MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to discuss the correct procedure in exploring eligibility for vendor payments when a participant currently receiving MHABD enters a MO HealthNet certified bed (T19) in a nursing facility (SNF), an institution for the mentally retarded (IMR), or a state mental hospital (MHC) and to review the processing time frames when an application is received from an individual residing in a certified bed (T19) in a nursing facility (SNF), an institution for the mentally retarded (IMR), or a state mental hospital (MHC).

When an individual enters a MO HealthNet certified bed (T19) in a nursing facility (SNF), an institution for the mentally retarded (IMR), or a state mental hospital (MHC), payments may be made directly to the facility that is providing care to the individual.

To be eligible for vendor benefits, the individual must:

• Occupy a Medicaid certified bed, also known as a Title XIX bed (T19 in FAMIS).
• Have received a preadmission screening.
• Be certified as needing the level of care the facility provides.

Participant is Not Active MHABD

For persons not receiving any type of assistance, a MO HealthNet Adult (MHABD) application would be taken and eligibility for Vendor would be established based on MHABD requirements. Applications are expected to be processed without delay unless there are unusual or extreme circumstances. Approve or deny the application within 45 days (if based on OAA), or 90 days (if using PTD or AB criteria) from the date of application.

Participant is Active MHABD

When a MO HealthNet participant enters a nursing facility, eligibility for vendor benefits must be explored. Vendor benefits must be authorized as soon as all necessary information, including a level of care determination, is received. Complete the following steps:

• Change the individual's address.
  • Single Person The new facility address is added on the Supercase Address/Supercase Transfer (FMOA or ADDRESS) screen along with the new Living Arrangement code (NH).
  • Couple Case Community spouse is receiving benefits or is the payee for an active EU receiving benefits and the community spouse remains at the residential address. Add the institutionalized spouse's new facility address on the Person Detail (PRSNDTL) screen.
  • Couple Case Community spouse is not receiving benefits. The case is located in the institutionalized spouse’s county of residence. The new facility address is added on the Supercase Address/Supercase Transfer (FMOA or ADDRESS) screen along with the new Living Arrangement code (NH). Add the community spouse's address on the Person Detail (PRSNDTL) screen.

  On the comment screen accessed from the Eligibility Unit Member Role screen (EUMEMROL) document the reported change in living arrangements. This update should be made within two working days of notification of the placement.

• Enter the facility information on Facility Placement and Information Details (FMJ4 or FACPLACE) screen within two working days of notification of the placement. Comments must be entered from this screen to document verification of the placement. Refer to the FAMIS user guide Facility and Placement Information Details.
• For a couple-case, complete a Division of Assets. Refer to the Division of Assets user guide for step by step instructions on entering a Division of Assets in FAMIS.
• For individuals with dependents, explore any allotments to the community spouse and other dependents in the home or outside the home. Refer to the Allotment Information Screen user guide for more information on entering allotments in FAMIS.
• Complete an Eligibility Determination (EDRES) and authorize the change in FAMIS as soon as:
  • the participant is medically certified for NF, IMR, or MHC level of care cases;
  • pre-admission screening requirements are met for NF level of care cases cases;
  • the participant meets age requirements (MHC level of care cases);
  • the surplus, and when necessary the allotment can be determined; AND
  • transfer of property (FMWL or SELTRANS) penalty period no longer applies

Note: Review the I124 screen DA-124 Inquiry Report in FAMIS from the Facility and Placement Information Details (FMJ4 or FACPLACE) screen press F14=I124. Refer to memorandum IM-21 03/19/10, Guide to Interpreting the DA-124 Inquiry Screen for further information and guidance.

Timeliness of the decision for vendor requests is critical. The participant, the nursing facility, and family members are relying on a prompt decision.

The Eligibility Specialist must:

• Set Reminders in FAMIS to track pending actions;
  • 30 days from the date of entry into the facility to determine if the DA-124 certification is available, if not;
  • reminders must be set at 10 days intervals until the information is available
• Enter Comments in the EUMEMROL to include;
  • date of the report
  • name of the reporter
  • information reported relating to the need for vendor benefits

A separate memorandum will be sent when the Income Maintenance Manual Sections have been updated to include the FAMIS procedures.

NECESSARY ACTION:

• Review this memorandum with all appropriate staff.

AB