WAG 15-08-05: Allowable Medical Expenses

PM 15-08-05.

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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 non-allowable medical costs on Revised TextForm 360C generated by IES.

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.