Updated with Policy Memo Applying Department on Aging (DoA) Community Care Program (CCP) Services to Spenddown
To meet the requirement of being medically necessary, a charge for medical services/items must be given or prescribed by a professional medical provider. (This includes services provided by Christian Science Nurses and Christian Science sanatoriums.)
Allow medical costs towards meeting spenddown if proof is provided. The following proof is required:
- the date of service;
- the amount incurred;
- the nature of the service;
- the name and address of the provider and the name of the person for whom the service was provided; and
- if the bill is subject to TPL coverage, whether the bill has been adjudicated or whether the provider estimate can be accepted.
Enter nonallowable medical costs on Form 458SP-1C generated by ASDS.
When you are going to keep medical bills or receipts to figure if spenddown has been met and the client asks for a receipt, give them a letter.
The letter should contain enough information to identify each bill or receipt being kept by HFS.
DHS-Division of Rehabilitation Services (DRS)
DHS-DRS sends HFS 3444, Letter of Notification, when the DRS counselor refers a client to apply for MANG, and when an active MANG case begins receiving DHS-DRS HSP services. Use HFS 3444 or a statement from the client's DRS counselor to verify the initial estimated cost for DHS-DRS Home Service Program (HSP) services.
Verify ongoing costs by the monthly listing, CHANGES IN THE PROJECTED COST FOR DRS/MEDICAID ACTIVE CASES.
Each client's name appears on the list once a year, unless the cost of the HSP changes or the services are discontinued.
See PM 06-11-02-d and WAG 06-11-02-d for information about DHS-DMH/DDD Community Based Services, Determining Eligibility and Spenddown.