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
Requirements for Providers
Legal References
MN Stat. Chap. 14 – Administrative Procedure
MN Stat. secs. 14.57 – 14.62 – Contested Case Procedures
MN Stat. sec. 62D.04, subd. 5 – Issuance of Certificate Authority: Participation; government programs
MN Stat. Chap. 145C – Health Care Directives
MN Stat. sec. 256B.02 – Definitions
MN Stat. sec. 256B.02, subd. 7 – Definitions: Vendor of medical care
MN Stat. sec. 256B.02, subd. 8 – Definitions: Medical assistance; medical care
MN Stat. sec. 256B.03 – Payments to Vendors
MN Stat. sec. 256B.04 – Duties of State Agency
MN Stat. sec. 256B.04, subds. 21 and 22
MN Stat. sec. 256B.0625 – Covered Services
MN Stat. sec. 256B.0625, subd. 39 – Covered Services: Childhood immunizations
MN Stat. sec. 256B.064 – Sanctions; Monetary Recovery
MN Stat. sec. 256B.064, subd. 1d – Sanctions; Monetary Recovery: Investigative costs
MN Stat. sec. 256B.0644 – Reimbursement under Other State Health Care Programs
MN Stat. sec. 256B.27 – Medical Assistance; Cost Reports
MN Stat. sec. 256B.27, subd. 4 – Medical Assistance; Cost Reports: Authorization of commissioner to examine records
MN Stat. sec. 256B.434 – Nursing Facility Payment Rates and Procedures
MN Stat. sec. 256B.48 – Conditions for Participation
MN Stat. sec. 363A.36 – Certificates of Compliance for Public Contracts
MN Stat. sec. 609.48 – Perjury
MN Stat. sec. 609.52, subd. 2 – Theft: Acts constituting theft
MN Stat. sec. 609.625 – Aggravated Forgery
MN Stat. sec. 609.63 – Forgery
MN Stat. sec. 609.821 – Financial Transaction Card Fraud
MN Rules part 4685.1010 – Availability and Accessibility
MN Rules Chap. 9505 – Health Care Programs
MN Rules part 9505.0015, subp. 8 – Definitions: Authorized representative
MN Rules part 9505.0015, subp. 46 – Definitions: Third-party payer
MN Rules part 9505.0070, subp. 3 – Third-Party Liability: Provider responsibility to obtain information and assignment of benefits
MN Rules part 9505.0140 – Payment for Access to Medically Necessary Services
MN Rules parts 9505.0170 – 9505.0475 – Medical Assistance Payments
MN Rules part 9505.0195, subp. 10 – Provider Participation: Condition of participation
MN Rules part 9505.0210 – Covered Services; General Requirements
MN Rules part 9505.0215 – Covered Services; Out-of-State Providers
MN Rules part 9505.0225 – Request to Recipient to Pay
MN Rules part 9505.0315, subp. 1 – Medical Transportation: Definitions
MN Rules part 9505.0440 – Medicare Billing Required
MN Rules parts 9505.0455 – 9505.0475 – Billing Procedure; Business Agent; Consequences of a False Claim; Recovery of Payment to Provider; Provider Responsibility for Billing Procedure; Suspension of Provider Convicted of Crime Related to Medicare or Medicaid
MN Rules parts 9505.2160 – 9505.2245 – Surveillance and Integrity Review Program
MN Rules part 9505.2175 – Health Service Records
MN Rules part 9505.2175, subp. 3 – Health Service Records: Requirements for pharmacy service records
MN Rules part 9505.2180 – Financial Records
MN Rules part 9505.2185 – Access to Records
MN Rules part 9505.2185, subp. 2 – Access to Records: Department access to records
MN Rules part 9505.2190 – Retention of Records
MN Rules part 9505.2195 – Copying Records
MN Rules part 9505.2200, subp. 1 – Identifying Fraud, Theft, Abuse, or Error: Department investigation
MN Rules parts 9505.5200 – 9505.5240 – Department Health Care Program Participation Requirements for Vendors and Health Maintenance Organizations
42 CFR 422.455 – Special Rules for MA Regional Plans
42 CFR 422.504(d) – Contract provisions: Maintenance of records
42 CFR 431.53 – Assurance of transportation
42 CFR 431.107 – Required provider agreement
42 CFR 447.10 – Prohibition against reassignment of provider claims
42 CFR 447.15 – Acceptance of State payment as payment in full
42 CFR 447.31 – Withholding Medicare payments to recover Medicaid overpayments
42 CFR 455 – Program Integrity: Medicaid
42 CFR 455.101 – Disclosure of Information by Providers and Fiscal Agents: Definitions
42 CFR 455.102 – Disclosure of Information by Providers and Fiscal Agents: Determination of ownership or control percentages
42 CFR 455, subp. B – Disclosure of Information by Providers and Fiscal Agents
42 CFR 455.450 – Screening levels for Medicaid providers
42 CFR 1001.952 – Exceptions
Section 504 of the Rehabilitation Act of 1973
Title XI, section 1128(b) (formerly Title XIX, section 1909) of the Social Security Act
Title XVIII, section 1877(b) of the Social Security Act – Limitation on Certain Physician Referrals: General Exceptions to Both Ownership and Compensation Arrangement Prohibitions
42 USC 1320a-7b – Criminal penalties for acts involving Federal health care programs
42 USC 1320a-7b(b)(3)(D) – Criminal penalties for acts involving Federal health care programs: Illegal remunerations
Final Federal provider screening regulations, published February 2, 2011
PW_04-19_197
Updated_04/30/2020
