MO HealthNet for the Aged, Blind, and Disabled

IM-59 June 25, 2015

If entering an Institution for the Intellectually Disabled (IMR), determine if the participant is medically certified for the IMR level of care (See Section 0815.030.00.)

• If the claimant is medically certified, make the appropriate change in IMU5.
• If the claimant is not medically certified:
  1. Send an IM-80 (Advance Notice of Adverse Action) advising the participant that s/he is no longer eligible for vendor payments effective with the date s/he left the previous vendor facility.
  2. Follow procedures in Section 0815.070.10 Vendor Facility to Private Home, not receiving HCB to determine eligibility for Medical Assistance spenddown/non-spenddown coverage.