Mo. Code Regs. tit. 13 § 70-4.100

Current through Register Vol. 49, No.12, June 17, 2024

Section 13 CSR 70-4.100 - Preventing Medicaid Payment of Expenses Used to Meet Spenddown

PURPOSE: This amendment updates a legal reference in section (1) and outdated terminology throughout the rule. The amendment will change the term "Division of Medical Services" to the "MO HealthNet Division" and "recipients" to "participants."

(1) Aged persons (over sixty-five (65) years), blind persons, or people with disabilities with income above limits established under section 208.151.1(24), RSMo, for old age assistance benefits, permanent and total disability benefits, or aid to the blind benefits, as amended, are allowed to deduct from income incurred medical expenses (that is, spenddown) to become eligible.

(2) Spenddown eligibility shall be calculated on a monthly basis.

(3) The MO HealthNet program (Medicaid) will only reimburse enrolled Medicaid providers for covered medical expenses that exceed a recipient's spenddown amount. Medicaid does not pay the portion of a claim used to meet the applicant's spenddown obligation. For example, for the first day of coverage, the MO HealthNet Division denies or splits (partially pays) a claim or claims until the applicant's spenddown liability is reduced to zero (0).

(4) After the MO HealthNet Division has reduced the participant's liability to zero (0) for the first day of coverage, other claims submitted for that day of spenddown coverage and claims for the time remaining in the month are paid up to the Medicaid rate.

(5) Participants shall have the option to pay their monthly spenddown requirement to the MO HealthNet Division, much like a premium payment, in order to have continuous Medicaid coverage. Participants may also arrange to make the monthly spenddown payment through electronic funds transfer (EFT) from a bank account.

13 CSR 70-4.100

AUTHORITY: sections 208.151, RSMo Supp. 2004 and 208.153 and 208.201, RSMo 2000.* Emergency rule filed April 25, 2005, effective May 5, 2005, expired Oct. 31, 2005. Original rule filed April 29, 2005, effective Oct. 30, 2005.

Amended by Missouri Register June 1, 2022/Volume 47, Number 11, effective 7/31/2022

*Original authority 208.151, RSMo 1967, amended 1973, 1981, 1982, 1987, 1988, 1989, 1990, 1991, 1993, 1995, 2001; 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991; and 208.201, RSMo 1987.