2000 Minnesota Statutes

     256B.0625 Covered services. 

    Subdivision 1.    Inpatient hospital services.  Medical 
 assistance covers inpatient hospital services.  A second medical 
 opinion is required prior to reimbursement for elective 
 surgeries requiring a second opinion.  The commissioner shall 
 publish in the State Register a list of elective surgeries that 
 require a second medical opinion prior to reimbursement, and the 
 criteria and standards for deciding whether an elective surgery 
 should require a second medical opinion.  The list and the 
 criteria and standards are not subject to the requirements of 
 sections 14.001 to 14.69.  The commissioner's decision whether a 
 second medical opinion is required, made in accordance with 
 rules governing that decision, is not subject to administrative 
 appeal. 

    Subd. 2.    Skilled and intermediate nursing care.  
 Medical assistance covers skilled nursing home services and 
 services of intermediate care facilities, including training and 
 habilitation services, as defined in section 252.41, subdivision 
 3, for persons with mental retardation or related conditions who 
 are residing in intermediate care facilities for persons with 
 mental retardation or related conditions.  Medical assistance 
 must not be used to pay the costs of nursing care provided to a 
 patient in a swing bed as defined in section 144.562, unless (a) 
 the facility in which the swing bed is located is eligible as a 
 sole community provider, as defined in Code of Federal 
 Regulations, title 42, section 412.92, or the facility is a 
 public hospital owned by a governmental entity with 15 or fewer 
 licensed acute care beds; (b) the health care financing 
 administration approves the necessary state plan amendments; (c) 
 the patient was screened as provided by law; (d) the patient no 
 longer requires acute care services; and (e) no nursing home 
 beds are available within 25 miles of the facility.  Medical 
 assistance also covers up to ten days of nursing care provided 
 to a patient in a swing bed if:  (1) the patient's physician 
 certifies that the patient has a terminal illness or condition 
 that is likely to result in death within 30 days and that moving 
 the patient would not be in the best interests of the patient 
 and patient's family; (2) no open nursing home beds are 
 available within 25 miles of the facility; and (3) no open beds 
 are available in any Medicare hospice program within 50 miles of 
 the facility.  The daily medical assistance payment for nursing 
 care for the patient in the swing bed is the statewide average 
 medical assistance skilled nursing care per diem as computed 
 annually by the commissioner on July 1 of each year. 

    Subd. 3.    Physicians' services.  Medical assistance 
 covers physicians' services.  Rates paid for anesthesiology 
 services provided by physicians shall be according to the 
 formula utilized in the Medicare program and shall use a 
 conversion factor "at percentile of calendar year set by 
 legislature." 

    Subd. 3a.    Gender reassignment surgery.  Gender 
 reassignment surgery and other gender reassignment medical 
 procedures including drug therapy for gender reassignment are 
 not covered unless the individual began receiving gender 
 reassignment services prior to July 1, 1998. 

    Subd. 3b.    Telemedicine consultations.  (a) Medical 
 assistance covers telemedicine consultations.  Telemedicine 
 consultations must be made via two-way, interactive video or 
 store-and-forward technology.  Store-and-forward technology 
 includes telemedicine consultations that do not occur in real 
 time via synchronous transmissions, and that do not require a 
 face-to-face encounter with the patient for all or any part of 
 any such telemedicine consultation.  The patient record must 
 include a written opinion from the consulting physician 
 providing the telemedicine consultation.  A communication 
 between two physicians that consists solely of a telephone 
 conversation is not a telemedicine consultation.  Coverage is 
 limited to three telemedicine consultations per recipient per 
 calendar week.  Telemedicine consultations shall be paid at the 
 full allowable rate. 

    (b) This subdivision expires July 1, 2001.  

    Subd. 4.    Outpatient and physician-directed clinic 
 services.  Medical assistance covers outpatient hospital or 
 physician-directed clinic services.  The physician-directed 
 clinic staff shall include at least two physicians and all 
 services shall be provided under the direct supervision of a 
 physician.  Hospital outpatient departments are subject to the 
 same limitations and reimbursements as other enrolled vendors 
 for all services, except initial triage, emergency services, and 
 services not provided or immediately available in clinics, 
 physicians' offices, or by other enrolled providers.  "Emergency 
 services" means those medical services required for the 
 immediate diagnosis and treatment of medical conditions that, if 
 not immediately diagnosed and treated, could lead to serious 
 physical or mental disability or death or are necessary to 
 alleviate severe pain.  Neither the hospital, its employees, nor 
 any physician or dentist, shall be liable in any action arising 
 out of a determination not to render emergency services or care 
 if reasonable care is exercised in determining the condition of 
 the person, or in determining the appropriateness of the 
 facilities, or the qualifications and availability of personnel 
 to render these services consistent with this section.  

    Subd. 4a.    Second medical opinion for surgery.  
 Certain surgeries require a second medical opinion to confirm 
 the necessity of the procedure, in order for reimbursement to be 
 made.  The commissioner shall publish in the State Register a 
 list of surgeries that require a second medical opinion and the 
 criteria and standards for deciding whether a surgery should 
 require a second medical opinion.  The list and the criteria and 
 standards are not subject to the requirements of sections 14.01 
 to 14.69.  The commissioner's decision about whether a second 
 medical opinion is required, made according to rules governing 
 that decision, is not subject to administrative appeal. 

    Subd. 5.    Community mental health center services.  
 Medical assistance covers community mental health center 
 services provided by a community mental health center that meets 
 the requirements in paragraphs (a) to (j). 

    (a) The provider is licensed under Minnesota Rules, parts 
 9520.0750 to 9520.0870.  

    (b) The provider provides mental health services under the 
 clinical supervision of a mental health professional who is 
 licensed for independent practice at the doctoral level or by a 
 board-certified psychiatrist or a psychiatrist who is eligible 
 for board certification.  Clinical supervision has the meaning 
 given in Minnesota Rules, part 9505.0323, subpart 1, item F.  

    (c) The provider must be a private nonprofit corporation or 
 a governmental agency and have a community board of directors as 
 specified by section 245.66.  

    (d) The provider must have a sliding fee scale that meets 
 the requirements in Minnesota Rules, part 9550.0060, and agree 
 to serve within the limits of its capacity all individuals 
 residing in its service delivery area.  

    (e) At a minimum, the provider must provide the following 
 outpatient mental health services:  diagnostic assessment; 
 explanation of findings; family, group, and individual 
 psychotherapy, including crisis intervention psychotherapy 
 services, multiple family group psychotherapy, psychological 
 testing, and medication management.  In addition, the provider 
 must provide or be capable of providing upon request of the 
 local mental health authority day treatment services and 
 professional home-based mental health services.  The provider 
 must have the capacity to provide such services to specialized 
 populations such as the elderly, families with children, persons 
 who are seriously and persistently mentally ill, and children 
 who are seriously emotionally disturbed.  

    (f) The provider must be capable of providing the services 
 specified in paragraph (e) to individuals who are diagnosed with 
 both mental illness or emotional disturbance, and chemical 
 dependency, and to individuals dually diagnosed with a mental 
 illness or emotional disturbance and mental retardation or a 
 related condition.  

    (g) The provider must provide 24-hour emergency care 
 services or demonstrate the capacity to assist recipients in 
 need of such services to access such services on a 24-hour basis.

    (h) The provider must have a contract with the local mental 
 health authority to provide one or more of the services 
 specified in paragraph (e).  

    (i) The provider must agree, upon request of the local 
 mental health authority, to enter into a contract with the 
 county to provide mental health services not reimbursable under 
 the medical assistance program.  

