Subdivision 1. Authority. The commissioner shall establish procedures for determining medical assistance payment rates under a prospective payment system for inpatient hospital services in hospitals that qualify as vendors of medical assistance. The commissioner shall establish, by rule, procedures for implementing this section and sections 256.9686, 256.969, and 256.9695. Services must meet the requirements of section 256B.04, subdivision 15, to be eligible for payment.
Subd. 1a. Administrative reconsideration. Notwithstanding section 256B.04, subdivision 15, the commissioner shall establish an administrative reconsideration process for appeals of inpatient hospital services determined to be medically unnecessary. A physician, advanced practice registered nurse, physician assistant, or hospital may request a reconsideration of the decision that inpatient hospital services are not medically necessary by submitting a written request for review to the commissioner within 30 days after receiving notice of the decision. The reconsideration process shall take place prior to the procedures of subdivision 1b and shall be conducted by the medical review agent that is independent of the case under reconsideration.
Subd. 1b. Appeal of reconsideration. Notwithstanding section 256B.72, the commissioner may recover inpatient hospital payments for services that have been determined to be medically unnecessary after the reconsideration and determinations. A physician, advanced practice registered nurse, physician assistant, or hospital may appeal the result of the reconsideration process by submitting a written request for review to the commissioner within 30 days after receiving notice of the action. The commissioner shall review the medical record and information submitted during the reconsideration process and the medical review agent's basis for the determination that the services were not medically necessary for inpatient hospital services. The commissioner shall issue an order upholding or reversing the decision of the reconsideration process based on the review.
Subd. 1c. Judicial review. A hospital, physician, advanced practice registered nurse, or physician assistant aggrieved by an order of the commissioner under subdivision 1b may appeal the order to the district court of the county in which the physician, advanced practice registered nurse, physician assistant, or hospital is located by:
(1) serving a written copy of a notice of appeal upon the commissioner within 30 days after the date the commissioner issued the order; and
(2) filing the original notice of appeal and proof of service with the court administrator of the district court. The appeal shall be treated as a dispositive motion under the Minnesota General Rules of Practice, rule 115. The district court scope of review shall be as set forth in section 14.69.
Subd. 1d. Transmittal of record. Within 30 days after being served with the notice of appeal, the commissioner shall transmit to the district court the original or certified copy of the entire record considered by the commissioner in making the final agency decision. The district court shall not consider evidence that was not included in the record before the commissioner.
Subd. 2. Federal requirements. If it is determined that a provision of this section or section 256.9686, 256.969, or 256.9695 conflicts with existing or future requirements of the United States government with respect to federal financial participation in medical assistance, the federal requirements prevail. The commissioner may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial participation resulting from rates that are in excess of the Medicare limitations.
1989 c 282 art 3 s 36; 1991 c 292 art 4 s 22; 1992 c 513 art 7 s 22; 1Sp1993 c 1 art 5 s 17; 1995 c 207 art 6 s 16-18; 1997 c 187 art 1 s 19; 1998 c 407 art 4 s 8; 1999 c 245 art 4 s 24; 2002 c 277 s 7; 2014 c 312 art 24 s 3,4; 1Sp2017 c 6 art 4 s 5,6; 2020 c 115 art 4 s 105-107; 2022 c 58 s 128-130
Structure Minnesota Statutes
Chapters 245 - 267 — Public Welfare And Related Activities
Section 256.01 — Commissioner Of Human Services; Powers, Duties.
Section 256.011 — Administration Of Federal Grants-in-aid.
Section 256.0112 — Grants And Purchase Of Service Contracts.
Section 256.012 — Minnesota Merit System.
Section 256.0121 — Southern Cities Community Health Clinic.
Section 256.014 — State And County Systems.
Section 256.015 — Public Assistance Lien On Recipient's Cause Of Action.
Section 256.016 — Plain Language In Written Materials.
Section 256.0161 — Forecast On Children's Health Care Services.
Section 256.017 — Compliance System.
Section 256.018 — County Public Assistance Incentive Fund.
Section 256.019 — Recovery Of Money; Apportionment.
Section 256.02 — Investigations; Examinations; Supervision.
Section 256.021 — Vulnerable Adult Maltreatment Review Panel.
Section 256.023 — One Hundred Percent County Assistance.
Section 256.027 — Use Of Vans Permitted.
Section 256.028 — Tax Rebates.
Section 256.0281 — Interagency Data Exchange.
Section 256.029 — Domestic Violence Informational Brochure.
Section 256.041 — Cultural And Ethnic Communities Leadership Council.
Section 256.042 — Opiate Epidemic Response Advisory Council.
Section 256.043 — Opiate Epidemic Response Fund.
Section 256.045 — Administrative And Judicial Review Of Human Services Matters.
