Manual Letter #1

The redesigned HCPM replaces the previous version effective December 1, 2006.

The material has been reorganized. Use the Table of Contents and the navigation instructions on the manual home page to find policy information. Also refer to Bulletin # 06-21-15, "Redesign of the Health Care Programs Manual" for more information on the organizational changes.

This manual letter summarizes the policy changes and clarifications that are not in the latest version of the previous HCPM.

Recent Bulletins Incorporated.

Recent Bulletins With Links in the Manual.

General Changes.

Chapter Descriptions and New Material.

01 - Introduction.

02 - Minnesota Health Care Programs.

03 - Eligibility Groups and Bases of Eligibility.

04 - Social Security Administration (SSA) Benefits.

05 - Client Rights.

06 - Client Responsibilities.

07 - Applications.

08 - Renewals.

09 - Verification Requirements.

10 - Social Security Number.

11 - Citizenship and Immigration Status.

12 - Certification of Disability.

13 - State and County Residence Requirements.

14 - Living Arrangements.

15 - Insurance and Third Party Liability (TPL).

16 - Medical Support.

17 - Household Composition.

18 - Deeming Income and Assets.

19 - Assets.

20 - Income.

21 - Income Calculation (Community).

22 - Standards and Guidelines.

23 - Long-Term Care (LTC) and Elderly Waiver (EW).

24 - Medical Spenddowns.

25 - Premiums.

26 - Notices.

27 - Appeals.

28 - Health Care Service Delivery.

29 - Quality Assurance.

30 - Other Related Programs.

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Recent Bulletins Incorporated

The redesigned HCPM incorporates information from the following DHS bulletins. Specific manual sections in which the material is incorporated are noted in the chapter description section of this manual letter.

l  04-21-16, ”Changes in Procedures When Submitting Requests for SMRT Certifications.”

l  04-75-02, ”DHS Issues New Good Cause Notices and Clarifies the Role of the Good Cause Committee.”

l  05-21-03, ”DHS Provides Guidance Regarding New Medicare Prescription Drug Coverage.”

l  05-21-04, ”2005 Legislative Change for MinnesotaCare Enrollees Called to Active Military Duty.”

l  05-21-09, ”Legislative Changes Affecting Medical Assistance and MinnesotaCare Effective October 1, 2005.”

l  05-21-10, ”Changes to Cost Effective Insurance Guidelines Due to Medicare Part D Prescription Drug Coverage.”

l  06-21-02, ”Determination of Medical Assistance Overpayments from Income and Eligibility Verification System (IEVS) Matches.”

l  06-21-04, ”DHS Implements Policies and Procedures to Help Minnesota Health Care Programs Enrollees Transition to Medicare Prescription Drug Coverage.”

l  06-21-05, ”Minnesota Senior Health Options Expansion Update.”

l  06-21-08, ”Redesign of the Minnesota Health Care Programs Application and Renewal Forms.”

l  06-21-10, ”Failure to Verify Assets for MA Results in Ineligibility for MinnesotaCare and GAMC.”

l  06-21-11, ”Changes in Living Arrangement Codes in MMIS.”

l  06-21-13, ”Medical Assistance (MA) Policy Changes for Uncompensated Transfers.”

l  06-85-01, ”Procedures for Deciding Financial Responsibility Disputes Between Counties.”

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Recent Bulletins With Links in the Manual

Information from other recent bulletins will be added later. Currently the manual contains limited information from and links to the following bulletins in the appropriate chapters.

l  06-21-07, ”DHS Implements the Minnesota Family Planning Program.”

l  06-21-09C, ”Citizenship and Identity Documentation Requirements for Certain Minnesota Health Care Programs Applicants and Enrollees.”

l  06-21-12, ”New Eligibility Requirements for the GAMC Program and Introduction of a New Transitional MinnesotaCare Program.”

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General Changes

l  Removes references to the QI-2 (Qualified Individuals) program, which ended December 31, 2002. The program formerly known as QI-1 is now referred to as QI.

l  Removes policy for the Prescription Drug Program (PDP), which ended December 31, 2005, when the Medicare Part D program began.

l  Removes references to the Joint Commission on Accreditation of Health Care Organizations (JCAHCO).

