1997 Minnesota Statutes

     256B.071 Medicare maximization program. 

    Subdivision 1.    Definition.  (a) "Dual entitlees" 
 means recipients eligible for either the medical assistance 
 program or the alternative care program who are also eligible 
 for the federal Medicare program.  

    (b) For purposes of this section, "home care services" 
 means home health agency services, private duty nursing 
 services, personal care assistant services, waivered services, 
 alternative care program services, hospice services, 
 rehabilitation therapy services, and suppliers of medical 
 supplies and equipment. 

    Subd. 2.    Technical assistance to providers.  (a) The 
 commissioner shall establish a technical assistance program to 
 require providers of services and equipment under this section 
 to maximize collections from the federal Medicare program.  The 
 technical assistance may include the provision of materials to 
 help providers determine those services and equipment likely to 
 be reimbursed by Medicare.  The technical assistance may also 
 include the provision of computer software to providers to 
 assist in this process.  The commissioner may expand the 
 technical assistance program to include providers of other 
 services under this chapter. 

    (b) Any provider of home care services enrolled in the 
 medical assistance program, or county public health nursing 
 agency responsible for personal care assessments, or county case 
 managers for alternative care or medical assistance waiver 
 programs, is required to use the method developed and supplied 
 by the department of human services for determining Medicare 
 coverage for home care equipment and services provided to dual 
 entitlees to ensure appropriate billing of Medicare.  The method 
 will be developed in two phases; the first phase is a manual 
 system effective July 1, 1996, and the second phase will 
 automate the manual procedure by expanding the current Medicaid 
 Management Information System (MMIS) effective January 1, 1997.  
 Both methods will determine Medicare coverage for the dates of 
 service and Medicare coverage for home care services, and create 
 an audit trail including reports.  Both methods will be linked 
 to prior authorization, therefore, either method must be used 
 before home care services are authorized and when there is a 
 change of condition affecting medical assistance authorization.  
 The department will conduct periodic reviews of participant 
 performance with the method and upon demonstrating appropriate 
 referral and billing of Medicare, participants may be determined 
 exempt from regular performance audits.  

    Subd. 3.    Referrals to Medicare providers required.  
 Non-Medicare certified home care providers and medical suppliers 
 that do not participate or accept Medicare assignment must refer 
 and document the referral of dual eligible recipients to 
 Medicare providers when Medicare is determined to be the 
 appropriate payer for services and supplies and equipment.  
 Providers will be terminated from participation in the medical 
 assistance program for failure to make such referrals. 

    Subd. 4.    Medicare certification requirement.  
 Medicare certification is required of all medical assistance 
 enrolled home care service providers as required under Title XIX 
 of the Social Security Act.  

    Subd. 5.    Advisory committee.  The commissioner shall 
 establish an advisory committee comprised of home care services 
 recipients, providers, county public health nurses, home care 
 and county nursing associations, and department of human 
 services staff to make recommendations to the Medicare 
 maximization program.  The recommendations shall include:  
 nursing practice issues as they relate to home care services 
 funded by Medicare and medical assistance; and streamlining 
 assessment, prior authorization, and up-front payer 
 determination processes to achieve administrative efficiencies. 

    HIST: 1996 c 451 art 2 s 22; 1997 c 195 s 2-4 

*   NOTE:  Subdivision 3, as added by Laws 1996, chapter 451, 
*article 2, section 22, is effective upon federal approval.  Laws 
*1996, chapter 451, article 2, section 62.