0630.000.00 REINVESTIGATIONS AND INTERIM ACTIVITIES

0630.015.15 SNC TRANSFERS TO A VENDOR NF

IM-#30 April 4, 2008

When an active SNC participant enters a vendor nursing facility, (or moves to a MO HealthNet certified bed in a facility that has both vendor and non-vendor beds) refer to the policy in the Medical Assistance chapter for guidance in determining eligibility and transferring a case to vendor payments. Take action to stop the SNC cash grant, but continue MO HealthNet under SNC while vendor eligibility is being determined. Count any SNC payment the participant receives as income in the surplus computation.

EXAMPLE: An SNC participant receives a $200 SNC grant and $700 RSDI. He enters a MO HealthNet certified nursing facility on 9/23. The medical certification (DA-124) approving NF level of care is received 10/25. Since the November SNC payroll closing date has passed, the November SNC check should be pulled. The eligibility specialist would include the SNC check in the October surplus computation and base the November on-going surplus on the participant’s RSDI.

If the Department of Health and Senior Services returns the Initial Assessment (DA-124) and indicates the participant is NOT medically certified:

  1. File a copy of the Initial Assessment (DA-124) in the case record.
  2. Follow the procedures in Section 0630.020.05 to determine the participant’s eligibility for non-vendor MO HealthNet.
  3. Notify the participant of the ineligibility for vendor payments, but that they could continue to receive the SNC grant if they transfer to a non-MO HealthNet certified bed.

NOTE: When an active MO HealthNet/Supplemental Nursing Care participant changes to a vendor level of care or changes facilities, a reinvestigation is not required to complete the action. Make the appropriate changes to the case and if a reinvestigation is due, complete that as a separate action.