1) State:Minnesota

2) Own or Federal Exchange?State Exchange called the “MNSure”

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3) Medicaid Expansion? Yes

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4) What kind of coverage is available for mental health/substance abuse treatment through Medicaid?

In order to be covered by Medicaid in Minnesota, a health service must be determined by prevailing community standards or customary practice and usage to be:

• Medically necessary

• Appropriate and effective for the medical needs of the of the patient

• Able to meet quality and timeliness standards

• Able to represent an effective and appropriate use of program funds

• Able to meet specific limits outlined in rules adopted by DHS and explained in the service-specific MHCP Provider Manual sections

• Personally rendered by a provider, except as specifically authorized in the MHCP Provider Manual

Minnesota Medicaid does not cover:

• Health services:

• For which a physician’s order is required but not obtained

• Not documented in the recipient’s health/medical record

• Not in the recipient’s plan of care, individual treatment plan, IEP, or individual service plan

• Not provided directly to the recipient unless the service is identified as a covered service in MHCP Provider Manual

• Of a lower standard of quality than the prevailing community standard of the provider’s professional peers (providers of services that are determined to be of low quality must bear the cost of these services)

• Other than an emergency health service, provided to a recipient in a long-term care facility that are not in the recipient’s plan of care and have not been ordered, in writing, by a physician when an order is required

• Other than emergency health services, provided without the full knowledge and consent of the recipient or the recipient’s legal guardian

• Paid for directly by the recipient or other source, except when the recipient made the payment for services incurred during the recipient’s retroactive eligibility period. Refer to Billing Policy and Billing the Recipient

• That do not contain documentation of supervision, if supervision is required

• Missed appointments (do not bill MHCP recipients for missed appointments)

• Non-U.S. (out-of country) care

• Reversal of voluntary sterilizations

• Surgery primarily for cosmetic purposes

• Vocational or educational services, including functional evaluations or employment physicals, except as provided under IEP-related services

Related to mental health and substance abuse, MCOs and the Consolidated Chemical Dependency Treatment Fund (CCDTF) cover all services provided under a licensed program of care. These services include:

• Nonresidential treatment

• Residential treatment

• Hospital-based inpatient treatment

• Room and board (when CD treatment is currently authorized and used)

• Service coordination

Service Coordination

Minnesota Medicaid will not reimburse for the following services or situations:

• Services provided by a nonlicensed provider

• Services provided by a provider that does not have a host county or tribal purchase of service contract

• Services not included in the provider’s host county or tribal purchase of service contract

• Services provided by a non-MHCP-enrolled provider

• Services provided by individuals (CCDTF reimburses only licensed providers)

• Room-and-board services that are not clinically or medically necessary

• Room-and-board services without a concurrent treatment span

• Rule 25 chemical use assessments

• Services delivered to people who are not financially eligible for the CCDTF

• Services delivered to people who are not clinically eligible for the CCDTF

• Services delivered before the completion of a Rule 25 assessment, except for retroactive MA

• Services not authorized by a county or tribe

• Services delivered to people on public health care managed by an MCO, except when authorized by a county that agrees to pay 100 percent

• Detoxification services that are not part of a licensed program of care

• Telemedicine

• More than one treatment service for the same recipient, for the same date span, provided by the same provider, except for nonresidential group and individual

• Services delivered at one location and billed to another location

• Guest dosing

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5) Does the state allow the court to order treatment and still have it paid by Medicaid?

  • The court can order treatment and have it paid by Medicaid if the services are covered by Medicaid (shown in the question above).

6) Are there restrictions related to treatment providers for probationers, substance abuse, or mental health treatment? Will only certain providers be covered?

  • The Minnesota Division of Health Services oversees the Alcohol and Drug Abuse Division (ADAD). The ADAD develops and maintains the chemical health service system in Minnesota, and it encourages and supports research-informed practices, expands the use of successful models, and systematically monitors outcomes.
  • Treatment providers must be contracted with ADAD and must have the appropriate license and certification to treat patients in Minnesota.

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7) Is there coverage for residential substance abuse treatment? What are the parameters?

  • Minnesota has limited services available for Medicaid beneficiaries. All inpatient admissions must receive authorization from the Medicaid agency before treatment and every 30 days. Inpatient stays must also be deemed medically necessary by a health care professional. (See question 4)

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8) What is the process and what are the regulations for treatment providers to be able to participate?

  • Providers must be licensed or certified to practice in the state of Minnesota. They also must be Minnesota Medicaid Certified to receive reimbursements.
  • Medicaid reimbursement is available for mental and behavioral health services covered under various service categories: physician services, inpatient and outpatient hospital services, licensed practitioner’s services, clinics, and rehabilitative services.

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9) Is dental care covered?

  • Dental care is an option in the Marketplace, but is not included in the basic plan (except for children).
  • Minnesota Medicaid adult dental care coverage is limited to an exam and cleaning once per year.

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