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Benefits by State: Minnesota (October 2008) Notes
 
 
 
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Acute Care Services

Is the Benefit Covered? Copayment Requirement Prior Approval Requirement Coverage Limitations Reimbursement Methodology Populations Covered


Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes Fee for service or percentage of charge A & B - See state-specific FN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes $3/visit for non-preventive service Fee for service A & B - See state-specific FN
Federally Qualified Health Center Services
Yes $3/visit for non-preventive service Prospective cost based rate/visit or alternative reimbursement methodology using cost based payment A & B - See state-specific FN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes B1 - $10,000 annual limit- See state-specific FN Prospective payment/discharge using DRG A & B - See state-specific FN
Outpatient Hospital Services
Yes $6/non-emergency visit in ER, $3/visit for non-preventive service Payments based on Medicare methodology, cost based payment for critical access hospitals A & B - See state-specific FN
Rehabilitation Services: Mental Health and Substance Abuse
Yes Mental health service and visit limits vary Fee for service or negotiated rates A & B - See state-specific FN
Rural Health Clinic Services
Yes $3/visit for non-preventive service Prospective cost based rate/visit or alternative reimbursement methodology using cost based payment A & B - See state-specific FN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes Fee for service A & B - See state-specific FN
Chiropractor Services
Yes $3/visit 24 visits/year Fee for service A & B - See state-specific FN
Dental Services
Yes Specified services Fee for service A & B - See state-specific FN
Medical and Remedial Care - Other Practitioners
Medical/Surgical Services of a Dentist
Yes Specified services Fee for service A & B - See state-specific FN
Nurse Midwife Services
Yes Fee for service A & B - See state-specific FN
Nurse Practitioner Services
Yes $3/visit for non-preventive service Fee for service A & B - See state-specific FN
Optometrist Services
Yes $3/visit for non-preventive service Fee for service A & B - See state-specific FN
Physician Services
Yes $3/visit for non-preventive service 3 telemedicine consultations/week Fee for service A & B - See state-specific FN
Podiatrist Services
Yes $3/visit for non-preventive services Fee for service A & B - See state-specific FN
Psychologist Services
Yes Fee for service A & B - See state-specific FN
Prescription Drugs
Prescription Drugs
Yes A - $1/generic Rx, $3/brand Rx, up to $12/month, antipsychotic Rxs not subject to copayments; B - $3/Rx with no cap and no exceptions - See state-specific FN Non-preferred and brand Rx when generic available AWP-12%, plus $3.65 dispensing fee; specialty drug products paid less - See state-specific FN A & B - See state-specific FN
Physical Therapy and Other Services
Occupational Therapy Services
Yes After initial 200 units of service Fee for service A & B - See state-specific FN
Physical Therapy Services
Yes After initial 30 sessions Fee for service A & B - See state-specific FN
Services for Speech, Hearing and Language Disorders
Yes After initial 80 sessions Fee for service A & B - See state-specific FN
Products and Devices
Dentures
Yes 1 full upper and/or lower denture or 1 partial denture/3 years Fee for service A & B - See state-specific FN
Eyeglasses
Yes A - $3/pair, B - $25/pair - See state-specific FN 1 pair eyeglasses/2 years, replaced lost or broken eyeglasses must be identical to originals Fee for service A & B - See state-specific FN
Hearing Aids
Yes Items from other than state's contractors 1 hearing aid/5 years Most products provided by state's volume purchase contractors A & B - See state-specific FN
Medical Equipment and Supplies
Yes Specified services Fee for service for most products, oxygen delivery systems available through state's volume purchase contractors A & B - See state-specific FN
Prosthetic and Orthotic Devices
Yes Specified services Fee for service using Medicare rates where available A & B - See state-specific FN
Transportation Services
Ambulance Services
Yes Fee for service using Medicare unadjusted base rate A & B - See state-specific FN
Non-Emergency Medical Transportation Services
Yes See service-specific FN A - See state-specific FN
Other Services
Diagnostic, Screening and Preventive Services
Yes Fee for service A & B - See state-specific FN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women
Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes B - $3/diagnostic test - See state-specific FN Specified services Fee for service A & B - See state-specific FN
Targeted Case Management
Yes B - limited to mental health conditions Fee for service, cost based payment or negotiated rate A & B - See state-specific FN


Long-Term Care Services

Community Based Care
Home and Community Based Services Waiver
Yes Services for the following populations: 1, 2, 4 & 8 - See service-specific FN Dependent upon the services provided A - See state-specific FN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes After initial 9 skilled nurse visits A - 2 nursing or home health aide visits/day Fee for service A & B - See state-specific FN
Hospice Care
Yes Two 90-day periods with additional 60-day periods as necessary Prospective rates based on Medicare methodology A & B - See state-specific FN
Personal Care Services
Yes Yes Fee for service A - See state-specific FN
Private Duty Nursing Services
Yes Yes Fee for service A - See state-specific FN
Program of All-Inclusive Care for the Elderly
No
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes Prospective payment per discharge using DRG A - See state-specific FN
Inpatient Psychiatric Services, under age 21
Yes 18 acute care hosp leave days/year Prospective cost based per diem for private facilities, cost based payment for public facilities A - See state-specific FN
Intermediate Care Facility Services for the Mentally Retarded
Yes 18 hosp leave days/hospitalization, 72 therapeutic leave days/year Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, leave day payment dependent on occupancy level A - See state-specific FN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes 18 hosp leave days/hospitalization, 36 therapeutic leave days/year, residents in facilities licensed to serve physically disabled permitted 72 therapeutic leave days/year Prospective per diem with annual legislated rate adjustment, acuity and quality adjusted, leave days paid at 60% of facility's rate A - See state-specific FN
Religious Non-Medical Health Care Institution and Practitioner Services
No


Notes: This State’s traditional Medicaid population of categorically and medically needy beneficiaries receives full benefits and is identified on the tables as “A.” Also included is the optional Medicaid buy-in group of disabled adults permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA). These working disabled beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, irrespective of annual income, however they are responsible for applicable copayments and an income-based monthly premium is required for any beneficiary with income above the federal poverty level (FPL). Minnesota has an approved Section 1115 Waiver from CMS under which it extended Medicaid eligibility to a number of previously uninsured individuals with income at or below 275 percent of the FPL, including children, pregnant women and the parents and caretakers of Medicaid and SCHIP-eligible children. The program, called MinnesotaCare, requires monthly premiums based on gross family income. Children and pregnant women receive the same benefits as the traditional Medicaid population, with no copayments, so are included within the meaning of group “A” on the tables. Parents and caretakers on MinnesotaCare receive a lesser benefit package and copayments apply to this group in two tiers, depending on income. The group with income at or below 175 percent of the FPL, identified as “B1” on the tables, has a higher copayment requirement than the group with higher income but that variance is expected to end in mid 2007. MinnesotaCare also provides a limited benefit package to childless adults with income at or below 175 percent of the FPL but pays for the services with state funds. All MinnesotaCare beneficiaries receive services through managed care organizations. The reference to specialty drug products under prescription drug reimbursement relates to those drugs used by a small number of beneficiaries with specific complex and chronic diseases, such as HIV/AIDS. Reduced reimbursement rates are negotiated with a limited number of providers.
 
 
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