Category: 2020

FROM:  KIM EVANS, DIRECTOR 

SUBJECT:  UPDATE OF POVERTY INCOME GUIDELINES FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS

MANUAL REVISION #09 – Appendix J, Adult Standards Chart, Appendix K, MO HealthNet Aged, Blind, and Disabled Program Descriptions, Appendix L, Aged, Blind, Disabled Income Chart, Appendix M, Medicare Cost Savings Program

DISCUSSION:

Effective April 1, 2020, the Federal Poverty Level (FPL) income guidelines increase for the following programs: MO HealthNet for the Aged, Blind and Disabled (MHABD) Spend Down and Non-Spend Down, Ticket to Work Health Assurance (TWHA), Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB and SLMB-2), Qualified Disabled Working Individuals (QDWI), MO HealthNet for Disabled Children (MHDC) and Gateway to Better Health programs (GTBH).  The Blind Pension (BP) spousal support income maximum has also increased with the FPL.   

On the weekend of March 07, 2020, MO HealthNet for the Aged, Blind and Disabled programs in FAMIS with income eligibility based on the federal poverty level will be adjusted. This memorandum includes information on:

• PREMIUM REFUNDS
• REQUEST FOR HEARING/CONTINUED BENEFITS
• INCOME CHARTS AND PROGRAM DESCRIPTIONS

PREMIUM REFUNDS

Premiums paid for April coverage will be refunded to the participant if the FPL causes the case to become eligible as a non-premium case. The refund process will take approximately 8 weeks to complete.

REQUEST FOR HEARING/CONTINUED BENEFITS

Any participant receiving an FA-420 MO HealthNet Adverse Action Notice may request a hearing on the mass adjustment action.  

If a participant receiving an FA-420 requests a hearing on the adjustment within ten days from the date of the notice, the participant may request benefits be continued at the level received before the FPL adjustment, until the hearing decision is made. Staff should inform the participant if continued benefits are issued and the agency is determined to be correct, a claim will be established for any overpayment.

Refer to the “FAMIS Changes Due to the Federal Poverty Level Adjustments” for eligibility system processes to allow continued MO HealthNet benefits at the same level of care prior to the FPL adjustment when a hearing decision is pending.  The “FAMIS Changes Due to the Federal Poverty Level Adjustments” will also provide information regarding specific cases in FAMIS the FPL mass adjustment is unable to systematically adjust. 

INCOME CHARTS

Income Charts are no longer being updated in each Manual Section, but instead will be updated in the Appendices.  For historical purposes, the income standards listed below will be included in the FPL memo:

MHABD OAA/PTD Income standards effective April 01, 2020 through March 31, 2021

MHABD AB Income standards effective April 01, 2020 through March 31, 2021

Blind Pension sighted spouse income maximum effective April 01, 2020 through March 31, 2021

QDWI income standards effective April 01, 2020 through March 31, 2021 

QMB income standards effective April 01, 2020 through March 31, 2021

SLMB1 income standards effective April 01, 2020 through March 31, 2021

SLMB2 income standards effective April 01, 2020 through March 31, 2021

TWHA Premiums for Single Cases

TWHA Premiums for Couple Cases

PROGRAM DESCRIPTIONS AND OTHER RESOURCES

The MO HealthNet for the Aged, Blind, and Disabled (MHABD) Standards Chart, MO HealthNet Aged, Blind, and Disabled Program Descriptions, the MO HealthNet Aged, Blind, Disabled Income Chart, and the Medicare Cost Savings Programs (QMB and SLMB) internet pages are updated in Appendices J, K, L, and M in the Medical Assistance for the Aged, Blind, and Disabled Manual to include the change in FPL income limits.

NECESSARY ACTION:

• Begin using the new federal poverty level income guidelines effective for April 2020 and later.
• Follow the FPL FAMIS Guide to resolve conflicting actions.
• Review this memorandum with appropriate staff.

