IM-92 INTRODUCING NEW FLYER FOR FSD UPLOAD PORTAL

FROM: KIM EVANS, DIRECTOR

SUBJECT: INTRODUCING NEW FLYER FOR FSD UPLOAD PORTAL

FORM REVISION #
IM-4 UPLOAD
IM-4 UPLOAD (SPANISH)

 

DISCUSSION:

The FSD Document Upload Portal (IM-4 Upload) flyer is now available for Family Support Division (FSD) staff to provide to participants. This flyer has step-by-step instructions to explain to participants how they can submit documents to FSD electronically at https://mydssupload.mo.gov/UploadPortal.

English and Spanish versions are available in the public and internal forms manuals. The new flyer has been ordered and a supply will be mailed to each office for use in Resource Centers and for community outreach.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Share with community partners.

 

 

 

KE/cj

 

IM-90 UPDATED MODIFIED ADJUSTED GROSS INCOME (MAGI) VERIFICATION PLAN

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATED MODIFIED ADJUSTED GROSS INCOME (MAGI) VERIFICATION PLAN

MANUAL REVISION #
1800.005.00

 

DISCUSSION:

The Missouri MAGI Verification Plan has been updated and posted online with an implementation date of April 3, 2023. The MAGI verification plan is required to outline policies, processes and data sources used to determine MAGI eligibility.

Federal Regulations, 42 CFR 435.945(j) and 457.380(j), require state Medicaid and CHIP agencies to develop and maintain a MAGI State Eligibility Verification Plan. States are required to submit their verification plan to Centers for Medicare and Medicaid Services (CMS) who posts the plan on Medicaid.gov.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/rc

IM-89 OCTOBER 2023 – QUARTERLY FORMS UPDATE

FROM: KIM EVANS, DIRECTOR

SUBJECT: OCTOBER 2023 – QUARTERLY FORMS UPDATE

 

DISCUSSION:

Income Maintenance forms and documents are reviewed and revised quarterly and as necessary. New forms and documents are created as required or requested.

All new and revised IM forms show a revision date of 10/2023, unless otherwise stated. Revised IM forms with older revisions dates are now obsolete. Family Support Division (FSD) will accept obsolete forms until 12/31/2023.

New and Revised Forms available in the public and internal forms manuals:

Form Number Form Name New or Revision: 
CARS-8 Request for Reduction of Claim Revision to update the Department of Social Services (DSS) logo.

CS-9

CS-9 (Spanish)

Changing Support Order Revision to update the DSS logo. This flyer has a 9/2023 revision date.

IM-1ABDS

IM-1ABDS (Large Print)

IM-1ABDS (Spanish)

Aged, Blind, and Disabled Supplement

Revision to update the DSS logo.

IM-1BC Breast and Cervical Cancer Treatment (BCCT) MO HealthNet Application Revision to update the DSS logo.

IM-1CC

IM-1CC (Large Print)

IM-1CC (Spanish)

Application for Child Care Subsidy Revision to update the DSS logo.

IM-1MAC

IM-1MAC(Spanish)

MO HealthNet Application Addendum: Request to Add Cash Benefits Revision to update the DSS logo.

IM-4MLIS

Multi-Language Interpreter Services Revision to update the DSS logo.

IM-6AR

IM-6AR (Large Print)

IM-6AR (Spanish)

Appointing an Authorized Representative Revision to update the DSS logo.

IM-31F

IM-31F (Spanish)

Applying for SNAP Benefits Revision to update the DSS logo.

IM-31V

Allowed Verification Revision to update the DSS logo.

IM-50AA

Information Notice – Regarding Action Taken on Your Case – Accuity Revision to update the DSS logo.

IM-50AFGE

Information Notice – Regarding Action Taken on Your Case – Accurint Revision to update the DSS logo.

IM-50E

Information Notice – Regarding Action Taken on Your Case – Equifax Revision to update the DSS logo.

IM-80A

Waiver of 10 Day Advance Notice Revision to update the DSS logo.

IM-85

Online Hearing Request Revision to update the DSS logo.

IM-86

Online Cancel Hearing Request Revision to update the DSS logo.

IM-114

Voluntary Repayment Authorization Form Revision to update the DSS logo.

IM-150

Suspending Incarcerated Participants Revision to update the DSS logo.

IM-151

Inpatient Coverage for Incarcerated Participants Revision to update the DSS logo.

IM-152

Restoring a Suspended Participant Change Report Revision to update the DSS logo.

IM-153

Applying for Incarcerated Participants in Department of Corrections Revision to update the DSS logo.

