This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective July 1, 2008.
Annual Changes in Federal Poverty Guidelines (FPG).
Chapter 15 - Insurance and Third Party Liability.
Chapter 22 - Standards and Guidelines.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 11 - Citizenship and Immigration Status.
Chapter 18 - Deeming Income and Assets.
Chapter 21 - Income Calculation (Community).
The following updates are due to the annual increases that are effective July 1, 2008. In addition to the specific changes noted below, minor formatting changes were made throughout these sections for greater consistency and clarity.
Chapter 15 - Insurance and Third Party Liability
l Section 15.05.20.10, Determining Employer-Subsidized Insurance (ESI) Cash Benefits.
Updates the maximum MinnesotaCare premium amounts in the examples under ”r;Cash Contribution for Coverage.”
l Section 16.20, Parental Fees.
Change in subsection, ”How Is the Fee Determined?” to state that if a parent overpays a fee it is reimbursed to the parent when the child turns 18 or the child’s eligibility changes to a type not assessed a fee.
l Section 16.20.05, Refer to DHS for Parental Fee.
n In the subsection Children in 24-Hour Care adds ”child support, or other forms of payment” to the third bullet to read: The county must deduct any money it has retained to reduce social services costs, such as RSDI, child support, or other forms of payment from the total expenditures.
n Also clarifies that workers must notify DHS any time an eligibility change is made.
l Section 16.20.10, Computation of Fees.
n There are no changes to the parental fee formula for July 1, 2008.
n Language is added to explain that once the fee has been calculated, parents will receive a determination order. It further explains that the fee will be annualized for monthly payments, that fee amounts can change due to changes in adjusted gross income or family size, and that parents are obligated to notify DHS of changes in income of more than 10%.
n A new subsection is added, Variance for Undue Hardship, listing expenses for which parents may request a variance of the parental fee.
Chapter 22 - Standards and Guidelines
l Section 22.05.05, 75 Percent of FPG.
Adds the new federal poverty guideline (FPG) figures for July 1, 2008 through June 30, 2009.
l Section 22.05.10, 100 Percent of FPG.
Adds the new FPG figures for July 1, 2008 through June 30, 2009.
l Section 22.05.15, 120 Percent of FPG.
Adds the new FPG figures for July 1, 2008 through June 30, 2009.
l Section 22.05.20, 135 Percent of FPG.
Adds the new FPG figures for July 1, 2008 through June 30, 2009.
l Section 22.05.25, 150 Percent of FPG.
Adds the new FPG figures for July 1, 2008 through June 30, 2009.
l Section 22.05.30, 175 Percent of FPG.
Adds the new FPG figures for July 1, 2008 through June 30, 2009.
l Section 22.05.35, 185 Percent of FPG.
Adds the new FPG figures for July 1, 2008 through June 30, 2009.
l Section 22.05.40, 200 Percent of FPG.
Adds the new FPG figures for July 1, 2008 through June 30, 2009.
l Section 22.05.45, 275 Percent of FPG.
Adds the new FPG figures for July 1, 2008 through June 30, 2009.
l Section 22.05.50, 280 Percent of FPG.
Adds the new FPG figures for July 1, 2008 through June 30, 2009.
l Section 22.15, MCHA Premiums.
Adds the new annual premium amounts for July 1, 2008 through June 30, 2009. There will now be just one rate so references to contracts existing before or after July 1, 2002, have been deleted from the new table.
l Section 22.20, MinnesotaCare Premium Amounts.
Updates the maximum MinnesotaCare premium amounts. Effective July 1, 2008, the maximum premium amounts are $392 for a household of one; $784 for a household of two; and $1176 for a household of three or more.
l Section 22.35, SAPSNF.
Updates the figures for the statewide average payment for skilled nursing facility care (SAPFSNF). Effective July 1, 2008, the SAPSNF for MA is $4772, and the SAPSNF for GAMC is $3728.
l Section 22.45, Long-Term Care Allowances.
Updates the following figures that are effective July 1, 2008:
n The home maintenance allowance is $867.
n The maintenance needs allowance (SIS-EW) is $860.
n The basic shelter allowance is $526.
n The minimum monthly income allowance is $1751.
l Section 22.50, Remedial Care Expense.
