Minnesota Department of Human Services

Member and Provider Services

Minnesota Health Care Programs (MHCP) - Provider Screening and Enrollment Unit
Elmer L. Andersen Building
540 Cedar Street
PO Box 0987
St Paul, MN 55164-0987

March 17, 2017

John Noseworthy, M.D.

Chief Executive Officer
Mayo Clinic Hospital - 1841266194
1216 Second Street SW
Rochester, MN 55902

Dr. Noseworthy:

I am writing in follow-up to Commissioner Emily Pipers letter dated March 16, 2017. The Department of Human
Services has several questions about a press report that your organization may be changing some internal
policies of operation that may affect Minnesotans with Minnesota Health Care Program coverage.

In August 2015, your organization completed its revalidation as part of the federal screening requirements
under the Affordable Care Act. During this process, Ronald Grouskly, reported as Vice Chair, signed and returned
the MHCP Provider Agreement (DHS-4138), which includes these items:
Item 16, at the top of page 2, which states that your organization agrees to:

Render to recipients services of the same scope and quality as would be provided to the general
public, within MHCP guidelines, in accordance with Section 1902(a)(10)(B) (E) of the Social
Security Act.

Minnesota Rules, Part 9505.0195, subd. 10 provides:

Subpart 10. Condition of participation.

A provider shall comply with title VI of the Civil Rights Act of 1964 and all regulations under the act, and
with Minnesota Statutes, chapter 363. A provider shall not place restrictions or criteria on the services it
will make available, the type of health conditions it will accept, or the persons it will accept for care or
treatment, unless the provider applies those restrictions or criteria to all individuals seeking the
provider's services. A provider shall render to recipients services of the same scope and quality as would
be provided to the general public. Furthermore, a provider who has such restrictions or criteria shall
disclose the restrictions or criteria to the department so the department can determine whether the
provider complies with the requirements of this subpart.
Given this information, please respond and submit further clarification about the following to Provider
Enrollment as soon as possible. I will look forward to your response in the next two weeks.
What is the change in policy you referred to in the speech that was reported on in the March 15 Star
Tribune article, Mayo to give preference to privately insured patients over Medicaid patients? Please
provide a detailed explanation and the specific criteria for implementing the change.
What is the effective date of the change?
Which Mayo facilities and locations will be implementing the change? Please provide an attachment
with a list of the facilities and locations names, their National Provider Identifiers (NPIs), and their
Federal Employer Tax ID Numbers (EINs).
How will you continue to meet the conditions of participation as indicated in MN Rules, Part 9505.0195?
How will you operationalize the changes in relation to patient privacy and compliance with data privacy
rules and regulations?
How is information about the diagnosis, severity of the medical need, and symptoms translated to the
intake person for that person to determine whether the privately and publicly ensured have the same
needs?
Does an intake person have the professional knowledge to assess and determine the equality of medical
needs and care between two different individuals?
Although comments reported in the article mention that emergency rooms will continue to accept
people regardless of their coverage, will the changes result in any delays in the order that people are
seen and provided care?
How will the change affect patients with public coverage who currently are under Mayos care?
When a person starts under your care as privately insured, exhausts his or her resources, and obtains
public-program insurance, either as a supplement or in addition to the persons private insurance, how
will the change affect the persons continued care?
Will the change clarify different preferences for a person who has both private and public-program
coverage and a person who has only public-program coverage?
For a person whose coverage changes from private to public-program coverage, will professionals and
direct care staff providing the persons care be notified the person now has public-program coverage?
Will a person with public-program coverage experience delays in getting care because of having to
reschedule previously scheduled appointments so Mayo can accommodate someone with private
coverage?
Do you have a written policy and procedure describing the process your organization will follow in
implementing the change? Please attach a copy with your response.

Sincerely,

Nathan Moracco
Assistant Commissioner

CC: Emily Piper

Enclosures:
Mayo Hospital MHCP Provider Agreement dated July 7, 2015
DHS-4138