Workers no longer need to inquire whether psychiatric hospitals or other facilities have JCAHO accreditation. Psychiatric hospitals enrolled as MA providers must be licensed by the State of Minnesota. Minnesota will not license an unaccredited facility. Accreditation of facilities other than psychiatric hospitals does not affect MA eligibility for the residents.

l  Clarifies the terms "qualified noncitizen" and "nonqualified noncitizen." ”Qualified noncitizen” is a U.S. Citizenship and Immigration Services term that designates the legal status of some noncitizens. A qualified status does not give a noncitizen automatic health care program eligibility, nor does it ensure federal funding.

l  Replaces the term ”non-IV-E adoption assistance” with ”State Adoption Assistance”.

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Chapter Descriptions and New Material

l  Glossary.

The glossary precedes the numbered chapters of the manual. Terms can be searched alphabetically. This updated version removes obsolete terms and adds new terms.

l  Chapter 1 - Introduction.

Provides a brief description of the purpose and legal authority for the manual.

l  Chapter 2 - Minnesota Health Care Programs.

n  02.00 Minnesota Health Care Programs.

Provides an overview and history of Medical Assistance, MinnesotaCare, General Assistance Medical Care, Medicare Savings Programs, and waiver programs.

n  02.05 Hierarchy of Major Programs.

Adds new information to guide workers in choosing the appropriate major program for people who may qualify for multiple programs and/or bases. This process is referred to as major program hierarchy. Factors for program hierarchy include funding, client cost-sharing, and covered services available to the client.

n  02.10 Benefit Sets.

Adds a brief overview of benefit sets. Adds a link to a document that summarizes Minnesota Health Care Program benefit sets.

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l  Chapter 3 - Eligibility Groups and Bases of Eligibility.

n  03.05.05  Change in MinnesotaCare Eligibility Group.

Adds new instructions for acting on reported changes in income from bulletin #05-21-09. Act on changes immediately. Do not wait until renewal.

n  03.15  Enrollee Becomes Pregnant.

n  03.20.05  MinnesotaCare for Pregnant Women.

Adds the policy change from bulletin #05-21-09 that pregnant MinnesotaCare clients are now potentially eligible with a pregnant woman status effective the first day of the month of conception (instead of the month of diagnosis).

Adds that a pregnant woman who was eligible for MinnesotaCare before the entry of the pregnancy status on the system is eligible for a refund of co-payments if the status changes retroactively.

Adds certified nurse practitioners to the list of medical providers who may verify pregnancy for MinnesotaCare.

n  03.20.10  MinnesotaCare for Auto Newborns.

Clarifies that at the end of the auto newborn eligibility period, workers should not request updated information if other members of the household are actively eligible at the time. Use the information that is already available for the household.

n  03.20.20  MinnesotaCare Adults With Children.

Removes policy related to mandatory referrals from GAMC to MinnesotaCare. This policy has been replaced by the new Transitional MinnesotaCare program.

n  03.20.25  MinnesotaCare Adults Without Children.

Adds a brief reference and link to bulletin #06-21-12, "New Eligibility Requirements for the GAMC Program and Introduction of a New Transitional MinnesotaCare Program."

n  03.25.05  Medical Assistance for Pregnant Women.

Adds the policy change from bulletin #05-21-09 that undocumented or nonimmigrant pregnant women who have other health insurance are no longer eligible for state-funded MA (program NM) for pre- and post-natal care. They may be eligible only for EMA for labor and delivery or other conditions that meet the definition of a medical emergency.

n  New Household Members for TMA and TYMA.

Clarifies that if an auto newborn is part of the TMA/TYMA household when the auto newborn period ends, workers should process eligibility for the auto newborn as a new household member.

n  03.45  Health Care for Other Populations.

n  03.45.35  Minnesota Family Planning Program.

Adds reference and brief description of the Minnesota Family Planning Program introduced in bulletin #06-21-07, "DHS Implements the Minnesota Family Planning Program," and information about the health care worker’s role.

n  03.45.20  Group Residential Housing.

