reglab/statecodes huggingface dataset:
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.038 — Provider Rate Increases After June 30, 1999.

256B.038 PROVIDER RATE INCREASES AFTER JUNE 30, 1999.
(a) For fiscal years beginning on or after July 1, 1999, the commissioner of management and budget shall include an annual inflationary adjustment in payment rates for the services listed in paragraph (b) as a budget change request in each biennial detailed expenditure budget submitted to the legislature under section 16A.11. The adjustment shall be accomplished by indexing the rates in effect for inflation based on the change in the Consumer Price Index-All Items (United States city average)(CPI-U) as forecasted by Data Resources, Inc., in the fourth quarter of the prior year for the calendar year during which the rate increase occurs.
(b) Within the limits of appropriations specifically for this purpose, the commissioner shall apply the rate increases in paragraph (a) to home and community-based waiver services for persons with developmental disabilities under section 256B.501; home and community-based waiver services for the elderly under chapter 256S; waivered services under community access for disability inclusion under section 256B.49; community alternative care waivered services under section 256B.49; brain injury waivered services under section 256B.49; nursing services and home health services under section 256B.0625, subdivision 6a; personal care services and nursing supervision of personal care services under section 256B.0625, subdivision 19a; home care nursing services under section 256B.0625, subdivision 7; day training and habilitation services for adults with developmental disabilities under sections 252.41 to 252.46; physical therapy services under section 256B.0625, subdivision 8; occupational therapy services under section 256B.0625, subdivision 8a; speech-language therapy services under Minnesota Rules, part 9505.0390; respiratory therapy services under Minnesota Rules, part 9505.0295; physician services under section 256B.0625, subdivision 3; dental services under section 256B.0625, subdivision 9; alternative care services under section 256B.0913; adult residential program grants under section 245.73; adult and family community support grants under Minnesota Rules, parts 9535.1700 to 9535.1760; and semi-independent living services under section 252.275, including SILS funding under county social services grants formerly funded under chapter 256I.
(c) The commissioner shall increase prepaid medical assistance program capitation rates as appropriate to reflect the rate increases in this section.
(d) In implementing this section, the commissioner shall consider proposing a schedule to equalize rates paid by different programs for the same service.
History:
1998 c 407 art 4 s 12; 2005 c 56 s 1; 2009 c 101 art 2 s 109; 2012 c 216 art 14 s 2; 2014 c 275 art 1 s 56; 2014 c 291 art 9 s 5; 2015 c 78 art 6 s 31; 2016 c 158 art 1 s 109; art 2 s 79; 2019 c 54 art 2 s 15
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.041 — Centralized Disbursement Of Medical Assistance Payments.

256B.041 CENTRALIZED DISBURSEMENT OF MEDICAL ASSISTANCE PAYMENTS.
Subdivision 1.
Statewide disbursement system.
The state agency shall establish on a statewide basis a system for the centralized disbursement of medical assistance payments to vendors.
Subd. 2.
Account.
An account is established in the state treasury from which medical assistance payments to vendors shall be made. Into this account there shall be deposited federal funds, state funds, county funds, and other moneys which are available and which may be paid to the state agency for medical assistance payments and reimbursements from counties or others for their share of such payments.
Subd. 3.
Vendor forms.
The state agency shall prescribe and furnish vendors suitable forms for submitting claims under the medical assistance program.
Subd. 4.
Comply with federal requirements.
The state agency in establishing a statewide system of centralized disbursement of medical assistance payments shall comply with federal requirements in order to receive the maximum amount of federal funds which are available for the purpose, together with such additional federal funds which may be made available for the operation of a centralized system of disbursement of medical assistance payments to vendors.
Subd. 5.
[Repealed, 2010 c 382 s 87]
Subd. 6.
Contracted services.
The commissioners of human services and administration may contract with any agency of government or any corporation for providing all or a portion of the services for carrying out the provisions of this section. Local welfare agencies may pay vendors of transportation for nonemergency medical care when so authorized by rule of the commissioner of human services.
Subd. 7.
Disbursement of federal funds.
Federal funds available for administrative purposes shall be distributed between the state and the county on the same basis that reimbursements are earned, except as provided for under section 256.017.
History:
1973 c 717 s 2; 1975 c 437 art 2 s 4; 1978 c 560 s 12; 1983 c 312 art 5 s 13,14; 1984 c 654 art 5 s 58; 1985 c 248 s 70; 1988 c 719 art 8 s 11,12; 1989 c 277 art 2 s 7; 1Sp1989 c 1 art 16 s 6; 2002 c 277 s 9; 2003 c 112 art 2 s 50; 2009 c 101 art 2 s 109
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.043 — Cost-containment Efforts.

