The Department of Human Services (DHS) sent out the following notice on Tuesday, November 29 about the change in coverage for Emergency Medical Assistance (EMA) enrollees to internal DHS staff, lead agencies, providers and other interested stakeholders. There are about 2,300 EMA enrollees in various settings who will be affected by the changes in benefits — people on EMA are individuals who do not qualify for “regular MA because they are not legal immigrants or citizens.” DHS will also be sending this announcement out to lead agencies with further details and instructions about changes to service agreements.

We are writing to give you information about DHS plans to implement benefit changes for Emergency Medical Assistance (EMA).

Beginning January 1, 2012, EMA will be limited to payment for the care and treatment of emergency medical conditions in an emergency room or inpatient hospital. This change is a result of the 2011 legislation passed last July. A limited exception to this payment rule, consistent with federal law, will be made for some care and treatment provided in other settings without which the person’s cardiovascular or respiratory condition would reasonably be expected to result in placing the person’s health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of any bodily organ or function.

Examples of services that will no longer be paid include prescriptions filled at an outpatient pharmacy, alcohol or drug treatment, and non-emergency treatment of chronic conditions (including nursing facility care). Labor and delivery will be covered; pregnancy-related services other than labor and delivery are not included.

Starting Nov. 29, DHS began mailing notices to enrollees about the benefit change. Read a copy of the notice from the DHS website.

DHS is developing the review process for the limited exceptions and will provide more details by Dec. 7.

The notice is the result of ongoing discussions with DHS; during these discussions, we advocated for and expected a broader interpretation of services that could be covered outside of hospital and/or emergency rooms, in more cost-effective settings. In the notice linked above (which was sent to recipients of EMA on Tuesday), they specifically state:

What services will be covered?

• EMA will only pay for a medical emergency treated in an emergency room or hospital. This includes labor and delivery.
• Follow-up care from the same provider is covered if the services were paid for as part of treating the emergency.
• EMA may pay some nursing home and home health care services for some limited emergency conditions. The provider must make a request to cover the continued emergency care.

The notice details the appeal rights for the recipients — they must appeal right away — within 10 days of receiving the notice or before December 30, 2011. Here are some recommended action steps for members:

1. Determine if you have any residents currently on EMA that received this notice.
2. Educate your admissions staff about this significant change to avoid admitting future recipients who would have been on EMA (as EMA is no longer a payor source). At this point, it is not clear how the policies stated above will be implemented for new cases on or after January 1, 2012.
3. Notify DHS that you want to make a request for coverage of continued emergency care for affected residents (the exact process for providers will not be available until around December 7).
4. We have found out from county staff that some residents on EMA could actually qualify for MA because they have legal permanent resident status, or asylum status. Help the families/resident contact the county financial worker to determine if there is a possibility of changing the eligibility category. Specifically, some clients in nursing facilities that are lawful permanent residents (LPRs) were placed into EMA because the clients sponsor did not disclose income. These clients are able to switch to MA.
5. Assist residents/families with the appeal of the benefits change as noted above, and detailed in the notices sent to beneficiaries on November 29. Note that DHS will be publishing the process and criteria for review next week.
6. Determine if the resident/family has resources to pay privately for any length of time; and
7. If #3-#6 above don’t “work,” the only option you will have is discharging for non-payment. The discharge notice for involuntary discharges must be issued 30 days in advance. Notice information can be found on the Department of Health website at http://www.health.state.mn.us/divs/fpc/profinfo/ib94_1.htm. The reason to include in the notice for discharge is: (483.12.(a)(2)) “The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility.”

Currently we are working with the Immigrant Law Center (ILCM) to determine who and how many people may be able to receive immigration legal services to improve their immigration statuses and hopefully, for some, help them retain or regain coverage. Watch for another email or newsletter articles on this topic, and around the DHS issuance of process details for requesting coverage.

Patti Cullen, CAE
952.851.2487
pcullen@careproviders.org

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