IM-15 MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) APPLICATIONS FOR INDIVIDUALS BEING DISCHARGED FROM A STATE MENTAL HOSPITAL

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

IM-14 MANUAL REVISION FOR QUALIFIED INCOME TRUSTS FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD)

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

IM-13 2020 MAGI COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION AND RAILROAD INCOME

FROM:  KIM EVANS, DIRECTOR

SUBJECT:   2020 MAGI COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION AND RAILROAD INCOME

DISCUSSION:

This memorandum informs staff that Railroad Retirement (RR) and Veterans Administration (VA) participants received a 1.6% Cost of Living Adjustment (COLA) for MAGI programs effective January 2020.

Cases Adjusted

Cases that included income types RR and/or VA Benefits in the eligibility system were subject to an automatic increase of 1.6% for those income types.  The eligibility system end dated the previous income and added a new piece of income evidence that reflected the adjusted income amount.

Cases That Did Not Adjust

Some cases did not adjust during this COLA.  These cases will require manual intervention from staff to add the increased income amounts.  As cases are reviewed, check income on each case to determine if the current income is entered.  Update and verify income as required using established procedures.

Notices
For case updates made as a result of COLA, the eligibility system finalized the decision(s) and sent out the appropriate notices.  The reasons and notices that were sent are as follows:

  • Cases with no change were sent the IM-33C.
  • Cases that resulted in benefit reduction were sent an IM-80 allowing 10 days for the individual to respond to the proposed case action. The IM-33C was sent after the IM-80 expired.
  • Cases that resulted in individuals who no longer qualify were sent IM-80 PRE allowing 10 days for the individual to respond to the proposed case action. An IM-80PRE and IM-80 were sent, followed by the IM-33C.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

KE/kg

IM-12 INTRODUCTION OF NEW FORMS FOR SUSPENDED MO HEALTHNET (MHN) BENEFITS FOR INCARCERATED PARTICIPANTS

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

IM-11 INTRODUCTION OF SUSPENSION OF MO HEALTHNET BENEFITS FOR INCARCERATED PARTICIPANTS FOR ALL MO HEALTHNET PROGRAMS

FROM:  KIM EVANS,  DIRECTOR

SUBJECT:  INTRODUCTION OF SUSPENSION OF MO HEALTHNET BENEFITS FOR INCARCERATED PARTICIPANTS FOR ALL MO HEALTHNET PROGRAMS

MANUAL REVISION #07

0105.040.30

0840.020.00

1020.005.00

1885.015.00

1885.040.00

FORMS REVISION #04

IM-33 SUSPENSION

IM-80 Suspension

 

DISCUSSION:

The 2018 SUPPORT for Patients and Communities Act (H.R. 6, P.L. 115-271) and SB 514 (2019) enacted RSMo §217.930 and §221.125 to require that MO HealthNet (MHN) benefits are suspended for individuals who are incarcerated, rather than ending his/her benefits and closing his/her case. This policy change affects all MO HealthNet for Aged, Blind, and Disabled (MHABD) and Family MO HealthNet (MAGI) programs. This applies only to participants who became incarcerated AFTER August 28, 2019.

Manual sections have been added to the Family MO HealthNet manual and to the MO HealthNet for the Aged, Blind, and Disabled manual to update information regarding participants receiving MHN benefits. For specific information regarding each program, refer to 1885.040.00 Suspension of MAGI Benefits for Incarcerated Individuals and 0840.020.00 Suspending Incarcerated Participants.

To update information for MHN participants that are incarcerated, there will be an assigned unit to make changes in FAMIS and MEDES. All information regarding incarcerated household members received by staff at the Service Centers should be sent to MHNJailsandDOCReport@ip.sp.mo.gov.

Until future system changes are completed, it may appear that there was no change made to cases in FAMIS and MEDES when an individual is incarcerated, but eligibility is suspended and changes are made by MO HealthNet Division (MHD) to prohibit medical expenses to be paid for a suspended participant while  incarcerated.  Staff should review FAMIS comments on EUMEMROL and MEDES comments on the Head of Household’s Client Contact tab, under Notes. Comments should include at a minimum: when a participant became incarcerated, an expected release date, and when information was sent to MHD to suspend benefits.

Participants will be notified of actions taken on cases regarding suspended benefits: when benefits are suspended, when a redetermination is completed and a participant’s benefits are restored, and if a redetermination is completed and a new level of care is authorized. These notices will be sent as IM-33 Suspension and IM-80 Suspension.

If a redetermination and ex parte review is completed and the participant is no longer eligible for any program, a standard adverse action will be sent regarding the reason he/she is no longer eligible (example: no eligible child in the home, over the income limit for MO HealthNet for Families, or no longer meeting the disability requirements).