IM-161A

Withdrawal of Waiver of Administrative Disqualification Hearing Consent Agreement Revision to update the DSS logo.

IM-312VAV

Veterans Administration Verification (Vendor) Revision to change form number (previously FA-312) and update the DSS logo.

IM-312VAL

Veterans Administration Vendor Letter Revision to change form number (previously FA-313) and update the DSS logo.

IM-365P

Emergency MO HealthNet Care for Ineligible Aliens (EMCIA) Provider Request Revision to update the DSS logo.

IM-583CCO

Childcare Outreach flyer Revision to add a form number and update the DSS logo.

IM-583SO

IM-583SO (Spanish)

School Outreach flyer Revision to add a form number and update the DSS logo.

 

New and Revised Forms available only to FSD staff in the internal forms manual:

Form Number Form Name New or Revision:
IM-31Q Contact Requested for Quality Control Review Revision to update terminology and rename form.
Instructions related to this form are now obsolete.

IM-80TMH

IM-80TMH (Spanish)

MO HealthNet for Families Adverse Action Notice Revision to convert to fillable PDF.
IM-311Q Quality Control Referral to Family Support Division Revision to update terminology and rename form.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Begin using revised forms immediately.
  • Discard and recycle blank obsolete forms.
  • Share with community partners.

 

 

 

KE/cj

IM-88 UPDATES TO IIVE STORAGE AND USE

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATES TO IIVE STORAGE AND USE

MANUAL REVISION #
0110.025.10
1141.010.10
1805.020.05.05
1805.030.20.10

 

DISCUSSION:

Policy is updated to match current processes and clarify that copies of IIVEs cannot be stored in the case record. Policy manual updates are summarized below:

0110.025.10 Unearned Income in the General Information manual:

  • Review IIVE to verify Social Security and/or SSI for all participants.

1805.020.05.05 Documents to Verify Citizenship for MO HealthNet:

  • Note: Do NOT file IIVE screens in case record.

1805.030.20.10 Income Excluded Under MAGI in the Family Healthcare manual:

  • Enter all sources of income into the eligibility system including excluded income.

1141.010.10 Incarceration Matches in the SNAP manual:

  • Review IIVE for a TPQY Prisoner Response at SNAP application. The TPQY Prison Response provides the following:
    • Prisoner’s name, identifying information and status code
      • 02 – Non-pay inmate of public institution
      • 22 – Non-pay Inmate of correction institution
    • Confinement and release date,
    • Facility name and contact information,
    • Reporter and reported date

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/se

IM-85 REVISED INFORMATIONAL DOCUMENTS FOR DEPARTMENT OF SOCIAL SERVICES (DSS) PROGRAMS

FROM: KIM EVANS, DIRECTOR

SUBJECT: REVISED INFORMATIONAL DOCUMENTS FOR DEPARTMENT OF SOCIAL SERVICES (DSS) PROGRAMS

 

DISCUSSION:

DSS has revised flyers and brochures for numerous programs that are administered by the Family Support Division (FSD) or may be beneficial for FSD participants.

Revised flyers and brochures now utilize the new DSS logo and show a 7/2023 revision date.

FSD team members should utilize and distribute the revised flyers and brochures which are all IM-4 forms and can be found in the public and internal forms manuals.

Note: FSD staff should continue to use existing documents, but utilize revised documents when current office supply runs out. Information provided on the documents has not changed.

 

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Begin using the new flyers and brochures when existing office supply runs out.

 

 

 

KE/cj

IM-82 UPDATING INCIDENT RESPONSE FOR UNAUTHORIZED IRS DISCLOSURES IN THE GENERAL INFORMATION MANUAL

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATING INCIDENT RESPONSE FOR UNAUTHORIZED IRS DISCLOSURES IN THE GENERAL INFORMATION MANUAL

MANUAL REVISION #
0165.000.05

 

DISCUSSION:

Effective August 21, 2023, federal, state, and local agency partners will report improper inspection or disclosure of federal tax information (FTI) including data breaches, data incidents, and information spillage to the Internal Revenue Service (IRS) Office of Safeguards only. Agencies are no longer required to report improper inspections or disclosures to the Treasury Inspector General for Tax Administration (TIGTA).

General Information Manual section 0165.000.05 INCIDENT RESPONSE FOR UNAUTHORIZED IRS DISCLOSURES is updated to reflect this change.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/pm

IM-80 UPDATE TO MO HEALTHNET (MHN) APPLICATION AND RELATED MHN FORMS

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATE TO MO HEALTHNET (MHN) APPLICATION AND RELATED MHN FORMS

FORM REVISION #

IM-1ADP IM-1SSL (SPANISH)
IM-1ADP (SPANISH) IM-1SSL (LARGE PRINT)
IM-1OSR IM-1SSL (DARI)
IM-1SSL IM-1SSL (PASHTO)

 

DISCUSSION:

Revisions to the Application for Health Coverage & Help Paying Costs (IM-1SSL) requested through a state plan amendment (SPA) have been approved by the Centers for Medicare and Medicaid Services (CMS).

