1. MHABD Spend Down August, 2012 Provided by the Family Support Division Welcome! Family Support DivisionJuly 25, 2012

2. Objectives  New Options effective 7/1/12  Forms  IM-4 What is Spend Down? brochure  IM-29 (SPDN)  Spend Down Payment Options  Provider Form  FSD Required Documentation Family Support DivisionJuly 25, 2012

3.  Carryover of Incurred Expenses  Combination of Incurred Expenses & Pay-In NOTE: Current Incurred Expenses and Pay In remain as options MHABD Spend Down New Options effective 7/1/12 MHABD Spend Down New Options effective 7/1/12 Family Support DivisionJuly 25, 2012

4.  Participant’s choice  Incurred medical expense  Currently owed  They are responsible to pay  In a different Month Carryover of Incurred Expenses Family Support DivisionJuly 25, 2012

5. MayJuneJulyAugust (Current Eligibility Month) SeptemberOctoberNovember Use carryover eligible expenses from these months Apply carryover eligible expenses toward spend down in these months Carryover of Incurred Expenses Family Support DivisionJuly 25, 2012

6.  Participant Spend Down Eligibility  Not eligible for payment by a third party or MO HealthNet  Not previously applied  Owed by participant  No SLMB2 (QI-1)  This will eliminate them from eligibility for MO HealthNet coverage Requirements for Carryover Family Support DivisionJuly 25, 2012

7.  September 2012 current month of eligibility  Mr. K’s spend down $300  Incurred carryover eligible expenses $1000 in July 2012 (bill provided September 2012)  Expenses not used in July 2012 MonthSpend Down Liability Apply CarryoverCarryover Remaining September$300 (met)$1000 - $300$700 October$300 (met)$700 - $300$400 November$300 (met)$400 - $300$100 December$300 (not met)$100$0 Carryover Example: Meet/Exceed Family Support DivisionJuly 25, 2012

8.  Understand options  Provided In writing  (IM-29 Spend Down Payment Options page)  Cannot change designation  If no designation, applied to current month or succeeding months Participant Designation of the Carryover Participant Designation of the Carryover Family Support DivisionJuly 25, 2012

9.  Carryover = Spend Down  Coverage = 1 st of the Month  Carryover + Incurred Expense = Spend Down  Coverage = date of incurred expense Carryover Coverage Dates Family Support DivisionJuly 25, 2012

10.  Coverage begins on first day of September, October, and November  Incurred expense December 6 th for $200  coverage begins December 6th MonthSpend Down Liability Apply CarryoverCarryover Remaining September$300 (met)$1000 - $300$700 October$300 (met)$700 - $300$400 November$300 (met)$400 - $300$100 December$300 (not met)$100$0 Carryover Example: Meet/Exceed Family Support DivisionJuly 25, 2012

11.  September 2012  Mrs. Lautner’s spend down $180 MonthSpend Down Liability Incurred Expenses Carryover June$180$50 July$180$70$50 + $70 = $120 August$180$60$120 + $60 = $180* September$180Spend Down met by using carryover Carryover Example 2 Family Support DivisionJuly 25, 2012

12. Review  Apply expenses to a different Month  Three Month limit  Requirements:  Participant Spend Down Eligibility  Not eligible for payment by a third party or MO HealthNet  Not previously applied  Owed by participant  No SLMB2 (QI-1) Family Support DivisionJuly 25, 2012

13.  Participant can combine incurred expenses with partial pay-in to meet spend down Combination Incurred/Pay-In Family Support DivisionJuly 25, 2012

14.  Apply to spend down  Notify using IM-29 (SPDN)  Submit More bills/MO HealthNet Spend Down Provider Form(s)  Pay-in balance Bills/MO HealthNet Spend Down Provider Form received before a partial payment Combination Incurred/Pay-In Family Support DivisionJuly 25, 2012

15. Spend Down Payment Options Page Family Support DivisionJuly 25, 2012

16.  July 2012  Spend Down $100  Coverage begins July 12 DateExpense or PaymentSpend Down Remaining July 1$100 July 12$75 Expense$25 July 28$25 Payment Spend Down Met, payment applied July 12 Incurred + Partial Pay-In Example Family Support DivisionJuly 25, 2012

17.  August 2012  Spend Down $200  Coverage begins August 1 DateExpense or PaymentSpend Down Remaining July$100 to carryover August 1$100 carryover used$100 August 24$100 partial pay-in $100 + $100 = Spend Down Met payment applied August 1 Carryover + Partial Pay-In Example Family Support DivisionJuly 25, 2012

18. Review  Bills/MO HealthNet Spend Down Provider Form + Partial Pay-In  Bill submitted, does not meet spend down, send IM-29 (SPDN)  Participant’s option to submit balance Family Support DivisionJuly 25, 2012

19. Review  Bills/MO HealthNet Spend Down Provider Form + Partial Pay-In  Incurred + Partial Pay-In meets?  Coverage is date of service that meets  Carryover + Partial Pay-In meets?  Coverage is 1 st of the Month Family Support DivisionJuly 25, 2012

20.  The payment will be held for 60 days for additional:  Incurred expenses to be submitted  Additional payment to be made  Then determine start date of coverage If a payment is received & the Spend Down amount is not met: Combination Incurred/Pay-In Family Support DivisionJuly 25, 2012

21. IM-29 (SPDN) Family Support DivisionJuly 25, 2012

22. Spend Down Payment Options Page Family Support DivisionJuly 25, 2012

23. IM-4 What is Spend Down? Family Support DivisionJuly 25, 2012

24. MHN Spend Down Provider Form Family Support DivisionJuly 25, 2012

25.  Date of service  Type of service  Total charges  Amount of participant responsibility  Name of 3 rd party insurer  Amount of 3 rd party liability Acceptable Verification Family Support DivisionJuly 25, 2012

26. Review  New Options effective 7/1/12  Forms  IM-4 SPEND DOWN  IM-29 (SPDN)  Spend Down Payment Options  Provider Form  http://dss.mo.gov/fsd/massist.htm  FSD Required Documentation Family Support DivisionJuly 25, 2012

27. MHABD Spend Down August, 2012 Provided by the Family Support Division Thank you for your participation! Family Support DivisionJuly 25, 2012