    (j) The provider may not be enrolled with the medical 
 assistance program as both a hospital and a community mental 
 health center.  The community mental health center's 
 administrative, organizational, and financial structure must be 
 separate and distinct from that of the hospital. 

    Subd. 6. Repealed, 1991 c 292 art 7 s 26 

    Subd. 6a.    Home health services.  Home health services 
 are those services specified in Minnesota Rules, part 9505.0290. 
 Medical assistance covers home health services at a recipient's 
 home residence.  Medical assistance does not cover home health 
 services for residents of a hospital, nursing facility, or 
 intermediate care facility, unless the commissioner of human 
 services has prior authorized skilled nurse visits for less than 
 90 days for a resident at an intermediate care facility for 
 persons with mental retardation, to prevent an admission to a 
 hospital or nursing facility or unless a resident who is 
 otherwise eligible is on leave from the facility and the 
 facility either pays for the home health services or forgoes the 
 facility per diem for the leave days that home health services 
 are used.  Home health services must be provided by a Medicare 
 certified home health agency.  All nursing and home health aide 
 services must be provided according to section 256B.0627. 

    Subd. 7.    Private duty nursing.  Medical assistance 
 covers private duty nursing services in a recipient's home.  
 Recipients who are authorized to receive private duty nursing 
 services in their home may use approved hours outside of the 
 home during hours when normal life activities take them outside 
 of their home and when, without the provision of private duty 
 nursing, their health and safety would be jeopardized.  To use 
 private duty nursing services at school, the recipient or 
 responsible party must provide written authorization in the care 
 plan identifying the chosen provider and the daily amount of 
 services to be used at school.  Medical assistance does not 
 cover private duty nursing services for residents of a hospital, 
 nursing facility, intermediate care facility, or a health care 
 facility licensed by the commissioner of health, except as 
 authorized in section 256B.64 for ventilator-dependent 
 recipients in hospitals or unless a resident who is otherwise 
 eligible is on leave from the facility and the facility either 
 pays for the private duty nursing services or forgoes the 
 facility per diem for the leave days that private duty nursing 
 services are used.  Total hours of service and payment allowed 
 for services outside the home cannot exceed that which is 
 otherwise allowed in an in-home setting according to section 
 256B.0627.  All private duty nursing services must be provided 
 according to the limits established under section 256B.0627.  
 Private duty nursing services may not be reimbursed if the nurse 
 is the spouse of the recipient or the parent or foster care 
 provider of a recipient who is under age 18, or the recipient's 
 legal guardian. 

    Subd. 8.    Physical therapy.  Medical assistance covers 
 physical therapy and related services, including specialized 
 maintenance therapy.  Services provided by a physical therapy 
 assistant shall be reimbursed at the same rate as services 
 performed by a physical therapist when the services of the 
 physical therapy assistant are provided under the direction of a 
 physical therapist who is on the premises.  Services provided by 
 a physical therapy assistant that are provided under the 
 direction of a physical therapist who is not on the premises 
 shall be reimbursed at 65 percent of the physical therapist rate.

    Subd. 8a.    Occupational therapy.  Medical assistance 
 covers occupational therapy and related services, including 
 specialized maintenance therapy.  Services provided by an 
 occupational therapy assistant shall be reimbursed at the same 
 rate as services performed by an occupational therapist when the 
 services of the occupational therapy assistant are provided 
 under the direction of the occupational therapist who is on the 
 premises.  Services provided by an occupational therapy 
 assistant that are provided under the direction of an 
 occupational therapist who is not on the premises shall be 
 reimbursed at 65 percent of the occupational therapist rate. 

    Subd. 8b.    Speech language pathology and audiology 
 services.  Medical assistance covers speech language pathology 
 and related services, including specialized maintenance 
 therapy.  Medical assistance covers audiology services and 
 related services.  Services provided by a person who has been 
 issued a temporary registration under section 148.5161 shall be 
 reimbursed at the same rate as services performed by a speech 
 language pathologist or audiologist as long as the requirements 
 of section 148.5161, subdivision 3, are met. 

    Subd. 8c.    Care management; rehabilitation services.  
 (a) Effective July 1, 1999, one-time thresholds shall replace 
 annual thresholds for provision of rehabilitation services 
 described in subdivisions 8, 8a, and 8b.  The one-time 
 thresholds will be the same in amount and description as the 
 thresholds prescribed by the department of human services health 
 care programs provider manual for calendar year 1997, except 
 they will not be renewed annually, and they will include sensory 
 skills and cognitive training skills. 

    (b) A care management approach for authorization of 
 services beyond the threshold shall be instituted in conjunction 
 with the one-time thresholds.  The care management approach 
 shall require the provider and the department rehabilitation 
 reviewer to work together directly through written 
 communication, or telephone communication when appropriate, to 
 establish a medically necessary care management plan. 
 Authorization for rehabilitation services shall include approval 
 for up to 12 months of services at a time without additional 
 documentation from the provider during the extended period, when 
 the rehabilitation services are medically necessary due to an 
 ongoing health condition. 

    (c) The commissioner shall implement an expedited five-day 
 turnaround time to review authorization requests for recipients 
 who need emergency rehabilitation services and who have 
 exhausted their one-time threshold limit for those services. 

    Subd. 9.    Dental services.  Medical assistance covers 
 dental services.  Dental services include, with prior 
 authorization, fixed cast metal restorations that are 
 cost-effective for persons who cannot use removable dentures 
 because of their medical condition. 

    Subd. 10.    Laboratory and x-ray services.  Medical 
 assistance covers laboratory and x-ray services. 

    Subd. 11.    Nurse anesthetist services.  Medical 
 assistance covers nurse anesthetist services.  Rates paid for 
 anesthesiology services provided by certified registered nurse 
 anesthetists shall be according to the formula utilized in the 
 Medicare program and shall use the conversion factor that is 
 used by the Medicare program. 

    Subd. 12.    Eyeglasses, dentures, and prosthetic devices. 
  Medical assistance covers eyeglasses, dentures, and 
 prosthetic devices if prescribed by a licensed practitioner.  

    Subd. 13.    Drugs.  (a) Medical assistance covers 
 drugs, except for fertility drugs when specifically used to 
 enhance fertility, if prescribed by a licensed practitioner and 
 dispensed by a licensed pharmacist, by a physician enrolled in 
 the medical assistance program as a dispensing physician, or by 
 a physician or a nurse practitioner employed by or under 
 contract with a community health board as defined in section 
 145A.02, subdivision 5, for the purposes of communicable disease 
 control.  The commissioner, after receiving recommendations from 
 professional medical associations and professional pharmacist 
 associations, shall designate a formulary committee to advise 
 the commissioner on the names of drugs for which payment is 
 made, recommend a system for reimbursing providers on a set fee 
 or charge basis rather than the present system, and develop 
 methods encouraging use of generic drugs when they are less 
 expensive and equally effective as trademark drugs.  The 
 formulary committee shall consist of nine members, four of whom 
 shall be physicians who are not employed by the department of 
 human services, and a majority of whose practice is for persons 
 paying privately or through health insurance, three of whom 
 shall be pharmacists who are not employed by the department of 
 human services, and a majority of whose practice is for persons 
 paying privately or through health insurance, a consumer 
 representative, and a nursing home representative.  Committee 
 members shall serve three-year terms and shall serve without 
 compensation.  Members may be reappointed once.  