The revised IM-1SSL allows participants to apply for MHN coverage and provide information so that applications can be processed by Family Support Division (FSD) quickly, and often without requiring additional contact or information from the participant.

Application improvements include:

  • Clarifying instructions.
  • Adding demographic questions to capture more accurate reporting data.
  • Improving ease of reading and understanding of eligibility questions.
  • Removing questions that do not impact eligibility.
  • Adding questions regarding MO HealthNet Adult Expansion Group eligibility.
  • Updating Rights & Responsibilities.
  • Adding a new Appendix A (optional) form to capture prior quarter income information.
  • Aligning the Appendix C (optional) form with the Family Support Division Appointing an Authorized Representative (IM-6AR) form.

The revised IM-1SSL is available in English, Spanish, Dari, Pashto, and large print.

Other forms are used with the IM-1SSL and were revised to match formatting and other changes made to the IM-1SSL:

  • Ongoing Coverage Signature Request (IM-1OSR) was revised and has a new form number. This was previously form number, IM-1SSL Ongoing.
  • MO HealthNet Add a Person (IM-1ADP) was revised and renamed. As the IM-1SSL only has room for two household members, this form is used to include additional people on an initial IM-1SSL application. The IM-1ADP may also be used to request to add a new household member to an active MO HealthNet case. IM-1ADP (Spanish) was also revised.

All revised forms have a 9/2023 revision date. All other versions of these forms are now obsolete. FSD will accept obsolete forms until 12/31/23.

Forms are available in the public forms manual and the internal forms manual.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Immediately begin using forms with the 9/2023 revision date.
  • Share with community partners.

 

 

 

KE/cj

 

IM-79 SEPTEMBER 2023 – FORMS UPDATE

FROM: KIM EVANS, DIRECTOR

SUBJECT: SEPTEMBER 2023 – FORMS UPDATE

 

DISCUSSION:

Income Maintenance (IM) forms and documents are reviewed and revised periodically, as necessary. New forms and documents are created as required or requested.

Note: Supplemental Nutrition Assistance Program (SNAP) replacement benefit forms are updated due to new replacement policies and procedures related to electronically stolen benefits. Refer to New and Revised internal forms for revisions to IM-112 and new form IM-112RB.

All new and revised IM forms show a revision date of 9/2023; previous versions of these forms with other revision dates are now obsolete. Family Support Division (FSD) will accept obsolete forms until 12/31/2023.

New and Revised Forms available in the public and internal forms manuals:

Form Number  Form Name New or Revision:
FSD-4 Customer Service Revision to add DSS logo and electronic signature attestation.
FSD-4 (Spanish) Servicio Al Cliente New form translating the FS-4 to Spanish.
IM-100RWC Request to Withdraw or Close Revision to add new form number, AEG program option, and non-discrimination statement.
IM-100RWC Solicitud de Suspension o Cierre Revision to IM-100RWC Spanish.
IM-110 Replacement Request Revision to add non-discrimination statement and remove office use only section.
IM-110 (Spanish) Solicitud de Substitucion New form translating the IM-110 to Spanish.
IM-145  Change Report Revision to add new question regarding pregnant household members and additional instructions for active MO HealthNet (MHN) participants requesting a different MHN program.
IM-145 (Spanish) Informe de Cambios New form translating the IM-145 to Spanish.

 

New and Revised Forms available only to FSD staff in the internal forms manual:

Form Number Form Name New or Revision: 
IM-112 Action Taken On Your Supplemental Nutrition Assistance Program (SNAP) Case Revision to remove replacement benefit language and add non-discrimination statement.
IM-112 (Spanish) Acción Implementada en su Caso del Programa de Asistencia Nutricional Suplementaria (SNAP) Revision to IM-112 (Spanish).
IM-112RB Action Taken on Your Request for Replacement Benefits New form to notify participants who have requested replacement benefits due to household misfortune, stolen EBT card, or electronically stolen benefits.
IM-112RB (Spanish) Medida Adoptada en su Solicitud de Sustitucion de Beneficios New form translating IM-112RB to Spanish.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Begin using revised forms immediately.
  • Discard and recycle blank obsolete forms.
  • Share with community partners.

