IM-82 September 20, 2012; IM-27 March 16, 2012
For medical expenses incurred by an individual receiving Community Substance Abuse and Rehabilitation (CSTAR), Community Psychiatric Rehabilitation (CPR), Developmental Disabilities (DD), or Targeted Case Management (TCM) waiver services paid by the Department of Mental Health, obtain a completed MO HealthNet Spend Down Provider Form or an invoice with all of the following information:
- Name and DCN of the MO HealthNet participant.
- Name of service provider. This is the name of the Community Mental Health Center (CMHC) or Community Substance Abuse and Rehabilitation (CSTAR) provider.
- Provider type (First two digits of the provider number, 87 for CPR, 86 for CSTAR, 15 for TCM). The full provider number may be included, but is not required.
- Date the service was provided.
- A service description identifying the service as CPR, CSTAR, or Targeted Case Management (TCM).
- Charge for service on the date it was provided.
NOTE: CPR, CSTAR, and TCM are not covered by Medicare or other insurance, therefore there will not be a third party liability identified.