KE/vm      

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 MO HealthNet (MHN) Coverage for Positive COVID-19 Diagnosis

DISCUSSION:

FSD will provide MO HealthNet coverage for individuals between the ages of 19 and 64 who have a positive COVID-19 diagnosis and meet current MHABD eligibility guidelines, including income and resources. 

Applications for individuals who have a positive COVID-19 diagnosis will be accepted on a signed IM-1MA application form.   

• To expedite the process, applications for individuals who have a positive COVID-19 diagnosis can be submitted to FSD.COVIDAPPS@dss.mo.gov.
• Submitting verification of the COVID-19 diagnosis with the application will allow for expedited processing. Verification of a positive COVID-19 diagnosis includes, but is not limited to, a letter signed by the physician, lab results, discharge summary, or hospital records that clearly state the diagnosis.
  • NOTE: FSD must accept fillable applications from hospitals, providers, friends and/or family with an electronic signature that includes a statement from the applicant who is quarantined and wishing to apply for Missouri Medicaid. 

If eligible, COVID-19 MHN coverage will begin the first day of the month of application in which a positive COVID-19 was performed and the determination of disability will be authorized for 90 days and reassessed moving forward.  To authorize coverage for the month of a test completed prior to the month of application, indicate a request for prior quarter coverage on the REQUEST/FM0G screen and entering the date of the diagnosis on the DISABLED/FMMX screen with the COV code.  When entering an approval ensure that only the appropriate months are authorized.

• Additional information will be released when available regarding participants that continue to have a positive COVID-19 diagnosis at the end of the 90 day time period.
• This coverage will remain in effect until the health emergency ends or the individual is no longer considered disabled whichever occurs last.

NOTE:  Utilize prior quarter as needed for medical services that are related to a positive COVID-19 test but not prior to February 1, 2020.  System updates allow for coverage based on a COVID-19 diagnosis to be authorized back to March 1, 2020.  When applicable, staff must use the Worker Initiated Budget Calculation screen in order to authorize coverage for February 2020.

Processing applications:

An application for COVID-19 coverage must be registered in the same manner as an MHABD-PTD application.  These applications are a high priority.    

• Use the standard income and resource limits for the MHABD-PTD program.
• Verification of a positive COVID-19 diagnosis is required.
• To be eligible, individuals must be between the ages of 19 and 64.
• Accept self-attestation of income and resources unless questionable, with the exception of trusts and annuities. Trusts and annuities must still be submitted to the Program and Policy unit for interpretation.
• Staff must explore all avenues available to FSD to verify citizenship and identity before requesting verification from the participant.
• The COVID-19 diagnosis will be captured in FAMIS on the DISABLED/FMMX screen using code “COV.”
  • The begin date is the date of the test that resulted in a positive COVID-19 diagnosis.
  • Only enter hard copy verification of the COV code if the individual is within the designated age range and has a positive COVID-19 diagnosis.
• Coverage will be displayed as Spend Down or Non-Spend Down coverage. A new ME code will not be created for this program and coverage will show as ME 13.  If staff need to identify that coverage was authorized due to a positive COVID-19 test, this information can be located by checking the DISABLED/FMMX screen, or reviewing the technical details screen associated with the authorization. 
• Programming is being completed to add specific information to the approval notice sent to eligible individuals who have a positive COVID-19 diagnosis.
• Enter a comment on the Eligibility Unit Member Role (EUMEMROL/FM3Z) screen with label “COVID-19 Application” on every case approved for coverage due to positive diagnosis.
• Include a comment on each income or resource entry that is verified with self-attestation with label “COVID-19 Self-Attestation” on every case approved for coverage due to positive diagnosis. The body of the comment should include the following statement:  “Self-attestation accepted as verification due to special circumstances.  42 CFR §435.952(c)(3)”

NOTE:  MAGI coverage should be explored if coverage could be offered through Family MHN programs

Questions regarding the entry of COVID-19 MHN coverage may be sent via email to Cole.MHNPolicy@dss.mo.gov.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/rr/vb

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 VERIFICATIONS FOR FAMILY HEALTHCARE PROGRAMS (MAGI)           

DISCUSSION:

On March 13, 2020 a national health emergency was declared in response to COVID-19.  This allows The Centers for Medicare and Medicaid Services (CMS) to approve waivers for states to have all points of eligibility temporarily waived with the exceptions of citizenship and identity. 

