M E M O R A N D U M

IM-80  06/28/02  MEDICAL ASSISTANCE IMU5 SYSTEM CHANGES


SUBJECT:
MEDICAL ASSISTANCE IMU5 SYSTEM CHANGES
 
DISCUSSION:
Changes will be made to the IMU5 system effective July 8, 2002 to better identify current eligibility groups on Medical Assistance cases.  This requires additional codes in Field 13G2.  These new codes will recognize additional eligibility differences within the MA program.  Also, there will now be an age check for field 23 to ensure entry of the proper code for OAA, PTD, and Disabled child cases on Medical Assistance.

The new codes for FIELD 13G2 - Sanction Reason/Reason for TXIX Only are:
 

S SPENDDOWN -
Required if field 34 is greater than field 33.
H HCB or MISSOURI CHILDREN WITH DEVELOPMENTAL DISABILITIES-
(MACDD, see IM Memo 75 dated 12/26/95)
Required if field 33 is 952.00, edits if age not 63 or over on HCB cases.  Edits if age is 18 or over on MOCDD cases.
P PACE (St. Louis only) -
Required if field 33 is 952.00 and client is enrolled in PACE program.  Edits if age is less than 55.
O 1619 A/B -
Required if field 33 is 1840.00, no age edit.

The IMU5 instructions and IMU5 code sheet will be revised in the future to include the new codes.  Until then, add the new codes to the current IMU5 code sheet.

PACE:

Program of All - Inclusive Care for the Elderly (PACE), is an alternative service delivery system for adults, age 55 and older, who would otherwise require care in a nursing home.  To enroll in PACE, the individual must be assessed at a higher level of care than for vendor nursing home or HCB.  Services include primary care, restorative therapy, transportation, home health care, inpatient acute care, and even long term care in a nursing facility when home and community-base services are no longer appropriate.  Services are provided by a contracted provider in the PACE center, the home, or in the hospital, depending upon the needs of the individual.

Enrollment in the PACE program is voluntary.  The non-spenddown income limit is the same as the Home and Community Based Waiver limit.  If the income is over the HCB limit, regular spenddown budgeting and procedures are followed using the SSI maximum as the income limit.  Division of Assets rules apply for those with income below the HCB limit

To enroll in PACE, an individual must reside in the service delivery area of a PACE provider.  There currently is only one PACE provider in the state, Alexian Brothers.  Their service delivery area is limited to parts of St. Louis city and St. Louis county.  In the future, PACE may be expanded to other locations and providers.
NECESSARY ACTION:
  • Review this memorandum with appropriate staff.
  • Begin using the new codes July 8, 2002.
DS
Distribution 6
IM-79
[ 2002 Memorandums ]
IM-81