0815.000.00 Vendor Eligibility

IM-120 November 18, 2021; IM-59 June 25, 2015

If entering an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), determine if the participant is medically certified for the ICF/IID level of care (see 0815.030.00 Vendor Surplus Computation):

• If the claimant is medically certified, make the appropriate change in the eligibility system on screen FACPLACE (FMJ5).
• If the claimant is not medically certified:
  1. The eligibility system will send an Advance Notice of Adverse Action advising the participant that s/he is no longer eligible for vendor payments effective with the date s/he left the previous vendor facility.
  2. Follow procedures in 0815.070.10 Vendor Facility to Private Home, Not Receiving HCB to determine eligibility for MO HealthNet for the Aged, Blind, and Disabled (MHABD) Spend Down/Non-Spend Down coverage.