This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective March 1, 2007.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 04 - Social Security Administration (SSA) Benefits.
Chapter 21 - Income Calculation (Community).
Chapter 22 - Standards and Guidelines.
Chapter 28 - Health Care Service Delivery.
Chapter 29 - Quality Assurance.
Bulletin #06-21-07, DHS Implements the Minnesota Family Planning Program
The following sections were updated with information from this bulletin. The Minnesota Family Planning Program (MFPP) began on July 1, 2006.
l Section 03.45.35, Minnesota Family Planning Program.
This section has been revised and expanded to include details on MFPP eligibility requirements and procedures.
l Section 03.45.35.05, Application Process for MFPP.
This is a new section with information on how people apply for the MFPP and how providers determine presumptive eligibility.
l Section 07.20.50, Programs Overlap.
Adds information on the limited circumstances in which the MFPP can overlap with other health care programs.
Chapter 3, Eligibility Groups and Bases of Eligibility
l Section 03.20.10, MinnesotaCare for Auto Newborns.
l Section 03.20.15, MinnesotaCare for Children Under 21.
Corrects policy to clarify that 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. This policy change was incorporated with Manual Letter #1 in chapter 10 (Social Security Number).
In section 03.20.15, also clarifies who may apply on their own behalf under "Application Process," and clarifies MMIS versus worker action under "Premiums."
l Section 03.30.20, Medical Assistance for Employed Persons with Disabilities (MA-EPD).
n Under "Verifications," clarifies that people who are eligible for the Medicare extension should not be referred to SMRT until two months before the Medicare extension ends.
n Under "Income Guidelines," clarifies that it is average monthly earned income that must be above $65.
l Section 03.45.30.10, Presumptive Eligibility Providers for MA-BC.
Updates list of providers. This section replaces POLI/TEMP TE02.07.444, which will be end-dated.
l Section 03.50.15, Legal Factors for GAMC.
Removes references to asset transfers for GAMC. Questions about asset transfers for all health care program applicants are now included on the HCAPP (DHS-3417), and are no longer on the Required Questions for GAMC (DHS-3423).
Chapter 4, Social Security Administration (SSA) Benefits
l Section 04.45, Medicare and Minnesota Health Care Programs.
Adds information about reimbursement of Medicare Part B premiums for certain MA-EPD enrollees.
Chapter 21, Income Calculation (Community)
l Section 21.05, Certification Period.
Clarifies current policy for GAMC enrollees who become eligible for GA during the income certification period by adding a link to the six-month GAMC income standard, and by expanding on the action needed in the related ”Roy” example.
Chapter 22, Standards and Guidelines
l Section 22.45, Long-Term Care Allowances.
n Corrects the term ”home maintenance allowance” by removing the word ”needs” in several places.
n Adds ”(SIS-EW)” after ”maintenance needs allowance” in several places to clarify that this allowance pertains to SIS-EW eligibility.
n Corrects figures in three tables:
m Home Maintenance Allowance - Corrects the current figure from $816 to $817.
m Maintenance Needs Allowance (SIS-EW) - Corrects the current figure from $817 to $816; corrects the 07/01/05-06/30/06 figure from $798 to $789; and corrects the 07/01/04-06/30/05 figure from $776 to $766.
m Minimum Monthly Income Allowance - Corrects the 07/01/04-06/30/05 figure from $1582 to $1562.
l Section 24.15.30, R Bills.
Clarifies that it is the recipient amount that is applied for MSHO and MnDHO spenddown and waiver obligations.
l Section 25.10.25, MA-EPD Good Cause for Late Payment.
n Changes the name of the section from ”MA-EPD Good Cause for Nonpayment” to ”MA-EPD Good Cause for Late Payment.”
n Updates good cause procedures.
n Clarifies definition of good cause for late payment of MA-EPD premium.
Chapter 28, Health Care Service Delivery
l Section 28.05.05, Benefit Sets by Major Program.
Clarifies that MA-EPD is one of the major programs that receives the full MA benefit set.
l Section 28.15.10.05, Managed Care Exclusions.
n Clarifies that the exclusion due to eligibility for Emergency Medical Assistance (EMA) pertains to undocumented people or nonimmigrants who receive only EMA.
n Clarifies that people under age 65 who are excluded due to blindness or disability:
m Must be certified by the Social Security Administration (SSA) or the State Medical Review Team (SMRT).
m May also be waiver program enrollees.
m May voluntarily enroll in managed care if they also have and are using a parent/caretaker basis of eligibility.
n Removes exclusion policy for SIS-EW enrollees. Enrollment in SIS-EW is no longer an exclusion for managed care. This change was effective January 1, 2007, and was first announced in a September 26, 2006 e-mail to county managed care contacts/supervisors.
n Clarifies that the exclusion for residents of state institutions includes the Minnesota Sex Offender Program (MSOP).
n Clarifies exclusion policy for American Indians living on a reservation. These enrollees may choose to be excluded from managed care.
n Clarifies that adults who are excluded due to serious and persistent mental illness (SPMI) may voluntarily enroll in managed care if they have and are using a parent/caretaker basis of eligibility.
n Adds PrimeWest Health Systems and South Country Health Alliance to the list of HMOs certified by the Minnesota Department of Health.
n Clarifies that people with medical spenddowns are excluded from managed care, except for certain MSHO and MnDHO enrollees.
n Adds the policy change from bulletin #05-21-10 (Changes to Cost Effective Insurance Guidelines Due to Medicare Part D Prescription Drug Coverage) that only non-Medicare health plans meet the cost effective exclusion criteria. This change was effective September 1, 2005.
n Adds a reminder for workers to code the TPCO screen for all cost effective insurance policies, and includes a link to the MMIS User Manual.
n Adds the policy change from bulletin #05-21-10 that TRICARE is considered cost effective insurance. Enrollees with TRICARE coverage are excluded from managed care. This change was effective January 1, 2006.
l Section 28.15.10.10, Voluntary Enrollment.
n Removes voluntary enrollment policy for SIS-EW enrollees. Enrollment in SIS-EW is no longer an exclusion for managed care. This change was effective January 1, 2007, and was first announced in a September 26, 2006 e-mail to county managed care contacts/supervisors.
n Adds exclusion policy for American Indians living on a reservation. These enrollees may choose to be excluded from managed care.
n Clarifies that adults who are excluded due to serious and persistent mental illness (SPMI) may voluntarily enroll in managed care if they have and are using a parent/caretaker basis of eligibility.
l Section 29.05.30, IEVS Overpayment Process.
Clarifies that there are special tracking requirements for overpayments discovered through the IEVS process. It removes an example that no longer applies.
l Section 29.15, Overpayments.
This new section includes information on:
n When and how to determine overpayments for Minnesota Health Care Programs (MHCP) in circumstances other than those discovered through IEVS.
n How to determine MinnesotaCare overpayments.
n Relationship between programs when considering whether overpayments exist.
l Section 29.15.05, Overpayment Notification and Collection.
This new section:
n Introduces the Minnesota Health Care Programs Notice of Overpayment (DHS-4939). This form is currently used by MinnesotaCare Operations and is available on eDocs.
n Lists the collection methods that agencies may use to recover overpayments. Which methods are available depends on the program, current enrollment status and whether or not there has been a court finding.