*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: March 1, 2014 |
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25.10.05 - Initial MA-EPD Premiums |
Archived: June 1, 2016 (Previous Versions) |
County agencies are responsible for issuing the initial premium billing for MA for Employed Persons with Disabilities (MA-EPD). This section provides policy information on initial premium billing.
Initial Premium Collection Amount.
After determining MA-EPD eligibility and the MA-EPD premium amount, take the following steps at initial eligibility:
1. Review the MA-EPD Overdue Premiums Report to determine if there are overdue premiums.
Note: The MA-EPD Overdue Premiums Report can be found on InfoPac Report #MWN180. It must be printed at the county by the 10th day of each month.
2. Determine the months for which a premium must be billed. This first premium billing may be for more than one month of coverage. More information on what premiums to collect for initial billing can be found in Initial Premium Collection Amount.
3. Complete the Initial Premium Notice (DHS-3547).
n Mail or give the original notice to the applicant.
n Include a return envelope addressed to the county agency.
n Retain a copy in the case file.
4. Approve or Pend results in MAXIS.
n If the client is present and pays the premium immediately approve eligibility in MAXIS and update MMIS. See Initial Premium Paid for additional steps to take when the initial payment is paid.
n If the client is not present, or does not pay the premium immediately, pend the results in MAXIS.
Allow 30 days from the date of the Initial Premium Notice (DHS-3547) for the client to pay the premium. See Initial Premium Collection Amount for information on which premiums must be paid before MA-EPD eligibility can be approved.
Set a reminder (REPT/TIKL) for 30 days from the date the DHS-3547 is sent or given to the client.
Note: See Initial Premium Paid for steps to take when the initial payment is returned.
See Initial Premium Not Paid for steps to take when the initial payment is not returned.
5. Case note the following:
n The monthly premium amount.
n The total amount requested at initial billing.
n The date the Initial Premium Notice is mailed or given to the applicant.
Initial Premium Collection Amount
County agencies are responsible to bill and collect the initial premium(s), including:
l Each retroactive month requested.
Note: Clients may choose which retro month(s) they want eligibility. Do not approve eligibility for any month until payment for that month is received. Clients are not required to pay retro premiums to obtain current month or future eligibility. They may change their mind and choose to pay only one or two of the retro months, the current month or the ongoing premiums.
Example:
Mai applies for MA-EPD on October 5 and requests three months of retroactive coverage. On October 20 it is determined Mai must pay a premium of $35 for each month to qualify for MA-EPD.
Action:
Complete and send the DHS-3547 requesting the premiums for the retro months of July through September, the application month of October and because the initial notice is created after the 15th of the month, the following month, November.
On October 23, Mai reports she does not want to pay for all five monthly premiums and would like eligibility only for August, October and ongoing. She pays her August, October and November premiums to the county.
Action:
Approve eligibility for August, October and November. Send a SIR webmail message to dhs.made@state.mn.us to notify DHS of the premium amount.
l The application month.
l All other months through the processing month, if the application is processed after the application month.
l The month after the processing month, if the application is processed on or after the 15th day of the month in which coverage is approved.
l Any overdue premiums for previous MA-EPD coverage. Check the MA-EPD Overdue Premiums Report (InfoPac report MWN180) before billing or approving eligibility.
Example:
Karen applies for MA-EPD on October 10 and does not request retroactive coverage. On October 12 it is determined Karen must pay a premium of $35 to qualify for MA-EPD. She also owes an overdue premium of $35 for coverage she had in July.
Action:
Complete and send the DHS-3547 requesting the initial premium payment for October and the overdue premium for July. Karen must pay both premiums ($70) before MA-EPD can be approved for October.
l Initial and overdue premiums for MA-EPD enrollees who have been removed from the Special Recovery Unit (SRU) billing system. This includes:
n Former enrollees who are reapplying.
n Enrollees removed from or not entered on the system in error.
n Enrollees closed and reopened in the same month.
Take the following actions if the premium is paid on or before the due date:
1. Approve eligibility results in MAXIS and update in MMIS.
Note: Applicants must pay premiums for a retroactive month before coverage can be approved for that retroactive month.
2. Send an e-mail to the Special Recovery Unit (SRU) via SIR webmail message to dhs.made@state.mn.us with a subject of ”MA-EPD Premium New/Changes” and include the following information:
n Enrollee Name.
n Case number.
n PMI.
n Billing Address.
n Representative Payee.
n Month/Amounts Paid.
n SRU Premium Billing Begin Date.
n Premium Amount.
n County and worker name.
n Worker e-mail code.
n Comments.
3. Forward the premium payment and the MA-EPD Initial Premium Payment Stub to DHS at the following address:
DHS - MA-EPD,
Attn. Cashier,
P. O. Box 64834,
St. Paul, MN 55164-0834
Include the following information with each premium:
n Enrollee name.
n PMI number.
n Amount paid.
n For which months the payment applies.
4. Enter a MAXIS case note with the amount paid and the months covered. Document that a SIR webmail was sent to dhs.made@state.mn.us to initiate billing.
Take the following actions if the premium is not received within 30 days of the initial notice:
1. Deny MA-EPD and determine MA eligibility under another basis.
2. Add the following worker comments to the notice:
"You are denied Medical Assistance for Employed Persons with Disabilities (MA-EPD) because we did not receive your premium payment by the due date."
See the following sections for more information on MA-EPD:
MA for Employed Persons with Disabilities.
MA-EPD Payment Options, Refunds and Dishonored Payments.
MA-EPD Good Cause for Late Payment.