Updates the remedial care expense amount to $210 effective July 1, 2008.
l ”Home and Community-Based Services” was added to define waiver programs.
l The link to HealthQuest is changed to the secure site.
Chapter 03 - Eligibility Groups and Bases of Eligibility
l Section 03 - Eligibility Groups and Bases of Eligibility.
For clarification purposes the word ”characteristics” has been changed to ”factors.”
l Section 03.05.05 - Change in MinnesotaCare Eligibility Group.
Several small changes in wording improve reading ease. The date of verification is deleted from the Greta example because MinnesotaCare is not required to verify income changes between renewals.
l Section 03.10 - MA/GAMC Bases of Eligibility.
Wording changed throughout to be more specific and several links added to other relevant sections.
l Section 03.10.05 - Multiple Bases of Eligibility.
Minor wording changes.
l Section 03.20 - MinnesotaCare (MCRE).
Wording changes for clarification and consistency with other sections.
l Section 03.20.20 - MinnesotaCare for Adults with Children.
A link is added in the Eligibility Group section because it is important for users to refer to the complete information about MinnesotaCare Eligibility Groups. Other minor changes were made for language consistency with other sections.
l Section 03.20.25 - MinnesotaCare for Adults Without Children.
A statement was added to clarify that noncitizens with an undocumented or nonimmigrant status are not eligible for MinnesotaCare. Information under the Residency section was deleted and a link added to the State Residence – MinnesotaCare Adults Without Children section.
l Section 03.20.25.05 - Disabled Adults Without Children.
Clarifies that a Notice of 60-Day MinnesotaCare Eligibility - Must Apply for MA (DHS-3404), must be sent to the client when MinnesotaCare is approved for people who meet the eligibility criteria while an MA application is pending. Other language changes help clarify information.
l Section 03.25.10 - Medical Assistance for Auto Newborns.
Clarification is added regarding documents used to change custody and control of a child. Enrollees in these cases are not required to provide the documents. Other minor wording changes provide consistency with other sections.
l Section 03.25.15 - Medical Assistance for Children Under 21.
Clarification is added throughout and new information is provided in the End of Eligibility Basis section. Links are added to refer the user to the full information in appropriate sections. Household Composition information is deleted and a link refers readers to the full information in the specific section.
l Section 03.25.30 - Medical Assistance for Parents or Relative Caretakers.
Information is added in the first paragraph to clarify who is not considered a dependent child and or a relative caretaker. New links refer readers to other relevant sections for more information.
l Section 03.25.35 - Transitional MA/Transition Year MA (TMA/TYMA).
Clarification is added in the first paragraph on the reporting requirements for the 12 months of TYMA. Information has been added on eligibility requirements, increased earnings, multiple reasons for MA ineligibility, second six-months of TYMA, as well as other clarifications throughout the section.
l Section 03.25.35.05 - Potential Eligibility for TMA and TYMA.
Clarification is added on the conditions for eligibility and potential eligibility, and an additional example was added to help clarify the policy.
l Section 03.25.35.10 - Concurrent Eligibility for TMA and TYMA.
Concurrent eligibility is further clarified in the first paragraph and in the examples.
l Section 03.30 - Medical Assistance (MA) for People Who are Age 65 or Older, Blind or Disabled.
Wording and formatting changes for clarification of policy.
l Section 03.30.05 - Medical Assistance for People Age 65 or Older.
Links referring to other specific sections have been added throughout this section to ensure that the user has full information.
l Section 03.30.10 - Medical Assistance for People With Blindness.
Links are added to refer the user to long-term care sections for information on long-term care specific policies. Further information has been added in the Service Delivery section.
l Section 03.30.15 - Medical Assistance for People With A Disability.
Changes made to clarify household composition and service delivery.
l Section 03.30.25 - TEFRA Option.
Additional information is added about children who may not need to use the TEFRA Option because they may be eligible under MA without TEFRA or under a home and community-based disability waiver. Links to other sections have been added for clarification. A new example helps to explain procedure for an End in Eligibility Basis.
l Section 03.35 - Medicare Savings Programs (MSP).
New information and links at the beginning of this section explain the Medicare Savings Programs. Other changes in wording help to clarify this section.
l Section 03.35.05 - Qualified Medicare Beneficiary (QMB).
