This manual letter lists new and revised material for the Health Care Programs Manual (HCPM). Unless otherwise noted, new and revised instructions are effective November 1, 2009.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Sections are updated to clarify procedures; a number of other sections have updates on household composition and verification requirements.
Chapter 13 - State and County Residence.
Many sections are modified based on a regularly scheduled review.
Chapter 15 - Third Party Liability.
Cost effective sections are updated and modified based on a regularly scheduled review and to incorporate the bulletin #09-19-01, "DHS Announces New Process for Cost Effective Health Insurance Reviews."
Retirement funds, real property, and life estate information is updated based on a regularly scheduled review.
Updates to this chapter are based on a regularly scheduled review.
Chapter 04 - Social Security Administration (SSA) Benefits.
Chapter 23 - MA Payment of Long-Term (LTC) Services.
Chapter 30 - Other Related Programs.
Chapter 03 - Eligibility Groups and Bases of Eligibility
l Section 03.15 - Enrollee Becomes Pregnant.
Clarifies that the husband of a pregnant woman does not have a parent or caretaker basis of eligibility for MA until the child is born, unless he is already a parent of another child.
l Section 03.20.05 - MinnesotaCare for Pregnant Women.
n Aligns Medical Assistance and MinnesotaCare pregnancy verification process.
n Defines the process for approval and requesting verifications of date of conception and due date.
n Clarifies that MinnesotaCare may be approved for pregnant women who meet all other eligibility requirements before receiving verification of the pregnancy.
n Clarifies that while pregnancy must be verified, the providers’ signature is not required on the verification.
l Section 03.25.05 - Medical Assistance (MA) for Pregnant Women.
n Explains to use an estimated date of delivery while waiting to receive verification.
n Clarifies to send a Proof of Pregnancy (DHS-3236), but to accept any other form of verification as long as it includes the necessary information.
n Clarifies that while pregnancy must be verified, the provider’s signature is not required on the verification. However, obtain a signed release from the client if it is necessary to contact the provider because the verification she provides is incomplete.
n Changes references to the State Children’s Health Insurance Program (SCHIP) to Children’s Health Insurance Program (CHIP) to comply with a change in federal program terminology.
l Section 03.25.30 - Medical Assistance (MA) for Parents or Relative Caretakers.
Clarifies that the husband of a pregnant woman does not have a parent or caretaker basis of eligibility until the child is born, unless he is already a parent of another child in that household.
l Section 03.50.05 - General Assistance Medical Care (GAMC) with Full Benefits.
Clarifies that the husband of a pregnant woman does not have a parent or caretaker basis of eligibility until the child is born, unless he is already a parent of another child in that household.
Chapter 13 - State and County Residence
l Section 13 - State and County Residence.
Deletes a sentence about rules for certain groups that do not follow all or some of the basic residence rules. Policy for all groups is addressed where appropriate.
l Section 13.05 - State Residence for Medical Assistance (MA) and MinnesotaCare Families.
n Clarifies policy for children under age 18.
n Adds information to this section that was formerly in the Migrant Agricultural Worker section (13.05.10) because it pertains to anyone who may travel from state to state for work.
n Clarifies verification requirements for state residence.
l Section 13.05.05 - Institutional Residence.
n Clarifies policy on state residency for MA clients living in an institution who are age 18 or older and those who are under age 18.
n Clarifies the agreement between Minnesota and North Dakota regarding placement in an institution.
l Section 13.05.10 - Migrant Agricultural Workers (Archived).