Section 256.0451 — Hearing Procedures.
Section 256.046 — Administrative Fraud Disqualification Hearings.
Section 256.0471 — Overpayments Become Judgments By Operation Of Law.
Section 256.25 — Old Age Assistance To Be Allowed As Claim In District Court.
Section 256.263 — Land Acquired By State Under Old Age Assistance Liens.
Section 256.362 — Reports And Implementation.
Section 256.462 — Applicability Of Other Law; Recovery Of Assistance Furnished.
Section 256.476 — Consumer Support Program.
Section 256.477 — Self-advocacy Grants.
Section 256.4772 — Minnesota Inclusion Initiative Grant.
Section 256.4776 — Parent-to-parent Peer Support.
Section 256.478 — Transition To Community Initiative.
Section 256.479 — Customized Living Quality Improvement Grants.
Section 256.481 — Person With A Disability; Definition.
Section 256.482 — Council On Disability.
Section 256.4825 — Report Regarding Programs And Services For People With Disabilities.
Section 256.4835 — Minnesota Rare Disease Advisory Council.
Section 256.484 — Social Adjustment Services To Refugees.
Section 256.741 — Child Support And Maintenance.
Section 256.82 — Payments By State.
Section 256.87 — Contribution By Parents.
Section 256.8799 — Supplemental Nutrition Assistance Outreach Program.
Section 256.88 — Social Welfare Fund Established.
Section 256.89 — Fund Deposited In State Treasury.
Section 256.90 — Social Welfare Fund; Use; Disposition; Depositories.
Section 256.92 — Commissioner Of Human Services, Accounts.
Section 256.925 — Optional Voter Registration For Public Assistance Applicants And Recipients.
Section 256.93 — Commissioner Of Human Services, Possession Of Estates.
Section 256.935 — Funeral Expenses, Payment By County Agency.
Section 256.9365 — Purchase Of Health Care Coverage For People Living With Hiv.
Section 256.94 — Conferences Of Various Officials.
Section 256.95 — Expense Of Attendance At Conference.
Section 256.958 — Retired Dentist Program.
Section 256.959 — Dental Practice Donation Program.
Section 256.96 — Cooperation With Other Boards.
Section 256.962 — Minnesota Health Care Programs Outreach.
Section 256.963 — Primary Care Access Initiative.
Section 256.9655 — Payments To Medical Providers.
Section 256.9656 — Deposits Into The General Fund.
Section 256.9657 — Provider Surcharges.
Section 256.9685 — Establishment Of Inpatient Hospital Payment System.
Section 256.9686 — Definitions.
Section 256.969 — Payment Rates.
Section 256.9693 — Inpatient Treatment For Mental Illness.
Section 256.9695 — Appeals Of Rates; Prohibited Practices For Hospitals; Transition Rates.
Section 256.974 — Office Of Ombudsman For Long-term Care.
Section 256.9741 — Definitions.
Section 256.9742 — Duties And Powers Of The Office.
Section 256.9744 — Office Data.
Section 256.975 — Minnesota Board On Aging.
Section 256.9752 — Senior Nutrition Programs.
Section 256.9753 — Volunteer Programs For Retired Senior Citizens.
Section 256.9754 — Community Services Development Grants Program.
Section 256.9755 — Caregiver Support Programs.
Section 256.976 — Foster Grandparents Program.
Section 256.977 — Senior Companion Program.
Section 256.978 — Location Of Parents, Access To Records.
Section 256.979 — Child Support Incentives.
Section 256.98 — Wrongfully Obtaining Assistance; Theft.
Section 256.981 — Training Of Welfare Fraud Prosecutors.
Section 256.982 — Training Of Welfare Fraud Investigators.
Section 256.983 — Fraud Prevention Investigations.
Section 256.9831 — Benefits; Gambling Establishments.
Section 256.984 — Declaration And Penalty.
Section 256.986 — County Coordination Of Fraud Control Activities.
Section 256.9861 — Fraud Control; Program Integrity Reinvestment Project.
Section 256.9862 — Electronic Benefit Transaction Card Fee.
Section 256.9863 — Electronic Benefit Transaction Card; Receipt Of Benefits.
Section 256.9864 — Reports By Recipient.
Section 256.9865 — Recovery Of Overpayments And Atm Errors.
Section 256.9866 — Community Service As A County Obligation.
Section 256.987 — Electronic Benefit Transfer Card.
Section 256.9872 — Ebt Transaction Costs; Supplemental Nutrition Assistance Program.
Section 256.99 — Reverse Mortgage Proceeds Disregarded.
Section 256.995 — School-linked Services For At-risk Children And Youth.
Section 256.997 — Child Support Obligor Community Service Work Experience Program.