MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual

0815.055.00 INPATIENT PSYCHIATRIC SERVICES FOR INDIVIDUALS UNDER 21 YEARS OF AGE

IM-#33, March 29, 2012

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:

  1. Have the applicant (if age 18 to 21), parent, legal guardian, or responsible relative complete and sign the application.
  2. Verify the claimant’s age and record the verification on the Birth/Death Information (BIRTH or FMAQ) screen in FAMIS
  3. 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).
  4. 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.
  5. 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.
  6. Complete the surplus computation.