Relevant information from this section is moved to section 13.05, State Resident for MA and MinnesotaCare Families.
l Section 13.05.10 - Adoption Assistance - State Residence.
n Formerly numbered 13.05.15.
n Clarifies policy under state-funded adoption assistance regarding the Interstate Compact on Adoption and Medical Assistance (ICAMA).
n Clarifies that states have the option of providing MA for state adoption assistance children who move from other states with adoption assistance agreements that include medical coverage.
l Section 13.05.15 - Foster Care - State Residence.
n Formerly numbered 13.05.20.
n Clarifies enrollment requirements for federally funded Title IV-E foster care children.
n Minor clarifications and updates.
l Section 13.10 - State Residence - GAMC and GHO.
n Defines a valid, rather than a current, driver’s license as acceptable verification of residence.
n Adds a note to determine whether there is a medical emergency that fits the 30-day residence exception if a client applies for GHO.
l Section 13.15 - State Residence - MinnesotaCare Adults Without Children.
n Clarifies verification requirements showing intent to live in Minnesota permanently.
n Minor clarifications.
l Section 13.20 - Temporary Absence from Minnesota.
n Adds two new sub-sections: Temporary Absence Due to Training or School Attendance and Verification of Inconsistent or Questionable Absence to clarify policy in these areas.
n Minor clarifications and updates.
l Section 13.25 - County Residence.
Clarifies that if there is a dispute about financial responsibility or county of service, the county where the applicant submitted the application must administer the case until the dispute is resolved.
Chapter 15 - Third Party Liability (TPL)
l Section 15.10.05 - Cost Effective Health Care Coverage.
n Adds information on new required cost effective forms.
n Clarifies sanction for non-cooperation of adult enrollees.
n Adds information about special enrollment periods for people who lose MA eligibility or become eligible for MA. This provision is effective April 1, 2009.
n Adds instructions about what to do if the employer offers more than one group health plan.
n Moves information on Medicare cost effective requirements to a new section.
l Section 15.10.05.05 - Determining Cost Effectiveness.
n Formerly ”Steps in Cost Effective Determination.”
n Combines information from Always Cost Effective and Never Cost Effective into one section.
n Modifies steps used to determine if policy is cost effective.
l Section 15.10.05.10 - Medicare Cost Effective Requirements (New).
n Formerly ”Always Cost Effective.”
n Moved information on Medicare to this section from 15.10.05.
n Clarifies information needed for Medicare Part A and Part B cost effective review.
l Section 15.10.05.15 - Cost Effective Premium Reimbursement.
n Formerly ”Never Cost Effective.”
n Clarifies that the client must verify premium payment before being reimbursed.
n Clarifies retroactive premium reimbursement.
n Changes earlier instruction to consult with the child support officer if coverage is available through an employer, but the employee or court-ordered parent has a change in circumstances and is unable to keep the coverage in effect. Child Support agency staff only have authority to enforce the provisions of the current court order.
n Changes instruction to contact the Benefit Recovery Section (BRS), to instead contact the Recipient Help Desk if an enrollee who receives MA or GAMC on a fee-for-service basis has a mail-order only drug benefit with co-payments. The Help Desk will initiate a request to BRS to send the enrollee a letter with instructions about acceptable proof of payment.
n Other minor clarifications and updates.
l Section 19.20 - Verification of Assets.
n Clarifies when clients are required to provide verification of assets.
n Clarifies types of documentation to verify assets.
n Clarifies that MinnesotaCare enrollees who have an asset limit must report assets, but may not always have to verify those assets.
n Adds additional information about when not to verify an asset.
n Explains when it is necessary to verify any encumbrances.
n Other minor updates and clarifications.
l Section 19.25.10 - Retirement Funds and Retirement Plans.
n Revises the layout of this section to explain more clearly the differences between and the types of retirement funds and retirement plans.
n Provides lists and examples of retirement plans.
n Explains how plans are counted or excluded for different Minnesota Health Care Programs.
n Clarifies information on evaluating retirement plans.
l Section 19.25.15 - Real Property.
n Adds extensive information to this section on types of property ownership, limits on ownership, verifications and availability of real property.
n Defines and explains terms used in relation to types of property ownership that may be applicable when determining how property is counted for Minnesota Health Care Programs.
l Section 19.25.15.15 - Life Estates.
n Clarifies policy on life estates and the rights and responsibilities of the life estate owner.
n Adds information about the rights of the remainderman.
n Other minor updates and clarifications.
l Section 19.25.15.20 - Life Estate Mortality Table.
