DHS Updates MHCP Spenddown Refund and Prohibited Practices Guidance

Posted on November 7, 2024 by Mark Schulz

The Department of Human Services (DHS) has updated the Minnesota Health Care Programs (MHCP) manual with two changes impacting nursing facilities.

One change is a simple reminder while the other is more detailed regarding long-term care (LTC) spenddown and Medicare Part A refunds nexus with a resident’s spenddown requirement.

Spenddown Refund Requests

Residents residing in a nursing facility who have a LTC spenddown are obligated to pay the nursing facility their LTC spenddown amount. When a resident is also covered by Medicare Part A, the resident may receive a refund for a portion of the LTC spenddown amount due to Medicare payments the nursing facility receives after the resident has already paid the LTC spenddown. The nursing facility may retain the refund amount for payment of a past-due obligation, but only with the agreement of the resident.

Follow the instructions for spenddown refund request for Long-term Care (DHS-4277A) to apply for a spenddown refund from DHS. Within these instructions, DHS reminds nursing facilities that they will need to complete all the listed documents for each month the facility is requesting a refund.

Prohibited Practices

Within the same MHCP document, DHS is reminding nursing facilities of practices that it considers as prohibited and that may result in penalties to the nursing facility if it is found to be in violation. The list of prohibited practices comes directly from Minnesota statutes and includes, but is not limited to, the following:

• financial exploitation
• restricting resident choice of vendors of medical services
• differential treatment
• discrimination
• kickbacks
• refusing admission to the nursing facility.

For a detailed definition of each of these prohibited practices, please review Minn. Stat. § 256R.04.

Resources

You care read the full MHCP Nursing Facilities guidance here or directly read the spenddown and refund change information or the prohibited practices changes. 

Please reach out to Mark Schulz with questions.