MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to introduce the Provider Attestation of Physician's Order of Medical Necessity form ((IM-29) (PA)). This form is to accompany the MO HealthNet Spend Down Provider form or bills submitted for services provided in the patient's home to verify the provider's services to the participant are medically necessary. Only medically necessary services or supplies needed for the diagnosis or treatment of the participant's medical condition that meet accepted standards of medical practice as recognized under state law can be used to meet spend down.

The Provider Attestation of Physician's Order of Medical Necessity will:

• Allow the provider to attest they have the physician's order and that all the services provided and billed are consistent with the individual's plan of care ordered by the physician.
• Eliminate the need for Eligibility Specialists (ES) to verify the existence of a physician's order when there is not a plan of care authorized by the Department of Health and Senior Services (DHSS).
• Eliminate the need for the ES to match the services provided and billed expenses with the care plan or physician's s order, as the provider is attesting the charges they have submitted are consistent with the care plan and/or the physician's order.

The Provider Attestation of Physician's Order of Medical Necessity is not acceptable unless every question is completed and the form is signed by the provider or an authorized employee of the provider. The provider is accepting legal responsibility for any false or incomplete submissions and any over-reporting of services.

A new attestation form is required for each care plan period, as specified on the attestation, or when there is a change is medical need. The ES must make comments on the Eligibility Unit Member Role (EUMEMROL, FM3Z) screen with the beginning and ending dates of the care plan as reported on the attestation. Do not allow expenses after the care plan end date, until the new attestation is received.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Begin requiring the Provider Attestation of Physician's Order of Medical Necessity ((IM-29) (PA)) for expenses submitted to meet spend down for services provided in the patient's home when a DHSS plan of care is not available.
• Do not accept the IM-29 (PA) if it is not complete and signed.
• Require a new IM-29 (PA) when the duration of the DHSS Care Plan or IM-29 (PA) in record has lapsed.

AC/VB