Rule 101 requires providers who want to be paid for other state-sponsored health care programs to participate in MHCP and accept new patients (per current procedural terminology [CPT] definition) who are MHCP recipients on a continuous basis. Other state-sponsored health care programs include:
Non-dental providers may limit acceptance of new patients who are MHCP recipients if recipients comprise at least 20 percent of the provider’s active caseload based on the following calculations:
Dental providers may limit acceptance of new MHCP recipients at their practice locations within the seven-county metro area (Anoka, Carver, Dakota, Hennepin, Ramsey, Washington and Scott) if they meet one of these conditions:
The above requirement applies only to dental practice located within the seven-county metro area. Dental practice located outside of the seven-county metro area who want to be paid for other state-sponsored health care programs are not subject to the required 10 percent annual active case load.
All providers must notify MHCP Provider Enrollment in writing before limiting acceptance of new recipients, and include active patient caseload data used to calculate the percentage of patients who are recipients.
If MHCP accepts the notice, the acceptance will be effective 10 days after MHCP notifies the provider in writing, and will remain in effect for the remainder of the provider's fiscal year. Providers who wish to continue limiting MHCP caseload must file a new notice each year. A provider who has a contract with an MHCP-contracted MCO must notify each plan of its intention to limit acceptance of new MHCP patients.
MHCP shares lists of providers who comply with participation requirements quarterly with the State Departments of Commerce, Management & Budget, and Labor and Industry. A provider who fails to comply with the requirements of Rule 101 will be excluded from state-sponsored health care programs. MHCP will notify a provider if we have reason to believe they are not complying with these participation requirements. The provider will have 30 days to provide MHCP with evidence of participation compliance. After the response period expires, those who have not submitted evidence of compliance will be excluded from participation in the other state health care programs.
Minnesota Statutes 62D.04, subd. 5 Issuance of Certificate Authority, Participation; government programs
Minnesota Statutes 256B.0644 Reimbursement under Other State Health Care Programs
Minnesota Rules 9505.5200–9505.5240 Rule 101, purpose, definitions, conditions, reports/exclusion