COVERED SERVICES; OUT-OF-STATE PROVIDERS

Subpart 1. Out-of-state provider. For purposes of this part, "out-of-state provider" means a provider who is located outside of Minnesota and outside of the recipient's local trade area. Subp. 2. Reimbursement requirements. A health service provided to a recipient by an out-of-state provider is eligible for medical assistance payment if the service meets the requirements of items A, B, and C. A. The service must be a covered service as defined in part 9505.0175 , subpart 6. B. The provider must obtain prior authorization if prior authorization is required under Minnesota Statutes, section 256B.0625 , subdivision 25, parts 9505.0170 to 9505.0475 , or parts 9505.5000 to 9505.5030 . C. The service must meet one of the following conditions: (1) the department determines, on the basis of medical advice from a consultant as defined in part 9505.5005 , subpart 3, that the service is not available in Minnesota or the recipient's local trade area; (2) the service is in response to an emergency; or (3) the service is needed because the recipient's health would be endangered if the recipient was required to return to Minnesota. Subp. 3. Inapplicability when recipient not out-of-state. The requirements in subpart 2, item C, do not apply when, at the time of service, the recipient is located within Minnesota or the recipient's local trade area.