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Effective: December 1, 2006 |
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25.10.05ar1 - Initial MA-EPD Premiums (Archive) |
Archived: July 1, 2008 |
County agencies are responsible for issuing the initial premium billing for MA for Employed Persons with Disabilities (MA-EPD). This section provides policy information on initial premium billing.
Initial Premium Collection Amount.
After determining MA-EPD eligibility and the MA-EPD premium amount, take the following steps at initial eligibility:
1. Review the MA-EPD Overdue Premiums Report to determine if there are overdue premiums.
Note: The MA-EPD Overdue Premiums Report must be printed at the county by the 20th day of each month.
2. Determine the months for which a premium must be billed. This first premium billing may be for more than one month of coverage. More information on what premiums to collect for initial billing can be found in Initial Premium Collection Amount.
3. Complete the Initial Premium Notice (DHS-3547).
n Mail or give the original notice to the applicant.
n Include a return envelope addressed to the county agency.
n Retain a copy in the case file.
4. Approve or Pend results in MAXIS.
n If the client is present and pays the premium immediately approve eligibility in MAXIS and update MMIS. See Initial Premium Paid on steps to take when the initial payment is returned.
n If the client is not present, or does not pay the premium immediately, pend the results in MAXIS.
Allow 30 days from the date of the Initial Premium Notice (DHS-3547) for the client to pay the premium. Applicants must pay all current and overdue premiums before MA-EPD can be approved.
Set a reminder (REPT/TIKL) for 30 days from the date the DHS-3547 is sent or given to the client.
Note: See Initial Premium Paid on steps to take when the initial payment is returned.
See Initial Premium Not Paid for steps to take when the initial payment is not returned.
5. Case note the following:
n The monthly premium amount.
n The total amount requested at initial billing.
n The date the Initial Premium Notice is mailed or given to applicant.
Initial Premium Collection Amount
County agencies are responsible for collecting the following premiums at initial premium billing:
l Initial premiums for applicants, including the following premiums:
n Each retroactive month requested.
Note: Clients may choose which retro premium they choose to pay. They are not required to pay retro premiums for initial and future eligibility.
n The application month.
n All other months through the processing month, if the application is processed after the application month.
n The month after the processing month, if the application is processed on or after the 15th day of the month in which coverage is approved.
l Any overdue premiums for previous MA-EPD coverage.
l Initial and overdue premiums for MA-EPD enrollees who have been removed from the Special Recovery Unit (SRU) billing system. This includes:
n Former enrollees who are reapplying.
n Enrollees removed from or not entered on the system in error.
n Enrollees closed and reopened in the same month.
Example:
Karen applies for MA-EPD on October 10 and does not request retroactive coverage. On October 12 it is determined Karen must pay a premium of $35 to qualify for MA-EPD. She also owes an overdue premium of $35 for coverage she had in July.
Action:
Complete and send the DHS-3547 requesting the initial premium payment for October and the overdue premium for July. Both premiums ($70) must be collected before MA-EPD can be approved for October.
Example:
Mai applies for MA-EPD on October 5 and requests three months of retroactive coverage. On October 20 it is determined Mai must pay a premium of $35 for each month to qualify for MA-EPD.
Action:
Complete and send the DHS-3547 requesting the premiums for the retro months of July through September, the application month of October and because the initial notice is created after the 15th of the month, the following month, November.
October and November premiums must be collected before MA-EPD can be approved ongoing. Mai can choose which months she wants retroactive coverage and pay only the premiums for those months. The premium for each retroactive month must be collected before coverage is approved for that month.
Take the following actions if the premium is paid on or before the due date:
1. Approve eligibility results in MAXIS and update in MMIS.
Note: Applicants must pay premiums for each retroactive month before coverage can be approved for that retroactive month.
2. Send an e-mail to the Special Recovery Unit (SRU) via MAXIS to MADE with a subject of ”r;MA-EPD Premium New/Changes” and include the following information:
n Enrollee Name.
n Case number.
n PMI.
n Billing Address.
n Representative Payee.
n Month/Amounts Paid.
n SRU Premium Billing Begin Date.
n Premium Amount.
n County and worker name.
n Worker e-mail code.
n Comments.
3. Forward the premium payment and the MA-EPD Initial Premium Payment Stub to DHS at the following address:
DHS - MA-EPD,
Attn. Cashier,
P. O. Box 64836,
St. Paul, MN 55164-0836
Include the following information with each premium:
n Enrollee name.
n PMI number.
n Amount paid.
n For which months the payment applies.
4. Enter a MAXIS case note with the amount paid and the months covered. Document that email was sent to MADE to initiate billing.
Take the following actions if the premium is not received within 30 days of the initial notice:
1. Deny MA-EPD and determine MA eligibility under another basis.
2. Add the following worker comments to the notice:
"You are denied Medical Assistance for Employed Persons with Disabilities (MA-EPD) because we did not receive your premium payment by the due date. You may claim "good cause" for late payment. This must be approved by the Department of Human Services (DHS). To claim "good cause", send a letter with your name, address, case number, and reason for late payment to:
DHS Special Recovery Unit,
MA-EPD Good Cause,
PO Box 64995,
St. Paul, MN 55164-0995."
Note: Clients may also fax their good cause request to SRU directly at (651) 431-7431.
See the following sections for more information on MA-EPD:
MA for Employed Persons with Disabilities.
MA-EPD Payment Options, Refunds and Dishonored Payments.