- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- SPEND DOWN REGULATION 13CSR 40-2.395 EFFECTIVE OCTOBER 30, 2012
- MANUAL REVISIONS:
- 0810.010.15.02; and
- 0810.010.15.05
DISCUSSION:
13 CSR 40-2.395 Spend Down Program was published in the Code of State Regulations September 30, 2012 and is effective October 30, 2012.
MANUAL REVISIONS
Income Maintenance Manual section 0810.010.15.02 has been revised to clarify procedures for determining patient responsibility when:
- third party liability exists and third party has paid; and
- the portion subject to payment by a third party can not be identified.
Because the regulation requires medical providers to provide any additional information required to establish that the individual has incurred a medical expense and the Family Support Division Provider Form can be accepted as documentation of the expense that the participant is responsible to pay, it is only in rare circumstances, such as a catastrophic loss of provider billing records, that the portion subject to third party payment can not be identified. Refer to 0810.010.15.02 for procedures Calculating Medical Expenses AFTER Third Party Liability Pays and Calculating Medical Expenses When the Portion Subject to Third Party Payment Can Not be Identified.
Income Maintenance Manual section 0810.010.15.05 is clarified to state:
- Mileage cost for transportation to obtain medical treatment or services is allowed at the current rate of mileage reimbursement for state employees.
- Transportation expenses are not allowed for individuals with active MO HealthNet/non-emergency transportation coverage. NEMT is considered a third party liability, unless it is verified that the participant was unable to obtain NEMT services, and
- The date(s) of the individual's medically related trips is considered the date of service; not the date paid.
NECESSARY ACTION:
- Review this memorandum with all appropriate staff.
- Begin using third party liability procedures immediately.
- Use state mileage reimbursement rate for determining transportation cost.
- Disallow transportation expenses to participants who have access to NEMT.
- Consider the date of the medically necessary transportation as the date of the service.
AC/tm