PM 15-08-12: Change in Spenddown Met Day

WAG 15-08-12.

When a client submits a medical bill for a month where spenddown has already been met, use the bill(s) to meet spenddown for a later month (see PM 15-08-08-c), unless the client directs that the bill(s) be used to recalculate spenddown for the month of service. The unused bill(s) may be used regardless of the reason why they were not originally submitted.

When the spenddown met day must be changed to an earlier day in the month, review all the bills previously used to meet spenddown for that month. Determine if the client has made payment on:

  • any of the bills used to meet spenddown for that month, or
  • any other medical bill incurred during the month, or
  • any bill incurred before the current month that has not already been used to meet spenddown.

Determine the new spenddown met date by deducting the following items from the spenddown amount:

  • any payments made on the above mentioned bills, using the oldest first, and
  • the spenddown amount that remained on the day that spenddown was previously met, and
  • in chronological order, incurred medical expenses including the new bill submitted by the client.

If a new split-bill day is determined, both the original split-bill day and the newly determined split-bill day are maintained in MMIS. To be paid by the Department, any bills submitted for either split-bill day require a split-billing transmittal.