    (b) The commissioner shall establish a drug formulary.  Its 
 establishment and publication shall not be subject to the 
 requirements of the Administrative Procedure Act, but the 
 formulary committee shall review and comment on the formulary 
 contents.  The formulary committee shall review and recommend 
 drugs which require prior authorization.  The formulary 
 committee may recommend drugs for prior authorization directly 
 to the commissioner, as long as opportunity for public input is 
 provided.  Prior authorization may be requested by the 
 commissioner based on medical and clinical criteria before 
 certain drugs are eligible for payment.  Before a drug may be 
 considered for prior authorization at the request of the 
 commissioner:  

    (1) the drug formulary committee must develop criteria to 
 be used for identifying drugs; the development of these criteria 
 is not subject to the requirements of chapter 14, but the 
 formulary committee shall provide opportunity for public input 
 in developing criteria; 

    (2) the drug formulary committee must hold a public forum 
 and receive public comment for an additional 15 days; and 

    (3) the commissioner must provide information to the 
 formulary committee on the impact that placing the drug on prior 
 authorization will have on the quality of patient care and 
 information regarding whether the drug is subject to clinical 
 abuse or misuse.  Prior authorization may be required by the 
 commissioner before certain formulary drugs are eligible for 
 payment.  The formulary shall not include:  

    (i) drugs or products for which there is no federal 
 funding; 

    (ii) over-the-counter drugs, except for antacids, 
 acetaminophen, family planning products, aspirin, insulin, 
 products for the treatment of lice, vitamins for adults with 
 documented vitamin deficiencies, vitamins for children under the 
 age of seven and pregnant or nursing women, and any other 
 over-the-counter drug identified by the commissioner, in 
 consultation with the drug formulary committee, as necessary, 
 appropriate, and cost-effective for the treatment of certain 
 specified chronic diseases, conditions or disorders, and this 
 determination shall not be subject to the requirements of 
 chapter 14; 

    (iii) anorectics, except that medically necessary 
 anorectics shall be covered for a recipient previously diagnosed 
 as having pickwickian syndrome and currently diagnosed as having 
 diabetes and being morbidly obese; 

    (iv) drugs for which medical value has not been 
 established; and 

    (v) drugs from manufacturers who have not signed a rebate 
 agreement with the Department of Health and Human Services 
 pursuant to section 1927 of title XIX of the Social Security Act.

    The commissioner shall publish conditions for prohibiting 
 payment for specific drugs after considering the formulary 
 committee's recommendations.  

    (c) The basis for determining the amount of payment shall 
 be the lower of the actual acquisition costs of the drugs plus a 
 fixed dispensing fee; the maximum allowable cost set by the 
 federal government or by the commissioner plus the fixed 
 dispensing fee; or the usual and customary price charged to the 
 public.  The pharmacy dispensing fee shall be $3.65.  Actual 
 acquisition cost includes quantity and other special discounts 
 except time and cash discounts.  The actual acquisition cost of 
 a drug shall be estimated by the commissioner, at average 
 wholesale price minus nine percent.  The maximum allowable cost 
 of a multisource drug may be set by the commissioner and it 
 shall be comparable to, but no higher than, the maximum amount 
 paid by other third-party payors in this state who have maximum 
 allowable cost programs.  The commissioner shall set maximum 
 allowable costs for multisource drugs that are not on the 
 federal upper limit list as described in United States Code, 
 title 42, chapter 7, section 1396r-8(e), the Social Security 
 Act, and Code of Federal Regulations, title 42, part 447, 
 section 447.332.  Establishment of the amount of payment for 
 drugs shall not be subject to the requirements of the 
 Administrative Procedure Act.  An additional dispensing fee of 
 $.30 may be added to the dispensing fee paid to pharmacists for 
 legend drug prescriptions dispensed to residents of long-term 
 care facilities when a unit dose blister card system, approved 
 by the department, is used.  Under this type of dispensing 
 system, the pharmacist must dispense a 30-day supply of drug.  
 The National Drug Code (NDC) from the drug container used to 
 fill the blister card must be identified on the claim to the 
 department.  The unit dose blister card containing the drug must 
 meet the packaging standards set forth in Minnesota Rules, part 
 6800.2700, that govern the return of unused drugs to the 
 pharmacy for reuse.  The pharmacy provider will be required to 
 credit the department for the actual acquisition cost of all 
 unused drugs that are eligible for reuse.  Over-the-counter 
 medications must be dispensed in the manufacturer's unopened 
 package.  The commissioner may permit the drug clozapine to be 
 dispensed in a quantity that is less than a 30-day supply.  
 Whenever a generically equivalent product is available, payment 
 shall be on the basis of the actual acquisition cost of the 
 generic drug, unless the prescriber specifically indicates 
 "dispense as written - brand necessary" on the prescription as 
 required by section 151.21, subdivision 2. 

    (d) For purposes of this subdivision, "multisource drugs" 
 means covered outpatient drugs, excluding innovator multisource 
 drugs for which there are two or more drug products, which: 

    (1) are related as therapeutically equivalent under the 
 Food and Drug Administration's most recent publication of 
 "Approved Drug Products with Therapeutic Equivalence 
 Evaluations"; 

    (2) are pharmaceutically equivalent and bioequivalent as 
 determined by the Food and Drug Administration; and 

    (3) are sold or marketed in Minnesota. 

 "Innovator multisource drug" means a multisource drug that was 
 originally marketed under an original new drug application 
 approved by the Food and Drug Administration. 

    Subd. 13a.    Drug utilization review board.  A 
 nine-member drug utilization review board is established.  The 
 board is comprised of at least three but no more than four 
 licensed physicians actively engaged in the practice of medicine 
 in Minnesota; at least three licensed pharmacists actively 
 engaged in the practice of pharmacy in Minnesota; and one 
 consumer representative; the remainder to be made up of health 
 care professionals who are licensed in their field and have 
 recognized knowledge in the clinically appropriate prescribing, 
 dispensing, and monitoring of covered outpatient drugs.  The 
 board shall be staffed by an employee of the department who 
 shall serve as an ex officio nonvoting member of the board.  The 
 members of the board shall be appointed by the commissioner and 
 shall serve three-year terms.  The members shall be selected 
 from lists submitted by professional associations.  The 
 commissioner shall appoint the initial members of the board for 
 terms expiring as follows:  three members for terms expiring 
 June 30, 1996; three members for terms expiring June 30, 1997; 
 and three members for terms expiring June 30, 1998.  Members may 
 be reappointed once.  The board shall annually elect a chair 
 from among the members. 

    The commissioner shall, with the advice of the board: 

    (1) implement a medical assistance retrospective and 
 prospective drug utilization review program as required by 
 United States Code, title 42, section 1396r-8(g)(3); 

    (2) develop and implement the predetermined criteria and 
 practice parameters for appropriate prescribing to be used in 
 retrospective and prospective drug utilization review; 

    (3) develop, select, implement, and assess interventions 
 for physicians, pharmacists, and patients that are educational 
 and not punitive in nature; 

    (4) establish a grievance and appeals process for 
 physicians and pharmacists under this section; 

    (5) publish and disseminate educational information to 
 physicians and pharmacists regarding the board and the review 
 program; 

    (6) adopt and implement procedures designed to ensure the 
 confidentiality of any information collected, stored, retrieved, 
 assessed, or analyzed by the board, staff to the board, or 
 contractors to the review program that identifies individual 
 physicians, pharmacists, or recipients; 

    (7) establish and implement an ongoing process to (i) 
 receive public comment regarding drug utilization review 
 criteria and standards, and (ii) consider the comments along 
 with other scientific and clinical information in order to 
 revise criteria and standards on a timely basis; and 

    (8) adopt any rules necessary to carry out this section. 

