This manual letter lists new and revised material for the Health Care Programs Manual (HCPM). Unless otherwise noted, new and revised instructions are effective February 1, 2009.
Sections of Chapter 4 (Social Security Administration (SSA) Benefits) regarding Medicare are updated.
Several sections of Chapter 6 are updated.
Several sections of Chapter 15 are updated.
Several sections of Chapter 19 are updated.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 21 - Income Calculation (Community).
Chapter 22 - IRS Mileage Rate.
Social Security Administration (SSA) Benefits
l Section 04.40 - Medicare.
n Definitions subsection deleted and definitions moved to glossary.
n Clarifies who qualifies for Medicare.
n New subsections provide information about when Medicare starts, enrollment in Medicare, and Medicare supplement products.
n Updates Medicare contact information.
l Section 04.40.05 - Medicare Part A.
Significant revisions have been made to the premiums subsection. Clarifies who qualifies for premium-free Medicare Part A.
l Section 04.40.10 - Medicare Part B.
n Adds information about the Medicare Method B enrollment process.
n Provides information about Medicare Advantage Plans (Part C) that subsidize the Medicare Part B premiums for their members. Medical Assistance (MA) enrollees in certain Medicare Advantage plans may pay reduced Part B premiums.
n Adds a table that lists Medicare Advantage Plans (Part C) that subsidize Part B premiums.
l Section 04.40.15 - Medicare Part C.
n New subsection on Medicare Part C describes who may choose to enroll in a Medicare Advantage plan.
n The coverage subsection now explains that Medicare Advantage organizations can offer three types of plans.
n New subsection explains that a Medicare beneficiary may choose to enroll in a Medicare Advantage plan during their initial enrollment, the annual election period, open enrollment, or during a special enrollment period.
l Section 04.40.20 - Medicare Part D.
n Adds information about how to enroll in Medicare Part D. Medicare enrollees may enroll in Part D during their initial enrollment period, the annual election period, or a special enrollment period. Also, explains that Medicare beneficiaries may choose not to enroll in a Part D plan, but may have to pay a higher premium if they decide to enroll later.
n New subsection explains who is automatically eligible for the full Extra Help subsidy, regardless of income and assets.
n Provides information about how to apply for Extra Help for people not automatically eligible.
n New subsection provides information about temporary prescription drug coverage for full benefit dual eligible. Instructs workers to encourage full benefit dual eligibles to proactively enroll in a Part D plan and not wait for the Centers for Medicare and Medicaid Services (CMS) to enroll them in a plan.
n Significant revisions made throughout to provide clarification in this section.
l Section 04.40.20.05 - Medicare Part D Benchmark Plans.
n All 2009 Medicare Part D Benchmark Plans are listed.
n 2008 benchmark plans not available in 2009 are listed.
l Section 04.45 - Medicare and Minnesota Health Care Programs (MHCP).
n Clarifies that people who are entitled to premium-free Medicare Part A or enrolled in Medicare Part B are ineligible for MinnesotaCare. Applicants or enrollees cannot establish or keep MinnesotaCare eligibility by refusing or failing to sign up for Medicare coverage.
n Explains that MA and General Assistance Medical Care (GAMC) enrollees who qualify for Medicare must enroll in Parts A and B as a condition of their MA eligibility, if it is cost-effective.
n Clarifies that residence in an Institution for Mental Diseases (IMD) does not affect a person’s Medicare coverage, but does affect eligibility for MA and Medicare Savings Programs (MSP).
n Adds examples that show how Medicare and GAMC interact. Notes that GAMC enrollees with Medicare may also be eligible for a MSP. However, an enrollee cannot be enrolled concurrently in both GAMC and an MSP.
l Section 04.45.05 - Medicare Part D and Minnesota Health Care Programs (MHCP).
n The section was previously named MA/GAMC and Medicare Part D.
n New subsections add information about the MA and GAMC benefit change notice and federally funded MA and MSP.
n Significant wording changes made throughout this section to add clarity.
l Section 04.45.10 - Referrals to Medicare.
Significant updates clarify when and how to refer applicants and enrollees to Medicare.
l Section 04.45.15 - The Buy-In.
n Language added to the Buy-In subsection that explains that a client can be on the buy-in with or without MA eligibility. Additional information explains worker responsibility for entering data in MMIS and how the buy-in process works in MMIS.
n Clarifies that Buy-In payments for Medicare cost-sharing is based on the enrollee’s program and lists what the Buy-In pays for.
n Adds information about Buy-In eligibility and the Buy-In begin date for people turning age 65.
n Significant revisions made through this section to clarify policy.
l Section 06 - Client Responsibilities.
n Clarifies DHS Eligibility Audit review program titles.
n Adds Payment Error Rate Measurement (PERM) as a review requiring client cooperation.
l Section 06.05 - Cooperation.
n Explains what will happen if clients fail to cooperate without good cause. Provides instructions for workers for noting disqualification in case notes and coding MAXIS.
n Clarifies that clients whose coverage is closed for failure to cooperate with Medicaid Eligibility Quality Control (MEQC), PERM, or MinnesotaCare Quality Assurance reviews are not eligible for any health care program, even if they apply for and meet the eligibility criteria of the other program.
n Provides instruction to workers to add a worker comment to the notice or send a memo to inform clients when good cause is granted.
l Section 15.10.05 - Cost Effective Health Care Coverage - MA and GAMC.
