Manual Letter #30

This manual letter lists new and revised material for the Health Care Programs Manual (HCPM). Unless otherwise noted, new and revised instructions are effective January 1, 2010.

Chapter 24 - Medical Spenddowns.

Updates are made to this chapter are based on a regularly scheduled review, in addition to the change in monthly spenddowns announced in bulletin #09-21-12, "DHS Announces Streamlined Procedures for Medical Assistance (MA) Monthly Medical Spenddowns and Information on Reporting Medical Expenses."

Other Updates.

Chapter 03 - Eligibility Groups and Bases of Eligibility.

Chapter 08 - Renewals.


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Chapter 24 - Medical Spenddowns

l  Section 24 - Medical Spenddowns.

n  Clarifies that each member of the household may have a different spenddown amount.

n  Explains the difference between medical expenses a client submits at the eligibility determination and how those expenses may be paid when the provider submits them for payment.

n  Adds the Minnesota Family Planning Program, GAMC, and MinnesotaCare to the list of programs or people who cannot have a spenddown.

n  Deletes references to ”countable” income and instead uses the more accurate ”net” income.

l  Section 24.05 - Spenddown Standards.

Provides additional detail about changing the spenddown standard for clients whose income exceeds the non-spenddown standard and provides examples.

l  Section 24.10 - Spenddown Types.

n  Changes wording to correspond with the change to one streamlined monthly medical spenddown so there are only two spenddown types:  monthly and six-month.

n  Provides more detailed information on when to use each type of spenddown.

n  Clarifies that clients who receive waiver services and have a spenddown may use either a monthly or a six-month spenddown.

l  Section 24.10.05 - Monthly Spenddown.

n  Changes the name from Automated Monthly Spenddown but explains that MAXIS and MMIS will retain the name ”automated monthly spenddown".

n  Adds sections for MnDHO and SNBC and monthly spenddowns.

n  Clarifies criteria for using a monthly spenddown.

n  Explains to first determine if the client can meet a six-month spenddown before calculating a monthly spenddown.

l  Section - Client Option Spenddown.

General clarifications and updates.

l  Section - Designated Provider Option.

Clarifies criteria for use.

l  Section 24.10.10 - Six-Month Spenddown.

n  Clarifies that each household member may have a different spenddown amount depending on the net income and FPG standard used to determine that member’s eligibility.

n  Adds a note and example to explain the appropriate spenddown standard to use for clients whose income exceeds the standard for their basis of eligibility.

n  General clarifications and updates.

n  Renumbered from 24.10.15.

l  Section - Six-Month Spenddown Example.

n  General clarifications and updates.

n  Renumbered from

l  Section 24.10.15 - Shortened Spenddown.

n  General clarifications and updates.

n  Renumbered from 24.10.20.

l  Section 24.15 - Health Care Expenses.

n  Clarifies that the health care expenses used to determine eligibility might not be the actual expenses applied to the client’s spenddown because claims are applied in the order received.

n  Explains the use of the Medical Expenses form (DHS-1844).

n  Clarifies reporting of health care expenses not covered by MA.

n  Clarifies that discounted health care expenses or any portion of an incurred expense that the provider writes off or absorbs cannot be applied to the spenddown.

l  Section 24.15.05 - Verification of Health Care Expenses.

Clarifies to verify all health care expenses used to meet a spenddown, whether paid or unpaid, including those a health care provider has written off.

l  Section 24.15.10 - Determining Net Health Care Expenses.

n  Deletes definitions from this section; relevant terms are linked from the text to the glossary.

n  Minor clarifications and updates.

l  Section 24.15.15 - H Bills.

n  Clarifies when health insurance premiums can be applied to meet a spenddown.

n  Clarifies information on indemnity policies.

l  Section 24.15.20 - M Bills.

Minor clarifications and updates.

l  Section 24.15.25 - P Bills.

n  Clarifies the remedial care expense deduction.

n  Clarifies that expenses of dependents and financially responsible relatives become non-reimbursable P Bills because the dependent or relative is not on MA or GAMC.

n  Minor updates and clarifications.

l  Section 24.15.30 - R Bills.

n  Explains to record R Bills on MAXIS to show that enough medical expenses were incurred to meet the spenddown.

n  Adds a new section explaining how R bills become P bills.

l  Section 24.15.35 - MinnesotaCare Expenses.

Minor updates and clarifications.

l  Section 24.15.40 - Associated Recipients.

Minor updates and clarifications.

l  Section 24.20 - Inpatient Hospitalization - MinnesotaCare Enrollees.

Minor updates and clarifications.

l  Section 24.25 - Spenddown Adjustments.

n  Adds information regarding health care expenses reported monthly or at renewal.

n  Minor updates and clarifications.

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Other Updates

Chapter 03 - Eligibility Groups and Bases of Eligibility

l  Section - MA-EPD Employment Definition.

Corrects information on a four-month medical leave to state that the leave begins the month after the enrollee is unable to work, rather than on the date the enrollee is unable to work.

Chapter 08 - Renewals

l  Section 08.30 - Monthly Renewals.

n  Deletes reference to manual monthly spenddowns from monthly renewals. Only people with an LTC spenddown who have income changes now have a monthly renewal.

n  Changes example to delete reference to manual monthly spenddown.


l  Potluck Processing (new term).

l  Varying Income (revised definition).

l  Write-off (new term).

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