MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to clarify transportation charges allowed for Consumer Directed Services (CDS) participants to meet spend down.

IM-# 59, dated June 14, 2013, introduced the MO HealthNet Spend Down Transportation Expense Log to provide a method for reporting transportation expenses to meet spend down. When a CDS participant submits a transportation log, verify if transportation expenses are authorized in the Department of Health and Senior Services Division of Senior and Disability Services Care Plan for CDS before allowing the transportation to meet spend down. Transportation that is authorized in a CDS care plan must be submitted as CDS units of service to be allowable to meet spend down. Transportation that is authorized in a CDS care plan must not be submitted on the MO HealthNet Spend Down Transportation Expense Log.

CDS care plans with transportation authorized by Department of Health and Senior Services (DHSS) are for essential transportation needs of the participant, including medical appointments that Non-Emergency Medical Transportation (NEMT) does not cover; which includes transportation to:

• Non-MO HealthNet covered services,
• Pharmacy,
• Adult day health services,
• Some Comprehensive Substance Treatment Abuse and Rehabilitation (CSTAR) services, and
• Developmental Disability (DD) Waiver services.

Transportation expenses for NEMT covered services are allowable expenses for CDS participants to meet spend down; because:

• The participant does not yet have access to NEMT, and
• The CDS care plan does not authorize this transportation—the care plan only authorizes transportation for non-NEMT services.

Transportation expenses may be an allowable expense to meet spend down for CDS participants if:

• The DHSS authorized care plan does not include transportation; or
• The DHSS authorized care plan does include transportation, but the transportation expenses are for transportation to NEMT covered services.

  EXAMPLE:  Ms. Jones submits the MO HealthNet Spend Down Transportation Expense Log with transportation charges to an office visit with her doctor. Ms. Jones' care plan does not authorize transportation. The charges submitted for the transportation to the doctor are allowable to be applied to her spend down liability.

  EXAMPLE: Ms. Hays submits the MO HealthNet Spend Down Transportation Expense Log with transportation charges to an office visit with her doctor. Ms. Hays' DHSS authorized care plan does authorize transportation. The charges submitted for the transportation to the doctor are allowable to be applied to her spend down liability; because, her care plan does authorize essential transportation as a CDS service, but the transportation expenses are for transportation to an NEMT covered service.

Transportation is not an allowable expense to meet spend down for CDS participants when submitted on the MO HealthNet Spend Down Transportation Expense Log, and must be submitted as a CDS service when:

• The DHSS authorized care plan does include transportation; and
• The transportation expenses are for non-NEMT covered services.

  EXAMPLE:  Mr. Smith submits the MO HealthNet Spend Down Transportation Expense Log with transportation to the pharmacy to pick up his monthly prescriptions. Mr. Smith's care plan does authorize essential transportation as a CDS service. The charges submitted on the expense log for transportation to the pharmacy are not allowable to be applied to his spend down liability, because this is a non-NEMT covered service that should be provided under the CDS plan.

   

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

AC/HA