IM-96      09/21/07

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
P.O. BOX 2320
JEFFERSON CITY, MISSOURI

TO:	ALL COUNTY OFFICES
FROM:	JANEL R. LUCK, DIRECTOR
SUBJECT:	IMU5 CODE SHEET FORMS MANUAL REVISION #11

DISCUSSION:

The IMU5 Code Sheet is revised to reflect the changes introduced in Memorandum IM-77, dated 8/28/07 for the Ticket to Work Health Assurance (TWHA) Program. It has been updated to include the following changes and additions:

Field 23 - MA-NC Eligibility Criteria

T - TWHA Basic Coverage Group

I - TWHA Medically Improved Group

Field 13G2 - SANCTION REASON/REASON FOR T-XIX ONLY

The Following are for LOC “T” Only

1. TWHA Basic Coverage Group, premium
2. TWHA Basic Coverage Group, non-premium
3. TWHA Medically Improved Group, premium
4. TWHA Medically Improved Group, non-premium

This code sheet is available on the Intranet only. To access the code sheet from the FSD Intranet, select Medicaid under the Programs section. Select the Tools/Guides link. Select IMU5 Codesheet. Finally, select the link for IMU5 Code Sheet - Revised 08/2007.

NECESSARY ACTION:

• Begin using the IMU5 Code Sheet dated 8/07 effective immediately.

ER