HPE Frequently Asked Questions (FAQs)

Overview
HPE Contact Information

HPE Frequently Asked Questions (FAQs)
HPE Toolkit – Forms and Documents

HPE Training

HPE Basics

Q: What is Hospital Presumptive Eligibility (HPE)?

Hospital Presumptive Eligibility (HPE) permits hospitals to determine eligibility for temporary Medical Assistance (MA) for individuals based on preliminary information these applicants provide. For more information on HPE refer to HPE Policy Guide and HPE Procedure Guide].

Q: Who can get HPE?

To qualify for HPE a person must:

  • • Have a “basis of eligibility” for HPE (see below).
  • • Have income below the HPE income limits.
  • • Be a Minnesota resident.
  • • Be a U.S. citizen, a U.S. national, or have a qualified immigration status.
  • • Not have current MA or MinnesotaCare coverage.
  • • Not have received HPE within the past 12 months (or if pregnant, during current pregnancy).

  • Eligibility for HPE is limited to individuals in the following eligibility groups:

    Basis of eligibility

    Income limit for HPE

    Infants and children (age 0 to 2)

    288% FPL (federal poverty level)

    Children (age 2 through 18)

    280% FPL

    Children (age 19 & 20)

    138% FPL

    Pregnant women

    283% FPL

    Parents and Caretaker Relatives of children under age 19

    138% FPL

    Adults without children (age 19 through 64) who do not have Medicare

    138% FPL

    Former foster care (age 26 and younger)

    No income limit

    Q: Can an inmate at a Minnesota Correctional Facility receive HPE?

    No. Inmates residing in a correctional facility in Minnesota are only eligible for inpatient hospital services under MA. DHS developed a dedicated application process for inmate coverage. This process has been communicated to the Minnesota Department of Corrections and county detention facilities.

    Q: Does a person need to be seeking medical treatment to file an application for HPE?

    No. Any person who belongs to one of the HPE eligibility groups can apply for HPE. However, a person is only eligible to receive HPE once in a 12-month period (or once during current pregnancy). Individuals seeking ongoing coverage should be advised to complete the full Medical Assistance application. Individuals can complete the full MA application online at: www.mnsure.org or file a Paper Application for Health Coverage and Help Paying Costs (DHS-6696) (PDF).

    Q: How long does HPE coverage last?

    HPE coverage begins on the day that the qualified hospital approves an individual for HPE.

    HPE coverage ends:

  • • The last day of the month following the month in which HPE was approved; or
  • • For people who submit a full application before the last day of the month following the month in which HPE was approved, HPE coverage ends on the day that a full determination is made.

  • For more information on HPE coverage begin and end dates refer to the HPE Policy Guide (DHS-7267) (PDF).

    Q: What does HPE cover?

    A person who is approved for HPE is eligible to receive the full MA for adults and families with children benefit set. For more information about covered services, please refer to Summary of Coverage, Cost Sharing and Limits (DHS-3860) (PDF) or the MHCP Provider Manual and the MHCP Member Evidence of Coverage.

    Q: How can a hospital enroll as an HPE provider?

    To be approved to make HPE determinations, a hospital must: (1) be an enrolled MHCP provider; and (2) agree to comply with DHS HPE policy and procedures. Hospitals must sign and submit HPE Applicant Assurance Statement (DHS-3887) (PDF). Hospitals must also submit to DHS the names of two members of the hospital’s staff who have passed the DHS HPE training using the Hospital Staff Who Passed DHS Hospital Presumptive Eligibility Online Training Course (DHS-3889) (PDF).

    Q: Can a hospital enroll as a HPE provider at any time?

    Yes. HPE begins in Minnesota on July 1, 2014. Hospital participation in HPE is optional. A hospital may choose to become a qualified HPE provider at any time.

    Q: What are hospitals required to do if they want to be an HPE provider?

    A qualified HPE hospital must:

  • 1. Help individuals it approves for HPE with completing and submitting the full MA application. Hospitals can provide direct assistance in completing the application, or help individuals connect with a navigator organization or certified application counselor.
  • 2. Comply with HPE policy and procedures. See HPE Toolkit
  • 3. Meet the HPE performance metrics.
  • Q: What are the HPE performance metrics?

    HPE hospital providers must show:

  • • That 80 percent of the people the hospital approves for HPE go on to file the IAP Application; and
  • • That 80 percent of the people who go on to file the IAP application are found to be eligible for MA.
  • Q: Will hospitals be required to meet these standards right away?