This new section clarifies existing MA and GAMC policy for people who live in Group Residential Housing (GRH).

n  Presumptive Eligibility Providers for MA-BC.

Adds and updates the presumptive eligibility provider list for MA for Breast and Cervical Cancer that was in POLI/TEMP TE02.07.444, ”Presumptive Eligibility Providers for MA-BC.”

n  03.50  GAMC.

n  03.50.05  GAMC With Full Benefits.

n  Transitional MinnesotaCare.

n  03.50.10  GHO.

These sections:

m Add general references and overview for Transitional MinnesotaCare and a link to bulletin #06-21-12.

m Remove old policy related to mandatory referrals from GAMC to MinnesotaCare.

m Add the list of GAMC qualifiers from bulletin #06-21-12.

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l  Chapter 4 - Social Security Administration Benefits.

This new chapter adds basic eligibility information for the Railroad Retirement, RSDI, SSI and Medicare programs. Workers can use this information to assess clients’ potential eligibility and make referrals.

n  04.05  Railroad Retirement Board.

Adds information on eligibility for Railroad Retirement Benefits (RRB). This program is not run by the Social Security Administration, but provides similar benefits to railroad workers.

Adds information on Medicare ID numbers for RRB beneficiaries.

Adds information on how people apply for RRB benefits.

n  04.20  SS Claim Numbers and SS Claim Number Table.

Adds information on how Social Security claim numbers are constructed and a table to help workers identify what type of SS benefits a person is receiving based on the claim number.

n  04.35  Referrals to Social Security Benefits.

Adds expanded information on when people may be eligible for Social Security benefits. Some people who are potentially eligible must apply for the benefits as a condition of eligibility for MN Health Care Programs.

n  04.40  Medicare.

n  04.40.05  Part A.

n  04.40.10  Part B.

n  04.40.15  Part C.

These sections add information on who is eligible for Medicare, benefits provided, and cost-sharing.

n  04.40.20 Part D.

n Medicare Part D Cost Sharing Chart.

These sections incorporate information from bulletin #05-21-03 and bulletin #06-21-04, including:

m Open enrollment and special enrollment for Part D.

m Coverage and cost-sharing.

m ”Extra Help” available to subsidize all or part of a person’s premiums or cost-sharing.

n Medicare Part D Benchmark Plans

Adds a list of the 2006 and 2007 Medicare Part D benchmark plans available.

n  04.45 Medicare and MHCP

Adds information on how Medicare eligibility affects eligibility for the Minnesota Health Care Programs.

Incorporates information from bulletin #06-21-05 on the relationship between Medicare, including Part D, and MSHO.

n  04.45.05 MA/GAMC and Medicare Part D

Incorporates information from bulletin #06-21-04 on the relationship between MA/GAMC benefits and Part D and how Extra Help with Part D affects spenddown and LTC income calculations.

Adds information from bulletin #06-21-05 that MSHO enrollees who lose MA eligibility may continue to receive Medicare Part D benefits for up to three calendar months.

n  04.45.10 Referrals to Medicare

Adds information on how to refer people to apply for Medicare and how their eligibility for MHCP may be affected. Incorporates information from bulletin #06-21-04.

n  04.45.15 The Buy-In

Adds information on how the MHCP pay Medicare premiums through the Buy-In process.

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l  Chapter 5 - Client Rights.

n  05.00 Client Rights.

Updates the address for the Office for Equal Employment Opportunity (EEO), Affirmative Action (AA), and Civil Rights.

Removes a statement that the HCAPP includes a brief explanation of health care programs benefits and limitations as noted in bulletin #06-21-08.

n  05.05  Limited English Proficiency.

Adds Limited English Proficiency (LEP) information for counties.

n  05.10  Data Privacy.

Adds information about children's privacy rights.

n  05.10.05  HIPAA.

Adds general information about the Health Insurance Portability and Accountability Act (HIPAA).

l  Chapter 6 - Client Responsibilities.

n  06.10 Changes in Circumstances.

