Manual Letter #23

This manual letter lists new and revised material for the Health Care Programs Manual (HCPM). Unless otherwise noted, new and revised instructions are effective June 1, 2009.

Annual Changes.

Updates to the following sections are for the annual federal poverty guideline (FPG) amounts and premium changes for July 1, 2009, through June 30, 2010. Other changes to these sections that were announced in bulletins #09-21-06, "DHS Implements a New MinnesotaCare Sliding Fee Premium Scale" and #09-21-07, "Legislative Changes to MinnesotaCare for Certain Adults Effective July 1, 2009" will be included in Manual Letter #24, effective July 1, 2009.

Chapter 15 - Third Party Liability (TPL).

Chapter 16 - Medical Support.

Chapter 22 - Standards and Guidelines.

Chapter 28 - Health Care Service Delivery.

Most sections have been archived because they duplicate the Prepaid Minnesota Health Care Programs (PMHCP) Manual. A crosswalk from this manual to the PMHCP Manual is available. All remaining sections are modified based on a regularly scheduled review.

Chapter 29 - Quality Assurance.

Several sections are modified based on a regularly scheduled review.

Other Updates.

Chapter 03 - Eligibility Groups and Bases of Eligibility.

Chapter 11 - Citizenship and Immigration Status.

Chapter 14 - Living Arrangements.

Chapter 15 - Cost-Effective Reimbursement.

Chapter 20 - Income.

Top of Page

Annual Changes

The following updates are due to the annual increases that are effective July 1, 2009.

Chapter 15 - Insurance and Third Party Liability

n  Section - Determining Employer-Subsidized Insurance (ESI) Cash Benefits.

Updates the maximum MinnesotaCare premium amounts in the examples under Cash Contribution for Coverage.

Chapter 16 - Medical Support

n  Section 16.20.10 - Computation of Fees.

m There are no changes to the parental fee formula for July 1, 2009.

m Dates are updated to use 2008 tax forms to calculate parental fees for 2010.

Chapter 22 - Standards and Guidelines

n  Section 22.05.05 - 75 Percent of FPG.

n  Section 22.05.10 - 100 Percent of FPG.

n  Section 22.05.15 - 120 Percent of FPG.

n  Section 22.05.20 - 135 Percent of FPG.

n  Section 22.05.25 - 150 Percent of FPG.

n  Section 22.05.30 - 175 Percent of FPG.

n  Section 22.05.35 - 185 Percent of FPG.

n  Section 22.05.40 - 200 Percent of FPG.

n  Section 22.05.45 - 275 Percent of FPG.

n  Section 22.05.50 - 280 Percent of FPG.

n  Section 22.15 - Minnesota Comprehensive Health Association (MCHA) Premiums.

n  Section 22.20 - MinnesotaCare Premium Amounts.

n  Section 22.35 - SAPSNF.

n  Section 22.45 - Long-Term Care (LTC) Allowances.

n  Section 22.50 - Remedial Care Expense.

Top of Page

Chapter 28 - Obtaining Health Care Services

l  Section 28 - Obtaining Health Care Services.

n  Renames chapter to more accurately reflect its contents.

n  Incorporates information from archived sections.

l  Section 28.05 - Access Services.

Updates information to match current policy.

l  Section 28.05.05 - Access Transportation Services.

Updates information to match current policy.

l  Section 28.10 - Out-of-State Services.

Removes duplicative material.

Archived Sections of Chapter 28 (crosswalk)

n  Section 28.05 - Health Care Services and Benefits.

n  Section 28.05.05 - Benefit Sets by Major Program.

n  Section 28.05.10 - Managed Care Covered Services.

n  Section - Access Services Eligibility Requirements.

n  Section 28.10 - Service Delivery Systems.

n  Section 28.10.05 - Fee-for-Service.

n  Section - MinnesotaCare Fee-for-Service.

n  Section - MA/GAMC Fee-for-Service.

n  Section 28.10.10 - Managed Care.

n  Section - County-Based Purchasing.

n  Section - Minnesota Senior Health Options (MSHO).

n  Section - Minnesota Senior Care (MSC) / Minnesota Senior Care Plus.

n  Section - Minnesota Disability Health Options (MnDHO).

n  Section 28.10.15 - Enrollees with Other Health Care Coverage.

n  Section 28.10.20 - Minnesota Health Care Programs Membership Card.

n  Section 28.10.25 - Electronic Verification System (EVS).

n  Section 28.10.30 - Minnesota Restricted Recipient Program (MRRP).

n  Section 28.15 - Managed Care Enrollment.

n  Section 28.15.05 - Managed Care Enrollment - MinnesotaCare.

n  Section 28.15.10 - Managed Care Enrollment - MA/GAMC.

n  Section - Managed Care Exclusions.

n  Section - Voluntary Enrollment.

n  Section 28.15.15 - Health Plan Changes.

n  Section 28.15.20 - Reenrollments and Reinstatements.

n  Section 28.15.25 - Disenrollments.

n  Section 28.15.30 - Adding/Removing People from Managed Care.

n  Section 28.15.35 - Adjustments.

n  Section 28.15.40 - Managed Care County Transfers.

Top of Page

Chapter 29 - Quality Assurance

l  Section 29.05 - IEVS.

Adds additional information on providing IEVS information to clients.

l  Section 29.05.05 - IEVS Data Security.

Adds link to IRS information on data security requirements.

l  Section 29.05.15 - New Hire Messages.

n  Employers have 20 calendar days from the date of hire to report the start of employment to Child Support Enforcement Division (CSED). This is a change from 15 days.

n  Minor wording changes.

Top of Page

Other Updates

Chapter 03 - Eligibility Groups and Bases of Eligibility

n  Section 03.45.10 - Refugee Medical Assistance (RMA).

Updates to comply with federal law that Afghan special immigrants are now eligible for federally funded MA for eight months, rather than six months. All refugees are now eligible for eight months.

Chapter 11 - Citizenship and Immigration Status

n  Section 11.05.10 - Process for Documentation of U.S. Citizenship and Identity.

Clarifies to keep a copy of the Worker Checklist in the case record for all households with members who are required to submit verification of citizenship and identity; however, it is not necessary to keep a copy if the household is comprised entirely of enrollees who are exempt from citizenship documentation requirements.

n  Section 11.25.20 - Afghan and Iraqi Special Immigrants.

Updates to comply with federal law that Afghan special immigrants are now eligible for federally funded MA for eight months, rather than six months.  

Chapter 14 - Correctional Facilities

n  Section 14.15 - Correctional Facilities.

m Eliminates ”r;Released to a publicly owned and operated halfway house with less than 17 beds” from the Coverage upon Release from Correctional Facility because currently all halfway houses in Minnesota are privately owned and operated.

m Adds IMDs and nursing homes to the list of places not considered correctional facilities for purposes of determining eligibility for MHCP.

m Adds MMIS code 80 for a correctional halfway house owned or managed by a private party.

Chapter 15 - Third Party Liability

n  Section - Cost Effective Reimbursement.

Updates Medicare reimbursement process for Part B premiums to MA-EPD enrollees who have income at or below 200% FPG.

Chapter 20 - Income

n  Section - Rental Income.

Clarifies that allowable expenses from rental income for Method B must be necessary for the production or collection of rental income and allowable for the IRS.

Top of Page