Subdivision 1. Appeals. A hospital may appeal a decision arising from the application of standards or methods under section 256.9685, 256.9686, or 256.969, if an appeal would result in a change to the hospital's payment rate or payments. Both overpayments and underpayments that result from the submission of appeals shall be implemented. Regardless of any appeal outcome, relative values, Medicare wage indexes, Medicare cost-to-charge ratios, and policy adjusters shall not be changed. The appeal shall be heard by an administrative law judge according to sections 14.57 to 14.62, or upon agreement by both parties, according to a modified appeals procedure established by the commissioner and the Office of Administrative Hearings. In any proceeding under this section, the appealing party must demonstrate by a preponderance of the evidence that the commissioner's determination is incorrect or not according to law.
To appeal a payment rate or payment determination or a determination made from base year information, the hospital shall file a written appeal request to the commissioner within 60 days of the date the preliminary payment rate determination was mailed. The appeal request shall specify: (i) the disputed items; (ii) the authority in federal or state statute or rule upon which the hospital relies for each disputed item; and (iii) the name and address of the person to contact regarding the appeal. Facts to be considered in any appeal of base year information are limited to those in existence 18 months after the last day of the calendar year that is the base year for the payment rates in dispute.
Subd. 2. Prohibited practices. (a) Hospitals that have a provider agreement with the department may not limit medical assistance admissions to percentages of certified capacity or to quotas unless patients from all payors are limited in the same manner. This requirement does not apply to certified capacity that is unavailable due to contracts with payors for specific occupancy levels.
(b) Hospitals may not transfer medical assistance patients to or cause medical assistance patients to be admitted to other hospitals without the explicit consent of the receiving hospital when service needs of the patient are available and within the scope of the transferring hospital. The transferring hospital is liable to the receiving hospital for patient charges and ambulance services without regard to medical assistance payments plus the receiving hospital's reasonable attorney fees if found in violation of this prohibition.
Subd. 3. [Repealed, 2014 c 312 art 24 s 48]
Subd. 4. [Repealed, 2014 c 312 art 24 s 48]
Subd. 5. Rules. The commissioner of human services shall adopt permanent rules to implement this section and sections 256.9685, 256.9686, and 256.969 under chapter 14, the Administrative Procedure Act.
1989 c 282 art 3 s 39; 1990 c 568 art 3 s 18,19; 1991 c 292 art 4 s 30,78; 1992 c 513 art 7 s 28; 1993 c 339 s 11,12; 1Sp1993 c 1 art 5 s 26; 1994 c 465 art 3 s 571; 1997 c 203 art 4 s 17; 1Sp2017 c 6 art 4 s 15; 2021 c 30 art 1 s 5
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.