Minnesota Regulations

MENTAL HEALTH SERVICES EXPENSES.  “Mental health services expenses” means all costs related to inpatient and outpatient mental health services that are coded using one or more of the following codes or amended equivalent codes:

302. ICD-9 diagnosis code ranges 290 to 302.9 and 306 to 319; and
303. CPT codes: 90801, 90841, 90843, 90844, 90844.22, 90846, 90847, 90847.22, 90849, 90853, 98900, 98902, 98910, and 98912.Mental health services expenses also means all costs related to inpatient and outpatient mental health services that are coded using codes from another coding system where the commissioner determines that the codes indicate diagnoses or procedures comparable to or consistent with codes listed in items A and B. A group purchaser may use a nationally recognized standardized reporting system to capture costs for mental health inpatient, outpatient, and other professional services. Mental health services expenses does not include prescription drugs or supplies administered or dispensed which are billed directly through a hospital or health care provider.

2. INPATIENT HOSPITAL SERVICES.

1. Enrollees are covered for medically necessary inpatient hospital services including acute care services, mental health services, and chemical dependency services.

11. SECOND MEDICAL OPINION. A health plan must include in its certificate of coverage information about enrollees’ right to a second medical opinion according to items A to C.
12. Upon enrollee request, the health plan shall provide at health plan expense a second medical opinion by a participating provider within the health plan.
13. The health plan shall comply with Minnesota Statutes, section 62D.103, and shall provide at health plan expense a second medical opinion by a qualified nonparticipating provider when the health plan determines that an enrollee’s chemical dependency or mental health problem does not require structured treatment.
14. The health plan shall provide at health plan expense a second medical opinion when ordered to do so by a state human services referee under Minnesota Statutes, section 256.045.