0810.010.15.10  Authorizing Spend Down Coverage Based on Incurred Expenses

IM-#8, January 24, 2012, IM-131,  October 18, 2002, IM-126,  October 3, 2002, IM-106,  September 10, 2002

For participants meeting spend down with incurred medical expenses, the eligibility specialist will enter a comment on the Eligibility Unit Member Role (FM3Z or EUMEMROL) screen. The recording should include:

The MSPA screen requires the eligibility specialist to enter the date of service and the participant’s personal responsibility for that date of service rounded to the nearest whole dollar. Participant liability is the amount of the spend down that was met on that day, rounded down to the nearest whole dollar. The dates of service must be in a month for which spend down eligibility has been entered in FAMIS and can not be a future month.  The system will enter a coverage end date of the last day of the month for which coverage is being authorized.

EXAMPLE: Participant's spend down for October is $100. They incur medical expenses for which they are personally responsible to pay of $75 on 10/1/12 and $50 on 10/2/12. The eligibility specialist enters the dates of service and participant’s responsibility on MSPA.  The MSPA system will determine the participant’s liability of $25 on 10/02/12.

Upon receipt of verification that spend down has been met with incurred expenses for a month, the eligibility specialist will enter dates of service and participant’s liability on the MSPA screen.

The eligibility specialist must send the Spend Down Notification form IM-29(SPDN) to inform the participant that they met spend down with incurred expenses. The letter informs the participant of the MO HealthNet start date and the amount of spend down met on the start date.  Send the IM-29(SPDN) on the date coverage is initially entered on the MSPA screen or corrected through the MSPU screen.