Medical re-certifications for NF, MHC and IMR level of care are not completed by Eligibility Specialists. These re-certifications are done by the Utilization Review Committees, as established through the Department of Health and Senior Services, Division of Senior and Disability Services.
When a change in level of care needs to be made as a result of a utilization review, the Division of Senior and Disability Services will notify the Eligibility Specialist of the change.
As a result of a utilization review, if COMRU sends a DA-125 to the Eligibility Specialist indicating that the participant is no longer eligible for the level of care s/he is receiving, follow the procedures in 0815.070.00 Claimant Leaves the Vendor Facility to determine eligibility for non-vendor MHABD.
- Update the entry on the Facility and Placement Information Details screen (FACPLACE or FMJ4) in the DA-124A/B Level of Care field.
- Enter a comment from the Facility and Placement Information Details screen (FACPLACE or FMJ4) noting the date the DA-125 was received and describing the verification of the change.
- Enter a comment from the Eligibility Unit Member Role (EUMEMROL or FM3Z) screen describing the adjustment.
- Complete the eligibility determination (EDRES) in FAMIS and authorize the adverse action to change the level of care or close the case.
NOTE: Always review the Budget Summary screen prior to authorizing a case action in FAMIS. From the MHABD Action Authorization screen (FMD9) use F16= MHABD to view the MHABD Assistance Group Summary screen. Select the coverage type and use F16= AGBUDSUMM to view the Adult MO HealthNet Budget Summary screen press F17=INCSUM to view the Income Summary Detail screen and F18=EXPSUM to view the Expense Summary Detail screen to ensure all countable income and expenses are included in the budget.