If an applicant has already provided documentation, use what was provided as verification.  Ensure all electronic sources are utilized when available.

When an applicant has not provided verification and the information is not able to be verified by electronic sources, follow these instructions:

• For income: reasonable compatibility does not need to be run. Accept self-attestation of income.
• For tax-filing status: if tax-filing status is blank on an application – the client must be contacted. If contact cannot be made, a manual Request for Information (IM-31A) must be sent and tracked.  The participant is still able to verbally provide their tax-filing status without submitting documentation. 
• For citizenship and identity: see 020.05.05 Documents to Verify Citizenship for a list of acceptable documents.
• Reasonable opportunity: Allow reasonable opportunity for applicants requesting benefits who do not have citizenship documents/proof of qualified immigrant status or a social security number (SSN) at the time of application.
  • When an SSN is not provided at application – attempt to contact the participant. If the applicant has indicated they have applied for an SSN, accept self-attestation of SSN application.  If the applicant indicates they have NOT applied for an SSN, allow reasonable opportunity on a good faith effort as individuals may not be able to go to a Social Security office at this time.
  • If a participant does not provide verification they have applied for a birth certificate – allow reasonable opportunity on a good faith effort as individuals may not be able to apply for a birth certificate at this time.

NECESSARY ACTION:

• Follow above instructions starting immediately.
• Review this memorandum with appropriate staff.
• If MEDES system will not accept self-attestation as a verification item-use “Other documentation, verified by caseworker.”
• In addition to the comment regarding the application, leave an additional comment with the label COVID-19 to state, “Self-attestation accepted as verification due to special circumstances. 42 CFR 435.952(c)(3).”
  • Note: Copy and paste the above label for comments.

KE/al

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 EMERGENCY MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED VERIFICATION REQUIREMENT CHANGES

DISCUSSION:

This memorandum will introduce temporary changes to the MO HealthNet for the Aged, Blind, and Disabled (MHABD) verification requirements due to the COVID-19 emergency.

For the duration of the emergency, MHABD programs will accept self-attestation for all verification requirements, except:

• positive COVID-19 diagnosis,
• ID,
• Citizenship,
• trusts and/or annuities.

NOTE:  Trusts and annuities must be submitted per normal procedures to Program and Policy for review.  Please note in the title of the Request for Interpretation of Policy (IM-14) if the review is for household that includes a COVID-19 positive participant.

SNAP is not making the same change to verification requirements at this time. 

FAMIS is an integrated system, meaning that changes made for one program will have an impact on the other programs. 

• FAMIS will continue to mail Request for Verification (FA-325) notices to participants, as they are still needed for other programs.
• System changes are in place that will prevent the closing of MHABD cases for any reason, including but not limited to failure to provide verification, or excess resources.  

Staff will enter the collateral contact (CC) verification code to indicate they are accepting self-attestation on MHABD cases.  Using CC may cause SNAP or other programs to complete, this is acceptable.

• Enter a comment on the Eligibility Unit Member Role (EUMEMROL/FM3Z) screen with label “COVID-19” on every case approved for coverage or continued due to positive diagnosis.
• Enter a comment on the each income or resource that is verified with self-attestation with label “COVID-19” and copy the following as the comment body: “Self-attestation accepted as verification due to special circumstances. 42 CFR 435.952(c)(3).”

When/if further verification is received staff should enter that information and complete and eligibility determination (EDRES).

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Do not require verification for MHABD cases, except for trusts and annuities.

KE/vb/rr

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  FORMS ADDED TO IM FORMS MANUAL TO VERIFY VETERAN’S ADMINISTRATION (VA) INCOME FOR VENDOR PARTICIPANTS

FORM REVISION #07 – FA-312 VA Vendor, FA-313 VA Vendor Letter

DISCUSSION:

When a participant is receiving VA income and enters a vendor facility, their income may or may not change depending on what type of VA income they are receiving.

