MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual – Table of Contents

0815.020.10 Claimant Not Medically Certified

IM-#33, March 29, 2012

If COMRU determines that the applicant or participant is not medically certified for NF, IMR or MHC level of care, (LOC = NONE):

  1. Record a comment on Eligibility Unit Member Role screen (EUMEMROL) to explain the individual’s ineligibility for vendor.
  2. File a copy of the DA-124 Inquiry Report screen in the case record.
  3. Enter the COMRU LOC determination on the Facility and Placement Information Details screen (FACPLACE or FMJ4) DA-124A/B Level of Care field, and record a comment.
  4. Complete the eligibility determination (EDRES) for MHABD Spend down or Non-Spend down.
  5. Authorize the actions to approve or reject the MHABD request.

If COMRU determines that the applicant or participant is not medically certified for NF, IMR or MHC level of care (LOC=SNC):

  1. Record a comment on Eligibility Unit Member Role screen (EUMEMROL) to explain the individual’s ineligibility for vendor.
  2. File a copy of the DA-124 Inquiry Report screen in the case record.
  3. Explore eligibility for a SNC cash grant if the claimant is in or will be moving to a non-MO HealthNet certified bed by updating entries on the Facility and Placement Information Details screen (FACPLACE or FMJ4) to facility type CGZ and type of bed SNF. Refer to the FAMIS User Guide Facility and Placement Information Details. Determine eligibility for SNC from the date of the request for MHABD vendor. Determine if the individual is qualified for Supplemental Nursing Care, using Section 0600.000.00.
  4. If ineligible for a SNC cash grant, complete the eligibility determination (EDRES) for MHABD Spend down or Non-spend down.
  5. Authorize the actions to approve or reject the MHABD request.

    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.