    No. During the first six months of the program, DHS will monitor hospital performance but will not implement any formal corrective action plans for hospitals that are not meeting the metrics.

    Requirements for hospitals choosing to enroll in HPE

    Q: Can a hospital system sign up all of its member hospitals using one HPE Applicant Assurance Statement? Or, are individual hospitals required to sign the HPE Applicant Assurance Statement?

    Enrollment will be done on a hospital by hospital basis. Each hospital that is approved as a qualified HPE provider must demonstrate that a minimum of two hospital staff have successfully passed the DHS HPE training.

    Q: Do hospital based outpatient clinics need to enroll separately or are they included with the hospital?

    Hospital based clinics are enrolled with the hospital as one entity. List hospital staff working in a hospital based outpatient clinic under the hospital’s name and NPI.

    Q: Can multiple-hospital systems train and get certified staff at the system office level to make HPE determinations for multiple hospitals within the system?

    Each hospital must have a minimum of two staff members who have passed the DHS HPE online training curriculum. We expect that hospitals may choose to have more than two staff members who have completed the DHS HPE training. The DHS HPE online training curriculum will be available to as many hospital staff who want to take the training.

    Hospitals that seek to participate in HPE must accept HPE applications from individuals during all hours of operation. Under Sec. 1920(c)(2)(A) of the SSA, hospitals must notify the state Medicaid agency within five business days of the date HPE is approved. At an earlier meeting, we indicated that hospitals would be able to preserve the HPE begin date by submitting a partially completed application. We reviewed this proposal and determined that it would create undue administrative burden on hospitals and DHS staff to require a partial application to be submitted. Instead, DHS will accept all HPE applications that are submitted to DHS within five business days of HPE approval.

    Ideally, hospitals will submit approved HPE applications immediately. This will speed up the process of getting the HPE coverage span entered into MMIS and allow all MHCP providers to verify HPE coverage in MN–ITS or EVS. However, within this five-day window, hospitals have the option of using HPE trained staff to review the HPE application and make the HPE determination.

    Q: Can hospital contract employees make HPE determinations?

    No. CMS made clear in its January 2014 FAQ document that hospitals are not allowed to delegate the HPE determination to third-party contractors. However, hospitals may use third-party contractors (or other non-hospital staff) to staff its HPE operations, including to help people complete the HPE application.

    Q: Is there a limit to the number of staff that can be approved to be HPE “approved agents” at each hospital?

    No, there is no upper limit. Each hospital is required to have a minimum of two hospital staff members who have passed the DHS HPE training for the hospital to be qualified to make HPE determinations. However, hospitals are allowed to register as many staff as they would like in the DHS Learning Center to take the HPE training. DHS will also be providing supplemental training materials on how to complete the HPE application that will be separate from the online HPE training modules.

    Q: Can we have staff that work at various hospitals in our system make HPE determinations? For example, can an approved agent be allowed to approve HPE for Hospital A and Hospital B?

    Yes, a hospital staff person who has passed the DHS HPE online training course would be able to approve HPE for Hospital A and Hospital B. However, that staff person cannot count as one of the two unique staff to meet the minimum for either hospital.

    To become qualified HPE providers, hospitals must submit the name and HPE Learning Center I.D. numbers of at least two hospital staff on the DHS-3889 list of hospital staff who have completed the HPE training. DHS will not approve hospitals as HPE hospital providers who list the same two staff members on the HPE addendum. Hospitals that choose to participate as HPE hospital providers should have staffing adequate to ensure that all patients are able to file an HPE application during all hours of operation.

    Eligibility for HPE

    Q: How do I determine if a person is eligible for HPE?

    Detailed information and instructions on how to make the HPE determination can be found in the HPE Procedures Guide (DHS-7267A) (PDF) and the HPE Policy Guide (DHS-7267) (PDF). The Income and Household Size Worksheet and the Citizenship and Immigration Status Information Sheet are also available for reference. These documents are all on the HPE Toolkit web page.

    Q: Can individuals who have other insurance (not including Medicare) get HPE?

    The only current coverage that would be a barrier to HPE is Medical Assistance or MinnesotaCare. Other coverage is not a barrier to HPE.

    Q: Is every person who could be eligible for Medical Assistance eligible for HPE?

    No. HPE is available to only those individuals who belong to one of the following eligibility groups:

  • • Infants (age 0–2)
  • • Children (age 2 through 18)
  • • Children (age 19 and 20)
  • • Adults without children (age 21 through 64) who are not receiving Medicare
  • • Parents or Caretaker Relatives with children under age 19
  • • Individuals under age 26 who received foster care in Minnesota at the age of 18 and who were receiving Medical Assistance when they turned 18 or when they left foster care after the age of 18
  • Q: Can individuals who are enrolled in and receiving Medicare receive HPE?

