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MHABD Spend Down
August, 2012
Provided by theFamily Support Division
Welcome!Family Support Division July 25, 2012
Objectives
New Options effective 7/1/12
Forms IM-4 What is Spend Down?
brochure IM-29 (SPDN)
Spend Down Payment Options Provider Form
FSD Required Documentation
Family Support Division July 25, 2012
Carryover of Incurred Expenses
Combination of Incurred Expenses & Pay-In
NOTE: Current Incurred Expenses and Pay In remain as options
MHABD Spend DownNew Options effective 7/1/12
Family Support Division July 25, 2012
Participant’s choiceIncurred medical expenseCurrently owedThey are responsible to payIn a different Month
Carryover of Incurred Expenses
Family Support Division July 25, 2012
May June July August
(Current Eligibility Month)
September October November
Use carryover eligible expenses from these months
Apply carryover eligible expenses toward spend down in these months
Carryover of Incurred Expenses
Family Support Division July 25, 2012
Participant Spend Down EligibilityNot eligible for payment by a third
party or MO HealthNetNot previously applied Owed by participantNo SLMB2 (QI-1)
This will eliminate them from eligibility for MO HealthNet coverage
Requirements for Carryover
Family Support Division July 25, 2012
September 2012 current month of eligibility Mr. K’s spend down $300 Incurred carryover eligible expenses $1000 in July
2012 (bill provided September 2012) Expenses not used in July 2012
Month Spend Down Liability
Apply Carryover CarryoverRemaining
September $300 (met) $1000 - $300 $700
October $300 (met) $700 - $300 $400
November $300 (met) $400 - $300 $100
December $300 (not met) $100 $0
Carryover Example: Meet/Exceed
Family Support Division July 25, 2012
Understand optionsProvided In writing
(IM-29 Spend Down Payment Options page)
Cannot change designation If no designation, applied to current month or succeeding months
Participant Designation of the Carryover
Family Support Division July 25, 2012
Carryover = Spend Down
Coverage = 1st of the Month
Carryover + Incurred Expense = Spend Down
Coverage = date of incurred expense
Carryover Coverage Dates
Family Support Division July 25, 2012
Coverage begins on first day of September, October, and November
Incurred expense December 6th for $200 coverage begins December 6th
Month Spend Down Liability
Apply Carryover CarryoverRemaining
September $300 (met) $1000 - $300 $700
October $300 (met) $700 - $300 $400
November $300 (met) $400 - $300 $100
December $300 (not met) $100 $0
Carryover Example: Meet/Exceed
Family Support Division July 25, 2012
September 2012 Mrs. Lautner’s spend down $180
Month Spend Down Liability
IncurredExpenses
Carryover
June $180 $50 $50
July $180 $70 $50 + $70 = $120
August $180 $60 $120 + $60 = $180*
September $180 Spend Down met by using carryover
Carryover Example 2
Family Support Division July 25, 2012
Review
Apply expenses to a different Month Three Month limit Requirements:
Participant Spend Down EligibilityNot eligible for payment by a third party
or MO HealthNetNot previously applied Owed by participantNo SLMB2 (QI-1)
Family Support Division July 25, 2012
Participant can combine incurred expenses with partial pay-in to meet spend down
Combination Incurred/Pay-In
Family Support Division July 25, 2012
Apply to spend downNotify using IM-29 (SPDN)
Submit More bills/MO HealthNet Spend Down Provider Form(s)
Pay-in balance
Bills/MO HealthNet Spend Down Provider Form received before a
partial payment
Combination Incurred/Pay-In
Family Support Division July 25, 2012
Spend Down Payment Options Page
Family Support Division July 25, 2012
July 2012 Spend Down $100
Coverage begins July 12
Date Expense or Payment Spend Down Remaining
July 1 $100
July 12 $75 Expense $25
July 28 $25 Payment Spend Down Met, payment applied July 12
Incurred + Partial Pay-In Example
Family Support Division July 25, 2012
August 2012 Spend Down $200
Coverage begins August 1
Date Expense or Payment Spend Down Remaining
July $100 to carryover
August 1 $100 carryover used $100
August 24 $100 partial pay-in$100 + $100 =
Spend Down Metpayment applied August 1
Carryover + Partial Pay-In Example
Family Support Division July 25, 2012
Review
Bills/MO HealthNet Spend Down Provider Form + Partial Pay-In
Bill submitted, does not meet spend down, send IM-29 (SPDN)
Participant’s option to submit balance
Family Support Division July 25, 2012
Review
Bills/MO HealthNet Spend Down Provider Form + Partial Pay-In
Incurred + Partial Pay-In meets?Coverage is date of service that meets
Carryover + Partial Pay-In meets?Coverage is 1st of the Month
Family Support Division July 25, 2012
The payment will be held for 60 days for additional: Incurred expenses to be submitted Additional payment to be made Then determine start date of coverage
If a payment is received & the Spend Down amount is not met:
Combination Incurred/Pay-In
Family Support Division July 25, 2012
IM-29 (SPDN)
Family Support Division July 25, 2012
Spend Down Payment Options Page
Family Support Division July 25, 2012
IM-4 What is Spend Down?
Family Support Division July 25, 2012
MHN Spend Down Provider Form
Family Support Division July 25, 2012
Date of service
Type of service
Total charges
Amount of participant responsibility
Name of 3rd party insurer
Amount of 3rd party liability
Acceptable Verification
Family Support Division July 25, 2012
Review
New Options effective 7/1/12
Forms IM-4 SPEND DOWN IM-29 (SPDN)
Spend Down Payment Options Provider Form
http://dss.mo.gov/fsd/massist.htm
FSD Required Documentation
Family Support Division July 25, 2012
MHABD Spend Down
August, 2012
Provided by theFamily Support Division
Thank you for your participation!
Family Support Division July 25, 2012
