9505 HEALTH CARE PROGRAMS

9505.0016 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0020 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0030 RESIDENCY REQUIREMENTS. Subpart 1. Minnesota residency required. Eligibility for medical assistance is limited to Minnesota residents or persons presumed to be Minnesota residents under Code of Federal Regulations, title 42, section 435.403. A Minnesota resident is: A. …

9505.0040 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0044 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0045 RESIDENTS OF INSTITUTIONS FOR TREATMENT OF MENTAL DISEASES. A resident of an institution for the treatment of mental diseases is eligible for medical assistance only if the resident is receiving inpatient psychiatric care in a psychiatric facility accredited by the join…

9505.0050 PERSONS DETAINED BY LAW. A person, regardless of age, who is detained by law in the custody of a correctional or detention facility as a person accused or convicted of a crime is not eligible for medical assistance. A resident of a correctional facility who is furloughe…

9505.0055 EFFECT OF PUBLIC ASSISTANCE STATUS ON MEDICAL ASSISTANCE ELIGIBILITY. Subpart 1. [Repealed, 26 SR 977] Subp. 2. [Repealed, 26 SR 977] Subp. 3. [Repealed, 26 SR 977] Subp. 4. [Repealed, 26 SR 977] Subp. 5. Child in foster care. A child whose foster care is paid under tit…

9505.0058 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0059 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0060 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0061 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0062 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0063 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0064 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0065 INCOME. Subpart 1. Income eligibility standard. Income becomes an asset if it is retained beyond the month in which it is received. Subp. 2. [Repealed, 26 SR 977] Subp. 3. [Repealed, 26 SR 977] Subp. 4. [Repealed, 26 SR 977] Subp. 5. [Repealed, 26 SR 977] Subp. 6. [Repe…

9505.0070 THIRD-PARTY LIABILITY. Subpart 1. Definition. For purposes of parts 9505.0070 and 9505.0071, "assignment" or "assignment of benefits" means the written authorization by a person, the person's authorized representative, a policyholder, or other authorized representative,…

9505.0071 ASSIGNMENT OF RIGHTS. Subpart 1. Notification to local agency. A person or the person's authorized representative shall notify the local agency of the availability of third-party payer coverage at the time of application, at the time of an eligibility redetermination, a…

9505.0075 Subpart 1. [Repealed, 26 SR 977] Subp. 2. [Repealed, 26 SR 977] Subp. 3. [Repealed, 26 SR 977] Subp. 4. [Repealed, 16 SR 2780] Subp. 5. [Repealed, 26 SR 977] Subp. 6. [Repealed, 26 SR 977] Subp. 7. [Repealed, 26 SR 977] Subp. 8. [Repealed, 26 SR 977] Subp. 9. [Repealed,…

9505.0080 COOPERATION WITH QUALITY CONTROL REVIEW. Subpart 1. Cooperation required. A recipient, or the recipient's authorized representative or guardian, shall cooperate with the department's quality control review process by providing information necessary to verify the recipie…

9505.0085 RIGHT TO APPLY; MAKING APPLICATION. Subpart 1. Applying for medical assistance. Any person or the person's authorized representative may apply for medical assistance at the local agency in the county of the person's residence, or in the county of the authorized represen…

9505.0090 LOCAL AGENCY ACTION ON APPLICATION. Subpart 1. [Repealed, 26 SR 977] Subp. 2. Time limit for agency action. The local agency shall act on an application for medical assistance no later than 45 days from the date of a medical assistance application on behalf of a person …

9505.0095 VERIFICATION OF ELIGIBILITY INFORMATION. The local agency shall verify the eligibility factors, in determining the medical assistance eligibility of the applicant. The local agency must not require an applicant or recipient to verify more than once an eligibility factor…

9505.0100 NOTICE OF AGENCY DECISION ON ELIGIBILITY. The local agency must notify a person, in writing, in the format determined by the department, of the agency's decision on the person's medical assistance eligibility. The notice must be sent within the time limits set in part 9…

9505.0105 APPLICATION FOR STATE HOSPITAL RESIDENTS. A state hospital resident may apply for medical assistance at the state hospital reimbursement office. The reimbursement office shall assist the hospital resident in completing the application form and shall forward the applicat…

9505.0110 PERIODS OF ELIGIBILITY. Subpart 1. Retroactive eligibility. Retroactive eligibility is available for the three calendar months before the month of application. Retroactive eligibility must be determined as if the applicant had applied in the retroactive month except for…