    The board may establish advisory committees.  The 
 commissioner may contract with appropriate organizations to 
 assist the board in carrying out the board's duties.  The 
 commissioner may enter into contracts for services to develop 
 and implement a retrospective and prospective review program. 

    The board shall report to the commissioner annually on the 
 date the Drug Utilization Review Annual Report is due to the 
 Health Care Financing Administration.  This report is to cover 
 the preceding federal fiscal year.  The commissioner shall make 
 the report available to the public upon request.  The report 
 must include information on the activities of the board and the 
 program; the effectiveness of implemented interventions; 
 administrative costs; and any fiscal impact resulting from the 
 program.  An honorarium of $50 per meeting shall be paid to each 
 board member in attendance.  

    Subd. 13b. Repealed, 1997 c 203 art 4 s 73 

    Subd. 14.    Diagnostic, screening, and preventive 
 services.  (a) Medical assistance covers diagnostic, 
 screening, and preventive services.  

    (b) "Preventive services" include services related to 
 pregnancy, including: 

    (1) services for those conditions which may complicate a 
 pregnancy and which may be available to a pregnant woman 
 determined to be at risk of poor pregnancy outcome; 

    (2) prenatal HIV risk assessment, education, counseling, 
 and testing; and 

    (3) alcohol abuse assessment, education, and counseling on 
 the effects of alcohol usage while pregnant.  Preventive 
 services available to a woman at risk of poor pregnancy outcome 
 may differ in an amount, duration, or scope from those available 
 to other individuals eligible for medical assistance. 

    (c) "Screening services" include, but are not limited to, 
 blood lead tests. 

    Subd. 15.    Health plan premiums and copayments.  (a) 
 Medical assistance covers health care prepayment plan premiums, 
 insurance premiums, and copayments if determined to be 
 cost-effective by the commissioner.  For purposes of obtaining 
 Medicare part A and part B, and copayments, expenditures may be 
 made even if federal funding is not available. 

    (b) Effective for all premiums due on or after June 30, 
 1997, medical assistance does not cover premiums that a 
 recipient is required to pay under a qualified or Medicare 
 supplement plan issued by the Minnesota comprehensive health 
 association.  Medical assistance shall continue to cover 
 premiums for recipients who are covered under a plan issued by 
 the Minnesota comprehensive health association on June 30, 1997, 
 for a period of six months following receipt of the notice of 
 termination or until December 31, 1997, whichever is later. 

    Subd. 16.    Abortion services.  Medical assistance 
 covers abortion services, but only if one of the following 
 conditions is met: 

    (a) The abortion is a medical necessity.  "Medical 
 necessity" means (1) the signed written statement of two 
 physicians indicating the abortion is medically necessary to 
 prevent the death of the mother, and (2) the patient has given 
 her consent to the abortion in writing unless the patient is 
 physically or legally incapable of providing informed consent to 
 the procedure, in which case consent will be given as otherwise 
 provided by law; 

    (b) The pregnancy is the result of criminal sexual conduct 
 as defined in section 609.342, clauses (c), (d), (e)(i), and 
 (f), and the incident is reported within 48 hours after the 
 incident occurs to a valid law enforcement agency for 
 investigation, unless the victim is physically unable to report 
 the criminal sexual conduct, in which case the report shall be 
 made within 48 hours after the victim becomes physically able to 
 report the criminal sexual conduct; or 

    (c) The pregnancy is the result of incest, but only if the 
 incident and relative are reported to a valid law enforcement 
 agency for investigation prior to the abortion. 

    Subd. 17.    Transportation costs.  (a) Medical 
 assistance covers transportation costs incurred solely for 
 obtaining emergency medical care or transportation costs 
 incurred by nonambulatory persons in obtaining emergency or 
 nonemergency medical care when paid directly to an ambulance 
 company, common carrier, or other recognized providers of 
 transportation services.  For the purpose of this subdivision, a 
 person who is incapable of transport by taxicab or bus shall be 
 considered to be nonambulatory. 

    (b) Medical assistance covers special transportation, as 
 defined in Minnesota Rules, part 9505.0315, subpart 1, item F, 
 if the provider receives and maintains a current physician's 
 order by the recipient's attending physician certifying that the 
 recipient has a physical or mental impairment that would 
 prohibit the recipient from safely accessing and using a bus, 
 taxi, other commercial transportation, or private automobile.  
 Special transportation includes driver-assisted service to 
 eligible individuals.  Driver-assisted service includes 
 passenger pickup at and return to the individual's residence or 
 place of business, assistance with admittance of the individual 
 to the medical facility, and assistance in passenger securement 
 or in securing of wheelchairs or stretchers in the vehicle.  The 
 commissioner shall establish maximum medical assistance 
 reimbursement rates for special transportation services for 
 persons who need a wheelchair lift van or stretcher-equipped 
 vehicle and for those who do not need a wheelchair lift van or 
 stretcher-equipped vehicle.  The average of these two rates per 
 trip must not exceed $15 for the base rate and $1.20 per mile.  
 Special transportation provided to nonambulatory persons who do 
 not need a wheelchair lift van or stretcher-equipped vehicle, 
 may be reimbursed at a lower rate than special transportation 
 provided to persons who need a wheelchair lift van or 
 stretcher-equipped vehicle. 

    Subd. 17a.    Payment for ambulance services.  Effective 
 for services rendered on or after July 1, 1999, medical 
 assistance payments for ambulance services shall be increased by 
 five percent.  

    Subd. 18.    Bus or taxicab transportation.  To the 
 extent authorized by rule of the state agency, medical 
 assistance covers costs of the most appropriate and 
 cost-effective form of transportation incurred by any ambulatory 
 eligible person for obtaining nonemergency medical care. 

    Subd. 18a.    Payment for meals and lodging.  (a) 
 Medical assistance reimbursement for meals for persons traveling 
 to receive medical care may not exceed $5.50 for breakfast, 
 $6.50 for lunch, or $8 for dinner. 

    (b) Medical assistance reimbursement for lodging for 
 persons traveling to receive medical care may not exceed $50 per 
 day unless prior authorized by the local agency. 

    (c) Medical assistance direct mileage reimbursement to the 
 eligible person or the eligible person's driver may not exceed 
 20 cents per mile. 

    Subd. 19. Repealed, 1991 c 292 art 7 s 26 

    Subd. 19a.    Personal care services.  Medical 
 assistance covers personal care services in a recipient's home.  
 To qualify for personal care services, recipients or responsible 
 parties must be able to identify the recipient's needs, direct 
 and evaluate task accomplishment, and provide for health and 
 safety.  Approved hours may be used outside the home when normal 
 life activities take them outside the home and when, without the 
 provision of personal care, their health and safety would be 
 jeopardized.  To use personal care services at school, the 
 recipient or responsible party must provide written 
 authorization in the care plan identifying the chosen provider 
 and the daily amount of services to be used at school.  Total 
 hours for services, whether actually performed inside or outside 
 the recipient's home, cannot exceed that which is otherwise 
 allowed for personal care services in an in-home setting 
 according to section 256B.0627.  Medical assistance does not 
 cover personal care services for residents of a hospital, 
 nursing facility, intermediate care facility, health care 
 facility licensed by the commissioner of health, or unless a 
 resident who is otherwise eligible is on leave from the facility 
 and the facility either pays for the personal care services or 
 forgoes the facility per diem for the leave days that personal 
 care services are used.  All personal care services must be 
 provided according to section 256B.0627.  Personal care services 
 may not be reimbursed if the personal care assistant is the 
 spouse or legal guardian of the recipient or the parent of a 
 recipient under age 18, or the responsible party or the foster 
 care provider of a recipient who cannot direct the recipient's 
 own care unless, in the case of a foster care provider, a county 
 or state case manager visits the recipient as needed, but not 
 less than every six months, to monitor the health and safety of 
 the recipient and to ensure the goals of the care plan are met.  
 Parents of adult recipients, adult children of the recipient or 
 adult siblings of the recipient may be reimbursed for personal 
 care services if they are not the recipient's legal guardian and 
 are granted a waiver under section 256B.0627.  Until July 1, 
 2001, and notwithstanding the provisions of section 256B.0627, 
 subdivision 4, paragraph (b), clause (4), the noncorporate legal 
 guardian or conservator of an adult, who is not the responsible 
 party and not the personal care provider organization, may be 
 granted a hardship waiver under section 256B.0627, to be 
 reimbursed to provide personal care assistant services to the 
 recipient, and shall not be considered to have a service 
 provider interest for purposes of participation on the screening 
 team under section 256B.092, subdivision 7. 

