2013 Memorandums

IM-#2      01/09/13

P.O. BOX 2320


The purpose of this memorandum is to notify staff of the Regional MO HealthNet Spend down Units (SDU), whose purpose is to review medical expense documentation and determine allowable spend down expenses. The creation of the SDU will allow the Family Support Division (FSD) to efficiently, accurately, and consistently process spend down expenses throughout the state.

Effective December 1, 2012, processing of all MO HealthNet Spend down (MHSD) expenses transitioned to the specialized Spend Down Units (SDU). SDU eligibility specialists (ES) will be responsible for processing medical expenses submitted for active MHSD participants and reporting known changes in circumstances to the local FSD office.

The SDU ES do not:

MHSD cases will continue to be maintained in the appropriate FSD office serving the participants' county of residence. The local FSD ES is responsible for maintaining the case record, including, but not limited to:

The local FSD ES, ES Supervisor, or Manager must not enter coverage dates on the MO HealthNet Division Add Spenddown Coverage (MSPA) screen or enter corrections to spend down coverage on the MO HealthNet Division Update Spenddown Coverage (MSPU) screen.

Responding to Inquiries

When an applicant/participant, authorized representative, or provider contacts the local FSD office, the ES will not redirect them to the SDU. The ES will obtain the information from available resources, such as MHABD Spend Down Information Resources Training Page, Spend Down Calculator if available, Income Maintenance Manual section 0810.000.00 MO HEALTHNET COVERAGE, and the comments entered in EUMEMROL by the SDU, to respond to inquiries. Send an email to the SDU for more information or follow-up only when necessary. This is similar to the ES role when a QMB participant has a question about Buy-in. The ES answers questions relating to eligibility for Buy-in and can review the IIVE screen to determine if the buy-in has been processed. Other buy-in related issues are sent to the Medicare Buy-In Unit's email address. Every effort should be made to ensure the correct information is given to all inquiries.

NOTE:  Information available to providers without written consent is limited to Department Client Number (DCN) and eligibility dates. When requests for information are received from sources other than those identified in Income Maintenance Manual section 0130.005.05, the worker cannot release any information, except for the information on the Income Maintenance Payroll, without the consent of the participant. Refer to Income Maintenance Manual section 0130.005.10.10 Uses and Disclosures for the privacy restrictions on protected health information.

It is very important that local FSD ES maintain a strong knowledge of MHSD program policies and procedures in order to correctly respond to inquiries from participants and providers, and to correctly determine eligibility for related programs. In an effort to ensure consistent processing of spend down charges and information provided to customers, MO HealthNet Program and Policy has developed Spend Down Hot Tips, which are emailed to FSD staff and are also available on the MHABD training page.

Documenting and Forwarding Spend Down Expenses to the SDU

When a participant submits expenses to the county office, the ES will:

  1. Accept the documentation, bills, receipts, invoices, etc.,
  2. Enter comments through the Eligibility Unit Member Role (EUMEMROL/FM3Z) screen documenting receipt of the medical expense. The comment must:
    • be labeled with the month the expenses were incurred and spend down. IE: July 2012- spend down.
    • include the name of the provider, the date of service, type of services (hospital, doctor, dialysis, etc), and the date the information was forwarded to the SDU.
  3. Scan and send the documentation to the SDU on the day the documentation is received.

    NOTE: When scanning receipts, bills, etc a naming standard has been established to simplify distribution. The file must be named: the date of scan, last name, first name, and dcn of participant.pdf

    Example: 01-10-13 Doe, Jan 0012345678.pdf).
    See attached scanning instructions for detailed information.

Completing Application for State Hearing (IM-87) Form and Representing the Agency at Hearings

The local FSD office ES will continue to represent the agency at hearings related to eligibility determinations and disability. The SDU ES will act as an agency witness in hearings contesting which expenses were allowed or not allowed to meet the spend down. The recipient of a hearing request will follow normal hearing procedures and notify the corresponding SDU or local FSD office, when the hearing request is related to authorization for MO HealthNet coverage based on incurred expenses to meet spend down.

When the hearing request is received by the local FSD office, the ES will:

The original, completed IM‐87 is retained in the claimant's case file. See Instructions for IM-87.

The SDU manager or supervisor will assign the hearing to the correct SDU ES, and notify the local FSD office who they should contact as an additional agency witness for the hearing. The SDU ES will provide documents to the local FSD ES to include in the agency exhibits by the next business. The local FSD ES must contact the SDU ES to notify of the date and time the hearing is scheduled. The SDU ES must be teleconferenced by the local FSD ES at the time of the hearing to provide testimony relating to the incurred medical expenses.

All FSD staff are reminded; there is no wrong door and no wrong phone when a participant contacts the agency. The local FSD ES and SDU ES will need to work closely to ensure the prompt sharing of necessary information and processing of spend down eligibility.




2013 Memorandums