*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: May 1, 2010 |
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23.15.15 - Verification of Medical Expenses |
Archived: June 1, 2016 |
A medical expense must be verified before it can be used as a deduction in the LTC income calculation. The verification that is needed is based on the type of medical expense and when it was incurred.
Verification Needed for Medical Expenses from a Medical Provider.
Verification Needed for Medical Expenses not from a Medical Provider.
Verification Needed for Housing with Services Establishments.
Verification of Medical Expenses at Renewal.
Verification Needed for Medical Expenses from a Medical Provider
Expenses for medical services received from a provider, such as a medical professional, ambulance service, pharmacist or medical facility, are assumed to be medically necessary. The following verification is needed to deduct a medical expense in the LTC income calculation:
l For an expense incurred in a month in which the enrollee does not have MA eligibility, the client must provide a copy of the medical bill showing the date the expense was incurred, the item or service provided and the unpaid amount the client owes the medical provider.
l For an expense incurred in a month in which the enrollee has MA eligibility, the client must provide a copy of the medical bill showing the date the expense was incurred, the item or service provided and the charge to the client for the service.
Verification Needed for Medical Expenses Not from a Medical Provider
A medical expense not from a medical provider includes items such as over-the-counter medications, medical supplies not prescribed by a medical professional, or home care services. Require the following verification to deduct these types of medical expenses in the LTC income calculation:
l Require all of the following verification for an expense incurred in a month in which the client does not have MA eligibility:
n Documentation showing the date the expense was incurred, the item or service provided, and the amount of the expense.
n A copy of the bill showing the expense is unpaid.
n A physician statement that the expense is medically necessary.
l Require all of the following verification for an expense incurred in a month in which the client has MA eligibility:
n Documentation showing the date the expense was incurred, the item/service provided, and the amount of the expense.
n Physician statement that the expense is medically necessary.
Verification Needed for Housing with Services Establishments
Additional verification is required to identify medical expenses for a person who resides in a housing with services establishment (commonly known as assisted living) or residential living arrangement that provides supportive services.
A person who resides in a living arrangement that provides supportive services may have expenses for room and board in addition to the supportive services. Only the services provided by the establishment can be considered for a medical expense deduction. Room and board is not an allowable medical expense.
Require all of the following verification to deduct a medical expense in the LTC income calculation:
l An itemized statement of incurred services from the living arrangement. The itemized statement must include the date the expense was incurred, the item or service provided, and the amount of the expense.
l A physician statement that each service is medically necessary.
When verification is required that an expense is medically necessary, send the MHCP Medical Need (DHS-6112) to the client to have his or her physician complete. This form is not mandatory; accept other documentation from a physician that verifies an expense is medically necessary as long as it contains the same information requested on the DHS-6112.
Do not require further verification after the client verifies an allowable medical expense and it is deducted in an LTC income calculation.
Continue to deduct any allowable amounts that can be carried forward into a new budget period.
Exception: Require verification that a medical expense is still unpaid and is still the responsibility of the client to pay when:
m an allowable medical expense was incurred in any of the three months prior to the month in which the client submitted the request for MA payment of LTC services to the agency; and
m no amount of the incurred expense was deducted in a previous budget period(s) because there was no income remaining from which to deduct the expense.
Allow the portion of the medical expense that is still unpaid and owed by the client as a medical expense deduction if it meets all criteria to be an allowable deduction. Do not allow it as a deduction in the LTC income calculation if the provider decided to absorb the cost of the expense (a ”write off”) or the medical expense has been paid.