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Effective: December 1, 2006 |
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25.10.10ar1 - Ongoing MA-EPD Premiums (Archive) |
Archived: July 1, 2008 |
This section provides policy information on the ongoing premium billing process for MA-EPD. It includes steps workers must follow when an ongoing premium is not received.
Ongoing Premium Issuance and Collection.
Closing MA-EPD for Nonpayment.
Ongoing Premium Issuance and Collection
The DHS Special Recovery Unit (SRU) will issue ongoing premium notices and collect all ongoing MA-EPD premiums.
l SRU mails premium notices on the fourth day of each month, or the next business day if the fourth falls on a weekend or holiday.
l Premiums are due on the 15th day of the month prior to the month of coverage.
l Premium decreases due to changes reported during the six-month certification period are effective with the next available billing cycle.
Note: See Changing the MA-EPD Premium Amount for more information on when and how to change an MA-EPD premium.
Worker action is required when an MA-EPD client does not pay the ongoing premium. Follow these steps each month:
1. Print the MA-EPD Overdue Premiums Report by the 20th day of each month.
2. Review the MA-EPD Overdue Premiums Report between the 20th of the month and 10-day notice cut-off the following month.
3. Close MA-EPD following the steps in Closing MA-EPD for Non-Payment giving 10-day notice for enrollees who have failed to pay their premiums without good cause.
Note: In some cases, enrollees may pay premiums after the overdue report is generated. If an enrollee reports the premium was paid, verify the payment with SRU. Do not end coverage. Reopen MA-EPD if it has been closed.
Example:
Joshua fails to pay his August MA-EPD premium by the 15th of the month. On the 20th of the month the MA-EPD Overdue Premiums Report is printed at the county and Joshua is listed as not paying his premium. The worker reviews the report on the 21st and sends 10-day notice to close MA-EPD for non-payment. Joshua pays his premium on the 23rd and calls his worker when he receives the closure notice.
Action:
Verify the payment with SRU. Re-open MA-EPD if SRU confirms Joshua has paid the premium.
Take the following steps when closing MA-EPD for nonpayment:
1. Redetermine eligibility for MA for the following month.
n If MA eligibility exists:
m Approve eligibility in MAXIS and update MMIS.
m Add the following worker comments to the approval notice:
"Your Medical Assistance for Employed Persons with Disabilities (MA-EPD) program eligibility will end DD/MM/YY because we did not receive your premium 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.
n If MA eligibility does not exist:
m Close MA-EPD eligibility in MAXIS (STAT/PACT - reason code A3 (Refused/Failed Required Info) and end eligibility in MMIS.
m Add the following worker comments to the approval notice:
"Your Medical Assistance for Employed Persons with Disabilities (MA-EPD) program eligibility will end DD/MM/YY because we did not receive your premium 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.
2. Notify SRU of the closure via MAXIS email to MADE and request billing be discontinued. SRU will not discontinue billing without an email. Include the following information:
n The enrollee’s name.
n Case Number.
n PMI number.
n Effective date of closure.
See the following sections for more information on MA-EPD:
MA for Employed Persons with Disabilities.
MA-EPD Payment Options, Refunds and Dishonored Payments.
Changing the MA-EPD Premium Amount.