Individuals under the age of 21 receiving psychiatric treatment as inpatients in a state or privately owned psychiatric institution or facility may qualify for vendor MHC level of care coverage. Certain special procedures exist for these individuals.
Note: An individual who is certified for MHC level of care when s/he is under the age of 21 may continue to qualify for vendor payment as MHC level of care until age 22.
Requirements for the facility:
- The facility must be accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).
- The facility must be certified to participate in the Missouri MO HealthNet program.
- The list of facilities which meet these criteria is included in Appendix C.
To process an application for inpatient psychiatric services for an individual under the age of 21:
- Have the applicant (if age 18 to 21), parent, legal guardian, or responsible relative complete and sign the application.
- Verify the claimant’s age and record the verification on the Birth/Death Information (BIRTH or FMAQ) screen in FAMIS
- If a disability or blindness must be established, submit medical information to MRT (IM-61& IM-61B) and/or to State Supervising Ophthalmologist ((M-68 & IM-69).
- Obtain a Certification of Need for Psychiatric Services (IM-71) from the facility. The form must be signed by a physician. Do not approve benefits until the IM-71 is signed and filed in the claimant’s case record. The Certification of Need verifies that:
- the required services are not available on an outpatient basis;
- the claimant is currently being treated on an inpatient basis; and
- the required services can reasonably be expected to improve the claimant’s condition or prevent further regression.
- Determine eligibility on all factors for prior quarter, if requested, and on-going eligibility. To be eligible for inpatient psychiatric services in the prior quarter, the IM-71 must have been completed and signed before the approval date for psychiatric services.
- Complete the surplus computation.