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4. Not be subject to payment by a third party (unless reasonable measures have been taken to determine the liability of the third party); 5. Expenses for a medical service not yet received cannot be anticipated. NOTE: Verified active health insurance and Medicare premiums for the benefit month can be used to reduce the cash option payment. 6. Be deducted in a specific order: a. Medical expenses incurred in the previous 3 months, chronologically; b. Medicare and/or health insurance premiums, regardless of date of month due, are used before other current month medical expenses; i. Medicaid pays Medicare Part B premiums for medically needy clients who also receive QMB or SLMB; do NOT use the Part B premium to reduce/meet the spend down. ii. Because Medicaid and MSP clients are automatically enrolled in Social Security Extra Help, these premiums are not allowed to reduce/meet the spend down. However, if the client is enrolled in enhanced or premium PDP, the difference between the basic and higher-level PDP premium can be allowed. c. Medically necessary care or any other type of remedial care recognized under Montana law, which must be furnished by a licensed medical practitioner within the scope and limitations of their medical practice as defined by state law, but which is not a benefit of the Medicaid program (e.g., chiropractic) are deducted chronologically after all Medicare and/or health insurance premiums. Examples (not all-inclusive): Goods and services that do not meet this definition include health club memberships, hot tubs, travel to services which themselves do not meet this definition, durable medical equipment that is not included in the Montana Medicaid State Plan, shoes, vitamins, etc., even if prescribed by a physician. d. Expenses for Medicaid-covered services are deducted chronologically after allowable expenses listed in a., b., and c. above. SERVICES RECOGNIZED UNDER STATE LAW: Services which State or federal law require a licensed medical practitioner to provide or prescribe can be used to reduce/meet the spend down. NOTE: Because naturopathic physicians are licensed to provide services in Montana, those expenses can be used to reduce/meet the spend down. However, they are not licensed to prescribe drugs, so the cost of any medicines purchased through naturopaths cannot be used. Services recognized under state law include services which are normally payable by Medicaid, but which exceed the agency's limits on amount, duration or scope of services. For example, if Medicaid limits the number of physical therapy visits per year to 25, the 26th and subsequent visits are allowable to reduce the spend down. Similarly, because Medicaid travel reimbursements are set at a minimal per diem amount, additional unreimbursed travel costs (such as hotel costs higher than reimbursed amount) can be used to reduce the spend down.