256B.043 COST-CONTAINMENT EFFORTS.
Subdivision 1.
Alternative and complementary health care.
The commissioner of human services, through the medical director and in consultation with the Health Services Advisory Council established under section 256B.0625, subdivision 3c, as part of the commissioner's ongoing duties, shall consider the potential for improving quality and obtaining cost savings through greater use of alternative and complementary treatment methods and clinical practice; shall incorporate these methods into the medical assistance and MinnesotaCare programs; and shall make related legislative recommendations as appropriate. The commissioner shall post the recommendations required under this subdivision on agency websites.
Subd. 2.
Access to care.
(a) The commissioners of human services and health, as part of their ongoing duties, shall consider the adequacy of the current system of community health clinics and centers both statewide and in urban areas with significant disparities in health status and access to services across racial and ethnic groups, including:
(1) methods to provide 24-hour availability of care through the clinics and centers;
(2) methods to expand the availability of care through the clinics and centers;
(3) the use of grants to expand the number of clinics and centers, the services provided, and the availability of care; and
(4) the extent to which increased use of physician assistants, advanced practice registered nurses, medical residents and interns, and other allied health professionals in clinics and centers would increase the availability of services.
(b) The commissioners shall make departmental modifications and legislative recommendations as appropriate on the basis of their considerations under paragraph (a).
History:
2006 c 267 art 1 s 9; 2014 c 192 art 4 s 2; 2016 c 158 art 2 s 83; 2020 c 115 art 4 s 111; 2021 c 30 art 1 s 24
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.05 — Administration By County Agencies.

256B.05 ADMINISTRATION BY COUNTY AGENCIES.
Subdivision 1.
Administration of medical assistance.
The county agencies shall administer medical assistance in their respective counties under the supervision of the state agency and the commissioner of human services as specified in section 256.01, and shall make such reports, prepare such statistics, and keep such records and accounts in relation to medical assistance as the state agency may require under section 256.01, subdivision 2, paragraph (p).
Subd. 2.
Fee or charges.
In administering the medical assistance program, no local social services agency shall pay a fee or charge for medical, dental, surgical, hospital, nursing, licensed nursing home care, medicine, or medical supplies in excess of the schedules of maximum fees and charges as established by the state agency.
Subd. 3.
Maximum allowances.
Notwithstanding the provisions of subdivision 2, the commissioner of human services shall establish a schedule of maximum allowances to be paid by the state on behalf of recipients of medical assistance toward fees charged for services rendered such medical assistance recipients.
Subd. 4.
[Repealed, 1987 c 403 art 2 s 164]
Subd. 5.
Obligation of local agency to process medical assistance applications within established timelines.
The local agency must act on an application for medical assistance within ten working days of receipt of all information needed to act on the application but no later than required under Minnesota Rules, part 9505.0090, subparts 2 and 3.
History:
Ex1967 c 16 s 5; 1971 c 961 s 28; 1982 c 640 s 4; 1984 c 580 s 3; 1984 c 654 art 5 s 58; 1988 c 719 art 8 s 13; 1989 c 89 s 10; 1994 c 631 s 31; 1Sp2011 c 9 art 7 s 5; 2015 c 78 art 4 s 61
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0594 — Payment Of Benefits From An Annuity.

256B.0594 PAYMENT OF BENEFITS FROM AN ANNUITY.
When payment becomes due under an annuity that names the department a remainder beneficiary, the issuer shall request and the department shall, within 45 days after receipt of the request, provide a written statement of the total amount of the medical assistance paid or confirmation that any family member designated as a remainder beneficiary meets requirements for qualification as a beneficiary in the first position. Upon timely receipt of the written statement of the amount of medical assistance paid, the issuer shall pay the department an amount equal to the lesser of the amount due the department under the annuity or the total amount of medical assistance paid on behalf of the individual or the individual's spouse. Any amounts remaining after the issuer's payment to the department shall be payable according to the terms of the annuity or similar financial instrument. The county agency or the department shall provide the issuer with the name, address, and telephone number of a unit within the department the issuer can contact to comply with this section. The requirements of section 72A.201, subdivision 4, clause (3), shall not apply to payments made under this section until the issuer has received final payment information from the department, if the issuer has notified the beneficiary of the requirements of this section at the time it initially requests payment information from the department.
History:
2006 c 282 art 17 s 29; 2008 c 326 art 1 s 22
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.061 — Eligibility; Retroactive Effect; Restrictions.