Adds information about when it is necessary do a cost effective determination for people enrolled in Medicare.
l Section 15.20 - Creditable Coverage.
n Explains that creditable drug coverage for Medicare Part D purposes means the drug coverage in a client’s current health care coverage is the same or better than coverage provided under the Part D benefit.
n Provides information about what will happen if people choose creditable drug coverage instead of Medicare Part D and instructs people to contact their employer or benefit administrator for more information before making a decision about their drug coverage.
l Section 19 - Assets.
n Provides an overview and links to chapter 19 asset topics.
n Definitions subsection deleted and definitions moved to glossary.
n Categorizes and defines asset types to assist with determining whether they are counted for health care program eligibility.
l Section 19.05 - Asset Limits.
n Clarifies that other family members’ assets are not counted when determining an Elderly Waiver recipient’s eligibility as a Qualified Medicare Beneficiary (QMB) or Service Limited Medicare Beneficiary (SLMB).
n Corrects an error in an example on establishing an asset limit under MA Method B and Waiver programs.
l Section 19.05.10 - Exemptions from Asset Limits.
n Clarifies that people who do not have an asset limit to qualify for MA must still meet requirements for the home equity limit and must comply with rules regarding the treatment of annuities for MA payment of long-term care (LTC) services.
n Explains that people receiving Group Residential Housing (GRH) who do not have an MA basis of eligibility are automatically eligible for GAMC.
l Section 19.05.15 - Calculating Countable Assets (New).
n Describes which method of calculating assets applies to different health care programs.
n Describes the steps for calculating countable assets for health care eligibility.
l Section 19.15 - Availability of Assets.
n Clarifies the rules on availability of assets for purposes of determining health care program eligibility.
n Reorganizes information within this section.
n Deletes information on Continuing Care Retirement Community (CCRC) entrance fees from this section because it is available in section 19.25.45.
Chapter 03 - Eligibility Groups and Bases of Eligibility
n Section 03.30.20.05 - MA-EPD Employment Definition.
Clarifies that a four-month extension of Medical Assistance for Employed Persons with Disabilities (MA-EPD) eligibility is allowed when an enrollee loses a job due to a situation that is not attributable to the enrollee.
n Section 07.20.10 - Pending an Application.
m Clarifies requirements and steps for pending an application for MA or GAMC.
m Reorganizes information within the section.
Chapter 21 - Income Calculation (Community)
n Section 21.55 - Budgeting Lump Sum Income (New).
m Information is moved to this page from section 20.25.10, Lump Sum Income so that all information on income calculation is in this chapter.
m This new page explains policies for budgeting counted lump sum income for all health care programs except MinnesotaCare. Do not count lump sum income for MinnesotaCare.
Chapter 22 - Standards and Guidelines
n Section 22.30 - IRS Mileage Rate.
The mileage reimbursement rate is reduced to $.55 per mile effective January 1, 2009.
n Section 26 - Notices.
m Information is reorganized and clarified.
m New subsection clarifies requirements for the timing of notices.
m Information added to clarify that worker comments or a SPEC/MEMO should be used to inform an enrollee that health care was also renewed when using cash assistance or food support renewals to also renew MA or GAMC before the MA or GAMC renewal date.
m Adds that workers must help applicants obtain information if processing is delayed due to the applicant’s inability to obtain information, and should not deny the case if the applicant is cooperating.
m Clarifies when a notice is generated by MAXIS, by MMIS, or when additional notice is required by adding worker comments to a MAXIS notice or by SPEC/MEMO.
The following terms have been added or revised in the following sections of the glossary:
n Section A - F.
m Cash.
m Extra Help.
m Dual Eligibles.
m Full-Benefit Dual Eligibles.
n Section G - L.
m Household Goods.
m Individual Development Account (IDA).
m Individual Development Account Demonstration Project (deleted).
m Individual Development Account TANF-Funded (deleted).
m Liquid Assets.
n Section M - R.
m Medicaid Eligibility Quality Control (MEQC).
m Medical Expense Account.
m MinnesotaCare Quality Assurance.
m Non-Liquid Asset.
m Payment Error Rate Measurement (PERM).
m Periodic Payment.
m Personal Effects.
m Quality Assurance (deleted).