provided during an inpatient stay; and
(3) physician services not provided during an inpatient stay; outpatient hospital services;
freestanding ambulatory surgical center services; chiropractic services; lab and diagnostic
services; diabetic supplies and equipment; and prescription drugs; subject to the following
co-payments:
(i) $50 co-pay per emergency room visit;
(ii) $3 co-pay per prescription drug; and
(iii) $5 co-pay per nonpreventive visit.
The services covered under this section may be provided by a physician, physician ancillary,
chiropractor, psychologist, or licensed independent clinical social worker if the services are
within the scope of practice of that health care professional.
For purposes of this section, "a visit" means an episode of service which is required
because of a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
ambulatory setting by any health care provider identified in this paragraph.
Enrollees are responsible for all co-payments in this section.
(b) Reimbursement to the providers shall be reduced by the amount of the co-payment,
except that reimbursement for prescription drugs shall not be reduced once a recipient has reached
the $20 per month maximum for prescription drug co-payments. The provider collects the
co-payment from the recipient. Providers may not deny services to recipients who are unable to
pay the co-payment, except as provided in paragraph (c).
(c) If it is the routine business practice of a provider to refuse service to an individual with
uncollected debt, the provider may include uncollected co-payments under this section. A provider
must give advance notice to a recipient with uncollected debt before services can be denied.
History: 1Sp2003 c 14 art 12 s 72; 2004 c 198 s 18; 1Sp2005 c 4 art 8 s 60