256B.061 ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS.
If any individual has been determined to be eligible for medical assistance, it will be made available for care and services included under the plan and furnished in or after the third month before the month in which the individual made application for such assistance, if such individual was, or upon application would have been, eligible for medical assistance at the time the care and services were furnished. The commissioner may limit, restrict, or suspend the eligibility of an individual for up to one year upon that individual's conviction of a criminal offense related to application for or receipt of medical assistance benefits.
History:
1973 c 717 s 3; 1983 c 312 art 5 s 16; 1986 c 444; 1999 c 245 art 4 s 36; 1Sp2003 c 14 art 12 s 32
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0615 — Mental Health Certified Peer Specialist.

256B.0615 MENTAL HEALTH CERTIFIED PEER SPECIALIST.
Subdivision 1.
Scope.
Medical assistance covers mental health certified peer specialist services, as established in subdivision 2, if provided to recipients who are eligible for services under sections 256B.0622, 256B.0623, and 256B.0624 and are provided by a mental health certified peer specialist who has completed the training under subdivision 5 and is qualified according to section 245I.04, subdivision 10.
Subd. 2.
MS 2020 [Repealed, 2021 c 30 art 17 s 113]
Subd. 3.
Eligibility.
Peer support services may be made available to consumers of (1) intensive residential treatment services under section 256B.0622; (2) adult rehabilitative mental health services under section 256B.0623; and (3) crisis stabilization and mental health mobile crisis intervention services under section 256B.0624.
Subd. 4.
Peer support specialist program providers.
The commissioner shall develop a process to certify peer support specialist programs, in accordance with the federal guidelines, in order for the program to bill for reimbursable services. Peer support programs may be freestanding or within existing mental health community provider centers.
Subd. 5.
Certified peer specialist certification.
A certified peer specialist is qualified as a mental health certified peer specialist, as defined in section 245I.04.
History:
2007 c 147 art 8 s 16; 2009 c 167 s 7,8; 2014 c 312 art 29 s 6; 2015 c 71 art 2 s 22; 2016 c 163 art 2 s 3,4; 2017 c 79 s 4; 2021 c 30 art 17 s 50,51; 2023 c 50 art 3 s 8,9
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0616 — Mental Health Certified Family Peer Specialist.

256B.0616 MENTAL HEALTH CERTIFIED FAMILY PEER SPECIALIST.
Subdivision 1.
Scope.
Medical assistance covers mental health certified family peer specialists services, as established in subdivision 2, subject to federal approval, if provided to recipients who have an emotional disturbance or severe emotional disturbance under chapter 245, and are provided by a mental health certified family peer specialist who has completed the training under subdivision 5 and is qualified according to section 245I.04, subdivision 12. A family peer specialist cannot provide services to the peer specialist's family.
Subd. 2.
MS 2020 [Repealed, 2021 c 30 art 17 s 113]
Subd. 3.
Eligibility.
Family peer support services may be provided to recipients of inpatient hospitalization, partial hospitalization, residential treatment, children's intensive behavioral health services, day treatment, children's therapeutic services and supports, or crisis services.
Subd. 4.
Peer support specialist program providers.
The commissioner shall develop a process to certify family peer support specialist programs, in accordance with the federal guidelines, in order for the program to bill for reimbursable services. Family peer support programs must operate within an existing mental health community provider or center.
Subd. 5.
Certified family peer specialist training and certification.
The commissioner shall develop a training and certification process for certified family peer specialists. The candidates must have raised or be currently raising a child with a mental illness, have had experience navigating the children's mental health system, and must demonstrate leadership and advocacy skills and a strong dedication to family-driven and family-focused services. The training curriculum must teach participating family peer specialists specific skills relevant to providing peer support to other parents. In addition to initial training and certification, the commissioner shall develop ongoing continuing educational workshops on pertinent issues related to family peer support counseling.
History:
2013 c 108 art 4 s 15; 2017 c 79 s 5; 2021 c 30 art 17 s 52-54; 2022 c 99 art 1 s 48
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0626 — Estimation Of 50th Percentile Of Prevailing Charges.

