Domestic Refugee Health Screening Guidance
The Minnesota Initial Refugee Health Assessment
On this page:
Background
Best practices and special considerations
Components of the Minnesota Initial Refugee Health Assessment
Reportable diagnoses
Reimbursement for the Minnesota Initial Refugee Health Assessment
Resources
Background
The Minnesota Department of Health (MDH) Refugee Health Program serves refugees, asylees Cuban/Haitian entrants, victims of trafficking, Amerasians, and humanitarian parolees eligible for refugee benefits. In collaboration with local health departments and health care providers, the program oversees the administration of the domestic refugee health assessment and follow-up process. The objectives of this screening are to identify and treat health problems which may interfere with the refugee’s resettlement, including the ability to obtain employment, attend classes, and/or access the health care system. MDH encourages all refugees to have a comprehensive health screening performed within 90 days of arrival to the state. The health assessment protects the health of the newcomers and Minnesota’s public through disease diagnosis and treatment. Another benefit of this organized statewide screening process is the collection of data used to predict future trends in communicable disease, set policy, and offer increased services for newcomers.
The Minnesota Initial Refugee Health Assessment exam is the recommended screening in Minnesota and fulfills the national requirements for the Domestic Refugee Health Assessment. This exam differs significantly from the medical examination completed overseas in both its purpose and scope. The overseas medical examination is intended to identify medical conditions which will exclude a person from coming to the U.S. (Class A condition). The domestic refugee health assessment is designed to reduce health-related barriers to successful resettlement, while protecting the health of Minnesota residents and the U.S. population.
The overseas medical examination is typically valid for up to six months, if there are no Class A or Class B TB conditions; so, there is potential for a lag period between medical clearance and arrival in Minnesota. The health status of a person may change during this time, which is why there is some overlap between lab tests done overseas and domestically.
The third common medical examination for refugees occurs after one year of residency when refugees apply for their adjustment of status to become legal permanent residents. Refugees without a Class A designation only need to be up to date with their immunizations. Civil surgeons and local public health departments with a medical director may sign-off on the immigration examination for refugees. That process is under the jurisdiction of the U.S. Customs and Immigration Services (USCIS).
Best practices and special considerations
Each local public health department has established relationships with health care systems and screening clinics to coordinate the initial health assessment. Together, they arrange transportation and an interpreter for the visits, and attempt to schedule refugees as a family unit. They will also try to coordinate referrals for follow-up care needs.
Best practices to address social determinants of health, gender concordance, consent and confidentiality, and incorrect dates of birth have been addressed in Key Clinical and Cultural Considerations for the Domestic Medical Screening.
Components of the Minnesota Initial Refugee Health Assessment
The components of the examination in Minnesota, available here, are based upon the recommendations of the Immigrant and Nationality Act of 1980, the Office of Refugee Resettlement: Refugee Medical Screening revised guidelines issued in 2012, and the CDC: Refugee Health Domestic Guidance. Some guidance has been adapted based on local epidemiology and state protocols.
Any board-certified health care provider in Minnesota can perform this examination and document findings on the Minnesota Initial Refugee Health Assessment form. When completed, this form should be returned to the local county public health department. Providers who perform the Minnesota Initial Refugee Health Assessment within the first 90 days of the refugee’s arrival can receive reimbursement from MDH providing no other source of reimbursement is available, as described below.
- Minnesota Initial Refugee Health Assessment Form (PDF)
For providers and local public health agencies to complete during the Refugee Health Assessment exam. Recommended for all primary refugees within 90 days of their arrival in Minnesota. Updated 10/2021 - Refugee/Immigrant Health Assessment Outcome Report (PDF)
One copy of this form should be filed for each family that did not receive an assessment. Updated 9/2019
Reportable diagnoses
Minnesota law requires that physicians, health care facilities, and laboratories report certain diseases to the Minnesota Department of Health. Submission of the Refugee Health Assessment Form does not satisfy this reporting obligation. A copy of this law, the requirements for reporting, and the form used to report are included below. For more information about mandatory reporting or to report a case, call 651-201-5414 or 877-676-5414 (toll free) or contact MDH by fax at 1-800-233-1817.
- Minnesota Department of Health: Disease Report Card
The MDH "Yellow Card" is used to report cases of most reportable infectious diseases in Minnesota residents to the Minnesota Department of Health. - Minnesota Administrative Rules: Chapter 4605, Communicable Diseases
Legislation covering the mandated reporting of certain communicable diseases.
Reimbursement for the Minnesota Initial Refugee Health Assessment
Several methods of reimbursement are available to refugees and providers to cover the cost of the Minnesota Initial Refugee Health Assessment.
Most refugees are eligible for state-sponsored medical assistance programs and are often tracked into managed care plans through PMAP. Clinics and health care providers may seek reimbursement for the initial health screening, including immunizations.
- For refugees with straight MA, bill each service provided as you would for any other MA patient.
- Managed-care enrollees must receive services from designated providers who are in their health plan network. Providers are encouraged to verify individual eligibility and health plan enrollment status by calling the Department of Human Services or Verify Eligibility for MHCP Members.
MDH offers a flat fee reimbursement ($505.32 per assessment) to health care providers performing the Minnesota Initial Refugee Health Assessment exam for refugees who are not eligible for health care coverage for these services. This fee is contingent upon refugees being seen for the exam within 90 days of arrival to the U.S. for primary refugees, parolees, Special Immigrant Visa-holders, or derivative asylees, or within 90 days of certification for U.S.-granted asylees and certified victims of human trafficking. The reimbursement rate is based on Medicaid approved laboratory and examination rates and includes partial payment for interpreter services incurred as part of the assessment.
To access the flat fee reimbursement, the provider should:
- Verify with the MDH Refugee Health Program (651-201-5414 or 877-676-5414) that the patient is a primary refugee, has lived in the U.S. less than 90 days, has not had a health assessment, and does not qualify for MA.
- Conduct the exam and document findings on the Minnesota Initial Refugee Health Assessment form.
- Submit the completed Minnesota Initial Refugee Health Assessment form to the local public health department and check on the form that you will be requesting flat-fee reimbursement.
- Submit the flat fee reimbursement request form to MDH.
- MDH will verify and process payment request upon receipt.
Resources
- Minnesota Refugee Health Program
Learn more about the Refugee Health Program's efforts to coordinate domestic refugee health screenings, analyze, summarize, and share data, and train health professionals. - CDC: Technical Instructions for Panel Physicians
Instructions for CDC-designated physicians who complete the overseas medical examinations, and information on Class A and B classifications for medical conditions. - Form I-693, Report of Medical Examination and Vaccination Record
Find the latest I-693 form on the USCIS website. - Minnesota Civil Surgeons
A brief overview of the role of the civil surgeon and a list of USCIS-designated medical providers in Minnesota who can sign off on the I-693 medical exam. - Local Health Departments Allowed “Blanket” Designation to Participate as a Civil Surgeon (PDF)
- Resettlement Agencies
Local, federal, and international organizations supporting refugees through the process of getting settled in a new country and home. Includes the Office of Refugee Resettlement and selected sites of the Centers for Disease Control and Prevention. - Directories for Organizations Serving Diverse Communities
Three directories (health resource, community-based organizations, and media) for organizations serving the refugee, immigrant and migrant community in Minnesota. - Cultural Competence
Cross-cultural knowledge and sensitivity are critical to providing good health care to foreign born people. Local and national resources.