Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: REVISIONS TO NOTICE OF ELIGIBILITY FOR NURSING FACILITY AND OTHER VENDOR SERVICES (IM-62)
FORM REVISION #
The IM-62 and IM-62 (Spanish) were updated to add the participant’s Managed Care Health Plan. Other changes were made for participant clarity and to remove information no longer utilized by staff.
The Managed Care Health Plan information in the middle of the form allows staff to enter the managed care name and date of enrollment for easy identification by vendors.
The IM-62 shows a revision date of 6/2022 and is available in the internal forms manual.
- Review this memorandum with appropriate staff.
- Begin using the revised IM-62 immediately.