Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: REGINALD E. McELHANNON, INTERIM DIRECTOR
SUBJECT: MO HEALTHNET SPEND DOWN PROVIDER FORM REVISION
FORM REVISION #35
MO HealthNet Spend Down Provider Form
The MO HealthNet Spend Down Provider form has been revised. A fillable box has been added to the signature line.
A typed signature is allowed on the MO HealthNet Spend Down Provider Form only if the typed signature can be authenticated using either:
- A letter on company letterhead that includes verifiable contact information. The letter must state that the letter constitutes a signature on the MO HealthNet Spend Down Provider form, or
- An email including a signature block that includes verifiable contact information.
NOTE: A typed signature is not allowed on other FSD forms. These instructions are specific to the MO HealthNet Spend Down Provider form.
For additional information regarding submitting Spend Down charges, please refer to MHABD manual section 0810.010.15.01 Documentation of Incurred Medical Expenses.
- Review this memorandum with appropriate staff.
MO HealthNet Spend Down Provider form