Clarifies that all changes must be reported within ten days of the date of the change.

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l  Chapter 7 - Applications.

n  07.05.05  Application Forms.

n  07.15.05  Application Not Required.

These sections:

m Remove references to the obsolete Minnesota Health Care Programs Application for People Who Have a Disability and Seniors Age 65 and Older (DHS-3531).

m Delete information about the Information for LTC and Waiver Program Services form (DHS-3543) and replace it with a new section about the newly renamed Request for Payment of LTC (DHS-3543). Add that payment cannot be made for long term care services until the DHS-3543 or other request is received.

m Add that applicants who apply on a CAF or a version of the HCAPP earlier than September 2006 must complete the Required Questions for Long-
Term Care (DHS-4803).

n  07.20  Processing Applications.

n  07.20.40  Shared and Transferred Applications.

Adds policy from bulletin #06-21-10 that people who are denied MA solely due to failure to verify assets are not eligible for MinnesotaCare or GAMC. Do not transfer applications denied solely for this reason to MinnesotaCare Operations.

Removes policy related to mandatory referrals from GAMC to MinnesotaCare. This policy has been replaced by the new Transitional MinnesotaCare program.

l  Chapter 8 - Renewals.

n  08.20  MinnesotaCare Renewals.

n  08.20.10  MinnesotaCare Renewal Examples.

These sections change the mailing schedule for MinnesotaCare renewals from ten weeks to 45 days in advance of the renewal due date.

n  08.25  MA and GAMC Renewals.

Adds the requirement from bulletin #05-21-09 that pregnant women must provide updated income and asset information and submit required verifications before the end of the 60-day postpartum period.

n  08.25.05  Processing MA and GAMC Renewals.

Adds requirement from bulletin #06-21-10 that people found ineligible at renewal due solely to failure to verify assets are ineligible for MinnesotaCare and GAMC.

Removes policy related to mandatory referrals from GAMC to MinnesotaCare. This policy has been replaced by the new Transitional MinnesotaCare program.

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l  Chapter 9 - Verification Requirements.

n  09.05  Mandatory Verification.

Adds the change from bulletin #05-21-09 requiring verification of unearned income for MinnesotaCare.

Adds the requirement from bulletin #06-21-09 that some U. S. citizens must verify their citizenship and identity to be eligible for Minnesota Health Care Programs.

l  Chapter 10 - Social Security Number.

Changes MinnesotaCare policy to clarify that only children eligible as auto newborns are exempt from providing or applying for Social Security Numbers through the month of the first birthday. Previous policy extended this exemption to all children up to age two.

l  Chapter 11 - Citizenship and Immigration Status.

Adds links to refugee assistance program information from the DHS website on several pages.

Adds expanded information on many immigration statuses and on verification of immigration status.

n  11.05  Verification of U. S. Citizenship.

Adds the instruction from bulletin #06-21-09 on verifying citizenship for U. S. citizens and nationals.

n  11.25  Federally or State-Funded Health Care.

Removes the language about eligibility criteria for noncitizens who were lawfully residing in the U.S. on August 22, 1996 who currently receive SSI or RSDI or have otherwise been certified as blind or disabled. Earlier changes in federal law do not affect eligibility under Minnesota guidelines.

n  11.35  Changes in Immigration Status.

Adds information about naturalization requirements.

Removes the seven-year time limit for eligibility under the original status for noncitizens who entered the U.S. with an immigration status that qualifies for federal funding (such as refugee) and later adjusted to lawful permanent resident (LPR) status. This was included previously due to changes in federal law. However, most states (including Minnesota) chose the option to continue to determine eligibility under the original status indefinitely.

Clarifies that noncitizens who originally entered the U.S. with an immigration status that does not qualify for federal funding and later adjust to lawful permanent resident (LPR) status may subsequently qualify for federally funded health care programs whether or not they were residing in the U.S. lawfully prior to adjustment.

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l  Chapter 12 - Certification of Disability.

n  12.00 - Certification of Disability.

