Spend Down Update

April 4th, 2013

Home Health Issue: Some FSD offices were requiring home health providers to submit the physician order, or plan of care (485) along with the bill for private services delivered during the time the patient is not receiving MO HealthNet benefits (not active on Medicaid-during their spend down period). If you are providing private pay home health services to a patient, under a physicians order (as is required for all home health care) the invoice for your services, along with the attestation form available at: https://dss.mo.gov/fsd/massist.htm (then go to the little box on the right hand side under Spend Down and click on the attestation statement), is sufficient to be counted towards the patient’s spend down.
Pay-In Option to meet Spend Down: Patients who choose to pay their spend down amount at the beginning of the month are NOT to send the payment to the local FSD office. Below are the rules for pay-in:The pay-in option allows participants to meet their spend down obligation by making a monthly payment of their spend down amount to the State, much like paying a monthly health insurance premium. They have two options to pay-in their spend down. They must choose only 1 option. Participants will have coverage for the whole month that they pay for.
- Option 1:Participants may send a payment (check, money order, or cashier’s check) to the MO HealthNet Division. Participants may mail spend down payments to:
  MO HealthNet Division
  P.O. Box 808001
  Kansas City, MO 64180-8001
  
  The participant must put their MO HealthNet number (case number) on the check or money order. They should mail their payment along with the invoice stub for the month for which they are paying. If they do not have the correct invoice stub to send, they must write on the check or money order what month they are paying for. They must not send an old invoice to pay for a current month.
- Option 2: Participants may have their payment taken directly out of their bank account on the 10th of each month by the MO HealthNet Division to pay for their spend down obligation for the following month. To have their payment automatically taken from their bank account the participant must complete the Spend down Automatic Withdrawal Form. They must allow 30 days for the automatic withdrawal to process. The participants cannot use bills to meet their spend down if they chose to have the payment taken from their bank account each month through automatic withdrawal. If the participant has insufficient funds to cover the automatic withdrawal, they must send either a money order or cashier’s check to cover the insufficient payment.
  If the participant changes banks or changes accounts within their bank, they will need to submit a new automatic withdrawal form (https://dss.mo.gov/mhd/participants/pdf/awa-spenddown.pdf) marked “change,” and will need to allow 30 days for this change to take place.
Amounts and Submission of Invoices for private pay services delivered when the recipient is not receiving MO HealthNet benefits (not active on Medicaid) to meet Spend Down: The invoice/bills may be submitted by the provider on behalf of the patient or by the patient directly.
1. Home Health services may be billed to the patient at the agencies usual and customary (private pay) rate (for the same service).
2. CDS and Personal Care services authorized by the Department of Health and Senior Services are allowed to meet spend down but must be billed at the state rate (the Medicaid reimbursement rate for the service). Personal care services that are not authorized by the Department of Health and Senior Services but are medically necessary as prescribed by a physician are allowed to be billed at your usual and customary (private pay) rate. However, you must submit the physician’s order for these services along with the invoice/bill that is submitted to FSD. FSD will review each of these cases and consult with DSDS when necessary.
Documenting in-home tasks/time: If you are providing personal care to a DSDS in-home or CDS client on a private pay basis at the beginning of the month during the period of time that the client has not met spend down, you do not have to document every task (5 minutes to brush teeth, 20 minutes to help with bathing, etc.). You may bill for the hour(s) of personal care authorized and delivered. Obviously you can only bill for a service that you provided and for the amount of time it takes (in total) to deliver. So if you were providing 2 hours of personal care and during those two hours you provided assistance with bathing, toileting, meal prep, etc. you do not have to list each of the tasks you provided just list that you provided 2 hours of personal care, the date, the worker, etc.

Tags: home health, invoices, pay-in option, personal care, spend down

Quick Navigation

Spend Down Update

April 4th, 2013

Recent Posts

Archives