0815.075.00 Claimant Moves From One Type of Vendor Facility to Another

IM-120 November 18, 2021; IM-59 June 25, 2015

If a participant who is 65 year of age or older leaves the Nursing Facility (NF) or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) and enters the State Hospital, the facility sends FSD a Facility Notification Information Sheet (FNIS) of admission. FSD staff will:

1. Record the information in the eligibility system on the FACPLACE screen (pend for verification)
2. Determine claimant’s eligibility for Mental Health Center (MHC) level of care by obtaining the medical certification on the DA-124 (see 0815.030.00 Vendor Surplus Computation)

If a participant, 65 years of age or older, leaves the NF or ICF/IID for the State Mental Hospital and is certified by the Central Office Medical Review Unit (COMRU) for MHC Level of Care:

1. Record the information in the eligibility system on the FACPLACE screen and explore Vendor coverage
2. Enter the new level of care in the system
3. The eligibility system sends the participant, legal guardian, and relative an FA-460 and a new facility notification letter FA-465)

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 MO HealthNet for the Aged, Blind, and Disabled (MHABD) eligibility (see 0815.020.10 Participant Not Medically Certified):

1. Record information in the eligibility system
2. Complete an MHABD Spend Down/Non-Spend Down determination as if the participant were in his/her own home.