Oct 03
Contents
1. EW program may use the designated provider option beginning with the month following the month in which eligibility is approved The designated provider option cannot be added changed or deleted for a current or retroactive month including the month of application SIS EW clients who choose this option must select a waivered service provider as the designated provider See 0913 13 05 Waiver Obligation SIS EW Clients who choose the designated provider option must sign the Agreement to Use Designated Provider DHS 3161 Refer to the MMIS User Manual II 31 Designated Provider for instructions on entering designated provider cases on MMIS Providers cannot refuse to be designated providers MDHS HEALTH CARE PROGRAMS MANUAL ML 38 OCTOBER 2003 DESIGNATED PROVIDER OPTION 0913 09 05 Clients can meet their spenddown using a provider other than the designated provider only in emergencies Clients must report emergency use within 5 days of incurring the expense Send the information below to the DHS Special Recovery Unit by MAXIS E Mail to COSD or by FAX to 651 282 6744 The client s full name Mailing address PMI number Dates of service The name s of the provider used instead of the designated provider v v v v v SRU will monitor these cases and may bill the client for any unmet spenddown balance for the given month They will also monitor all designated provider cases to make sure that the provider submits bills within 3 months a2. MDHS HEALTH CARE PROGRAMS MANUAL ML 38 OCTOBER 2003 DESIGNATED PROVIDER OPTION 0913 09 05 MinnesotaCare MA No provisions Some clients may designate 1 provider to whom they will pay their spenddown each month Clients using the long term care LTC spenddown must use this option Other clients may choose this option if they meet ALL the following conditions gt They have a 1 month automated spenddown AND gt They receive Personal Care Attendant PCA services child welfare targeted case management services or receive services through 1 of the following home and community based waivers Elderly Waiver EW Community Alternatives for Disabled Individuals CADI Traumatic Brain Injury TBD Community Alternative Care for Chronically Ill Individuals CAC or Home and Community Based Services for Persons with Mental Retardation or Related Conditions MR RC AND gt They are the only members of the MA GAMC household with a spenddown AND gt They can meet their entire spenddown with 1 designated provider Verify that clients have met their spenddown with the designated provider for the last 3 months and expect to continue to do so AND gt They are willing to pay the spenddown amount to the designated provider at the time they receive services Past payment history or other factors must indicate a strong likelihood that clients will cooperate in paying the spenddown Clients who have a waiver obligation under the SIS
3. nd that the client incurs enough bills to meet the spenddown If the provider indicates that a client has refused or failed to pay the spenddown remove the client from the designated provider option GAMC No provisions
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