Replaces the Medical Improvement Not Expected (MINE) list with a link to the Social Security Administration (SSA) Web site.

n  12.10  SMRT Disability Determinations.

n  12.10.05  Three-Month Waiting Period.

n  12.15  TEFRA Referrals to SMRT.

n  12.15.05  TEFRA Level of Care Determination.

These sections:

m Update and expand information about documentation and procedures for submitting SMRT referrals.

m Add and update some information that was previously found in POLI/TEMP TE02.07.369 (SMRT Referral Documentation) and POLI/TEMP TE02.07.368 (TEFRA Option Level of Care Determination).

m Incorporate information from bulletin #04-21-16, including links to the medical documentation forms required for adult and TEFRA referrals. These forms list the medical documentation requirements in detail.

l  Chapter 13 - State and County Residence.

n  13.10.25. County Residence Disputes.

Adds new information from bulletin #06-85-01.

Updates time lines and procedures.

Adds the form Request for Department Resolution of Financial Responsibility (DHS-4457).

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l  Chapter 14 - Living Arrangement.

Adds information on new and updated MMIS living arrangement codes from bulletin # 06-21-11.

Adds new and expanded information on types of facilities throughout the chapter. Organizes the material by facility type and living arrangement code.

n  14.10  Facility Living Arrangements.

Adds information about the current status of Regional Treatment Centers (RTCs) and new community-based facilities. Some new facilities will not be IMDs and residents can qualify for MA.

Adds information about 72-hour holds.

Adds information about CD treatment facilities.

n  14.10.05  Children in Facilities.

Clarifies eligibility for children in IMDs and correctional facilities.

Adds information about Title IV-E certified facilities and the quarterly bulletin that identifies eligible facilities. Generally, facilities certified for Title IV-E payment are also eligible for MA payment.

n  14.10.20  Correctional Facilities.

Clarifies and adds information on when people are considered to be under the control of the penal system.

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l  Chapter 15 - Insurance and Third Party Liability (TPL).

n  15.05.20  ESI.

Adds information from bulletin #06-21-08 that ESI verification forms are now attached to the HCAPP and renewal forms. The signature page now includes authorization to contact employers to obtain ESI information.

n  15.10.05  MA and GAMC Cost-Effective Insurance

Adds updated information from bulletin #05-21-10 about how Medicare Part C and non-Medicare group health insurance affect cost-effective determinations for people with disabilities and people age 65 and over.

n  Never Cost Effective

Adds information from bulletin #05-21-10 about Medicare and policies that are never cost effective.

n  15.15 Third Party Liability

Clarifies that enrollees whose coverage ended due to non-cooperation with TPL, who later cooperate, are eligible back to the first of the month of cooperation.

n  15.40  Accidents and Injuries.

Adds that workers should not deny or terminate benefits for children under age 18 for failure to provide information.

n  15.45  Health Insurance Policies.

Adds the MA requirement from bulletin #05-21-09 to get health insurance information for newborns as soon as the worker gets the birth report. Review the policy for cost effectiveness.

n  15.50  Cost Effective Insurance.

n  15.50.20  Medicare Supplements.

n  15.50.25  Non-Medicare Group Policies.

These sections add information from bulletin #05-21-09 about changes in the cost effective insurance guidelines because of Medicare Part D prescription drug coverage.

n  15.70  Noncitizen Pregnant Women - Insurance Barriers.

Adds the change from bulletin #05-21-09 that undocumented and nonimmigrant women with other health insurance are no longer eligible for pre- and postpartum coverage through state-funded MA.

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l  Chapter 16 - Medical Support.

n  16.05  When to Refer for Medical Support.

Adds information about referrals for some children ages 18-20.

Clarifies the use of the term ”child-only case” for this chapter.

Removes instructions not to refer if the caretaker has shown good cause. Make a referral to the IV-D agency even if the caretaker claims good cause.

Adds a definition of ”reserved.” Reserved means the court did not set a specific order, but reserves the right to do so in the future.

Clarifies procedures for referrals to the IV-D agency when it is the custodial parent who is not in compliance with a medical support order.