9505.0115 REDETERMINATION OF ELIGIBILITY. Subpart 1. Report of change. An applicant or recipient must report a change in an eligibility factor to the local agency within ten days of learning about the change. Subp. 2. Redetermination after change in eligibility factor. The local …

9505.0120 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0125 NOTICE OF DENIAL OR TERMINATION. Subpart 1. Notice to applicant or recipient. The local agency or department shall send the person a written notice, in the format prescribed by the department, when the agency or department denies prior authorization, restricts free choi…

9505.0130 RIGHT TO APPEAL; APPEAL PROCESS. Subpart 1. Rights of applicant or recipient. An applicant or recipient of medical assistance has the right to a hearing: A. if the local agency fails to act on the application within required time limits; B. if eligibility is denied or t…

9505.0131 WRONGFULLY OBTAINED ASSISTANCE. Subpart 1. Applicability to other laws. This part outlines procedures that apply to medical assistance eligibility and are available for use in combination with established civil and criminal procedures and law. Subp. 2. Responsibility of…

9505.0135 ADMINISTRATIVE FUNCTIONS OF LOCAL AGENCY. Subpart 1. Local agency responsibility. The local agency is responsible for the medical assistance program and shall determine eligibility for the program under the supervision of the department as provided in Minnesota Statutes…

9505.0140 PAYMENT FOR ACCESS TO MEDICALLY NECESSARY SERVICES. Subpart 1. Access to medically necessary services. The local agency shall ensure that a service listed in items A to C is available to a medical assistance recipient to enable the recipient to obtain a medically necess…

9505.0145 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0150 [Repealed, 26 SR 977] Published Electronically: August 12, 2008

9505.0170 APPLICABILITY. Parts 9505.0170 to 9505.0475 govern the administration of the medical assistance program, establish the services and providers that are eligible to receive medical assistance payments, and establish the conditions a provider must meet to receive payment. …

9505.0175 DEFINITIONS. Subpart 1. Scope. The terms used in parts 9505.0170 to 9505.0475 have the meanings given them in this part. Subp. 2. Attending physician. "Attending physician" means the physician who is responsible for the recipient's plan of care. Subp. 3. Business agent.…

9505.0180 SURVEILLANCE AND UTILIZATION CONTROL PROGRAM. Subpart 1. [Repealed, 15 SR 2563] Subp. 2. Duty to implement. The department shall carry out a program of a surveillance and utilization review under parts 9505.2160 to 9505.2245 and Code of Federal Regulations, title 42, pa…

9505.0185 [Repealed, 30 SR 1318] Published Electronically: August 12, 2008

9505.0190 RECIPIENT CHOICE OF PROVIDER. Subject to the limitations in Minnesota Statutes, section 256B.69, and in parts 9505.2160 to 9505.2245, a recipient who requires a medically necessary health service may choose to use any provider located within Minnesota or within the reci…

9505.0195 PROVIDER PARTICIPATION. Subpart 1. Department administration of provider participation. The department shall administer the participation of providers in the medical assistance program. The department shall: A. determine the vendor's eligibility to enroll in the medical…

9505.0200 COMPETITIVE BIDDING. Under certain conditions, the commissioner shall seek competitive bids for items designated in Minnesota Statutes, section 256B.04, subdivision 14, and for durable medical equipment. Competitive bids are required if the item of durable medical equip…

9505.0205 PROVIDER RECORDS. A provider shall maintain medical, health care, and financial records, including appointment books and billing transmittal forms, for five years in the manner required under parts 9505.1800 to 9505.1880. Statutory Authority: MS s 256B.04 History: 12 SR…

9505.0210 COVERED SERVICES; GENERAL REQUIREMENTS. The medical assistance program shall pay for a covered service provided to a recipient or to a person who is later found to be eligible at the time the person received the service. To be eligible for payment, a health service must…

9505.0215 COVERED SERVICES; OUT-OF-STATE PROVIDERS. Subpart 1. Out-of-state provider. For purposes of this part, "out-of-state provider" means a provider who is located outside of Minnesota and outside of the recipient's local trade area. Subp. 2. Reimbursement requirements. A he…

9505.0220 HEALTH SERVICES NOT COVERED BY MEDICAL ASSISTANCE. The health services in items A to X are not eligible for payment under medical assistance: A. health service paid for directly by a recipient or other source unless the recipient's eligibility is retroactive and the pro…

9505.0221 PAYMENT LIMITATION; PARTIES AFFILIATED WITH A PROVIDER. Except as allowed in part 9505.0287, equipment, supplies, or services prescribed or ordered by a physician are not eligible for medical assistance payment if they are provided: A. by a person or entity that provide…