- TO:
- ALL FAMILY SUPPORT DIVISION OFFICES
- FROM:
- PATRICK LUEBBERING, ACTING DIRECTOR
- SUBJECT:
- REVISED PROVIDER ATTESTATION OF PHYSICIAN’S ORDER OF MEDICAL NECESSITY AND SPEND DOWN PROVIDER FORM
DISCUSSION:
The purpose of this memorandum is to introduce revisions made to the Provider Attestation of Physician’s Order of Medical Necessity (IM-29 (PA)) and the Spend Down Provider form (MO 888-4501).
The IM-29 (PA) and has been revised to include:
- Section titles to make it more readable and understandable,
- An explanation of why the form is needed,
- Instructions on where to submit the completed form.
The MO 888-4501 has been reorganized and modified to make it more readable and understandable.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Begin using the revised forms immediately.
PL/vb