256B.0626 ESTIMATION OF 50TH PERCENTILE OF PREVAILING CHARGES.
(a) The 50th percentile of the prevailing charge for the base year identified in statute must be estimated by the commissioner in the following situations:
(1) there were less than five billings in the calendar year specified in legislation governing maximum payment rates;
(2) the service was not available in the calendar year specified in legislation governing maximum payment rates;
(3) the payment amount is the result of a provider appeal;
(4) the procedure code description has changed since the calendar year specified in legislation governing maximum payment rates, and, therefore, the prevailing charge information reflects the same code but a different procedure description; or
(5) the 50th percentile reflects a payment which is grossly inequitable when compared with payment rates for procedures or services which are substantially similar.
(b) When one of the situations identified in paragraph (a) occurs, the commissioner shall use the following methodology to reconstruct a rate comparable to the 50th percentile of the prevailing rate:
(1) refer to information which exists for the first four billings in the calendar year specified in legislation governing maximum payment rates; or
(2) refer to surrounding or comparable procedure codes; or
(3) refer to the 50th percentile of years subsequent to the calendar year specified in legislation governing maximum payment rates, and reduce that amount by applying an appropriate Consumer Price Index formula; or
(4) refer to relative value indexes; or
(5) refer to reimbursement information from other third parties, such as Medicare.
History:
1Sp1993 c 1 art 5 s 50; 1997 c 203 art 4 s 27
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.063 — Cost Sharing.

256B.063 COST SHARING.
Notwithstanding the provisions of section 256B.05, subdivision 2, the commissioner is authorized to promulgate rules pursuant to the Administrative Procedure Act, and to require a nominal enrollment fee, premium, or similar charge for recipients of medical assistance, if and to the extent required by applicable federal regulation.
History:
1973 c 717 s 5
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0636 — Controlled Substance Prescriptions; Abuse Prevention.

256B.0636 CONTROLLED SUBSTANCE PRESCRIPTIONS; ABUSE PREVENTION.
The commissioner of human services shall develop and implement a plan to:
(1) review utilization patterns of Minnesota health care program enrollees for controlled substances listed in section 152.02, subdivisions 3 and 4, and those substances defined by the Board of Pharmacy under section 152.02, subdivisions 8 and 12;
(2) develop a mechanism to address abuses both for fee-for-service Minnesota health care program enrollees and those enrolled in managed care plans; and
(3) provide education to Minnesota health care program enrollees on the proper use of controlled substances.
For purposes of this section, "Minnesota health care program" means medical assistance or MinnesotaCare.
History:
2007 c 147 art 12 s 11; 2016 c 158 art 2 s 90
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0637 — Presumptive Eligibility; Treatment For Breast Or Cervical Cancer.

256B.0637 PRESUMPTIVE ELIGIBILITY; TREATMENT FOR BREAST OR CERVICAL CANCER.
Medical assistance is available during a presumptive eligibility period for persons who meet the criteria in section 256B.057, subdivision 10. For purposes of this section, the presumptive eligibility period begins on the date on which an entity designated by the commissioner determines, based on preliminary information, that the person meets the criteria in section 256B.057, subdivision 10. The presumptive eligibility period ends on the day on which a determination is made as to the person's eligibility, except that if an application is not submitted by the last day of the month following the month during which the determination based on preliminary information is made, the presumptive eligibility period ends on that last day of the month.
History:
1Sp2001 c 9 art 2 s 42; 2002 c 379 art 1 s 113
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0641 — Recovery Of Overpayments.

