MEMORANDUM

DISCUSSION:

Income Maintenance Memorandum IM-# 112 dated 11/28/07 introduced the pilot authorized by Senate Bill 577 (2007) to evaluate and study the expansion of the Presumptive Eligibility (PE) for Children program to include as qualified entities Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Following the evaluation and study, the definition of qualified entity for the purpose of the PE program now includes both FQHCs and RHCs. The change in definition of qualified entity may potentially increase the numbers of children determined to qualify for PE and may increase applications for Family Healthcare programs. Due to the potential increase in activities, changes are being made in how presumptive eligibility determinations will be entered.

Effective immediately, all PE determinations will now be entered in IMU5 by local Family Support Division (FSD) offices. The MO HealthNet Service Center will continue to be the contact for qualified entities to assign DCNs and screen PE applicants to determine if PE was received within the past 12 months.

NOTE: Eligibility determinations for PE for Children can be made by qualified entities only, not FSD staff. However, qualified entities do not have access to IMU5 and cannot enter the PE approval. FSD staff must do the data entry required to enter the approval in IMU5.

This memorandum explains:

• MO HealthNet Service Center Responsibilities;
• Family Support Division County Office Responsibilities;
• Courtesy Applications; and
• Requests to be a Qualified Entity.

The Presumptive Eligibility for Children manual is updated.

MO HealthNet Service Center Responsibilities

Qualified entities contact the MO HealthNet Service Center for DCNs. MO HealthNet Service Center staff must carefully screen the applicant and provide a DCN if known, or assign a DCN if the applicant is not known to FSD.

MO HealthNet Service Center staff must also review IPAR and MXIX or IXIX screens for persons with DCNs to determine if the PE applicant received PE in the past 12 months. PE may only be granted one time in a 12 month period. If the applicant received PE in the past 12 months, the MO HealthNet Service Center staff informs the provider that the applicant is not PE eligible as he or she received PE in the past 12 months.

PE for Children is indicated by Case ID or type of assistance (TOA) code of PC (Presumptive Eligibility for Children) on IPAR, MXIX and IXIX. The IPAR screen shows a case status of active or closed along with a closing date. The MXIX and IXIX screens show the case status as well as start and stop dates. If the PE case has been active in the 12 months prior to the screening date, the applicant is not eligible for presumptive eligibility.

FSD County Office Responsibilities

Although qualified entities are instructed to contact the MO HealthNet Service Center for DCNs, if the qualified entity contacts the local FSD Office, a designated staff member at the local FSD office should screen for past PE eligibility and assign DCNs for the applicant(s) following the same procedures given above for MO HealthNet Service Center staff.

The FSD Office must contact local qualified entities to develop a procedure for the qualified entity to provide a daily exchange of Presumptive Eligibility Determination (PC-1) forms, Presumptive Eligibility MO HealthNet Authorization (PC-2) forms, and MO HealthNet Application (IM1UA) forms. The local FSD Office may designate a member of its staff to be a liaison with the qualified entity in the county. The responsibilities of the liaison are to provide technical assistance to the qualified entity, serve as a contact for the qualified entity on specific cases, and contact the qualified entity when made aware of any problems.

FQHCs and RHCs that signed agreements to determine PE have been added to the Presumptive Eligibility Qualified Entity List available under the Resource Link on FSD's MO HealthNet Intranet site at dssweb/fsd

FSD county offices must develop procedures to ensure the faxed or submitted PC-1 and PC-2 is assigned to the appropriate eligibility specialist the same day it is received. The eligibility specialist must enter the PE determination into the Legacy system via IMU5 transaction the same day it is received.

Entering Presumptive Eligibility (PE) for Children Determinations

Presumptive Eligibility (PE) for Children determinations are entered in the Legacy system through IAPP and IMU5 transactions.

Applicants for PE that are determined to be presumptively eligible, must have their approval for PE entered into the Legacy system via an IMU5 transaction on the date the qualified entity notifies FSD of the determination. Maintain approval PC-1 forms in the MO HealthNet case record. The following steps are followed to enter a PE for Children approval:

1. Register a Presumptive Eligibility (PE) for Children application via IAPP in the caretaker's name. This will be a P type of assistance with a C instead of sequence number. Example PCxxxxxxxx.
2. Enter the IMU5 transaction for Presumptive Eligibility (PE) for Children:

   Field 5 - Case action (use IMU5 code sheet)

   Field 6 - Reason open (use IMU5 code sheet)

   Field 13e - date of eligibility for eligible child(ren)

   Field 13G - level of care "T" for eligible child(ren)

   Field 15b - Enter the provider number. This must be a valid provider number for the system to accept the entry.

Applicants for PE that are determined to be presumptively ineligible, must also have their application and denial entered via IMU5. Maintain denial PC-1 forms in the MO HealthNet case record. PE applicants do not have hearing rights regarding presumptive eligibility decisions.

The system will only accept the following denial reasons in Field 7 of IMU5:

• 01 income exceeds limits
• 38 Non-resident
• 75 Received within last 12 months

NOTE: A PE for Children application can be taken and approved on participants with pending MO HealthNet applications.

Processing MO HealthNet Applications Received

When the IM1UA is received, register the application in FAMIS following normal application procedures within one working day of the day it is received in the county office.

If the Presumptive Eligibility (PE) for Children eligibility unit (EU) is determined to be ineligible for MO HealthNet for Families or MO HealthNet for Kids (MHF/MHK), the system will automatically close the PE effective the date the rejection is entered. The participant does not have hearing rights on the discontinuance of Presumptive Eligibility (PE) for Children. They have normal hearing rights on MHF/MHK application determinations.

Training for Qualified Entities

FSD is responsible for providing training when new contracted qualified entities sign agreements to begin processing applications for Presumptive Eligibility (PE) for Children. Once trained the FQHC/RHC trained staff may provide this training to other members of their staff. A qualified entity may also request and receive training from the liaison at the local FSD county office. A training packet is available at: dssweb/fsd

NOTE: Once trained the FQHC/RHC trained staff may provide this training to other members of their staff, However, if the qualified entity has made errors in determining eligibility, the date on the authorization notice is incorrect, or other problems are identified, the FSD office should immediately discuss these problems with the qualified entity designated staff.

Courtesy Applications

FQHCs and RHCs serve persons across the state. Applications may be received at the local FSD county office that are not for residents of that county. These applications should be handled as courtesy applications. Enter the Presumptive Eligibility (PE) for Children application on the day the PC-1 and PC-2 are received. Register the IM-1UA application and follow courtesy application procedures. Refer to FAMIS user guide Courtesy Applications for assistance with courtesy application procedures

Requests to be a Qualified Entity

If contacted by a medical facility regarding becoming a PE for Children qualified entity, please refer all inquiries to Jennifer Heimericks, Program Development Specialist in the Administrative Unit, at Jennifer.K.Heimericks@dss.mo.gov

NECESSARY ACTION:

• Begin using the outlined procedures immediately.

JH/TM