    Subd. 19b.    No automatic adjustment.  For fiscal years 
 beginning on or after July 1, 1993, the commissioner of human 
 services shall not provide automatic annual inflation 
 adjustments for home care services.  The commissioner of finance 
 shall include as a budget change request in each biennial 
 detailed expenditure budget submitted to the legislature under 
 section 16A.11 annual adjustments in reimbursement rates for 
 home care services. 

    Subd. 19c.    Personal care.  Medical assistance covers 
 personal care services provided by an individual who is 
 qualified to provide the services according to subdivision 19a 
 and section 256B.0627, where the services are prescribed by a 
 physician in accordance with a plan of treatment and are 
 supervised by the recipient under the fiscal agent option 
 according to section 256B.0627, subdivision 10, or a qualified 
 professional.  "Qualified professional" means a mental health 
 professional as defined in section 245.462, subdivision 18, or 
 245.4871, subdivision 27; or a registered nurse as defined in 
 sections 148.171 to 148.285.  As part of the assessment, the 
 county public health nurse will consult with the recipient or 
 responsible party and identify the most appropriate person to 
 provide supervision of the personal care assistant.  The 
 qualified professional shall perform the duties described in 
 Minnesota Rules, part 9505.0335, subpart 4.  

    Subd. 20.    Mental health case management.  (a) To the 
 extent authorized by rule of the state agency, medical 
 assistance covers case management services to persons with 
 serious and persistent mental illness and children with severe 
 emotional disturbance.  Services provided under this section 
 must meet the relevant standards in sections 245.461 to 
 245.4888, the Comprehensive Adult and Children's Mental Health 
 Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and 
 9505.0322, excluding subpart 10. 

    (b) Entities meeting program standards set out in rules 
 governing family community support services as defined in 
 section 245.4871, subdivision 17, are eligible for medical 
 assistance reimbursement for case management services for 
 children with severe emotional disturbance when these services 
 meet the program standards in Minnesota Rules, parts 9520.0900 
 to 9520.0926 and 9505.0322, excluding subparts 6 and 10. 

    (c) Medical assistance and MinnesotaCare payment for mental 
 health case management shall be made on a monthly basis.  In 
 order to receive payment for an eligible child, the provider 
 must document at least a face-to-face contact with the child, 
 the child's parents, or the child's legal representative.  To 
 receive payment for an eligible adult, the provider must 
 document: 

    (1) at least a face-to-face contact with the adult or the 
 adult's legal representative; or 

    (2) at least a telephone contact with the adult or the 
 adult's legal representative and document a face-to-face contact 
 with the adult or the adult's legal representative within the 
 preceding two months. 

    (d) Payment for mental health case management provided by 
 county or state staff shall be based on the monthly rate 
 methodology under section 256B.094, subdivision 6, paragraph 
 (b), with separate rates calculated for child welfare and mental 
 health, and within mental health, separate rates for children 
 and adults. 

    (e) Payment for mental health case management provided by 
 county-contracted vendors shall be based on a monthly rate 
 negotiated by the host county.  The negotiated rate must not 
 exceed the rate charged by the vendor for the same service to 
 other payers.  If the service is provided by a team of 
 contracted vendors, the county may negotiate a team rate with a 
 vendor who is a member of the team.  The team shall determine 
 how to distribute the rate among its members.  No reimbursement 
 received by contracted vendors shall be returned to the county, 
 except to reimburse the county for advance funding provided by 
 the county to the vendor. 

    (f) If the service is provided by a team which includes 
 contracted vendors and county or state staff, the costs for 
 county or state staff participation in the team shall be 
 included in the rate for county-provided services.  In this 
 case, the contracted vendor and the county may each receive 
 separate payment for services provided by each entity in the 
 same month.  In order to prevent duplication of services, the 
 county must document, in the recipient's file, the need for team 
 case management and a description of the roles of the team 
 members. 

    (g) The commissioner shall calculate the nonfederal share 
 of actual medical assistance and general assistance medical care 
 payments for each county, based on the higher of calendar year 
 1995 or 1996, by service date, project that amount forward to 
 1999, and transfer one-half of the result from medical 
 assistance and general assistance medical care to each county's 
 mental health grants under sections 245.4886 and 256E.12 for 
 calendar year 1999.  The annualized minimum amount added to each 
 county's mental health grant shall be $3,000 per year for 
 children and $5,000 per year for adults.  The commissioner may 
 reduce the statewide growth factor in order to fund these 
 minimums.  The annualized total amount transferred shall become 
 part of the base for future mental health grants for each county.

    (h) Any net increase in revenue to the county as a result 
 of the change in this section must be used to provide expanded 
 mental health services as defined in sections 245.461 to 
 245.4888, the Comprehensive Adult and Children's Mental Health 
 Acts, excluding inpatient and residential treatment.  For 
 adults, increased revenue may also be used for services and 
 consumer supports which are part of adult mental health projects 
 approved under Laws 1997, chapter 203, article 7, section 25.  
 For children, increased revenue may also be used for respite 
 care and nonresidential individualized rehabilitation services 
 as defined in section 245.492, subdivisions 17 and 23.  
 "Increased revenue" has the meaning given in Minnesota Rules, 
 part 9520.0903, subpart 3.  

    (i) Notwithstanding section 256B.19, subdivision 1, the 
 nonfederal share of costs for mental health case management 
 shall be provided by the recipient's county of responsibility, 
 as defined in sections 256G.01 to 256G.12, from sources other 
 than federal funds or funds used to match other federal funds.  

    (j) The commissioner may suspend, reduce, or terminate the 
 reimbursement to a provider that does not meet the reporting or 
 other requirements of this section.  The county of 
 responsibility, as defined in sections 256G.01 to 256G.12, is 
 responsible for any federal disallowances.  The county may share 
 this responsibility with its contracted vendors.  

    (k) The commissioner shall set aside a portion of the 
 federal funds earned under this section to repay the special 
 revenue maximization account under section 256.01, subdivision 
 2, clause (15).  The repayment is limited to: 

    (1) the costs of developing and implementing this section; 
 and 

    (2) programming the information systems. 

    (l) Notwithstanding section 256.025, subdivision 2, 
 payments to counties for case management expenditures under this 
 section shall only be made from federal earnings from services 
 provided under this section.  Payments to contracted vendors 
 shall include both the federal earnings and the county share. 

    (m) Notwithstanding section 256B.041, county payments for 
 the cost of mental health case management services provided by 
 county or state staff shall not be made to the state treasurer.  
 For the purposes of mental health case management services 
 provided by county or state staff under this section, the 
 centralized disbursement of payments to counties under section 
 256B.041 consists only of federal earnings from services 
 provided under this section. 

