Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: GUIDANCE ON SIGNING MO HEALTHNET (MHN) APPLICATIONS DURING THE COVID-19 PUBLIC HEALTH EMERGENCY (PHE)
Regulations allow for the electronic signing of MHN applications. With the exception of web applications, Family Support Division (FSD) does not have policy in place regarding the acceptance of electronic signatures on MHN applications.
Current policy regarding signing MHN applications:
Providers have reported that they are experiencing challenges assisting individuals with the application process. Many people do not have family members who can sign the application on their behalf when the participants are unable to sign the application themselves or due to social distancing guidelines.
Due to the COVID-19 PHE, the following considerations are being allowed by FSD regarding signatures on MHN applications:
Option 1: To fill out the application, the applicant can type in their responses on a fillable PDF application using a laptop, smart phone, or answer questions over the phone. The signature field on the PDF application form is not fillable (note: a typed signature is not necessarily an electronic signature). To sign the application, the applicant can write or type a statement that they would like to apply for MO HealthNet then type or sign their name and date. This information is then sent by email or fax to either the provider or to FSD. The email or fax is accepted as authenticating the electronic signature during the COVID-19 state of emergency.
- This type of signature is acceptable on any IM-1MA application for MHABD, it is not strictly for MHABD coverage due to a COVID-19 diagnosis.
- This type of signature is allowable on any Family MHN application.
- This type of signature is allowable on PE applications.
- This type of signature is allowed due to social distancing, self-quarantine, medically recommended quarantine or isolated quarantine in a medical facility.
- There is not required wording of the statement from the applicant, so long as the intent to apply for MHN coverage is expressed.
- Include a comment in the electronic record regarding the reason that a pen and ink signature is not on the application.
Option 2: If a participant is medically isolated or quarantined due to a diagnosis of COVID-19, someone acting responsibly for the applicant may sign on the applicant’s behalf. Note, individuals who are in isolated quarantine in a medical facility are not allowed to have paperwork come into or out of the quarantined area. The participant should type their information onto the fillable PDF using a laptop, smart phone, or answers the eligibility questions over the phone.
- Sample format for facility: “Name of person signing on behalf of (o/b/o) facility name for patient/applicant’s name”
- Unless the participant is unable to communicate, the applicant should give their verbal or electronic consent to the provider to sign the application on their behalf.
- Documentation must be included on the application that the application is being signed by the provider due to quarantined in isolation due to COVID-19.
- This option is to be used as a last resort.
Authorized Representative Forms:
Regulations and policies are already in place for an individual to electronically sign an IM-6AR form that allows another party to sign an application for them.
If the provider is unable to print and sign the IM-6AR to accept the designation, they can sign the form electronically or type/write a separate document that accepts the designation as long as it contains the same information as the designation portion of the IM-6AR form.
During the COVID-19 PHE, if additional support is needed regarding acceptable signatures on applications, please submit the case information through supervisory channels to Cole.MHNPolicy@dss.mo.gov.
- Reference COVID-19 and either MAGI or MHABD in the subject line of the email.
- Review this memorandum with appropriate staff.