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Effective: December 1, 2006 | |
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28.05.15.05ar1 - Access Services - Eligibility Requirements |
Archived: June 1, 2009 |
To qualify for access services, Minnesota Health Care Program enrollees must meet certain criteria and cooperate with verification and prior authorization requirements. They may receive access services through a county agency, MinnesotaCare Operations, the MNET program, or a Managed Care Organization (MCO) An organization certified by the Minnesota Department of Health which agrees to provide all defined health care benefits to individuals in return for a capitated payment. MCOs are also referred to as "health plans.".
The following enrollees are eligible for access services if they do not receive access services through an MCO:
l MinnesotaCare enrollees who are pregnant women or children under age 21.
l All Medical Assistance (MA) and General Assistance Medical Care (GAMC) enrollees.
Follow your agency’s access plan when enrollees request access services. Explain prior authorization requirements, limitations on services and billing procedures. Provide written information on your agency’s access plan to all enrollees who may be eligible for access services.
Access plans must require receipts for all of the following:
l Commercial carrier transportation.
l Meals.
l Parking (other than parking meters).
l Lodging.
Access plans must require prior authorization for:
l Lodging and meal expenses for people accompanying the enrollee.
l Transportation and related expenses outside the local trade area, as defined by the local agency.
Note: Access plans may also require prior authorization within the local trade area at county option.
l Transportation, if the local agency determines the enrollee has misused transportation in the past.
Access plans may not require prior authorization for emergency services.
Enrollees may receive access services in various ways:
l MinnesotaCare enrollees who are eligible for access services will receive those services through one of the following:
n The county agency's access plan if they receive case services through their MinnesotaCare county enrollment site.
n MinnesotaCare Operations’ access plan if they receive case services through MinnesotaCare Operations.
l MA and GAMC enrollees in managed care plans may receive some services through the MCO and other services through the county agency's access plan.
In general, MCOs must provide their members with:
l Sign language and foreign language interpreters if needed to receive medical services.
l Reimbursement for transportation and child care if needed for a state appeal hearing related to the MCO’s denial, reduction or termination of a health service.
l Common carrier transportation to receive medical services.
Managed care organizations are not required to provide:
l Reimbursement to enrollees for personal mileage or parking unrelated to an appeal.
l Lodging, meals or out-of-state airfare related to obtaining medical services.
County agencies are responsible for services in their access plans that are not covered by the MCOs.
For further information, see: