0810.000.00 MO HealthNet Coverage

IM-55 June 2, 2023

When Family Support Division (FSD) receives the request for Respite Care, FSD staff will:

1. Verify the individual’s current Title XIX status:
   1. If the individual is currently Title XIX eligible, staff will notify Division of Senior and Disability Services (DSDS) staff of current Title XIX eligibility dates and the request for Respite Care, by using the Referral for Services (IM-54) form or by verbal confirmation.
   2. If the individual is not currently Title XIX eligible, FSD staff will:
      • Take an MO HealthNet (MHN) application.
      • If the request was from a source other than DSDS, FSD staff will notify DSDS staff of the request for Respite Care Services by sending an IM-54, indicating Title XIX eligibility determination in process and Respite Care Services requested.
2. Complete the eligibility determination (a DA124A/B is NOT required); and
3. Notify DSDS staff of Title XIX eligibility or ineligibility. On approvals, beginning and ending Title XIX dates must be reported to DSDS staff, for Title XIX billing purposes. The IM-54 or a copy of the approval or rejection letter may be used as the vehicle for notifying DSDS staff. FSD staff will keep DSDS staff informed of any change in circumstance affecting the participant’s Title XIX eligibility, on an ongoing basis, including the results of annual renewals and any changes in Title XIX eligibility dates.