    (n) Case management services under this subdivision do not 
 include therapy, treatment, legal, or outreach services. 

    (o) If the recipient is a resident of a nursing facility, 
 intermediate care facility, or hospital, and the recipient's 
 institutional care is paid by medical assistance, payment for 
 case management services under this subdivision is limited to 
 the last 30 days of the recipient's residency in that facility 
 and may not exceed more than two months in a calendar year. 

    (p) Payment for case management services under this 
 subdivision shall not duplicate payments made under other 
 program authorities for the same purpose. 

    (q) By July 1, 2000, the commissioner shall evaluate the 
 effectiveness of the changes required by this section, including 
 changes in number of persons receiving mental health case 
 management, changes in hours of service per person, and changes 
 in caseload size. 

    (r) For each calendar year beginning with the calendar year 
 2001, the annualized amount of state funds for each county 
 determined under paragraph (g) shall be adjusted by the county's 
 percentage change in the average number of clients per month who 
 received case management under this section during the fiscal 
 year that ended six months prior to the calendar year in 
 question, in comparison to the prior fiscal year. 

    (s) For counties receiving the minimum allocation of $3,000 
 or $5,000 described in paragraph (g), the adjustment in 
 paragraph (r) shall be determined so that the county receives 
 the higher of the following amounts: 

    (1) a continuation of the minimum allocation in paragraph 
 (g); or 

    (2) an amount based on that county's average number of 
 clients per month who received case management under this 
 section during the fiscal year that ended six months prior to 
 the calendar year in question, in comparison to the prior fiscal 
 year, times the average statewide grant per person per month for 
 counties not receiving the minimum allocation. 

    (t) The adjustments in paragraphs (r) and (s) shall be 
 calculated separately for children and adults. 

    Subd. 20a.    Case management for persons with mental 
 retardation or a related condition.  To the extent defined in 
 the state Medicaid plan, case management service activities for 
 persons with mental retardation or a related condition as 
 defined in section 256B.092, and rules promulgated thereunder, 
 are covered services under medical assistance.  

    Subd. 21. Repealed, 1989 c 282 art 3 s 98 

    Subd. 22.    Hospice care.  Medical assistance covers 
 hospice care services under Public Law Number 99-272, section 
 9505, to the extent authorized by rule. 

    Subd. 23.    Day treatment services.  Medical assistance 
 covers day treatment services as specified in sections 245.462, 
 subdivision 8, and 245.4871, subdivision 10, that are provided 
 under contract with the county board. 

    Subd. 24.    Other medical or remedial care.  Medical 
 assistance covers any other medical or remedial care licensed 
 and recognized under state law unless otherwise prohibited by 
 law, except licensed chemical dependency treatment programs or 
 primary treatment or extended care treatment units in hospitals 
 that are covered under chapter 254B.  The commissioner shall 
 include chemical dependency services in the state medical 
 assistance plan for federal reporting purposes, but payment must 
 be made under chapter 254B.  The commissioner shall publish in 
 the State Register a list of elective surgeries that require a 
 second medical opinion before medical assistance reimbursement, 
 and the criteria and standards for deciding whether an elective 
 surgery should require a second medical opinion.  The list and 
 criteria and standards are not subject to the requirements of 
 sections 14.01 to 14.69.  

    Subd. 25.    Prior authorization required.  The 
 commissioner shall publish in the State Register a list of 
 health services that require prior authorization, as well as the 
 criteria and standards used to select health services on the 
 list.  The list and the criteria and standards used to formulate 
 it are not subject to the requirements of sections 14.001 to 
 14.69.  The commissioner's decision whether prior authorization 
 is required for a health service is not subject to 
 administrative appeal. 

    Subd. 26.    Special education services.  (a) Medical 
 assistance covers medical services identified in a recipient's 
 individualized education plan and covered under the medical 
 assistance state plan.  Covered services include occupational 
 therapy, physical therapy, speech-language therapy, clinical 
 psychological services, nursing services, school psychological 
 services, school social work services, personal care assistants 
 serving as management aides, assistive technology devices, 
 transportation services, and other services covered under the 
 medical assistance state plan.  Mental health services eligible 
 for medical assistance reimbursement must be provided or 
 coordinated through a children's mental health collaborative 
 where a collaborative exists if the child is included in the 
 collaborative operational target population.  The provision or 
 coordination of services does not require that the individual 
 education plan be developed by the collaborative. 

    The services may be provided by a Minnesota school district 
 that is enrolled as a medical assistance provider or its 
 subcontractor, and only if the services meet all the 
 requirements otherwise applicable if the service had been 
 provided by a provider other than a school district, in the 
 following areas:  medical necessity, physician's orders, 
 documentation, personnel qualifications, and prior authorization 
 requirements.  The nonfederal share of costs for services 
 provided under this subdivision is the responsibility of the 
 local school district as provided in section 125A.74.  Services 
 listed in a child's individual education plan are eligible for 
 medical assistance reimbursement only if those services meet 
 criteria for federal financial participation under the Medicaid 
 program.  

    (b) Approval of health-related services for inclusion in 
 the individual education plan does not require prior 
 authorization for purposes of reimbursement under this chapter.  
 The commissioner may require physician review and approval of 
 the plan not more than once annually or upon any modification of 
 the individual education plan that reflects a change in 
 health-related services. 

    (c) Services of a speech-language pathologist provided 
 under this section are covered notwithstanding Minnesota Rules, 
 part 9505.0390, subpart 1, item L, if the person: 

    (1) holds a masters degree in speech-language pathology; 

    (2) is licensed by the Minnesota board of teaching as an 
 educational speech-language pathologist; and 

    (3) either has a certificate of clinical competence from 
 the American Speech and Hearing Association, has completed the 
 equivalent educational requirements and work experience 
 necessary for the certificate or has completed the academic 
 program and is acquiring supervised work experience to qualify 
 for the certificate. 

    (d) Medical assistance coverage for medically necessary 
 services provided under other subdivisions in this section may 
 not be denied solely on the basis that the same or similar 
 services are covered under this subdivision. 

    (e) The commissioner shall develop and implement package 
 rates, bundled rates, or per diem rates for special education 
 services under which separately covered services are grouped 
 together and billed as a unit in order to reduce administrative 
 complexity.  

    (f) The commissioner shall develop a cost-based payment 
 structure for payment of these services.  

    (g) Effective July 1, 2000, medical assistance services 
 provided under an individual education plan or an individual 
 family service plan by local school districts shall not count 
 against medical assistance authorization thresholds for that 
 child. 

    Subd. 27.    Organ and tissue transplants.  Medical 
 assistance coverage for organ transplant procedures is limited 
 to those procedures covered by the Medicare program; heart-lung 
 transplants for persons with primary pulmonary hypertension and 
 performed at Minnesota transplant centers meeting united network 
 for organ sharing criteria to perform heart-lung transplants; 
 lung transplants using cadaveric donors and performed at 
 Minnesota transplant centers meeting united network for organ 
 sharing criteria to perform lung transplants; pancreas 
 transplants for uremic diabetic recipients of kidney transplants 
 and performed at Minnesota facilities meeting united network for 
 organ sharing criteria to perform pancreas transplants; and 
 allogenic bone marrow transplants for persons with stage III or 
 IV Hodgkin's disease.  Transplant procedures must comply with 
 all applicable laws, rules, and regulations governing (1) 
 coverage by the Medicare program, (2) federal financial 
 participation by the Medicaid program, and (3) coverage by the 
 Minnesota medical assistance program.  Transplant centers must 
 meet american society of hematology and clinical oncology 
 criteria for bone marrow transplants and be located in Minnesota 
 to receive reimbursement for bone marrow transplants. 