Changes made to revise and clarify this section include:
n Additional information under Application Process.
n A new example under Eligibility Begin Date.
n A policy change is noted in the Insurance and Benefit Recovery section that emphasizes that people age 65 or older who receive SSI and are not enrolled in Medicare, must be referred to apply as a condition of their MA eligibility. Do not enroll the person in QMB until Medicare eligibility has been established.
n New examples and clarification in the Household Composition and Income Guidelines sections.
n Instruction added to exclude Aid and Attendance benefits and Allowances for Unusual Medical Expenses received from the Veteran’s Administration (Deductions/Disregards section).
n Additional information and example in Relationship to Other Groups/Bases.
l Section 03.35.10 - Service Limited Medicare Beneficiary (SLMB).
Changes were made and information added to clarify this section.
n New examples and clarification in the Household Composition and Income Guidelines sections.
n Instruction added to exclude Aid and Attendance benefits and Allowances for Unusual Medical Expenses received from the Veteran’s Administration (Deductions/Disregards section).
n Additional information in End of Eligibility Basis and Relationship to Other Groups/Bases sections.
l Section 03.35.15 - Qualified Individuals (QI).
Changes were made to revise and clarify this section and for consistency with other Medicare Savings Program sections.
l Section 03.35.20 - Qualified Working Disabled (QWD).
Changes were made to revise and clarify this section and for consistency with other Medicare Savings Program sections.
n A note is added to remind users that people who meet the criteria for QWD likely qualify for MA-EPD, which covers more services and may be more beneficial to the client.
n Instruction added to exclude Aid and Attendance benefits and Allowances for Unusual Medical Expenses received from the Veteran’s Administration (Deductions/Disregards section).
l Section 03.40 - Waiver Programs.
Information and links other pertinent sections were added.
l Section 03.40.05 - Community Alternative Care (CAC).
Multiple changes were made to clarify policy for waiver programs. The Asset Guidelines section includes additional information on asset limits, transfers, and annuities. There is a new Service Delivery section about managed care enrollment.
l Section 03.40.10 - Community Alternatives for Disabled Individuals (CADI).
Multiple changes were made to clarify policy for waiver programs. The Asset Guidelines section includes additional information on asset limits, transfers, and annuities. There is a new Service Delivery section about managed care enrollment.
l Section 03.40.15 - Developmental Disabilities (DD).
Multiple changes were made to clarify policy for waiver programs. The Asset Guidelines section includes additional information on asset limits, transfers, and annuities. There is a new Service Delivery section about managed care enrollment.
l Section 03.40.20 - Traumatic Brain Injury (TBI).
Multiple changes were made to clarify policy for waiver programs. The Asset Guidelines section includes additional information on asset limits, transfers, and annuities. There is a new Service Delivery section about managed care enrollment.
l Section 03.40.25 - Elderly Waiver (EW).
Multiple changes were made to clarify policy for waiver programs. The Asset Guidelines section includes additional information on asset limits, transfers, and annuities. There are several changes in the names of services in the list of Covered Services and new information in the Service Delivery section about managed care enrollment.
l Section 03.45.30 - MA for Breast and Cervical Cancer (MA-BC).
Information is added to clarify eligibility and required documentation. When a woman’s doctor has provided a Minnesota Department of Health Sage Enrollment form, Sage Return Visit form, or Colposcopy Program form, do not require any further verification that treatment or diagnostic services are needed.
l Section 03.45.30.05 - Application Process for MA-BC.
Language and format changes were made for clarification of provider and county steps for eligibility determinations.
l Section 03.45.30.10 - Presumptive Eligibility Providers for MA-BC.
Minor wording changes clarify that precancerous conditions are also included.
l Section 03.45.35 - Minnesota Family Planning Program (MFPP).
n ”People” is changed to ”men and women” to be clear that both may be eligible for MFPP.
n Other changes clarify that MFPP eligibility does not prevent eligibility in other programs.
n Direct phone numbers and the e-mail address for the DHS Family Planning Unit are included to help in coordination of coverage.
n Steps to calculate countable income are added under Eligibility Method.
n Other wording changes help to clarify MFPP policy.
l Section 03.45.35.05 - Application Process for MFPP.
Wording changes throughout help to clarify the MFPP application process. Information was further divided into new sub-sections for Provider Certification and Presumptive Eligibility Determinations.