Regional Nursing Home offices can send a release form to the participant to sign so that staff may contact VA directly to verify any changes in income that occurred due to the participant entering a vendor facility.

Forms were added to the IM Forms Manual to assist staff with collecting this information. Veterans Administration Verification (Vendor) form (FA-312 VA Vendor) is the release form for the participant to sign. VA Letter (FA-313 VA Vendor Letter) is available for staff to send to the participant to request the signed release and explain why FSD needs to contact VA.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) APPLICATIONS FOR INDIVIDUALS BEING DISCHARGED FROM A STATE MENTAL HOSPITAL

FORM REVISION: #06 – FSD DBH Cover Sheet      

DISCUSSION:

The purpose of this memo is to update the coversheet that the Department of Mental Health’s (DMH) Division of Behavioral Health (DBH) uses when submitting an MHABD application to the Family Support Division (FSD) on behalf of an applicant who is anticipating discharge from a State Mental Hospital.

DBH and FSD work together to process these applications as quickly as possible to avoid disruption in services for the individual.  An application may be submitted as early as 90 days prior to an individual’s planned discharge date.  The date of the application is the date the application is received by FSD.  These applications must be processed within two (2) working days. 

Division of Behavioral Health Responsibilities:

DBH agrees to facilitate the application process for individual’s from age 22 up to age 65 who would appear to meet all factors of eligibility for MHABD except for the requirement that they not reside in a public institution. 

DBH will:

• Assist the applicant, authorized representative, or guardian with completing the necessary forms
• Provide medical documentation, when available
• Submit the application to FSD using the FSD DBH Coversheet
  • DBH facility staff send the applications to DMH Central Office who screens the application prior to submitting to FSD. DMH Central Office contact information is on the coversheet.
• DMH Central Office will submit the following to FSD at Greene.CoDFSIM@dss.mo.gov: completed application forms, anticipated discharge date, and contact information for the DMH Case Management Agency that will be providing mental health services upon discharge
• Notify FSD of the applicants actual date discharge and updated community address
• Provide contact information for specific DBH and DMH Case Management staff members who can be contacted during the application process

Family Support Division Responsibilities:

FSD will:

• Maintain designated staff members to process the applications that are received from DBH that include the FSD DBH Coversheet
  • Currently the designated staff members are in the Springfield Processing Center.
• Process the application using the date the application is received by FSD as the date of application
  • The application will need to be taken through the flow and left in ISD status at the QMB decision screen (FMD6) in order to keep the system from approving an application prior to the individual’s discharge.
• Request necessary verification from the applicant, authorized representative, or guardian
  • FSD may not provide DMH or DBH with an official request for information unless a specified DMH or DBH staff member is the authorized representative for the applicant.
• If the applicant is ineligible on any factor other than not residing in a public institution, the rejection may be authorized when that determination is made.
• If the individual is eligible on all factors other than not residing in a public institution, the application must be held until the discharge date or the due date, whichever is earlier.
  • If the applicant is still residing in a public institution on the due date, the application must be rejected. A new application can be submitted by the individual or DBH if needed.
  • The due date for MHABD applications based on permanent and total disability or blind assistance is 90 days from the date of application.
  • If the individual is discharged prior to the due date, the application must be processed within two (2) business days of discharge into the community if all eligibility factors are met.
  • If the individual is discharged on the application due date, the application should be processed that day.
  • An application must not be approved until confirmation is received from DBH that the individual was discharged from the facility.

