PM 15-08-10

  1. (FCRC or Pay-in Unit) Enters information into ASDS for each month spenddown is met. Enters information within 2 workdays of receipt of the medical expenses or payment that meet monthly spenddown.
  2. (System) Generates TA 55 to meet spenddown for month in which cut-off has passed, or TA 31 if spenddown is met for the current or future processing month(s).
  3. revised text(System) Updates eligibility in MMIS.

revised text(FCRC or Pay-in Unit) Update the IRDB (see WAG 22-08-18) if the client reports a need for medical services before the eligibility update is posted to MMIS.

revised textUpdate the IRDB no later than the end of the 2nd workday following the day of the request.

Example: If the client reports a medical need on Wednesday, update the IRDB no later than Friday of the same week.

Monthly Spenddown Met

  1. (FCRC or Pay-in Spenddown Unit) Immediately determine whether spenddown is met when the FCRC or Pay-in Spenddown Unit receives medical bills/receipts or payment report.

    The determination should be made in ASDS within 2 workdays of the day the bills were received in the FCRC or within 2 workdays of the day the Pay-in Spenddown Unit receives the payment report.

  2. (System) Whenever spenddown is met by ASDS, the system will generate TA 31 to automatically update Item 80 codes 390, 392, 396 and Item 77. If the case is enrolled in Pay-in Spenddown, the new Item 80 Pay-in Spenddown codes will be updated as well (see WAG 15-08-15-b).

    The action will appear on the Mercury payroll if spenddown is met for a month prior to the current processing month. 

  3. (FCRC) Complete and mail Form 2432 to the vendors within 14 calendar days of the receipt of the bills which caused spenddown to be met.
    1. Mail original to provider.
    2. File a copy in the case record.
  4. (ASDS) Prints Split Billing Transmittal for MANG (Form 2432C) when a spenddown met is processed.
  5. (FCRC) Make and distribute any additional required copies of Form 2432C.
    1. Mail original to provider.
    2. File a copy in the case record.

Monthly Spenddown Met Through Carryover

(FCRC) When monthly spenddown is met for one or more months through carryover, including the current processing month, enter information into ASDS.

(System) Generates TA 31 to automatically update Item 80 codes 390, 392, 396 and Item 77.

(System) Takes action, after cut-off for the date entered in Item 80 in the PERSONS field, when code 396 E SPD is present:

  • Generates Notice of End of Eligibility for Medical benefits (Form 3358) to the client. The notice says that medical coverage will be ending.
  • Changes the indicator following code 390 SPD to 2, Unmet.
  • Deletes code 396 E SPD.
  • Stops medical eligibility.

(FCRC) To meet spenddown for additional months, complete ASDS calculations for those months before schedule cut-off for the month entered in Item 80 code 396 E SPD.  The Item 80 code 396 E SPD date will be centrally updated.

Do not exceed 6 months from the month in which the action is being submitted, which will prevent the central action from taking place.

If spenddown is met by carryover for months that include the current processing month, complete a separate ASDS determination to authorize medical eligibility for each month that spenddown is met. The first day of eligibility is NOT a day on which a split bill form is required.

revised textFollow the Schedule of Mercury Transmittal Dates when authorizing eligibility for one-month only.

Monthly Spenddown Met by SMIB and/or Medical Insurance Premium Deductions

  1. (FCRC) Change spenddown to "met" when SMIB premiums and/or private medical insurance premiums that are deducted on a monthly basis from a regular source of monthly income (such as from a regular private pension benefit) meet monthly spenddown and the client or FCRC does not expect the spenddown amount or medical insurance premiums to change during the enrollment period.
  2. (FCRC) Determine spenddown met in ASDS for up to 6 calendar months from the month the action is being processed.
  3. (System) Generates TA 31 to automatically update Item 80 codes 390, 392, 396 and Item 77. 
  4. (FCRC) Set a control to update Item 80 before schedule cut-off for the month entered in Item 80.
  5. (FCRC) Complete and send Form 458SP-1 to notify the client of the spenddown met determination.