    Adults without children who are enrolled in Medicare cannot receive HPE. Other individuals such as parents and caretaker relatives, pregnant women, or children ages 19 and 20 who are on Medicare can receive HPE.

    For example, a grandmother (age 70 and receiving Medicare) who lives with her 7-year-old grandchild, and assumes primary responsibility for her grandchild, could have a basis of eligibility as a caretaker relative. This person would be eligible for HPE under the parent/caretaker relative basis of eligibility.

    If a person is ineligible for HPE due to current enrollment in Medicare, the hospital should advise that person to complete the IAP application, as well as advise the person to contact the county or tribal agency to determine if he or she is eligible for other programs.

    Q: Does HPE apply to people who are over age 65, blind or who have disabilities?

    A person must be in one of the following eligibility groups to qualify for HPE:

  • • Infants and Children (age 0–2)
  • • Children (age 2 through 18)
  • • Children (age 19 and 20)
  • • Parents of children under age 19
  • • Adults without children (age 19 through 64)
  • • Individuals under age 26 who received foster care in Minnesota at the age of 18 and who were receiving Medical Assistance when they turned 18 or when they left foster care after the age of 18.

  • Refer a person who does not meet one of the above bases of eligibility to a navigator, certified application counselor, or his or her county agency to see if he or she qualifies for MA or other Insurance Affordability Programs.

    Q: Can people get HPE with a spenddown (an option where people who are over the income limit for Medical Assistance can apply the cost of their medical care to spend down to MA eligibility)?

    No. The person must complete the full IAP application online at www.mnsure.org or by paper Application for Health Coverage and Help Paying Costs (DHS-6696) (PDF) to be considered for a Medical Assistance spenddown.

    Q: Does the question on the HPE application refer to the individual’s MAGI household size (tax household)?

    No, Minnesota has elected to compute households for HPE based on the Modified Adjusted Gross Income (MAGI) non-filer household composition rules. For more information on how to calculate an applicant’s HPE household size, refer to HPE Procedures Guide (DHS-7267A) (PDF).

    HPE Processing

    Q: Can a hospital approve an individual for HPE outside of DHS business hours?

    Yes. Determinations can be made at any time. However, hospitals must submit the approved application to DHS within 5 business days from the date of HPE approval. For more information on submitting an application after approval, see HPE Procedures Guide (DHS-7267A) (PDF).

    Q: What information can a hospital staff person get when they call DHS?

    During business hours, hospital staff can call Health Care Eligibility Operations (HCEO) at 651-431-3480 or 888-702-9968 (select Option 1).

    HCEO can provide the following information:

  • • Current coverage (MA, MinnesotaCare, or HPE)
  • • Whether the applicant has received HPE within the past 12 months or during current pregnancy
  • • After the application has been submitted and entered into the system, DHS can provide the individual’s PMI #
  • Q: Do I have to provide the applicant with the Notice of Privacy Rights?

    Yes. The information contained in the Notice of Privacy Rights is designed to ensure that HPE applicants know their rights and responsibilities. DHS is working to add a blank page between the signature page and the Notice of Privacy Rights. However, at the beginning of HPE implementation, hospital staff will need to print the application single-sided to ensure that the hospital retains the signature page and provides the Notice of Privacy Rights to the applicant.

    Q: Do I need to print the HPE Approval Notice on security paper?

    Yes. The HPE Approval Notice serves as proof of coverage for the consumer until he or she receives their MHCP ID card in the mail. To preserve the integrity of the approval notice, DHS requires qualified HPE providers to print all HPE approvals on security paper.

    Q: How does my hospital get security paper?

    Upon initial approval of your hospital as an HPE provider, DHS will mail two reams of security paper to the hospital address provided on the HPE Applicant Assurance Statement (DHS-3887).

    To request additional reams of paper, call the HPE phone line at 651-431-3480 or 888-702-9968 and press option 1. Allow 14 days from the time of the request for delivery.

    Hospitals are responsible for securing the DHS watermark paper to prevent any misuse.


    HPE and Billing

    Q: Is billing the same for HPE as it is for MA?

    Yes. Submit claims for services provided to recipients of HPE exactly as any other MHCP fee-for-service (FFS) program. Claims processing data will be on the same remittance advice as all other FFS claims. Reimbursement will be included in the FFS EFT or check warrant.

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