Behavioral health providers
Certain behavioral health drugs are offered orally or as an injectable. Drugs offered as an injectable (excluding immunizations) need to be administered in an inpatient setting by a home health professional, in a skilled nursing facility by a practitioner or in an outpatient setting by a practitioner.
According to the Minnesota State Statute 256B.0625, Covered Services, Subd. 13e, Payment Rates, “A retail or specialty pharmacy dispensing a drug for administration in an outpatient setting is not eligible for direct reimbursement.” Therefore, it is imperative that providers obtain the drug from a source other than a retail or specialty pharmacy and bill MHP/Hennepin Health for the drug using the appropriate J code.