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Effective: December 1, 2006 |
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24.15.30ar1 - R Bills (Archive) |
Archived: March 1, 2007 |
"R" bills are one type of health care expense. R bills are services that are reimbursable by MA if the client is eligible for MA. They are incurred during the current certification period for which MA eligibility is being determined.
R bills are applied to a spenddown after H bills, M bills and P bills are applied.
For information which affects all health care expenses see Health Care Expenses.
R bills must be incurred during the certification period for which eligibility is being determined.
R bills include:
l MA covered services incurred by the client during the six month or one month certification period.
MA-covered services are services that would be paid by MA if the client is eligible for MA on the date of service.
Note: Although MA limits how often some services are paid and requires prior authorization for others, do not apply these limits when determining what expenses are acceptable to meet a spenddown.
l Waiver services received through the waiver programs.
Apply the cost of waiver services the client is financially responsible for to the spenddown.
n Do not apply MA payments for these services to the spenddown as federal funds pay for these services.
n Contact the case manager for projected monthly costs.
n Apply the projected amounts as bills incurred on the first day of the month rather than on the dates of service.
l Minnesota Senior Health Options (MSHO) and Minnesota Disability Health Options (MNDHO) spenddown and waiver obligations.
Apply the recipient amount of MSHO and MnDHO spenddowns and waiver obligations to a spenddown.
n MSHO.
n MnDHO.
l Personal Care Attendant (PCA) services.
l Hospital bills paid by MinnesotaCare for enrollees who do not receive FFP and are not enrolled in a health plan.
Note: For more detailed information see MinnesotaCare Expenses.
l Targeted-Case Management services.
Apply the client's out-of-pocket targeted case management expenses to the client's spenddown amount.
Verify the amounts and dates of service with the case manager.
For information on when to apply R bills to the spenddown see the following sections: