Healthcare Update - December 2018
Key Highlights in this topic/WORKGROUP for the PREVIOUS month:
Marie Zimmerman, Medicaid Director, has left her position at DHS to join Hennepin Healthcare as the VP of Public Funding and Medicaid Transformation.
Effective 2/1/19, the Asset Verification System (AVS) will be required to be used to verify assets for all MA-Aged, Blind, Disabled (ABD) applicants and enrollees. If a client provides verification of their assets or reports no assets, a worker still has to send a query to verify assets using AVS. AVS cannot be used for MA- Family, Children, Adults (FCA) cases with a spenddown where an asset test is applied and only staff who determine eligibility for MA-ABD should have access to the system. There will be a bulletin issued towards the end of the year.
Effective 2/1/19, the MA spenddown standard for aged, blind, disabled individuals will increase from 80% FPG to 81% FPG.
Changes to the Spousal Impoverishment Rules effective 1/1/19 for community waiver. Bulletin #18-21-08 announces that Minnesota is returning to deeming waiver rules to determine eligibility for waivers for people with disabilities. The waivers include BI, CAC, CADI, and DD. EW & AC waivers not impacted and will continue to use spousal impoverishment protection rules. The ACA put into place a temporary provision that required spousal impoverishment protection rules to be applied to all waivers, including the disability waivers. The temporary ACA provision sunsets on December 31, 2018. At the beginning of 2019, workers should start to use deeming waiver rules again for married applicants applying for BI, CAC, CADI, and DD waivers.
Effective Jan. 1, 2019, DHS will no longer be a third-party administrator (TPA) for South Country Health Alliance (SCHA) health plan. Providers who have current Elderly Waiver service agreements with SCHA will have those agreements closed by a lead agency or case manager no later than Dec. 31, 2018. Elderly Waiver providers may continue to follow the fee-for-service billing process for dates of services through Dec. 31, 2018. For dates of service on or after Jan. 1, 2019, claims billed through the fee-for-service process will be denied. Providers will need to follow SCHA’s instructions, 2019 Changes Specific to Elderly Waiver Providers (PDF), for service authorization and billing for dates of service of Jan. 1, 2019, and after.
Beginning Jan. 1, 2019, all personal care assistance (PCA) and home care nursing (HCN) services for people under age 65 will be covered under fee-for-service (FFS). Members will continue to be enrolled in the MCO they were enrolled in, but managed care organization (MCO) contracts for Minnesota Health Care Programs (MHCP) members under age 65 will no longer cover PCA and HCN. MHCP will cover the services on a FFS basis beginning Jan. 1, 2019. Counties or tribes are responsible for annual assessments for service agreements that ended on Dec. 31, 2018, and after. Provider agencies should submit a Referral for Reassessment for PCA Services (DHS-3244P) to the member’s tribe or county of residence 60 days before the end date of a service agreement.
The METS 2019 roadmap was approved by the METS Executive Steering Committee (ESC) on November 27th (see attached).
Requested Actions needed from MACSSA in the next month:
A METS Appointment Nomination request has been sent out to the membership, seeking someone to sit on the METS Program Management Team (PMT) replacing Tiffinie Miller from Dakota County. Please seem emails from Pam Siebert for the nomination form and more information about the appointment.
APPARENT TRENDS IN THIS TOPIC AREA:
Statewide implementation of Periodic Data Matching (PDM) on an ongoing basis will start with the PDM month of February 2019. An email titled “PDM Update and Timeline” was sent to County Directors on 12/12/18.
Legislative Impacts:
Supporting Materials: METS 2019 Release Roadmap
Contact(s): Kari Ouimette