    Subd. 28.    Certified nurse practitioner services.  
 Medical assistance covers services performed by a certified 
 pediatric nurse practitioner, a certified family nurse 
 practitioner, a certified adult nurse practitioner, a certified 
 obstetric/gynecological nurse practitioner, a certified neonatal 
 nurse practitioner, or a certified geriatric nurse practitioner 
 in independent practice, if:  

    (1) the service provided on an inpatient basis is not 
 included as part of the cost for inpatient services included in 
 the operating payment rate; 

    (2) the service is otherwise covered under this chapter as 
 a physician service; and 

    (3) the service is within the scope of practice of the 
 nurse practitioner's license as a registered nurse, as defined 
 in section 148.171. 

    Subd. 28a.    Registered physician assistant services.  
 Medical assistance covers services performed by a registered 
 physician assistant if the service is otherwise covered under 
 this chapter as a physician service and if the service is within 
 the scope of practice of a registered physician assistant as 
 defined in section 147A.09. 

    Subd. 29.    Public health nursing clinic services.  
 Medical assistance covers the services of a certified public 
 health nurse or a registered nurse practicing in a public health 
 nursing clinic that is a department of, or that operates under 
 the direct authority of, a unit of government, if the service is 
 within the scope of practice of the public health or registered 
 nurse's license as a registered nurse, as defined in section 
 148.171. 

    Subd. 30.    Other clinic services.  (a) Medical 
 assistance covers rural health clinic services, federally 
 qualified health center services, nonprofit community health 
 clinic services, public health clinic services, and the services 
 of a clinic meeting the criteria established in rule by the 
 commissioner.  Rural health clinic services and federally 
 qualified health center services mean services defined in United 
 States Code, title 42, section 1396d(a)(2)(B) and (C).  Payment 
 for rural health clinic and federally qualified health center 
 services shall be made according to applicable federal law and 
 regulation. 

    (b) A federally qualified health center that is beginning 
 initial operation shall submit an estimate of budgeted costs and 
 visits for the initial reporting period in the form and detail 
 required by the commissioner.  A federally qualified health 
 center that is already in operation shall submit an initial 
 report using actual costs and visits for the initial reporting 
 period.  Within 90 days of the end of its reporting period, a 
 federally qualified health center shall submit, in the form and 
 detail required by the commissioner, a report of its operations, 
 including allowable costs actually incurred for the period and 
 the actual number of visits for services furnished during the 
 period, and other information required by the commissioner.  
 Federally qualified health centers that file Medicare cost 
 reports shall provide the commissioner with a copy of the most 
 recent Medicare cost report filed with the Medicare program 
 intermediary for the reporting year which support the costs 
 claimed on their cost report to the state. 

    (c) In order to continue cost-based payment under the 
 medical assistance program according to paragraphs (a) and (b), 
 a federally qualified health center or rural health clinic must 
 apply for designation as an essential community provider within 
 six months of final adoption of rules by the department of 
 health according to section 62Q.19, subdivision 7.  For those 
 federally qualified health centers and rural health clinics that 
 have applied for essential community provider status within the 
 six-month time prescribed, medical assistance payments will 
 continue to be made according to paragraphs (a) and (b) for the 
 first three years after application.  For federally qualified 
 health centers and rural health clinics that either do not apply 
 within the time specified above or who have had essential 
 community provider status for three years, medical assistance 
 payments for health services provided by these entities shall be 
 according to the same rates and conditions applicable to the 
 same service provided by health care providers that are not 
 federally qualified health centers or rural health clinics.  

    (d) Effective July 1, 1999, the provisions of paragraph (c) 
 requiring a federally qualified health center or a rural health 
 clinic to make application for an essential community provider 
 designation in order to have cost-based payments made according 
 to paragraphs (a) and (b) no longer apply. 

    (e) Effective January 1, 2000, payments made according to 
 paragraphs (a) and (b) shall be limited to the cost phase-out 
 schedule of the Balanced Budget Act of 1997. 

    Subd. 31.    Medical supplies and equipment.  Medical 
 assistance covers medical supplies and equipment.  Separate 
 payment outside of the facility's payment rate shall be made for 
 wheelchairs and wheelchair accessories for recipients who are 
 residents of intermediate care facilities for the mentally 
 retarded.  Reimbursement for wheelchairs and wheelchair 
 accessories for ICF/MR recipients shall be subject to the same 
 conditions and limitations as coverage for recipients who do not 
 reside in institutions.  A wheelchair purchased outside of the 
 facility's payment rate is the property of the recipient. 

    Subd. 31a.    Augmentative and alternative communication 
 systems.  (a) Medical assistance covers augmentative and 
 alternative communication systems consisting of electronic or 
 nonelectronic devices and the related components necessary to 
 enable a person with severe expressive communication limitations 
 to produce or transmit messages or symbols in a manner that 
 compensates for that disability. 

    (b) Until the volume of systems purchased increases to 
 allow a discount price, the commissioner shall reimburse 
 augmentative and alternative communication manufacturers and 
 vendors at the manufacturer's suggested retail price for 
 augmentative and alternative communication systems and related 
 components.  The commissioner shall separately reimburse 
 providers for purchasing and integrating individual 
 communication systems which are unavailable as a package from an 
 augmentative and alternative communication vendor. 

    (c) Reimbursement rates established by this purchasing 
 program are not subject to Minnesota Rules, part 9505.0445, item 
 S or T. 

    Subd. 32.    Nutritional products.  Medical assistance 
 covers nutritional products needed for nutritional 
 supplementation because solid food or nutrients thereof cannot 
 be properly absorbed by the body or needed for treatment of 
 phenylketonuria, hyperlysinemia, maple syrup urine disease, a 
 combined allergy to human milk, cow's milk, and soy formula, or 
 any other childhood or adult diseases, conditions, or disorders 
 identified by the commissioner as requiring a similarly 
 necessary nutritional product.  Nutritional products needed for 
 the treatment of a combined allergy to human milk, cow's milk, 
 and soy formula require prior authorization.  Separate payment 
 shall not be made for nutritional products for residents of 
 long-term care facilities.  Payment for dietary requirements is 
 a component of the per diem rate paid to these facilities. 

    Subd. 33.    Child welfare targeted case management.  
 Medical assistance, subject to federal approval, covers child 
 welfare targeted case management services as defined in section 
 256B.094 to children under age 21 who have been assessed and 
 determined in accordance with section 256F.095 to be:  

    (1) at risk of placement or in placement as defined in 
 section 260C.212, subdivision 1; 

    (2) at risk of maltreatment or experiencing maltreatment as 
 defined in section 626.556, subdivision 10e; or 

    (3) in need of protection or services as defined in section 
 260C.007, subdivision 4. 

    Subd. 34.    Indian health services facilities.  Medical 
 assistance payments to facilities of the Indian health service 
 and facilities operated by a tribe or tribal organization under 
 funding authorized by United States Code, title 25, sections 
 450f to 450n, or title III of the Indian Self-Determination and 
 Education Assistance Act, Public Law Number 93-638, shall be at 
 the option of the facility in accordance with the rate published 
 by the United States Assistant Secretary for Health under the 
 authority of United States Code, title 42, sections 248(a) and 
 249(b).  General assistance medical care payments to facilities 
 of the Indian health services and facilities operated by a tribe 
 or tribal organization for the provision of outpatient medical 
 care services billed after June 30, 1990, must be in accordance 
 with the general assistance medical care rates paid for the same 
 services when provided in a facility other than a facility of 
 the Indian health service or a facility operated by a tribe or 
 tribal organization. 

