*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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 |
|
24.15.30 - R Bills |
Archived: June 1, 2016 (Previous Versions) |
"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.
For information that affects all health care expenses see Health Care Expenses.
R bills must be incurred during the certification period for which eligibility is being determined. Record R bills on MAXIS to show that enough medical expenses were incurred if other bills applied first are not sufficient to meet the spenddown.
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 MA will pay 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 recording the expenses.
l Waiver services received through the waiver programs.
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 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.
R bills can become P bills when another member of the household who incurred a medical expense that was initially applied to the spenddown is found ineligible for MA.
Example:
Regina applies for MA in May for herself and her three children, Reggie age 12, Ruth age 17, and Roberta age 20. She is requesting one month of retroactive coverage. The budget period is April through September. Both Regina and Roberta have earned income. Regina has a spenddown and so does Roberta. Reggie and Ruth do not have a spenddown. Regina’s monthly spenddown is $150 and her six-month spenddown is $633. Roberta’s monthly spenddown is $575 and her six-month spenddown is $3,183.
They submitted the following expenses:
Name |
Expense |
Date of Service |
Amount |
Reggie |
allergy shot |
January 15 |
$55 |
Roberta |
optician visit |
April 12 |
$95 |
Roberta |
eyeglasses |
April 12 |
$225 |
Regina |
medical clinic visit |
April 28 |
$185 |
Reggie’s allergy shot is an M bill because it was incurred outside of the budget period. Roberta and Regina’s expenses are R bills because they were incurred within the budget period and they are both requesting MA. Roberta does not meet either her monthly or six-month spenddown with the expenses submitted.
Action:
Deny Roberta’s eligibility for MA. Her expenses are now P bills that can be applied to Regina’s spenddown because they were incurred within the budget period, but MA will not reimburse them. Change Roberta’s R bills to P bills so they can be used for other household members. Redetermine eligibility for Reggie and Regina due to this change.
For information on applying R bills to a certain spenddown type see the following sections: