M.S.A. §256B.04

Duties of State Agency

The state agency must supervise the administration of medical assistance programs by the counties.  The Commissioner must fulfill the duties to establish and implement a comprehensive health services system that promotes accessible and quality care for all Minnesota residents, provides health care within the state budget, provides statewide eligibility and benefits, manages care, develops risk management strategies and contains costs.  The state agency must also make uniform laws that carry out and enforce the provisions dealing with medical assistance programs.  The state agency must come up with, print and supply eligibility forms to the county agencies.  The state agency is responsible for reviewing applications for MinnesotaCare and determining eligibility.  Coordination with the federal government, fulfilling reporting requirements, and administering the Medicare Part D prescription drug benefit program are to be done by the state agency.   The state agency must file an annual report on the expenditures and costs associated with the medical assistance program, and must file a monthly statement showing the amounts paid to the counties and the number of people helped.  The state agency must also enforce safeguards to protect the unauthorized disclosure of information, investigate suspected medical fraud or theft, and coordinate with agencies in other states to coordinate medical payments.  The state agency has the responsibility of determining what services should be covered by medical assistance programs, including the determination of what qualifies as a “medically necessity,” the amounts to be paid for each service, and rules establishing maximum reimbursement rates for emergency and nonemergency transportation. 

The state agency must perform a utilization review to ensure that medical services are not being used unnecessarily or inefficiently.  It must also guard against overpayment to providers and lengthy hospital stays.  The state agency also governs the licensure of personal care services provided under medical assistance programs as well as promote early prenatal care.  The state agency must also establish a performance data reporting unit that works with the counties and the state.  The performance data reporting unit must share information among counties and between the counties and state. 

Related Laws:  MN ADC 9505.0205