This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective December 1, 2007.
These changes, which are effective January 1, 2008, include the annual updates to several LTC allowances, various Medicare cost-sharing amounts, and several disregards. See below for further information.
Chapter 04 - Social Security Administration (SSA) Benefits.
Chapter 21 - Income Calculation (Community).
Chapter 22 - Standards and Guidelines.
MR/RC Waiver - New Name and Policy Clarifications
The Mental Retardation and Related Conditions (MR/RC) waiver is now known as the Developmental Disabilities (DD) waiver. Also, the requirements for suspension of deeming and parental fees have been clarified. See below for further information.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Remedial Care Expense - New Fixed Amount and Policy Clarifications
Several policies for the remedial care expense have been clarified. The formula for determining this expense has been replaced by a fixed amount that is adjusted each January and July. See below for further information.
Chapter 22 - Standards and Guidelines.
Chapter 23 - Long-Term Care (LTC) and Elderly Waiver (EW).
Chapter 24 - Medical Spenddowns.
This manual letter includes a number of other updates and policy clarifications, such as restoring language pertaining to the four-month rule in section 15.05, MinnesotaCare Insurance Barriers; changing verification policy for earned income changes for MA in section 20.30.10, MA/GAMC Income Changes; and clarifying that reverse mortgages are excluded as income in long-term care budgeting in section 23.40.10, LTC Excluded Income. See below for further information.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 15 - Insurance and Third Party Liability.
Chapter 21 - Income Calculation (Community).
Chapter 23 - Long-Term Care (LTC) and Elderly Waiver (EW).
The following sections were updated with annual changes that are effective January 1, 2008. See each of the updated sections for further information.
Chapter 04 - Social Security Administration (SSA) Benefits
l Section 04.15 - Supplemental Security Income (SSI).
Adds the maximum monthly payment amounts for 2008. The maximum monthly SSI payment increases to $637 for an individual, and $956 for a couple.
l Section 04.40.20.05 - Medicare Part D Benchmark Plans.
Adds the Part D benchmark plans for 2008. Also notes the 2007 plans that are not available in 2008.
l Section 04.45.05 - MA/GAMC and Medicare Part D.
Revises the instructions under "Extra Help and Medicare/Medical Expense Deductions," and adds a link to a new reference document, 2008 Amounts in Excess of the Benchmark to Apply as Medical Expense.
Removes specific references to Wellpoint as the Medicare point of sale contractor and updates related material under "Temporary Prescription Drug Coverage." Wellpoint will not be the point of sale plan for 2008. Medicare has not announced the name of the new point of sale plan.
Chapter 21 - Income Calculation (Community)
l Section 21.50.15.05 - Pickle Disregard - COLA Chart.
Adds the Pickle Disregard computation factor for 2008. It increases to 1.023 to reflect the 2008 COLA increase of 2.3%.
l Section 21.50.40 - Blind or Disabled Student Child Disregard.
Adds the maximum disregard amounts for 2008: the disregard increases to $1550 per month, and $6240 per year.
Chapter 22 - Standards and Guidelines
l Section 22.10 - Special Income Standard (SIS).
Adds the Special Income Standard for 2008: the limit increases to $1911 per month.
l Section 22.30 - IRS Mileage Rate.
Adds the IRS mileage rate for 2008: the rate increases to 50.5 cents per mile.
l Section 22.40 - Minimum/Maximum Asset Allowance.
Adds the asset allowance figures for 2008: the minimum spousal asset allowance increases to $29,389, and the maximum spousal asset allowance increases to $104,400.
l Section 22.45 - Long-Term Care (LTC) Allowances.
Adds two allowance figures for 2008: the personal needs allowance increases to $84, and the maximum income allowance for the community spouse increases to $2610.
l Section 22.55 - Medicare Cost-Sharing Amounts.
Adds new Medicare amounts for 2008, including: the Part A hospital deductible increases to $1024; the main Part B premium increases to $96.40; and the average premium for the Part D standard benefit is $30.61.
MR/RC Waiver - New Name and Policy Clarifications
The Mental Retardation and Related Conditions (MR/RC) waiver is now known as the Developmental Disabilities (DD) waiver. This name change has been updated in section 03.40.15 and throughout the manual. Also, the requirements for suspension of deeming and parental fees have been clarified.
l Glossary M-R.
Modifies the definition of "Mental Retardation and Related Conditions" to reflect the change in the name of the waiver program to "Developmental Disabilities."
Chapter 03 - Eligibility Groups and Bases of Eligibility
l Section 03.40.15 - Developmental Disabilities (DD).
Changes the name of the section from "Mental Retardation and Related Conditions (MR/RC)" to "Developmental Disabilities (DD)."
Under "Eligibility Begin Date," adds note clarifying that waiver services may begin no earlier than the begin date of MA eligibility.
Removes the requirements for use of the "suspension of deeming" form under "Household Composition." Also revises language to clarify when a parental fee referral is or is not required. Moves parental fee-related information that was under "Other Requirements" to this subsection.
Updates the list of services under "Covered Services."
Adds under "Relationship to Other Groups/Bases" that children who do not require DD waiver services may be eligible for MA under TEFRA.
Remedial Care Expense - New Fixed Amount and Policy Clarifications
Several policies for the remedial care expense have been clarified. See each of the updated sections for further information.
l Glossary M-R.
Changes "remedial care amount" to "remedial care expense" and modifies the definition.