Changes were also made to update manual sections that referred to closing MHN cases or ending eligibility for MHN participants that are incarcerated. See updates below:

General Information Manual:

0105.040.30 MO HealthNet Application for Inmates in Custody of Department of Corrections

MHABD, December 1973 Eligibility Requirements Manual:

1020.005.00 Inmate of Public Institution

 

MAGI:

1885.015.00 REMOVING A PERSON

 

NECESSARY ACTION:

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

 

KE/cj/ams

IM-10 CLARIFICATION FOR UPDATING VETERANS ADMINISTRATION (VA) INCOME FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) VENDOR PARTICIPANTS

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  CLARIFICATION FOR UPDATING VETERANS ADMINISTRATION (VA) INCOME FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) VENDOR PARTICIPANTS

 

DISCUSSION:  

The purpose of this memorandum is to clarify policy regarding how VA income is treated when a participant enters a nursing home (vendor) facility.

When a participant enters a vendor facility, his/her VA will be reduced, usually to $90 per month.  This sometimes takes several months to be reduced.  The participant will normally not have to repay VA for the months between reporting the change and the actual reduction in benefits.  Do not reduce the VA payment until it has been verified the benefit has actually been reduced. 

Reducing the VA income budgeted prior to the actual reduction can result in an accumulation of resources, which can cause the participant to lose eligibility due to resources exceeding program limits.

NOTE:  These instructions are opposite the instructions given for SSI income reductions explained in IM-116 dated Aug 6, 2019.  The Social Security Administration requires SSI recipients to repay benefits received after the change in their living situation, VA normally does not.

If it is reported that a participant will be required to repay VA benefits received after entering a vendor facility, verify what months the participant will be required to repay.  Enter an adjustment to coverage using WIBCAs for the months that will be recouped by VA, using the reduced amount.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/vb

IM-09 INTRODUCTION OF THE IM-4 MO HEALTHNET FLYER

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INTRODUCTION OF THE IM-4 MO HEALTHNET FLYER

FORM REVISION #03

Flyer

 

DISCUSSION:

The purpose of this memorandum is to introduce the new Flyer.  This replaces the IM-4 MO HealthNet brochure, which is now obsolete.  The flyer contains information relevant to both Managed Care and Fee for Service participants.    

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Please destroy any previous brochures and immediately begin using this flyer.

 

KE/mc

IM-08 INTRODUCTION OF THE IM-4 VENDOR PLANNING AND IM-4 MO HEALTHNET FOR NURSING HOME CARE FLYER

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INTRODUCTION OF THE IM-4 VENDOR PLANNING AND IM-4 MO HEALTHNET FOR NURSING HOME CARE FLYERS                                  

FORM REVISION #02

IM-4 Vendor Planning Flyer

IM-4 MO HealthNet for Nursing Home Care Flyer

 

DISCUSSION:

The purpose of this memorandum is to introduce the new IM-4 Vendor Planning Flyer and IM-4 MO HealthNet for Nursing Home Care Flyer.  This replaces the IM-4 Vendor Planning brochure and IM-4 MO HealthNet for Nursing Home Care brochure, which are now obsolete.  These flyers contain information relevant to Nursing Home Care and Nursing Home Office Locations.      

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Please destroy any previous brochures and immediately begin using these flyers.

 

KE/mc

IM-07 INTRODUCTION OF THE IM-4 MEDICARE SAVINGS PROGRAM (MSP) FLYER

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INTRODUCTION OF THE IM-4 MEDICARE SAVINGS PROGRAM (MSP) FLYER

FORM REVISION #01

IM-4 Medicare Savings Program (MSP) Flyer            

 

DISCUSSION:

The purpose of this memorandum is to introduce the new IM-4 Medicare Savings Program (MSP) Flyer.  This replaces the IM-4 Qualified Medicare Beneficiaries (QMB) brochure and the Medicare Savings for Qualified Beneficiaries (QMB-A) brochure, which is now obsolete. This flyer contains information relevant to all Medicare Savings Programs.        

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Please destroy any previous brochures and immediately begin using this flyer.

 

KE/mc

IM-06 INTRODUCTION OF THE RELATIONSHIPS SECTION IN THE DECEMBER 1973 ELIGIBILITY REQUIREMENTS MANUAL

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INTRODUCTION OF THE RELATIONSHIPS SECTION IN THE DECEMBER 1973 ELIGIBILITY REQUIREMENTS MANUAL

MANUAL REVISION #06

1013.000.00

 

DISCUSSION:

The purpose of this memorandum is to introduce a policy addition to the December 1973 Eligibility Requirements manual, 1013.000.00 Relationships.

This section addresses observed and unobserved marriages in Missouri, defines certain relationships, and discusses relationship verification requirements.

Refer to this section when relationship is in question or affects eligibility for MO HealthNet for the Aged, Blind, and Disabled programs.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/ers