Clarifies that this table must be used to determine the expected duration of a life estate interest.
l Section 25.05 - MinnesotaCare Premiums.
n Refers users to the MinnesotaCare Premium Table (DHS-4139) and the MinnesotaCare Premium Calculator in MMIS to estimate a household’s premium.
n Minor clarifications.
l Section 25.05.05 - Initial, Ongoing and Changes to Premiums.
n Clarifies that there will be an automatic premium adjustment when coverage ends, when a premium was paid for a future month and capitation for the future month has not been paid.
n Other minor clarifications.
l Section 25.05.10 - Premium Payment Options.
n Clarifies that MMIS will terminate coverage and impose a four-month penalty period if the enrollee fails to replace an NSF check with a guaranteed form of payment.
n Other minor clarifications.
l Section 25.05.15 - MinnesotaCare Reinstatement.
Minor clarifications.
l Section 25.05.20 - Four-Month Penalty.
n Explains that enrollees may appeal and have benefits continue during the appeal when being closed for nonpayment of premiums if they pay all premiums due.
n Clarifies that Safe at Home participants may request and be granted good cause for late premium payments.
n Other minor updates and clarifications.
l Section 25.05.25 - Forgiving Premiums.
Minor updates and clarifications.
l Section 25.05.30 - Premium Credits and Refunds.
n Updates MMIS information regarding re-billing premiums and premium refunds.
n Explains to check the name and address attached to the National Provider Identifier (NPI) to confirm it is correct, and not the case address on the RCAD screen.
Chapter 04 - Social Security Administration (SSA)
n Section 04.30 - Verification of RSDI and SSI Benefits.
Adds a note to clarify that SSI recipients are not required to provide verification of other income that SSA considers when determining the SSI eligibility and benefit amount, unless they are requesting MA payment of LTC services.
n Section 04.40.20 - Medicare Part D.
Updates information on the change in frequency for the Medicare Part D data file interface with the Centers for Medicare and Medicaid Services (CMS).
n Section 08.05 - Annual Renewal Exemptions.
Deletes the sentence stating that adoption agreement renewals have to be verified annually to conform to the new policy on Medical Assistance for children receiving adoption assistance.
n Section 20.10 - Verification of Income.
Clarifies that verification is not required for income that the SSI program excludes when SSA determines the eligibility and benefit amount for SSI.
n Section 20.25.35 - RSDI and SSI Benefits.
Clarifies that other income that SSA considers in determining SSI eligibility and benefit amount does not need to be verified.
n Section 20.25.40 - Child Support.
m Explains the default date in PRISM.
m Provides additional information and an example for averaging child support income for MinnesotaCare.
m Clarifies how child support income is counted for MA Method A, MA, Method B, MA-EPD, Medicare Savings Programs, LTC, GAMC-Full Benefits, GAMC-Hospital Only and Transitional MinnesotaCare.
Chapter 23 - MA Payment of Long-Term Care (LTC) Services
n Section 23.20 - LTC Spenddowns and Waiver Obligations.
Clarifies that MMIS is unable to reprocess claims when a waiver obligation increases retroactively.
Chapter 30 - Other Related Programs
n Section 30.05 - Financial Needs.
Eliminates instructions to refer clients to apply for unemployment insurance; not all programs require clients to apply for any available benefits.
A number of terms have been added or updated.
n 401(k) Plan (new).
n 403(b) Plan (new).
n 457 Plans (new).
n Children’s Health Insurance Program (CHIP) (new).
n Deemed IRA (new).
n Emancipated Minor (revised).
n Employee Stock Ownership Plans (ESOPs) (revised).
n Institution (revised).
n Keogh Plan (new).
n Life Estate (revised).
n Payroll Deduction IRA (new).
n Profit Sharing Plans (new).
n Roth 401(k) (new).
n Savings Incentive Match Plan for Employees IRA (SIMPLE IRA) (new).
n SCHIP (revised).
n Simplified Employee Pension IRA (SEP IRA) (new).
n Spousal IRA (new).
n Thrift Savings Plans (TSPs) (new).