MEMORANDUM
2004 Memorandums
IM-72      08/04/04
SUBJECT:
spend down AND MEDICARE TRANSITIONAL ASSISTANCE
(REFER TO MEMORANDUM IM-64 06-23-04)
DISCUSSION:
DISREGARD MEMORANDUM IM-64 DATED 06-23-04.

The Centers for Medicare and Medicaid Services (CMS) have reversed their decision on not allowing that portion of prescription drugs paid by the Medicare Prescription Drug Discount Card to meet spend down.

Effective immediately, allow that portion of an individual or married couple’s prescription cost that was paid by the Medicare Prescription Drug Discount Card as an expense to meet spend down. This includes amounts paid by the $600.00 Medicare Transitional Assistance and discounts provided by the card sponsor. When the cost of medication is reduced by the Medicare Prescription Drug Discount Card and/or the $600.00 Transitional Assistance, apply the full cost to the spend down amount.

If a client submits a prescription bill that shows all or a part of the bill was paid by a different source, it may be necessary to contact the pharmacy to verify that the cost was reduced by the Medicare Prescription Discount Card or the Medicare Transitional Assistance.

 
NECESSARY ACTION:
  • Review this memorandum with appropriate staff immediately.
  • Allow the full cost of a prescription drug paid when a portion is paid by the Medicare Prescription Drug Discount Card or $600.00 Transitional Assistance toward meeting spend down.
GLS