1115.035.30.10 Anticipating Expenses – DSS Manuals

IM-51 June 8, 2007 ; IM-110 June 8, 2001 ; IM-01 January 15, 1999

Calculate an EU’s expenses based on the expenses the EU expects to be billed during the certification period. Use bills from the most recent months to anticipate expenses unless the EU is reasonably certain a change will occur.

EUs reporting one-time only medical expenses during the certification period may elect to have a one-time deduction or to have the expense averaged over the remaining months of the certification period. EUs certified for 24 months have a third option when the medical expense is incurred during the first 12 months of the certification period. EUs certified for 24 months may choose to average the expense over the remainder of the first 12 months of the certification period.

If a one-time medical expense is billed too late in the certification period to allow the expense in the applicable certification period, the expense can be averaged over the months of the new certification period provided no break exists between certification periods.

EXAMPLE : An EU is billed for a one-time expense on 11/27. December is the last month of the certification period. Since time does not permit the change to be effective for December, average it over the months of the new certification period, provided the EU is recertified for the next month.

The only other instance in which a one-time medical expense can be allowed outside of the certification period is when the EU timely agrees with the provider to pay the bill in installments.