 

 

 

KE/cj

IM-78 INTRODUCING ONLINE APPLICATION FOR MEDICARE SAVINGS PROGRAMS (MSP) AND REVISIONS TO THE APPLICATION FORM

FROM: KIM EVANS, DIRECTOR

SUBJECT: INTRODUCING ONLINE APPLICATION FOR MEDICARE SAVINGS PROGRAMS (MSP) AND REVISIONS TO THE APPLICATION FORM

FORM REVISION #
IM-1MSP
IM-1MSP (SPANISH)
IM-1MSP (LARGE PRINT)

 

DISCUSSION:

The MSP application (IM-1MSP) can now be completed and submitted online. MSP’s are available for certain individuals to get assistance with paying their Medicare premium and for some participants to also receiving assistance with coinsurance and deductibles.

Additional information about MSP’s and the link to the online application is located on the Department of Social Services webpage, Programs for Seniors & Individuals with Disabilities.

Note: The IM-1MSP is NOT an application for MO HealthNet (MHN). A participant can apply for MSP and MHN or MHN only online, by calling 855-373-9994, or by completing an Application for Health Care & Help Paying Costs (IM-1SSL).

The IM-1MSP is also available as a paper form in local offices and as a PDF that participants, community agencies, and advocates can access online and print.

The IM-1MSP is a stand-alone application and must be registered and processed without requiring the Application for Health Coverage & Help Paying Costs (IM-1SSL) or the Aged, Blind, and Disabled Supplement (IM-1ABDS). When registering or processing an IM-1MSP, always explore prior quarter coverage.

Revisions were made to the IM-1MSP to add preferences for opting out of automated calls and texts and some minor formatting changes to add clarification.

The revised IM-1MSP is available in English, Spanish, and large print with a revision date of 7/2023. All other versions of these applications should be removed and only the 7/2023 version should be distributed by FSD staff. FSD will accept the 1/2023 version until 12/31/23.

The applications are available in the public forms manual and internal forms manual.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Distribute 7/2023 revision as requested.
  • Remove obsolete forms (any other revisions date).
  • Share with community partners.

KE/cj

 

IM-76 DETERMINING CORRECT APPLICATION DATES FOR ALL PROGRAMS

FROM: KIM EVANS, DIRECTOR

SUBJECT: DETERMINING CORRECT APPLICATION DATES FOR ALL PROGRAMS

 

DISCUSSION:

In a recent Program Access Review (PAR), the Food and Nutrition Service (FNS) found Supplemental Nutrition Assistance Program (SNAP) applications registered with incorrect application dates. This memo provides clarification in determining correct application dates for all programs.

Incorrect application dates can result in:

  • benefit payment errors,
  • incorrect eligibility begin dates,
  • improper processing timeframes, and
  • increases to the agency’s error rates for accuracy and timeliness, potentially impacting federal funding.

Application dates must be carefully evaluated during both registration and processing to ensure that the correct date is used.

Application Date vs Agency Received Date

Application dates are determined by the date and time that an application with the minimum required information is received by the agency. (See policy for program-specific requirements.)

  • Applications received before 5:00 p.m. Monday – Friday are considered as received on that date.
  • Applications received outside of business hours (after 5:00 p.m., on a weekend, or on a holiday) are considered as received on the next business day.

Note: MO HealthNet (MHN) applications received by phone or online, including applications from the Federally Facilitated Marketplace (FFM), are an exception. Regardless of the time of day or day of the week received, online and FFM applications are dated the day the application was successfully submitted and phone applications are dated the day that the telephonic signature was captured.

Identifying Date/Time of Receipt

With the exception of applications received through the Upload Portal, applications must be opened and viewed in order to see the received date.

Received date location examples:

  • Upload Portal: Added On date in the Electronic Content Management system (ECM)

  • Online/AEM (not MHN): Submitted Date Time on bottom of each page

 

  • Mail: Date stamp

  • Resource Center: Date stamp

  • Fax: Receiving information on bottom or side of page

  • MHN – Online, phone, FFM: MHN Application Case tab

 

When Multiple Applications are Received:

If more than one application is received for the same program, the first application received is the application to be registered.

Example: Two Temporary Assistance applications are found in the ECM, dated 9/12 and 9/14. The eligibility system shows that neither has yet been processed.

    • The 9/12 application is registered but both applications are reviewed during processing.

Registering the Correct Applicant:

Care must be taken to ensure that applications are registered under the correct applicant. Applications registered under an incorrect head of household cause delays for the applicant and could result in a breach of confidentiality for either party.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Review content and resources in the Application Registration row of FAMIS Resources.

 

 

 

KE/mn