DHS-3050 – Consent for Release

The DHS MN-ITS system enables health care providers to verify eligibility for Minnesota Health Care Program (MHCP) enrollees. MN-ITS provides the following information for each enrollee, if applicable:

Major program.

Prepaid health plan enrollment.

Medicare coverage.

Third party liability (TPL).

Spenddown.

Benefit limitations.

Restricted recipient status.

Special transportation.

Elderly Waiver obligation.

Eyeglass payment.

The signed consent is not needed to communicate information available on MN-ITS.

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Level of Care Requirement - LTC Screenings - LTCF

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