Adds a flowchart attachment that gives an overview of medical support referral requirements.

n  16.05.10  Establishing Paternity

Adds instruction to make referrals if the alleged father is deceased and paternity has not been established.

n  16.05.15  Minor Child Lives Apart From Both Parents.

n  16.10.10  Minor Caretakers.

Changes policy to state that no medical support referral is required for either parent when a minor child lives apart from both parents. Previously, a referral was required if there was a non-custodial parent unless the parent was complying with an existing medical support order. Referrals are still required for the parent of a minor caretaker’s own child.

n  16.15  Good Cause for Non-Cooperation and subsections.

Updates good cause procedures from bulletin #04-75-02. Includes links to several forms used in the review process.

n  16.20  Parental Fees.

Adds information about the annual reconciliation process.

n  16.20.10  Computation of Parental Fees.

Updates figures for computing parental fees.

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l  Chapter 17 - Household Composition.

There are no policy changes in this chapter.

l  Chapter 18 - Deeming Assets and Income.

n  18.05.05  Sponsor Deeming Program Requirements.

Clarifies which income and assets to deem for all programs.

n  18.05.15  Family-Based Immigration Codes.

Adds and deletes other family-based codes. Removes employment-based immigration codes.

l  Chapter 19 - Assets.

n  19.20  Verification of Assets.

n  19.20.05  MA Asset Verification Denial/Closure.

Adds policy from bulletin #06-21-10 that people who are denied or closed on MA solely due to failure to verify assets are not eligible for GAMC or MinnesotaCare.

n  19.25.20  Contract for Deed and Property Agreements.

Adds information from bulletin #06-21-10 about the purchase of the actual contract for a contract for deed.

n  19.35.10  MA and GAMC Excess Assets.

Remove the instruction to request that applicants reduce excess assets in 15 days. This instruction is obsolete.

n  19.40  Transfers.

n  19.40.20  Purchases as Transfers.

n  19.40.25  Determining the Uncompensated Value.

These sections:

m Add information from bulletin #06-21-13 that purchases made on or after July 1, 2006, of loans, mortgages, promissory notes and life estate interest in another’s home are types of transfers. Adds instructions for determining the uncompensated value of these transfers.

m Add instructions for determining the uncompensated value of these transfers.

m Add information on what types of evidence are needed to determine that a transfer was not made to maintain or establish MA eligibility.

m Add information on fractional transfers made on or after February 8, 2006.

n  19.40.05  Transfer Exceptions.

Adds the change from bulletin #06-21-13 eliminating the $200 transfer exception for transfers made on or after February 8, 2006, for people requesting payment of LTC services on or after July 1, 2006.

n  19.40.15  Lookback Period.

Adds the information from bulletin #06-21-13 that the expanded lookback period for certain MA transfers will be phased in beginning in February 2009. Details of the expanded lookback period will be added when the phase-in begins.

n  19.40.30  Applying the Transfer Penalty.

Adds the new begin date from bulletin #06-21-13 for penalties for people who apply on or after July 1, 2006, who made transfers on or after February 8, 2006.

n  19.40.35  Multiple Transfers.

Adds information from bulletin #06-21-13 on determining the penalty period for multiple transfers.

n  19.40.45  Waiver of Transfer Penalty.

Adds the change from bulletin #06-21-13 that allows long-term care facilities to request a hardship waiver if certain conditions are met.

n  19.50 Liens and Estate Claims

This section is now included in the assets chapter and contains updated information.

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l  Chapter 20 - Income.

n  20.25.30  RSDI and SSI.

Clarifies that VA Aid and Attendance and VA unusual medical expenses payment are not excluded income when determining MA eligibility for SSI recipients.

n  20.30.05  MinnesotaCare Income Changes.

Adds and clarifies policy changes from bulletin #05-21-09 on verifying income, reporting changes, and acting on income increases for MinnesotaCare.

m Income must be verified and acted on at application and renewal.

m Income changes must be reported within 10 days of the date of the change.  No verification is required.

m Act on reported changes for the first available month, allowing for 10-day notice of adverse action.

n  20.30.10  MA/GAMC Income Changes.

