PM 15-08-05.

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.

DORS

DORS sends HFS 3444, Letter of Notification, when the DORS counselor refers a client to apply for MANG, and when an active MANG case begins receiving DORS HSP services. Use HFS 3444 or a statement from the client's DORS counselor to verify the initial estimated cost for DORS Home Service Program (HSP) services.

Verify ongoing costs by the monthly listing, CHANGES IN THE PROJECTED COST FOR DORS/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 DMHDD Community Based Services, Determining Eligibility and Spenddown.