This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective April 1, 2013.
Manual Letter #60 incorporates Bulletin #10-21-18, "DHS Reissues Information on Long-Term Care Partnership (LTCP) Program," Bulletin #11-21-09, "Changes to the State Medical Review Team (SMRT) Disability Determination Process," and Bulletin #13-69-01, "Settlement Agreement Between the Federal Government and American Indian Trust Beneficiaries."
This manual letter also includes updates related to overpayments for the Healthy Minnesota Contribution Program, referrals for medical support, excluded income and assets, reasonable efforts to sell, lump sums, Medical Assistance (MA) excess assets and the Pre-Existing Conditions Insurance Program (PCIP).
Chapter 3 - Eligibility Groups and Bases of Eligibility
Provides information regarding overpayments for the Healthy Minnesota Contribution Program.
Chapter 12 - Certification of Disability
Incorporates Bulletin #11-21-09.
Adds a circumstance for which a medical support referral is not required.
Incorporates Bulletin #13-69-01. Changes to this chapter also include updates to excluded assets, reasonable efforts to sell and MA excess assets.
Incorporates Bulletin #13-69-01 and updates information related to excluded income.
Chapter 23 - MA Payment of Long-Term Care (LTC) Services
Incorporates Bulletin #10-21-18.
Chapter 30 - Other Related Programs
Removes information related to PCIP.
Adds two new terms: Protected Asset Limit (PAL) and Partnership Policy.
Provides information about an update to DHS-3341, Asset Reduction.
Chapter 3 - Eligibility Groups and Bases of Eligibility
l Section 03.55 - Healthy Minnesota Contribution Program
Adds instruction to follow standard MinnesotaCare guidelines when assessing a Healthy Minnesota Contribution Program overpayment. Also clarifies that only the used amount indicated on the RHMC screen in MMIS should be considered in assessing a Healthy Minnesota Contribution Program overpayment.
Chapter 12 - Certification of Disability
l Section 12.10 - State Medical Review Team (SMRT) Disability Determinations
Incorporates Bulletin #11-21-09 by updating the State Medical Review Team (SMRT) Disability Determination process. Changes to this process include a client packet that must be sent to the client prior to submitting the referral to SMRT. Referrals must now be sent via fax or SIR mail. Additionally, SMRT will work with the client and his or her provider to schedule an appointment and transportation if an exam is needed. Information about the billing process, expedited case criteria and SMRT response is also included in this revision.
l Section 12.15 - TEFRA Referrals to the State Medical Review Team (SMRT)
Incorporates Bulletin #11-21-09 by removing information that is duplicated in Section 12.10 - State Medical Review Team Disability Determinations. Adds a link to Section 12.10.
An additional change to this section includes the merging of two subsections, Role of the Worker and Follow-Up, into one subsection, Parental Responsibilities. This merged subsection describes the responsibility of a current TEFRA enrollee to cooperate in submitting medical documentation. It also clarifies that parents of TEFRA-eligible children may be responsible for paying parental fees as partial reimbursement of the child’s MA costs.
l Section 16.05 - When to Refer for Medical Support
Clarifies that a medical support referral is not necessary if a parent is involuntarily out of the household because he or she is being detained by U.S. Immigration and Customs Enforcement (ICE) or is waiting for immigration authorization from U.S. Citizenship and Immigration Services (USCIS) from outside the United States.
l Section 19.10 - Excluded Assets
Incorporates Bulletin #13-69-01 by adding payments received as part of the Cobell Settlement for American Indians as an excluded asset. The payments are excluded as income in the month received and as an asset for one year after the date of receipt. Exclude payments whether issued as a lump sum or periodic payments. The exclusion applies to all members of the household. Accept verbal or written attestation regarding the date of receipt and amount of payment.
Also adds to the list of excluded assets payments received by a worker or volunteer, or if deceased, his or her heir, under the World Trade Center (WTC) Litigation Settlement or distributed by the WTC Captive Insurance Company. These payments are considered disaster assistance and are excluded on that basis.
l Section 19.25.15.10 - Non-Homesteaded Real Property
Updates the criteria of a reasonable effort to sell to broadly include advertising the property for sale using one or more public forms of advertisement available the residents of the geographic area where the property is located. This includes, but is not limited to, posting a readable "For Sale"; sign with the owner's name and telephone number, advertising by newspaper or distributing "For Sale" flyers, or posting the property for sale on commonly used internet listing sites.
l Section 19.35.10 - MA Excess Assets
Adds instructions to send DHS-3341, Asset Reduction Worksheet, to a client with excess assets. Workers indicate on the form the total value of the client’s counted assets, the asset limit, the amount of assets that needs to be reduced, and the date by which it needs to be reduced. The form also includes a section for workers to check off the acceptable ways the client can reduce his or her assets.
l Section 19.50 - Liens and Estate Recovery
Incorporates Bulletin #10-21-18 by providing estate recovery policy related to assets protected by a Partnership policy. This includes information regarding what assets are recoverable from an enrollee with a Partnership policy, options to protect previously unprotected assets and circumstances in which assets are recoverable when the surviving spouse of a predeceased enrollee with a Partnership policy dies.
l Section 20.25.05 - Excluded Income
Incorporates Bulletin #13-69-01 by adding payments received as part of the Cobell Settlement for American Indians as excluded income. This income is excluded as income in the month received and as an asset for one year after the date of receipt. Exclude the income whether issued as a lump sum or periodic payments. The exclusion applies to all members of the household. Accept verbal or written attestation regarding the date of receipt and amount of payment.
Also adds to the list of excluded income payments received by a worker or volunteer, or if deceased, his or her heir, under the WTC Litigation Settlement or distributed by the WTC Captive Insurance Company. These payments are considered disaster assistance and are excluded on that basis.
l Section 20.25.15 - Lump Sum Income
Adds a reference and a link to Section 19.10 - Excluded Assets as it relates to Retirement, Survivors, and Disability Insurance (RSDI) and Supplemental Security Income (SSI) lump sums.
Chapter 23 - MA Payment of Long-Term Care (LTC) Services
l Section 23 - MA Payment of Long-Term Care (LTC) Services
Incorporates Bulletin #10-21-18 by adding a description and link to new Section 23.40 - Long-Term Care Partnership Insurance in the Chapter 23 overview. The description of the new section indicates it provides information on how to treat Partnership policies.
l Section 23.40 - Long-Term Care Partnership Insurance (new)
Incorporates Bulletin #10-21-18 by providing policy for the Long-Term Care Partnership (LTCP) Program. This new section explains who is eligible to participate in the LTCP, what a Partnership policy is and how a client can use the LTCP to protect assets. This section also explains the roles and responsibilities of the worker, the client and DHS as it relates to the LTCP.
Chapter 30 - Other Related Programs
l Section 30.00.05 - Summary Chart
Removes information about PCIP from the Summary Chart of Other Related Programs. As of February 16, 2013, the program has suspended acceptance of new enrollment applications due to limited funds.
l Section 30.10 - Medical Needs
Removes all information related to PCIP.
l M-R
Adds the definitions of two new terms: Partnership Policy and Protected Asset Limit. These two terms are important to understanding the new policy related to LTCP.
This form was updated with a new section that allows workers to check off the acceptable ways a client can reduce his or her assets.