256B.0641 RECOVERY OF OVERPAYMENTS.
Subdivision 1.
Recovery procedures; sources.
Notwithstanding section 256B.72 or any law or rule to the contrary, when the commissioner or the federal government determines that an overpayment has been made by the state to any medical assistance vendor, the commissioner shall recover the overpayment as follows:
(1) if the federal share of the overpayment amount is due and owing to the federal government under federal law and regulations, the commissioner shall recover from the medical assistance vendor the federal share of the determined overpayment amount paid to that provider using the schedule of payments required by the federal government;
(2) if the overpayment to a medical assistance vendor is due to a retroactive adjustment made because the medical assistance vendor's temporary payment rate was higher than the established desk audit payment rate or because of a department error in calculating a payment rate, the commissioner shall recover from the medical assistance vendor the total amount of the overpayment within 120 days after the date on which written notice of the adjustment is sent to the medical assistance vendor or according to a schedule of payments approved by the commissioner;
(3) a medical assistance vendor is liable for the overpayment amount owed by a long-term care provider if the vendors or their owners are under common control or ownership; and
(4) in order to collect past due obligations to the department, the commissioner shall make any necessary adjustments to payments to a provider or vendor that has the same tax identification number as is assigned to a provider or vendor with past due obligations.
Subd. 2.
Overpayments to prior owners.
The current owner of a nursing home, boarding care home, or intermediate care facility for persons with developmental disabilities is liable for the overpayment amount owed by a former owner for any facility sold, transferred, or reorganized after May 15, 1987. Within 12 months of a written request by the current owner, the commissioner shall conduct a field audit of the facility for the auditable rate years during which the former owner owned the facility and issue a report of the field audit within 15 months of the written request. Nothing in this subdivision limits the liability of a former owner.
Subd. 3.
Facility in receivership.
Subdivision 2 does not apply to the change of ownership of a facility to a nonrelated organization while the facility to be sold, transferred or reorganized is in receivership under section 144A.15, 245A.12, or 245A.13, and the commissioner during the receivership has not determined the need to place residents of the facility into a newly constructed or newly established facility. Nothing in this subdivision limits the liability of a former owner.
History:
1Sp1985 c 9 art 2 s 39; 1987 c 133 s 1; 1991 c 292 art 6 s 46; 1995 c 207 art 7 s 22; 2005 c 56 s 1; 2009 c 79 art 8 s 22; 1Sp2011 c 9 art 6 s 53; 2015 c 74 s 7
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0642 — Federal Financial Participation.

256B.0642 FEDERAL FINANCIAL PARTICIPATION.
The commissioner may, in the aggregate, prospectively reduce payment rates for medical assistance providers receiving federal funds to avoid reduced federal financial participation resulting from rates that are in excess of the Medicare limitations.
History:
1989 c 282 art 3 s 59
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0643 — Vendor Request For Contested Case Proceeding.

256B.0643 VENDOR REQUEST FOR CONTESTED CASE PROCEEDING.
Unless otherwise provided by law, a vendor of medical care, as defined in section 256B.02, subdivision 7, must use this procedure to request a contested case, as defined in section 14.02, subdivision 3. A request for a contested case must be filed with the commissioner in writing within 60 days after the date the notification of an action or determination was mailed. The appeal request must specify:
(1) each disputed action or item;
(2) the reason for the dispute;
(3) an estimate of the dollar amount involved, if any, for each disputed item;
(4) the computation or other disposition that the appealing party believes is correct;
(5) the authority in statute or rule upon which the appealing party relies for each disputed item;
(6) the name and address of the person or firm with whom contacts may be made regarding the appeal; and
(7) other information required by the commissioner. Nothing in this section shall be construed to create a right to an administrative appeal or contested case proceeding.
History:
1990 c 568 art 3 s 53
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0646 — Minnesota Restricted Recipient Program; Personal Care Assistance Services.

256B.0646 MINNESOTA RESTRICTED RECIPIENT PROGRAM; PERSONAL CARE ASSISTANCE SERVICES.
(a) When a recipient's use of personal care assistance services or community first services and supports under section 256B.85 results in abusive or fraudulent billing, the commissioner may place a recipient in the Minnesota restricted recipient program under Minnesota Rules, part 9505.2165. A recipient placed in the Minnesota restricted recipient program under this section must: (1) use a designated traditional personal care assistance provider agency; and (2) obtain a new assessment under section 256B.0911, including consultation with a registered or public health nurse on the long-term care consultation team pursuant to section 256B.0911, subdivision 15, paragraph (b), clause (2).
(b) A recipient must comply with additional conditions for the use of personal care assistance services or community first services and supports if the commissioner determines it is necessary to prevent future misuse of personal care assistance services or abusive or fraudulent billing. Additional conditions may include but are not limited to restricting service authorizations for a duration of no more than one month and requiring a qualified professional to monitor and report services on a monthly basis.
(c) A recipient placed in the Minnesota restricted recipient program under this section may appeal the placement according to section 256.045.
History:
1Sp2019 c 9 art 2 s 118; 2022 c 98 art 17 s 9
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.065 — Social Security Amendments.

256B.065 SOCIAL SECURITY AMENDMENTS.
The commissioner shall comply with requirements of the Social Security amendments of 1972 (Public Law 92-603) necessary in order to avoid loss of federal funds, and shall implement by rule, pursuant to the Administrative Procedure Act, those provisions required of state agencies supervising Title XIX of the Social Security Act.
History:
1973 c 717 s 7
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0658 — Housing Access Grants.