Chapter 11 - Citizenship and Immigration Status
New legislation changes lawfully ”residing” to lawfully ”present.” This is changed wherever it appears throughout Chapter 11.
l Section 11.05.05, Acceptable Documentation of U.S. Citizenship and Identity.
Clarifies not to accept an affidavit to document identity if an affidavit is used to document citizenship.
l Section 11.30.05, Other Lawfully Present Noncitizens.
Numerous minor changes have been made in this section for clarification. Additional information is added to clarify the Pending Immigration status, and two new subsections explain a USCIS Order of Supervision and list other immigration categories of noncitizens lawfully present in the United States.
l Section 18.05 - Sponsor Deeming.
Clarifies that sponsor deeming ends when the sponsor or sponsored noncitizen dies.
Chapter 21 - Income Calculation (Community)
l Section 21.20.05, Excess Income and MinnesotaCare.
DHS-3407 and DHS-3408 have been combined into one form, the new DHS-3408. This section is updated to reflect this change.
n Clarifications emphasize that the gross annual household income is used when determining if children meet the MCHA exemption.
n Changes also note to close coverage if 10% of the annual income is equal to, as well as greater than, the MCHA premium.
n The note in the last sub-section about verification of new income has been deleted because verification of income changes between renewals is not required.
l Section 21.40, MA-EPD Income Calculation.
Clarification of income averaging has been added, as well as links to excluded income and availability of income sections.
Clarifications and links have been added throughout these sections:
l Section 25.10 - MA-EPD Premiums.
Clarifies that Good Cause for late payment is available and is determined by DHS.
l Section 25.10.05 - Initial MA-EPD Premiums.
n Adds information that the MA-EPD Overdue Premiums Report is found on InfoPac.
n Policy clarification and an example are added for Initial Premium Collection Amount.
l Section 25.10.10 - Ongoing MA-EPD Premiums.
Instructions are clarified for when an ongoing premium is not paid.
l Section 25.10.15 - Payment Options, Refunds and Dishonored Payments.
Adds that when a case been closed for non-payment and the client is re-applying, a guaranteed form of payment is needed for the initial premium.
l Section 25.10.20 - Changing MA-EPD Premium Amount.
Language changed to specify that workers should notify the DHS Special Recovery Unit (SRU) by sending a MAXIS e-mail to ”MADE” if a reported change results in a decreased premium.
l Section 25.10.25 - MA-EPD Good Cause for Late Payment.
Clarification is added that the client, the person acting on the client’s behalf (financial worker, authorized representative, or case manager) may request good cause for late payment of a MA-EPD premium.
l Section 25.15 - Automatic Withdrawal Plan (AWP).
Changes clarify the name to which the Automatic Withdrawal Plan form should be directed, adds the fax number and corrects the phone number for DHS Financial Management.
Glossary Additions and Updates
l A-F.
n Adds a definition for Certified MFPP Provider – a family planning services provider who is approved by DHS to make presumptive eligibility determinations for the Minnesota Family Planning Program.
n Adds a definition of Fiscal Year for a clear understanding of this terminology. A fiscal year is a 12-month accounting period. The DHS fiscal year begins July 1 and ends June 30. The fiscal year is designated by the calendar year in which it ends. For example, fiscal year 2009 is the year that begins July 1, 2008, and ends June 30, 2009.
l G-L.
n Adds definition of Lead Agency Case Manager – the health plan, county or tribal agency staff person who provides case coordination or case management services.
l M-R.
n Adds definitions for Minnesota Family Planning Program and its acronym MFPP to state: A DHS-administered health care program that covers family planning services and related supplies for people who are not enrolled in Minnesota Health Care Programs.
n Revises the definition of Presumptive Eligibility to "A temporary period of eligibility that is determined at the point of service by certain health care providers using preliminary information. Presumptive eligibility is used in the Minnesota Family Planning Program and MA for Breast and Cervical Cancer."
l S-Z.
n Revises the definition for Sage Screening Program to clarify that this is a free screening program administered by the Minnesota Department of Health.
n Expands the definition of Ten-Day Notice to state that notification must be sent at least ten calendar days before the effective date of an agency action, and that most adverse actions require ten-day notice.