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MHABD Spend Down August, 2012 Provided by the Family Support Division

MHABD Spend Down August, 2012 Provided by the Family 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.

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MHABD Spend Down August, 2012 Provided by the Family Support Division

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  1. MHABD Spend Down August, 2012Provided by theFamily Support Division • Welcome! Family Support Division July 25, 2012

  2. 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

  3. MHABD Spend Down • New Options effective 7/1/12 • Carryover of Incurred Expenses • Combination of Incurred Expenses & Pay-In NOTE: Current Incurred Expenses and Pay In remain as options Family Support Division July 25, 2012

  4. Carryover of Incurred Expenses • Participant’s choice • Incurred medical expense • Currently owed • They are responsible to pay • In a different Month Family Support Division July 25, 2012

  5. Carryover of Incurred Expenses Family Support Division July 25, 2012

  6. Requirements for Carryover • Participant Spend Down Eligibility • Not eligible for payment by a third party or MO HealthNet • Not previously applied • Owed by participant • No SLMB2 (QI-1) • This will eliminate them from eligibility for MO HealthNet coverage Family Support Division July 25, 2012

  7. Carryover Example: Meet/Exceed • 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 Family Support Division July 25, 2012

  8. Participant Designation • of the Carryover • Understand options • Provided In writing • (IM-29 Spend Down Payment Options page) • Cannot change designation • If no designation, applied to current month or succeeding months Family Support Division July 25, 2012

  9. Carryover Coverage Dates • Carryover = Spend Down • Coverage = 1st of the Month • Carryover + Incurred Expense = Spend Down • Coverage = date of incurred expense Family Support Division July 25, 2012

  10. Carryover Example: Meet/Exceed • Coverage begins on first day of September, October, and November • Incurred expense December 6th for $200 • coverage begins December 6th Family Support Division July 25, 2012

  11. Carryover Example 2 • September 2012 • Mrs. Lautner’s spend down $180 Family Support Division July 25, 2012

  12. Review • Apply expenses to a different Month • Three Month limit • Requirements: • Participant Spend Down Eligibility • Not eligible for payment by a third party or MO HealthNet • Not previously applied • Owed by participant • No SLMB2 (QI-1) Family Support Division July 25, 2012

  13. Combination Incurred/Pay-In • Participant can combine incurred expenses with partial pay-in to meet spend down Family Support Division July 25, 2012

  14. Combination Incurred/Pay-In • Apply to spend down • Notify 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 Family Support Division July 25, 2012

  15. Spend Down Payment Options Page Family Support Division July 25, 2012

  16. Incurred + Partial Pay-In Example • July 2012 • Spend Down $100 • Coverage begins July 12 Family Support Division July 25, 2012

  17. Carryover + Partial Pay-In Example • August 2012 • Spend Down $200 • Coverage begins August 1 Family Support Division July 25, 2012

  18. 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

  19. 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

  20. Combination Incurred/Pay-In • 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: Family Support Division July 25, 2012

  21. IM-29 (SPDN) Family Support Division July 25, 2012

  22. Spend Down Payment Options Page Family Support Division July 25, 2012

  23. IM-4 What is Spend Down? Family Support Division July 25, 2012

  24. MHN Spend Down Provider Form Family Support Division July 25, 2012

  25. Acceptable Verification • Date of service • Type of service • Total charges • Amount of participant responsibility • Name of 3rd party insurer • Amount of 3rd party liability Family Support Division July 25, 2012

  26. 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

  27. MHABD Spend Down August, 2012Provided by theFamily Support Division • Thank you for your participation! Family Support Division July 25, 2012

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