256B.0658 HOUSING ACCESS GRANTS.
The commissioner of human services shall award through a competitive process contracts for grants to public and private agencies to support and assist individuals with a disability as defined in section 256B.051, subdivision 2, paragraph (e), to access housing. Grants may be awarded to agencies that may include, but are not limited to, the following supports: assessment to ensure suitability of housing, accompanying an individual to look at housing, filling out applications and rental agreements, meeting with landlords, helping with Section 8 or other program applications, helping to develop a budget, obtaining furniture and household goods, if necessary, and assisting with any problems that may arise with housing.
History:
2008 c 363 art 15 s 5; 1Sp2019 c 9 art 5 s 34
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.075 — Disease Management Programs.

256B.075 DISEASE MANAGEMENT PROGRAMS.
Subdivision 1.
General.
The commissioner shall implement disease management initiatives that seek to improve patient care and health outcomes and reduce health care costs by managing the care provided to recipients with chronic conditions.
Subd. 2.
Fee-for-service.
(a) The commissioner shall develop and implement a disease management program for medical assistance recipients who are not enrolled in the prepaid medical assistance program and who are receiving services on a fee-for-service basis. The commissioner may contract with an outside organization to provide these services.
(b) The commissioner shall seek any federal approval necessary to implement this section and to obtain federal matching funds.
(c) The commissioner shall develop and implement a pilot intensive care management program for medical assistance children with complex and chronic medical issues.
Subd. 3.
Prepaid managed care programs.
For the prepaid medical assistance and MinnesotaCare programs, the commissioner shall ensure that contracting health plans implement disease management programs that are appropriate for Minnesota health care program recipients and have been designed by the health plan to improve patient care and health outcomes and reduce health care costs by managing the care provided to recipients with chronic conditions.
Subd. 4.
[Repealed, 2014 c 262 art 2 s 18]
Subd. 5.
[Repealed, 1Sp2005 c 4 art 8 s 88]
History:
2004 c 288 art 7 s 6; 1Sp2005 c 4 art 8 s 44; 2008 c 326 art 1 s 33; 2016 c 158 art 2 s 91,92
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0753 — Payment Restructuring; Care Coordination Payments.

256B.0753 PAYMENT RESTRUCTURING; CARE COORDINATION PAYMENTS.
Subdivision 1.
Development.
The commissioner of human services, in coordination with the commissioner of health, shall develop a payment system that provides per-person care coordination payments to health care homes certified under section 62U.03 for providing care coordination services and directly managing on-site or employing care coordinators. The care coordination payments under this section are in addition to the quality incentive payments in section 256B.0754, subdivision 1. The care coordination payment system must vary the fees paid by thresholds of care complexity, with the highest fees being paid for care provided to individuals requiring the most intensive care coordination. In developing the criteria for care coordination payments, the commissioner shall consider the feasibility of including the additional time and resources needed by patients with limited English-language skills, cultural differences, or other barriers to health care. The commissioner may determine a schedule for phasing in care coordination fees such that the fees will be applied first to individuals who have, or are at risk of developing, complex or chronic health conditions.
Subd. 2.
Implementation.
The commissioner of human services shall implement care coordination payments as specified under this section by July 1, 2010, or upon federal approval, whichever is later. For enrollees served under the fee-for-service system, the care coordination payment shall be determined by the commissioner in contracts with certified health care homes. For enrollees served by managed care or county-based purchasing plans, the commissioner's contracts with these plans shall require the payment of care coordination fees to certified health care homes.
Subd. 3.
Cost neutrality.
If initial savings from implementation of health care homes are not sufficient to allow implementation of the care coordination fee in a cost-neutral manner, the commissioner may make recommendations to the legislature on reallocating costs within the health care system.
History:
2008 c 358 art 2 s 3; 2020 c 115 art 3 s 30,39
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0754 — Payment Reform.

256B.0754 PAYMENT REFORM.
Subdivision 1.
Quality incentive payments.
By July 1, 2010, the commissioner of human services shall implement quality incentive payments as established under section 62U.02 for all enrollees in state health care programs consistent with relevant state and federal statute and rule. This section does not limit the ability of the commissioner of human services to establish by contract and monitor, as part of its quality assurance obligations for state health care programs, outcome and performance measures for nonmedical services and health issues likely to occur in low-income populations or racial or cultural groups disproportionately represented in state health care program enrollment that would likely be underrepresented when using traditional measures that are based on longer-term enrollment.
Subd. 2.
Payment reform.
By no later than 12 months after the commissioner of health publishes the information in section 62U.04, subdivision 3c, paragraph (b), the commissioner of human services may use the information and methods developed under section 62U.04 to establish a payment system that:
(1) rewards high-quality, low-cost providers;
(2) creates enrollee incentives to receive care from high-quality, low-cost providers; and
(3) fosters collaboration among providers to reduce cost shifting from one part of the health continuum to another.
History:
2008 c 358 art 2 s 4; 2010 c 344 s 3; 2012 c 164 s 8
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0756 — Hennepin And Ramsey Counties Pilot Program.

