Policies & Guidelines
- Compliance
- Definitions
- Ambulatory Surgical Services
- Billing Policy
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Legal References
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- Ambulatory Surgical Services
- Billing Policy
- CFSS
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- Equipment and Supplies
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Member Eligibility
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Quality: HEDIS
- Policies & Procedures
Pharmacy Services
Legal References
MN Stat. sec 62J.536 – Uniform Electronic Transactions and Implementation Guide Standards
MN Stat. Chap. 62M – Utilization Review of Health Care
MN Stat. sec. 62Q.527 – Nonformulary Antipsychotic Drugs; Required Coverage
MN Stat. Chap. 151 – Pharmacy Practice and Wholesale Distribution Act
MN Stat. sec. 151.01, subd. 5 – Definitions: Drug
MN Stat. sec. 151.01, subd. 16a – Definitions: Prescription
MN Stat. sec. 151.01, subd. 27 – Definitions: Practice of pharmacy
MN Stat. sec. 256B.0625, subd. 13 (c – j) – Covered Services: Drugs; Formulary committee; Drug formulary; Payment rates; Prior authorization; Preferred drug list; Medication therapy management services; Drug Utilization Review Board report; Antipsychotic and attention deficit disorder and attention deficit hyperactivity disorder medications
MN Rules Chap. 6800 – Pharmacies and Pharmacists
MN Rules part 6800.0910 – Patient Access to Pharmacist
MN Rules part 6800.2700 – Return of Drugs and Devices
MN Rules part 6800.3100 – Compounding and Dispensing
MN Rules part 6800.3110 – Patient Medication Profiles
MN Rules part 6800.3510 – Refill Limitations
MN Rules part 9505.0175, subp. 49 – Definitions: Usual and customary
MN Rules part 9505.0340 – Pharmacy Services
MN Rules parts 9505.5000 – 9505.5105 – Conditions for Medical Assistance and General Assistance Medical Care Payment
42 CFR 423.154 – Appropriate dispensing of prescription drugs in long-term care facilities under PDPs and MA-PD plans
42 CFR 440.120(a) – Prescribed drugs, dentures, prosthetic devices, and eyeglasses
42 CFR 447.53 – Cost sharing for drugs
42 CFR 483.10 – Resident rights
59 Fed. Reg. 242 (1994) #94-31157 – Publication of OIG Special Fraud Alerts
Title XIX, section 1927 of the Social Security Act – Payment for Covered Outpatient Drugs
Title 42 USC 1320a-7b – Criminal penalties for acts involving Federal health care programs
PW-04-19_194
Updated_10/11/2023