Please note that this is not a change in policy.  This memo is to update the FSD DBH Coversheet and remind staff of the process for MHABD applications received prior to an individual’s discharge from a state mental hospital.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

ATTACHMENT:

• FSD DBH Cover Sheet

KE/rr

FROM:   KIM EVANS, DIRECTOR

SUBJECT:  MANUAL REVISION FOR QUALIFIED INCOME TRUSTS FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD)

MANUAL REVISION # 08
1025.015.04.01.02

DISCUSSION:

Qualified Income Trusts (QIT) allow participants to place a portion of their income in a trust to enable the participant to qualify for Home and Community Based (HCB) waiver services and MO HealthNet for Children with Developmental Disabilities (MOCDD).

1025.015.04.01.02 Qualified Income Trusts was updated to clarify language, provide examples, and provide guidance for staff on evaluating QIT accounts. The account must be reviewed during annual reviews, at a change in circumstance, or if improper use of QIT funds are discovered.

When the participant is no longer participating in a QIT program, the income and resources must be reviewed. The income that is deposited in the QIT account and is excluded for QIT programs cannot be excluded for any other program, including MHABD Non-Spend Down/Spend Down and Vendor. The QIT account is only an excluded resource while the participant is eligible for a QIT program and must be counted when he/she is no longer participating in a QIT program.

Previously Program for All-Inclusive Care for the Elderly (PACE) participants were allowed to establish a QIT, but it is no longer considered a QIT program. References to PACE were removed from the manual section.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM:  KIM EVANS,  DIRECTOR

SUBJECT:  INTRODUCTION OF NEW FORMS FOR SUSPENDED MO HEALTHNET (MHN) BENEFITS FOR INCARCERATED PARTICIPANTS

FORMS REVISION #05

IM-150 SUSPENDING MO HEALTHNET PARTICIPANTS

IM-151 REQUESTING INPATIENT COVERAGE

IM-152 REPORTING RELEASE OF MO HEALTHNET PARTICIPANTS

DISCUSSION:

IM Memo #11 from February 19, 2020,  introduced new suspension policy for individuals who 1885.040.00 Suspension of MAGI Benefits for Incarcerated Individuals and 0840.020.00 Suspending Incarcerated Participants.

SB 514 (2019) enacted RSMo §217.930 and §221.125 and requires that Missouri correctional facilities and jails report when an active MO HealthNet participant is incarcerated. Department of Corrections (DOC) must report within 20 days; and city, county and private jails must report within 10 days after determining that an incarcerated individual is receiving MO HealthNet.

Information should be reported by the DOC and local jails within the required timeframes. A new form was created for the correctional facilities to use, Suspending MO HealthNet Participants (IM-150). This form collects information that allows FSD to determine if the incarcerated individual is a MO HealthNet participant and allows MO HealthNet Divicion (MHD) to suspend benefits and stop paying medical claims for the participant.

While a suspended participant is incarcerated, there may be medical situations that require him/her to be admitted to the hospital or other medical facility for 24 hours or more, for treatment. These participants may have their suspended benefits restored to allow for medical expenses to be paid. DOC and local jails can report this information using the new form, Requesting Inpatient Coverage (IM-151), to collect information regarding the inpatient stay.

When a participant is going to be released, FSD must complete a redetermination to evaluate if the participant’s eligibility has stayed the same, changed to a different level of care, or if he/she is no longer eligible. To complete this redetermination, FSD needs to collect information from the participant, DOC/jail, or the other household members who are still in the home. DOC is required to report this information within 45 days of the anticipated release date. DOC and local jails can use the new form, Reporting the Release of MO HealthNet Participants (IM-152), to report the participant’s anticipated circumstances at release.

FSD staff should also use these forms to collect information from participants or household members who report an incarcerated participant, or a suspended participant who has been released. If staff in the  Service Centers are notified of a participant, or household member, who has become incarcerated, or a suspended participant who has been released but benefits have not been restored yet, please complete the Suspending MO HealthNet Participants (IM-150) or the Reporting the Release of MO HealthNet Participants (IM-152). These forms do not have to be signed and can be completed over the phone. Email these forms to: MHNJailsandDOCReport@ip.sp.mo.gov , or FAX to: 573-751-0050.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• All questions regarding this policy should follow normal supervisory channels.

KE/cj/ams