This manual letter lists new and revised material for the Health Care Programs Manual (HCPM). Unless otherwise noted, new and revised instructions are effective January 1, 2010.
Chapter 24 - Medical Spenddowns.
Updates are made to this chapter are based on a regularly scheduled review, in addition to the change in monthly spenddowns announced in bulletin #09-21-12, "DHS Announces Streamlined Procedures for Medical Assistance (MA) Monthly Medical Spenddowns and Information on Reporting Medical Expenses."
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 24 - Medical Spenddowns
l Section 24 - Medical Spenddowns.
n Clarifies that each member of the household may have a different spenddown amount.
n Explains the difference between medical expenses a client submits at the eligibility determination and how those expenses may be paid when the provider submits them for payment.
n Adds the Minnesota Family Planning Program, GAMC, and MinnesotaCare to the list of programs or people who cannot have a spenddown.
n Deletes references to ”countable” income and instead uses the more accurate ”net” income.
l Section 24.05 - Spenddown Standards.
Provides additional detail about changing the spenddown standard for clients whose income exceeds the non-spenddown standard and provides examples.
l Section 24.10 - Spenddown Types.
n Changes wording to correspond with the change to one streamlined monthly medical spenddown so there are only two spenddown types: monthly and six-month.
n Provides more detailed information on when to use each type of spenddown.
n Clarifies that clients who receive waiver services and have a spenddown may use either a monthly or a six-month spenddown.
l Section 24.10.05 - Monthly Spenddown.
n Changes the name from Automated Monthly Spenddown but explains that MAXIS and MMIS will retain the name ”automated monthly spenddown".
n Adds sections for MnDHO and SNBC and monthly spenddowns.
n Clarifies criteria for using a monthly spenddown.
n Explains to first determine if the client can meet a six-month spenddown before calculating a monthly spenddown.
l Section 24.10.05.05 - Client Option Spenddown.
General clarifications and updates.
l Section 24.10.05.10 - Designated Provider Option.
Clarifies criteria for use.
l Section 24.10.10 - Six-Month Spenddown.
n Clarifies that each household member may have a different spenddown amount depending on the net income and FPG standard used to determine that member’s eligibility.
n Adds a note and example to explain the appropriate spenddown standard to use for clients whose income exceeds the standard for their basis of eligibility.
n General clarifications and updates.
n Renumbered from 24.10.15.
l Section 24.10.10.05 - Six-Month Spenddown Example.
n General clarifications and updates.
n Renumbered from 24.10.15.05.
l Section 24.10.15 - Shortened Spenddown.
n General clarifications and updates.
n Renumbered from 24.10.20.
l Section 24.15 - Health Care Expenses.
n Clarifies that the health care expenses used to determine eligibility might not be the actual expenses applied to the client’s spenddown because claims are applied in the order received.
n Explains the use of the Medical Expenses form (DHS-1844).
n Clarifies reporting of health care expenses not covered by MA.
n Clarifies that discounted health care expenses or any portion of an incurred expense that the provider writes off or absorbs cannot be applied to the spenddown.
l Section 24.15.05 - Verification of Health Care Expenses.
Clarifies to verify all health care expenses used to meet a spenddown, whether paid or unpaid, including those a health care provider has written off.
l Section 24.15.10 - Determining Net Health Care Expenses.
n Deletes definitions from this section; relevant terms are linked from the text to the glossary.
n Minor clarifications and updates.
l Section 24.15.15 - H Bills.
n Clarifies when health insurance premiums can be applied to meet a spenddown.
n Clarifies information on indemnity policies.
l Section 24.15.20 - M Bills.
Minor clarifications and updates.
l Section 24.15.25 - P Bills.
n Clarifies the remedial care expense deduction.
n Clarifies that expenses of dependents and financially responsible relatives become non-reimbursable P Bills because the dependent or relative is not on MA or GAMC.
n Minor updates and clarifications.
l Section 24.15.30 - R Bills.
n Explains to record R Bills on MAXIS to show that enough medical expenses were incurred to meet the spenddown.
n Adds a new section explaining how R bills become P bills.
l Section 24.15.35 - MinnesotaCare Expenses.
Minor updates and clarifications.
l Section 24.15.40 - Associated Recipients.
Minor updates and clarifications.
l Section 24.20 - Inpatient Hospitalization - MinnesotaCare Enrollees.
Minor updates and clarifications.
l Section 24.25 - Spenddown Adjustments.
n Adds information regarding health care expenses reported monthly or at renewal.
n Minor updates and clarifications.
Chapter 03 - Eligibility Groups and Bases of Eligibility
l Section 03.30.20.05 - MA-EPD Employment Definition.
Corrects information on a four-month medical leave to state that the leave begins the month after the enrollee is unable to work, rather than on the date the enrollee is unable to work.
l Section 08.30 - Monthly Renewals.
n Deletes reference to manual monthly spenddowns from monthly renewals. Only people with an LTC spenddown who have income changes now have a monthly renewal.
n Changes example to delete reference to manual monthly spenddown.
l Potluck Processing (new term).
l Varying Income (revised definition).
l Write-off (new term).