Section 245.4933 Medical Assistance Provider Status
245.4933 MEDICAL ASSISTANCE PROVIDER STATUS.
Subdivision 1.Requirements to become a prepaid medical provider.
(a) In order for a local children's mental health collaborative to become a prepaid provider of medical assistance services and be eligible to receive medical assistance reimbursement, the collaborative must:
(1) enter into a contract with the commissioner of human services to provide mental health services including inpatient, outpatient, medication management, services under the rehabilitation option, and related physician services;
(2) meet the applicable federal requirements;
(3) either carry stop-loss insurance or enter into a risk-sharing agreement with the commissioner of human services; and
(4) provide medically necessary medical assistance mental health services to children in the target population who enroll in the local children's mental health collaborative.
(b) Upon execution of the provider contract with the commissioner of human services the local children's mental health collaborative may:
(1) provide mental health services which are not medical assistance state plan services in addition to the state plan services described in the contract with the commissioner of human services; and
(2) enter into subcontracts which meet the requirements of Code of Federal Regulations, title 42, section 434.6, with other providers of mental health services including prepaid health plans established under section 256B.69.
Subd. 2.Children enrolled in a prepaid health plan.
A children's mental health collaborative may serve children in the collaborative's target population who are enrolled in a prepaid health plan under contract with the commissioner of human services by contracting with one or more such health plans to provide medical assistance or MinnesotaCare mental health services to children enrolled in the health plan. The collaborative and the health plan shall work cooperatively to ensure the integration of physical and mental health services.
Subd. 3.Children who become enrolled in a prepaid health plan.
A children's mental health collaborative may provide prepaid medical assistance or MinnesotaCare mental health services to children who are not enrolled in prepaid health plans until those children are enrolled. Publication of a request for proposals in the State Register shall serve as notice to the collaborative of the commissioner's intent to execute contracts for medical assistance and MinnesotaCare services. In order to become or continue to be a provider of medical assistance or MinnesotaCare services the collaborative may contract with one or more such prepaid health plans after the collaborative's target population is enrolled in a prepaid health plan. The collaborative and the health plan shall work cooperatively to ensure the integration of physical and mental health services.
Subd. 4.Commissioner's duties.
(a) The commissioner of human services shall provide to each children's mental health collaborative that is considering whether to become a prepaid provider of mental health services the commissioner's best estimate of a capitated payment rate prior to an actuarial study based upon the collaborative's operational target population. The capitated payment rate shall be adjusted annually, if necessary, for changes in the operational target population.
(b) The commissioner shall negotiate risk adjustment and reinsurance mechanisms with children's mental health collaboratives that become medical assistance providers including those that subcontract with prepaid health plans.
Subd. 5.Noncontracting collaboratives.
A local children's mental health collaborative that does not become a prepaid provider of medical assistance or MinnesotaCare services may provide services through individual members of a noncontracting collaborative who have a medical assistance provider agreement to eligible recipients who are not enrolled in the health plan.
Subd. 6.Individualized rehabilitation services.
A children's mental health collaborative with an integrated service system approved by the Children's Cabinet may become a medical assistance provider for the purpose of obtaining prior authorization for and providing individualized rehabilitation services.
History:
1995 c 207 art 8 s 22; art 11 s 11