256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.
(a) The commissioner, upon federal approval of a new waiver request or amendment of an existing demonstration, may establish a pilot program in Hennepin County or Ramsey County, or both, to test alternative and innovative integrated health care delivery networks.
(b) Individuals eligible for the pilot program shall be individuals who are eligible for medical assistance under section 256B.055 and who reside in Hennepin County or Ramsey County. The commissioner may identify individuals to be enrolled in the Hennepin County pilot program based on zip code in Hennepin County or whether the individuals would benefit from an integrated health care delivery network.
(c) Individuals enrolled in the pilot program shall be enrolled in an integrated health care delivery network in their county of residence. The integrated health care delivery network in Hennepin County shall be a network, such as an accountable care organization or a community-based collaborative care network, created by or including Hennepin County Medical Center. The integrated health care delivery network in Ramsey County shall be a network, such as an accountable care organization or community-based collaborative care network, created by or including Regions Hospital.
(d) In developing a payment system for the pilot programs, the commissioner shall establish a total cost of care for the recipients enrolled in the pilot programs that equals the cost of care that would otherwise be spent for these enrollees in the prepaid medical assistance program.
(e) The commissioner shall apply to the federal government for, or as appropriate, cooperate with counties, providers, or other entities that are applying for any applicable grant or demonstration under the Patient Protection and Affordable Health Care Act, Public Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, that would further the purposes of or assist in the creation of an integrated health care delivery network for the purposes of this subdivision, including, but not limited to, a global payment demonstration or the community-based collaborative care network grants.
History:
1Sp2010 c 1 art 16 s 20,48; 2013 c 108 art 6 s 18
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0758 — Health Care Delivery Pilot Program.

256B.0758 HEALTH CARE DELIVERY PILOT PROGRAM.
(a) The commissioner may establish a health care delivery pilot program to test alternative and innovative integrated health care delivery networks, including accountable care organizations or a community-based collaborative care network created by or including North Memorial Health Care. If required, the commissioner shall seek federal approval of a new waiver request or amend an existing demonstration pilot project waiver.
(b) Individuals eligible for the pilot program shall be individuals who are eligible for medical assistance under section 256B.055. The commissioner may identify individuals to be enrolled in the pilot program based on zip code or whether the individuals would benefit from an integrated health care delivery network.
(c) In developing a payment system for the pilot programs, the commissioner shall establish a total cost of care for the individuals enrolled in the pilot program that equals the cost of care that would otherwise be spent for these enrollees in the prepaid medical assistance program.
History:
2015 c 71 art 11 s 32
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.08 — Application.

256B.08 APPLICATION.
Subdivision 1.
Application process.
An applicant for medical assistance, or a person acting in the applicant's behalf, shall file an application with a local agency in the manner and form prescribed by the state agency. When a married applicant resides in a nursing home or applies for medical assistance for nursing home services, the local agency shall consider an application on behalf of the applicant's spouse only upon specific request of the applicant or upon specific request of the spouse and separate filing of an application.
Subd. 2.
Expedited review for pregnant women.
A pregnant woman who may be eligible for assistance under section 256B.055, subdivision 1, must receive an appointment for eligibility determination no later than five working days from the date of her request for assistance from the local agency. The local agency shall expedite processing her application for assistance and shall make a determination of eligibility on a completed application no later than ten working days following the applicant's initial appointment. The local agency shall assist the applicant to provide all necessary information and documentation in order to process the application within the time period required under this subdivision. The state agency shall provide for the placement of applications for medical assistance in eligible provider offices, community health offices, and Women, Infants and Children (WIC) program sites.
Subd. 3.
Outreach locations.
The local agency must establish locations, other than those used to process applications for cash assistance, to receive and perform initial processing of applications for pregnant women and children who want medical assistance only. At a minimum, these locations must be in federally qualified health centers and in hospitals that receive disproportionate share adjustments under section 256.969, subdivision 8, except that hospitals located outside of this state that receive the disproportionate share adjustment are not included. Initial processing of the application need not include a final determination of eligibility. Local agencies shall designate a person or persons within the agency who will receive the applications taken at an outreach location and the local agency will be responsible for timely determination of eligibility.
Subd. 4.
Data from Social Security.
The commissioner shall accept data from the Social Security Administration in accordance with United States Code, title 42, section 1396U-5(a).
History:
Ex1967 c 16 s 8; 1Sp1981 c 2 s 15; 1986 c 444; 1988 c 689 art 2 s 146,268; 1991 c 292 art 4 s 50; 2009 c 79 art 5 s 37
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.09 — Investigations.

