*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: January 1, 2010 |
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24.10.15 - Shortened Spenddown |
Archived: June 1, 2016 (Previous Version) |
A shortened spenddown is calculated only when a six-month spenddown is interrupted.
Shortened Spenddown Situations.
Steps to Determine a Shortened Spenddown.
Shortened Spenddown Situations
Calculate a shortened spenddown whenever a six-month spenddown is interrupted, including:
l MA certification period is being aligned with another program such as a cash program, Food Support or MinnesotaCare.
l A new household member is added to an existing MA household resulting in an increased household size for existing the household members.
l MA client becomes eligible for automatic MA due to receipt of MSA or GRH.
l Retroactive MA eligibility is being determined for an applicant who is eligible for automatic MA due to receipt of MSA or GRH.
l Client’s income calculation changes from a community income calculation to an LTC income calculation.
l MA client becomes eligible for MA-EPD, TMA, or TYMA.
For information about when a certification period must be interrupted, see Certification Period.
Steps to Determine a Shortened Spenddown
Follow these steps when a six-month spenddown is interrupted and a shortened spenddown must be calculated:
1. Determine the shortened spenddown period. The shortened period is the months in the existing certification period that precede the month in the existing certification period in which the change takes effect.
Example:
Delbert and Norma receive MA with a six-month spenddown. Their certification period is February through July. They report they moved out-of-state on April 6.
Action:
Close MA effective May 1. The shortened spenddown period is February through April.
2. Recalculate the total net countable income for the months of the shortened period.
3. Recalculate the shortened spenddown standard by totaling the monthly FPG standard for each month of the shortened period.
4. Determine the shortened spenddown amount by subtracting the total net countable income (Step 2) from the shortened spenddown standard (Step 3).
Note: If a client’s total net countable income is less than the shortened spenddown standard, the client does not have a spenddown for those months. Go to Step 6.
5. Apply the same health care expenses used to calculate the original spenddown following the order listed in Six-Month Spenddown.
Recalculate the satisfaction date and recipient amount based on the application of the health care expenses.
6. Determine if action is needed. If the result is:
l No spenddown for the shortened period. Go to Step 7.
l An earlier satisfaction date or decreased recipient amount, adjust the spenddown. Go to Step 7.
l A later satisfaction date or an increased recipient amount on the original date of satisfaction, do not adjust the spenddown. Go to Step 9.
7. Update MMIS with the changes benefiting the client.
Note: Do not make changes to MMIS if the shortened spenddown results in a later satisfaction date or an increased spenddown on the original satisfaction date.
8. Notify the household of changes resulting in a decreased spenddown amount, an earlier satisfaction date and/or a decreased recipient amount.
MMIS will automatically reprocess claims when the client's spenddown amount decreases. If a client is eligible for additional days before the original spenddown date, the client should notify the providers to bill for the additional days. MMIS will automatically reprocess claims for the original spenddown date.
Providers should not rebill or submit duplicate claims.
Note: Do not send the household a notice if the shortened spenddown results in a later satisfaction date or an increased spenddown on the original satisfaction date.
Medical spenddown increases require 10-day advance notices.
9. Document the results in case notes.
Roger receives MA with a six-month spenddown and an income certification period of May through October. Roger, who is single, entered a long-term care facility (LTCF) on September 12.
Roger’s net monthly income is $1,000, and his monthly FPG standard is $800. He has a six-month spenddown amount of $1,200 with a satisfaction date of May 8 and a recipient amount of $100. He meets the spenddown amount with the following health care expenses:
Type of Bill |
Date of Service |
Amount |
M |
01/03/this year |
$1000 |
R |
05/03/this year |
$100 |
R |
05/08/this year |
$500 |
Action:
The certification period is interrupted for MA due to his admittance to the LTCF. The LTC spenddown will begin in October. Determine a shortened spenddown.
1. The shortened spenddown period is May through September.
2. Roger’s total net countable income for the shortened period is $5,000.
$1,000 net monthly income X 5 months in shortened period = $5,000.
3. Roger’s shortened spenddown standard for the shortened period is $4,000.
$800 monthly FPG X 5 months in the shortened period - $4,000.
4. Roger’s shortened spenddown amount is $1,000.
$5,000 income - $4,000 FPG standard = $1,000.
5. Using the same health care expenses, Roger meets his shortened spenddown with the $1,000 M bill. His satisfaction date is now May 1 and his recipient amount is $0. MA will pay all covered services incurred on or after May 1.
6. Determine if action is needed. The spenddown amount, satisfaction date and recipient amount have all changed to Roger’s benefit. His eligibility information must be updated.
7. Update the new spenddown period, spenddown amount, satisfaction date and recipient amount in MMIS.
8. Notify Roger of the updated spenddown information so that appropriate providers can bill MA for the additional days before the original satisfaction date. MMIS will automatically reprocess claims for the original satisfaction date.
9. Document the actions taken in case notes.