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Effective: November 1, 2008 |
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06.05ar3 - Cooperation (Archive) |
Archived: February 1, 2009 |
Clients must comply with various requirements for health care program eligibility. This includes general requirements, such as providing information about and required verifications for eligibility factors such as income and assets. However, there are certain eligibility factors for which the term "cooperation" is used. A few of these specific cooperation requirements are highlighted in this manual section.
For more detailed information on these topics, please see the links to each chapter under Related Topics below.
Medicaid Eligibility Quality Control, Payment Error Rate Measurement and Quality Review Cooperation.
Other Health Care Coverage Cooperation.
Medicaid Eligibility Quality Control (MEQC), Payment Error Rate Measurement (PERM) and Quality Review Cooperation
Clients must cooperate with Medicaid Eligibility Quality Control (MEQC), Payment Error Rate Measurement (PERM) and MinnesotaCare quality reviews.
l Clients who fail to cooperate without good cause will lose eligibility for programs for which they did not cooperate.
l Good cause may be granted if a diagnosis of mental illness, or physical disability or illness is severe enough and lasting long enough to prevent a client from participating in the completion of the review process.
n Clients must provide a doctor’s statement that verifies their illness or disability.
l Do not process or approve eligibility if clients reapply at a later date until they agree to cooperate with the review process. Deny the reapplication if a client fails to cooperate by the end of the processing period.
l Approve health care coverage with retroactive MA eligibility for up to three months before the month of application if clients cooperate and all other eligibility criteria are met.
l Clients whose MA or federally funded MinnesotaCare (MCRE) is closed for failure to cooperate with an MEQC review are also ineligible for GAMC.
Some parents and legal guardians of children who are requesting or receiving MCRE or MA must cooperate with medical support requirements. They must work with the county child support enforcement office, also known as the IV-D Agency , to:
l Obtain medical support.
l Enforce an existing order.
l Establish paternity.
Examples of cooperation include:
l Providing information about non-custodial parents.
l Establishing paternity of eligible dependent children.
l Forwarding any medical support payments received directly from the non-custodial parent to DHS.
Clients assign their (and their legal dependents') rights to medical support by signing the application or renewal.
Parents and legal guardians required to assign rights who do not cooperate with obtaining medical support or establishing paternity are not eligible for Minnesota Health Care Program coverage. Non-cooperation is determined by the county child support enforcement office.
Note: Eligibility for the caretaker's children and the caretaker’s spouse is not affected by the caretaker’s actions.
Some Minnesota Health Care Program (MHCP) clients must cooperate with payment requirements to establish and maintain eligibility. The two programs that require a premium payment are:
l MinnesotaCare.
l Medical Assistance for Employed Persons with Disabilities (MA-EPD).
Other Health Care Coverage Cooperation
Most MHCP clients must cooperate by providing information about other health care coverage and any other third party liability (TPL) that they have or that may be available to them. They may also be required to maintain or enroll in coverage that is cost-effective.
l For MinnesotaCare, availability of other health care coverage may be a barrier to program eligibility.
l Most MA and GAMC clients must cooperate with cost-effective health care coverage requirements. Availability of other health care coverage does not affect eligibility for these programs.
Some other general cooperation requirements include:
l People who have other health care coverage must assign their rights to coverage to DHS as a condition of eligibility by signing the Health Care Application (HCAPP) or Combined Application Form (CAF).
l Adults who refuse to assign their rights or the rights of other household members for whom they are legally able to assign rights are not eligible for MA or GAMC.
Note: Children whose parents refuse to assign their rights to other health care coverage or third party liability remain eligible.
l Most applicants and enrollees must provide information on other health care coverage or TPL which is or may be available to them or their dependents, regardless of whether the applicant or enrollee is the policyholder.
l People must cooperate with the MCRE or county agency and the state Benefit Recovery Section (BRS) in identifying potential sources of other health care coverage.
For further information about specific cooperation requirements, see the following chapters: