Common Service Notifications
As a PICS participant, you will periodically receive notifications both from PICS and from your county of residence. Here you will find descriptions of several common types of notifications.
The Family Deductible is a cost-sharing program the Minnesota State Legislature passed into law at the end of 2011. As noted in the Minnesota Statute 256B.0631, MA enrollees over the age of 21 are to begin cost-sharing with providers by paying a monthly family deductible or co-payment for each period of eligibility, effective January 1, 2012.
The deductible is an out-of-pocket cost that qualifying service recipients are responsible to pay each month, in order to keep their services open and active. Waiver or budget dollars cannot be used to cover the cost. Whichever service provider bills DHS first for services in any given month will be assessed for the fee and they in turn will pass the bill onto the service recipient.
Example: PICS bills $100 for an April service. PICS is the first provider to bill in April, so the state will pay $100-$2.75=$97.25 and it becomes the responsibility of PICS to collect the additional amount owed from the service recipient directly.
The Over/Under report is issued every month to Representatives who are overspending or underspending their staffing line. If you receive this letter, you should contact your Service Coordinator to figure how to fix the problem. Your Lead Agency Representative also receives a copy.
Repayment Agreement Form
PICS helps Representatives stay within their budget. If a budget line is overspent, the Representative is held responsible for making changes or paying back the amount owed. The Repayment Agreement Form gives flexibility to Representatives in paying back the amount owed through payment options. For more information please contact your Service Coordinator.
A Spend Down is like an insurance deductible. If your income is more than the allowed income limit, you may still qualify for medical assistance by meeting a Spend Down. A Spend Down is the amount an individual must pay towards medical bills before the state will start to pay.
The county determines an individual’s Spend Down by subtracting net income from the income limit. An individual’s Spend Down amount is based on many factors, such as age and family size.
PICS does not participate in the determination of a Spend Down for anyone. Due to HIPAA laws, PICS is not allowed to have any information about a client’s financial situation with the exception of their waiver dollars. The only time PICS learns of an individual’s Spend Down is when we bill the state for payment and we receive a denial of payment on an invoice that is due to a Spend Down.
Your Spending Summary is a report listing each different budget line to help you manage your budget plan. For each budget line, the Spending Summary shows:
- Total amount budgeted
- Total spent
- Total remaining
- Projected amount spent
- Percent over or under
Spending Summaries are located in the portal under the “Reports” tab. If you don’t have access to the portal, PICS mails out Spending Summaries every month. If you need help reading your Spending Summary, please contact PICS.