Clarifies income verification and reporting requirements and when changes must be acted on.


m Income must be verified and acted on at application and renewal.

m Income changes must be reported within 10 days of change.  Do not verify the income change.  Provide 10-day notice for negative actions.

For MA:

m Follow GAMC for unearned income.

m For earned income, verify and act on earned income at application and renewal.

m For reported changes, verify income increases which affect eligibility. Act on the change for the first available month. Provide 10-day notice of adverse action.

m Do not verify decreases in income or increases which do not affect eligibility.

l  Chapter 21 - Income Calculation (Community).

There are no policy changes in this chapter.

l  Chapter 22 - Standards and Guidelines.

n  22.25  Roomer/Boarder Standard Amount.

Updates the standard deductions for MA Method A effective October 1, 2006.

l  Chapter 23 - Long-Term Care (LTC) and Elderly Waiver (EW).

n  23.05  Elderly Waiver.

n  23.40.15 LTC Medicare Premiums.

n  23.40.50 LTC Medicare Expense Deductions.

These sections add information from bulletin #06-21-04 on how Extra Help affects the use of the Medicare Part D premium, co-payments and co-insurance amounts as a deduction.

n  23.45.10  Waiver Obligations.

These sections add information from bulletin #06-21-05 on the relationship between MSHO and EW.

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l  Chapter 24 - Medical Spenddowns.

n  24.10-.05  Automated Monthly Spenddown.

Clarifies that unpaid health care expenses incurred before the certification period are allowable spenddown expenses for automated spenddowns.

n  24.10.20  P Bills.

Removes Minnesota Children with Special Health Needs (MSCHN) from P bills because the program ended.

n  24.10.35  R Bills.

Adds Minnesota Disability Health Options net spenddown as a deductible medical expense to apply to a spenddown.

n  24.15.15  H Bills.

n  24.15.25  P Bills.

These sections add information on how Extra Help affects the use of the Medicare Part D premium, co-payments and co-insurance amounts as a deduction.

l  Chapter 25 – Premiums.

n  25.05.05, MinnesotaCare Billing and Payments.

n  25.30, MA-EPD Payment Options.

Clarifies premium payment deadlines for same day credit for MinnesotaCare and MA-EPD.

n  25.15, No-Payment and Cancellation.

n  25.15.10, Four-Month Penalty Period.

These sections add information from bulletin #05-21-04 that households with a member on active duty may voluntarily cancel coverage without penalty.

l  Chapter 26 - Notices.

There are no policy changes in this chapter.

l  Chapter 27 - Appeals.

Replaces the term "appeals referee" with "human services judge".

n  27.05.05, Fee-for-Service Appeals.

Adds information on appealing medical service issues under fee-for-service.

n  27.05.10, Managed Care.

Adds information about DHS Managed Care ombudsman and the process for managed care appeals and complaints.

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l  Chapter 28 - Service Delivery.

n  28.10, Service Delivery Systems and subsections.

Expands information on County Based Purchasing (CBP), Minnesota Senior Health Options (MSHO), Minnesota Disability Health Options (MnDHO), and Minnesota Senior Care (MSC).

Adds information on the EVS system.

Adds information on the Restricted Recipient Program.

n  28.15, Managed Care Enrollment and subsections.

Removes some of the detailed information on managed care presentations and materials and replaces it with links to the Prepaid Minnesota Health Care Programs (PMHCP) manual.

l  Chapter 29 - Quality Assurance.

n  29.05, IEVS.

Adds IEVS procedures and instructions, including the instructions on computing IEVS-related overpayments from bulletin #06-21-02.

n  29.10, Fraud.

Adds basic fraud information.

n  29.10.05, Administrative Disqualification.

Adds information on Administrative Disqualification Hearings (ADH) and fraud disqualification provisions for MinnesotaCare Adults Without Children and GAMC.

l  Chapter 30 - Other Related Programs.

n  30.10, Medical Needs.

Adds a link to the form Primary Care Resources (DHS-4741) referenced in Bulletin #06-21-07.

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