0815.000.00 Vendor Eligibility

0815.015.10 Tracking MHABD to Vendor Requests

IM-33 March 29, 2012; IM-153 December 20, 2005

Timeliness of the decision for vendor requests is critical. The participant, the nursing facility, and family members are relying on a prompt decision.

Because no application request is entered in FAMIS for an active MHABD participant who enters a nursing facility, institution for the developmentally disabled or state mental hospital, the vendor request is not tracked by FAMIS. The Eligibility Specialist is required to monitor the case to ensure that all actions are completed promptly.

See 0815.015.00 Participant Currently Receiving MO HealthNet Enters a Vendor Placement.

Within two working days of notification of the placement in a facility the Eligibility Specialist must:

  • Change the individual’s address
  • Document the reported change in living arrangements on the comment screen accessed from the Eligibility Unit Member Role screen (EUMEMROL or FM3Z)
  • Enter the facility details and placement details on the Facility Placement and Information Details screen (FACPLACE or FMJ4) and, if needed, complete an eligibility determination and authorize the action to stop SNC cash payments; and
  • Set Reminders in FAMIS to track pending actions:
    • no more than 30 days from the date of entry into the facility to determine if the DA-124 certification is available on the DA-124 Inquiry Report screen and if the vendor eligibility determination can be completed, if not
    • at 10 days intervals until the information is available and the eligibility determination for vendor benefits is completed