Adds a new definition of "residential living arrangement" to reflect revisions in the remedial care expense deduction.
Chapter 22 - Standards and Guidelines
l Section 22.50 - Remedial Care Expense.
Renames the section and replaces the table for GRH Negotiated Rate with a new table, Remedial Care Deduction, with the fixed amounts for 2007, and for January 1, 2008 - June 30, 2008.
Chapter 23 - Long-Term Care (LTC) and Elderly Waiver (EW)
l Section 23.40.50 - LTC Medical Expense Deduction.
Revises the instructions under "Medical Expenses" on when clients may incur a remedial care expense.
Chapter 24 - Medical Spenddowns
l Section 24.15 - Health Care Expenses.
Adds remedial care expense to the list of "Allowable Health Care Expenses" and adds under "Reporting Health Care Expenses" that this expense does not have to be verified.
Adds remedial care as a type of P bill under "Types of Health Care Expenses."
Adds room and board charges in a residential living arrangement to the list of "Health Care Expenses Not Allowed."
l Section 24.15.25.05 - Remedial Care Expense Deduction.
Changes the title of the section to Remedial Care Expense Deduction and completely revises the text to reflect the following policy clarifications:
n Clarifies that the remedial care expense can be used as a health care expense for people with medical spenddowns, but must be applied as an income deduction for people who use long-term care budgeting, including those with waiver obligations under SIS-EW.
n Combines the previous categories of settings in which clients may have remedial care expenses into one category, residential living arrangements where counties have GRH agreements.
n Removes the formula for computing the remedial care amount and adds a link to renamed section 22.50, Remedial Care Expense. The deduction is a fixed amount adjusted in January and July.
l Glossary G-L.
Modifies the definition of "long-term care spouse" to include a person receiving or expecting to receive EW services for at least 30 consecutive days. This portion of the definition was inadvertently omitted from the original version.
l Glossary M-R.
Adds a definition for "Matching Grant Program" in conjunction with related updates to section 20.25.60, Refugee Resettlement Grants.
Chapter 03 - Eligibility Groups and Bases of Eligibility
l Section 03.45.30.10 - Presumptive Eligibility Providers for MA-BC.
Updates the list of providers who participate in the Sage Screening Program and have registered with DHS to become presumptive eligibility providers for Medical Assistance for Breast and Cervical Cancer (MA-BC).
Chapter 15 - Insurance and Third Party Liability
l Section 15.05 - MinnesotaCare Insurance Barriers.
Under "Four-Month Rule," restores language that was inadvertently omitted about TRICARE, MA, and GAMC. They are not considered as other health coverage for purposes of the four-month rule.
Updates language under "Current Insurance" and "Current Access to ESI" to make clearer that it is the child, not the other coverage, that is determined underinsured.
l Section 20.25.60 - Refugee Resettlement Grants.
Adds information about the Matching Grant program. The monthly cash allowance received through this program should be treated as unearned income. Continue to treat grants from the refugee resettlement program as lump sum income.
Also updates the grant amounts in the examples, and adds an example about RMA.
l Section 20.30.10 - MA/GAMC Income Changes.
Changes verification policy under "Earned Income Changes Between Renewals - MA." Do not require verification of changes in earned income reported between renewals. This implements a 2007 legislative change that eliminated this verification requirement.
Chapter 21 - Income Calculation
l Section 21.30 - MA Method B Income Calculation.
Adds the RSDI COLA disregard to the list of unearned income deductions.
l Section 21.50.25 - RSDI COLA Disregard.
Adds to EW under "Conditions for Use" that the RSDI COLA disregard is only available to EW enrollees who do not use LTC budgeting. This exception is already listed under "Do Not Apply RSDI COLA Disregard."
Chapter 23 - Long-Term Care (LTC) and Elderly Waiver (EW)
l Section 23.25 - Choosing Appropriate Income Calculation.
Adds to use the LTC income calculation for people who reside in an LTCF or are SIS-EW or EW with a community spouse when receiving care through hospice.
l Section 23.40 - LTC Income Calculation.
Removes the subsection ”Requirements for Use of LTC Income Calculation” and replaces it with a link to Choosing Appropriate Income Calculation, which already contains the information.
Under "LTC Income Calculation Steps," removes the notes about EW from steps 2f and h (community spouse and family allocations) and step 2k, Special SSI Deduction. Policy for when these deductions are allowed is covered when applicable in section 23.40.30, Community Spouse Allocation, and section 23.40.40, Family Allocation.
l Section 23.40.05 - LTC Income.
Deletes the subsection on ”Unearned Income.” The material from this subsection is now located in LTC Excluded Income.
l Section 23.40.10 - LTC Excluded Income.
Adds proceeds from reverse mortgages to the list of excluded income for LTC calculation.
Adds several other items moved from LTC Income.
l Section 23.40.55 - LTC SSI Deduction.
Revises the first sentence to clarify that SSI benefits are usually reduced to $30 for SSI recipients who enter an LTCF if the stay is expected to last more than three months. Also removes the note stating that the deduction is allowed for SIS-EW clients but not for other EW clients.
l Section 25.10.15 - Payment Options, Refunds, and Dishonored Payments.
Removes instructions about paying MA-EPD premiums by phone. This is no longer a payment option.
Also notes that this section pertains specifically to MA-EPD, and adds a link to the corresponding section for MinnesotaCare.