    Subd. 35.    Family community support services.  Medical 
 assistance covers family community support services as defined 
 in section 245.4871, subdivision 17.  In addition to the 
 provisions of section 245.4871, and to the extent authorized by 
 rules promulgated by the state agency, medical assistance covers 
 the following services as family community support services: 

    (1) services identified in an individual treatment plan 
 when provided by a trained mental health behavioral aide under 
 the direction of a mental health practitioner or mental health 
 professional; 

    (2) mental health crisis intervention and crisis 
 stabilization services provided outside of hospital inpatient 
 settings; and 

    (3) the therapeutic components of preschool and therapeutic 
 camp programs. 

    Subd. 36.    Therapeutic support of foster care.  
 Medical assistance covers therapeutic support of foster care as 
 defined in section 245.4871, subdivision 34. 

    Subd. 37.    Individualized rehabilitation services.  
 Medical assistance covers individualized rehabilitation services 
 as defined in section 245.492, subdivision 23, that are provided 
 by a collaborative, county, or an entity under contract with a 
 county through an integrated service system, as described in 
 section 245.4931, that is approved by the state coordinating 
 council, subject to federal approval. 

    Subd. 38.    Payments for mental health services.  
 Payments for mental health services covered under the medical 
 assistance program that are provided by masters-prepared mental 
 health professionals shall be 80 percent of the rate paid to 
 doctoral-prepared professionals.  Payments for mental health 
 services covered under the medical assistance program that are 
 provided by masters-prepared mental health professionals 
 employed by community mental health centers shall be 100 percent 
 of the rate paid to doctoral-prepared professionals.  For 
 purposes of reimbursement of mental health professionals under 
 the medical assistance program, all social workers who: 

    (1) have received a master's degree in social work from a 
 program accredited by the council on social work education; 

    (2) are licensed at the level of graduate social worker or 
 independent social worker; and 

    (3) are practicing clinical social work under appropriate 
 supervision, as defined by section 148B.18; meet all 
 requirements under Minnesota Rules, part 9505.0323, subpart 24, 
 and shall be paid accordingly.  

    Subd. 39.    Childhood immunizations.  Providers who 
 administer pediatric vaccines within the scope of their 
 licensure, and who are enrolled as a medical assistance 
 provider, must enroll in the pediatric vaccine administration 
 program established by section 13631 of the Omnibus Budget 
 Reconciliation Act of 1993.  Medical assistance shall pay an 
 $8.50 fee per dose for administration of the vaccine to children 
 eligible for medical assistance.  Medical assistance does not 
 pay for vaccines that are available at no cost from the 
 pediatric vaccine administration program. 

    Subd. 40.    Tuberculosis related services.  (a) For 
 persons infected with tuberculosis, medical assistance covers 
 case management services and direct observation of the intake of 
 drugs prescribed to treat tuberculosis. 

    (b) "Case management services" means services furnished to 
 assist persons infected with tuberculosis in gaining access to 
 needed medical services.  Case management services include at a 
 minimum: 

    (1) assessing a person's need for medical services to treat 
 tuberculosis; 

    (2) developing a care plan that addresses the needs 
 identified in clause (1); 

    (3) assisting the person in accessing medical services 
 identified in the care plan; and 

    (4) monitoring the person's compliance with the care plan 
 to ensure completion of tuberculosis therapy.  Medical 
 assistance covers case management services under this 
 subdivision only if the services are provided by a certified 
 public health nurse who is employed by a community health board 
 as defined in section 145A.02, subdivision 5. 

    (c) To be covered by medical assistance, direct observation 
 of the intake of drugs prescribed to treat tuberculosis must be 
 provided by a community outreach worker, licensed practical 
 nurse, registered nurse who is trained and supervised by a 
 public health nurse employed by a community health board as 
 defined in section 145A.02, subdivision 5, or a public health 
 nurse employed by a community health board. 

    Subd. 41.    Residential services for children with severe 
 emotional disturbance.  Medical assistance covers 
 rehabilitative services in accordance with section 256B.0945 
 that are provided by a county through a residential facility, 
 for children who have been diagnosed with severe emotional 
 disturbance and have been determined to require the level of 
 care provided in a residential facility. 

    Subd. 42.    Mental health professional.  
 Notwithstanding Minnesota Rules, part 9505.0175, subpart 28, the 
 definition of a mental health professional shall include a 
 person who is qualified as specified in section 245.462, 
 subdivision 18, clause (5); or 245.4871, subdivision 27, clause 
 (5), for the purpose of this section and Minnesota Rules, parts 
 9505.0170 to 9505.0475.  

    HIST: Ex1967 c 16 s 2; 1969 c 395 s 1; 1973 c 717 s 17; 1975 c 
 247 s 9; 1975 c 384 s 1; 1975 c 437 art 2 s 3; 1976 c 173 s 56; 
 1976 c 236 s 1; 1976 c 312 s 1; 1978 c 508 s 2; 1978 c 560 s 10; 
 1981 c 360 art 2 s 26,54; 1Sp1981 c 2 s 12; 1Sp1981 c 4 art 4 s 
 22; 3Sp1981 c 2 art 1 s 31; 1982 c 562 s 2; 1983 c 151 s 1,2; 
 1983 c 312 art 1 s 27; art 5 s 10; art 9 s 4; 1984 c 654 art 5 s 
 58; 1985 c 21 s 52-54; 1985 c 49 s 41; 1985 c 252 s 19,20; 
 1Sp1985 c 3 s 19; 1986 c 394 s 17; 1986 c 444; 1987 c 309 s 24; 
 1987 c 370 art 1 s 3; art 2 s 4; 1987 c 374 s 1; 1987 c 403 art 
 2 s 73,74; art 5 s 16; 1988 c 689 art 2 s 141,268; 1989 c 282 
 art 3 s 54-58; 1990 c 422 s 10; 1990 c 568 art 3 s 43-50,104; 
 1991 c 199 art 2 s 1; 1991 c 292 art 4 s 41-49; art 6 s 45; art 
 7 s 5,9-11; 1992 c 391 s 1,2; 1992 c 513 art 7 s 43-49; art 9 s 
 25; 1993 c 246 s 1,2; 1993 c 247 art 4 s 11; 1993 c 345 art 13 s 
 1; 1Sp1993 c 1 art 3 s 23; art 5 s 36-49; art 7 s 41-44; art 9 s 
 71; 1Sp1993 c 6 s 10; 1994 c 465 art 3 s 52; 1994 c 625 art 8 s 
 72; 1995 c 178 art 2 s 26; 1995 c 207 art 6 s 38-51; art 8 s 33; 
 1995 c 234 art 6 s 38; 1995 c 263 s 10; 1996 c 451 art 2 s 20; 
 art 5 s 15,16; 1997 c 203 art 2 s 25; art 4 s 25,26; 1997 c 225 
 art 4 s 3; art 6 s 5,8; 1998 c 398 art 2 s 46; 1998 c 407 art 4 
 s 20-28; 1999 c 86 art 2 s 4; 1999 c 139 art 4 s 2; 1999 c 245 
 art 4 s 37-49,121; art 5 s 20; art 8 s 5,87; art 10 s 10; 2000 c 
 298 s 3; 2000 c 347 s 1; 2000 c 474 s 6,7; 2000 c 488 art 9 s 16 

*   NOTE:  The medical assistance drug formulary committee 
*expires June 30, 2001.  Section 15.059, subdivision 5a.