Program HH Policy Manual

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Program HH Policy Manual

Program HH Policy Manual Program requirements and eligibility Payer of last resort

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Payer of last resort

Page posted: 8/5/20		Page reviewed:	Page updated:
Legal authority	Ryan White HIV/AIDS Treatment Extension Act of 2009
Overview	All Ryan White funds used to support Program HH are used as payer of last resort.
Non-covered items and services	Ryan White funds cannot be used for any item or service available through another funding source.
Ensuring compliance	To ensure compliance with the payer of last resort requirement, Program HH staff and agencies funded by the Minnesota HIV/AIDS Program ensure: · Eligible people enroll in health care coverage (e.g., Medical Assistance, MinnesotaCare, Medicare, state-funded HIV/AIDS programs, employer-sponsored insurance and/or private health insurance) · People are enrolled in health care coverage whenever possible and are informed about the consequences of not enrolling. Program HH uses the Minnesota Medicaid Management Information System (MMIS) to process drug claims and manage cost containment. If a pharmacy submits a Program HH claim for full reimbursement and MMIS has health insurance information on file for the person, the claim will be rejected and the pharmacy will be directed to bill the person’s insurance first. If a person is discovered to have retroactive Medical Assistance or health insurance coverage and Program HH paid their claims in full, MMIS will automatically re-determine claims for payment by the other payer.
Additional resources	Program HH Policy Manual – Eligibility requirements Program HH Policy Manual – Application process

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