256B.09 INVESTIGATIONS.
When an application for medical assistance hereunder is filed with a county agency, such county agency shall promptly make or cause to be made such investigation as it may deem necessary. The object of such investigation shall be to ascertain the facts supporting the application made hereunder and such other information as may be required by the rules of the state agency. Upon the completion of such investigation the county agency shall promptly determine eligibility. No approval by the county agency shall be required prior to payment for medical care provided to recipients determined to be eligible pursuant to this section.
History:
Ex1967 c 16 s 9; 1973 c 717 s 19
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0919 — Adult Foster Care And Family Adult Day Care.

256B.0919 ADULT FOSTER CARE AND FAMILY ADULT DAY CARE.
Subdivision 1.
Adult foster care licensure capacity.
Notwithstanding contrary provisions of the Human Services Licensing Act and rules adopted under it, an adult foster care license holder may care for five adults age 60 years or older who do not have serious and persistent mental illness or a developmental disability.
Subd. 2.
Adult foster care; family adult day care.
An adult foster care license holder who is not providing care to persons with serious and persistent mental illness or developmental disabilities may also provide family adult day care for adults age 60 years or older who do not have serious and persistent mental illness or a developmental disability. The maximum combined license capacity for adult foster care and family adult day care is five adults. A separate license is not required to provide family adult day care under this subdivision. Foster care homes providing services to five adults shall not be subject to licensure by the commissioner of health under the provisions of chapter 144, 144A, 157, or any other law requiring facility licensure by the commissioner of health.
Subd. 3.
County certification of persons providing adult foster care to related persons.
A person exempt from licensure under section 245A.03, subdivision 2, who provides adult foster care to a related individual age 65 and older, and who meets the requirements in Minnesota Rules, parts 9555.5105 to 9555.6265, may be certified by the county to provide adult foster care. A person certified by the county to provide adult foster care may be reimbursed for services provided and eligible for funding under chapter 256S, if the relative would suffer a financial hardship as a result of providing care. For purposes of this subdivision, financial hardship refers to a situation in which a relative incurs a substantial reduction in income as a result of resigning from a full-time job or taking a leave of absence without pay from a full-time job to care for the client.
Subd. 4.
[Repealed, 2010 c 329 art 1 s 24; 2010 c 352 art 2 s 16]
History:
1986 c 444; 1991 c 292 art 7 s 18; 1992 c 513 art 7 s 73; 2007 c 112 s 49; 2007 c 147 art 6 s 39; 2019 c 54 art 2 s 31
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0921 — Home And Community-based Services Innovation Pool.

256B.0921 HOME AND COMMUNITY-BASED SERVICES INNOVATION POOL.
The commissioner of human services shall develop an initiative to provide incentives for innovation in: (1) achieving integrated competitive employment; (2) achieving integrated competitive employment for youth under age 25 upon their graduation from school; (3) living in the most integrated setting; and (4) other outcomes determined by the commissioner. The commissioner shall seek requests for proposals and shall contract with one or more entities to provide incentive payments for meeting identified outcomes.
History:
2015 c 71 art 7 s 55; 2016 c 189 art 18 s 9; 1Sp2017 c 6 art 1 s 19; 1Sp2019 c 9 art 5 s 51
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256B — Medical Assistance For Needy Persons › Section 256B.0948 — Foster Care Rate Limits.

256B.0948 FOSTER CARE RATE LIMITS.
The commissioner shall decrease by five percent rates for adult foster care and supportive living services that are reimbursed under section 256B.092 or 256B.49, and are above the 95th percentile of the statewide rates for the service. The reduction in rates shall take into account the acuity of individuals served based on the methodology used to allocate dollars to local lead agency budgets, and assure that affected service rates are not reduced below the rate level represented by the above percentile due to this rate change. Lead agency contracts for services specified in this section shall be amended to implement these rate changes for services rendered on or after July 1, 2009. The commissioner shall make corresponding reductions to waiver allocations and capitated rates.
History:
2009 c 79 art 8 s 55