MO HealthNet for the Aged, Blind, and Disabled

0815.075.10.10 Participant Age 65 or Older Goes from NF or IMR to State Mental Hospital

IM-59 June 25, 2015

If a participant who is 65 year of age or older leaves the vendor situation and enters the State Hospital:

  1. Record the information at the Eligibility Unit Member Role/EUMEMROL/FM3Z screen in FAMIS.
  2. Contact the resource investigator at the facility to establish:
    1. whether the participant has been admitted to the General Medical and Surgical Unit or the Psychiatric Unit of this hospital.
    2. anticipated length of stay and/or possible date of release
    3. plans for placement and/or living arrangements upon release.
  3. If plans have been made for the participant’s release:
    1. set a priority to follow up on the participant’s planned date of release
    2. take necessary action, based on the participant’s living arrangements at the time of release from the State Hospital.
  4. If no plans have been made for the participant’s release, set a priority to follow up in 21 days.
    1. If, after 21 days, no plans have been made for the participant’s release and s/he is residing in the General Medical and Surgical Section of the State Hospital:
    2. record the information at the Eligibility Unit Member Role/EUMEMROL/FM3Z screen in FAMIS.
    3. Complete an MA spenddown/non-spenddown determination as if the claimant were in his/her own home.
  5. If, after 21 days, no plans have been made for the participant’s release and s/he is residing in the Psychiatric Section of the State Hospital, determine claimant’s eligibility for MHC level of care by obtaining the medical certification on the DA-124. (See Section 0815.030.00.)

If a participant, 65 years of age or older, leaves the NF or IMR for the State Mental Hospital and is certified by COMRU for MHC Level of Care:

  1. Record the change in the case record
  2. Enter the new level of care in the system
  3. Send the participant, legal guardian, relative and new facility a notification letter (IM-62).

If the participant who is 65 years of age or older is not medically certified by COMRU for MHC level of care but continues to meet all other Medical Assistance eligibility:

  1. Record information at the Eligibility Unit Member Role/EUMEMROL/FM3Z screen in FAMIS.
  2. Complete a MA spenddown/non-spenddown determination as if the participant were in his/her own home.