MEMORANDUM

DISCUSSION:

The Mo HealthNet for the Aged, Blind and Disabled (MHABD) policy manual is under revision. The manual revisions listed above contain no policy changes. The revised manual sections reflect the MO HealthNet program name change; correct terminology; define commonly used terms; provide links to User Guides, forms, and additional resources. Other additions include case examples and clarification of existing policy and processes.

All policy sections were updated to reflect MO HealthNet Program name changes introduced in Memorandum IM-102  dated October, 19, 2007. In addition, the following policy section changes were made:

0805.015.30 NON-EARNED INCOME:

Clarified existing policy of evaluating non-earned income of an applicant and spouse,  entering child support income as the child's income, if the child receiving child support is in the home; entering money withheld for federal intercepts as gross income; and disallowance of fees charged by Public Administrators as expenses for MHABD.

0815.000.00 VENDOR ELIGIBILITY

Policy was updated to reflect MHN program name changes and terminology.

0815.000.05 Missouri Care Options

Policy was updated to reflect MHN program name changes and terminology.

0815.000.10 Definitions for Vendor Coverage

Policy was updated to reflect MHN program name changes and terminology.

0815.005.00 ELIGIBILITY FOR VENDOR PAYMENTS:

Added links to Quick Guide to IMNF and FAMIS User Guide.  Clarification note added to check I124 screen.

0815.005.05 DECEMBER 1973 ELIGIBILITY REQUIREMENTS:

Policy was updated to reflect MHN program name changes and terminology.

0815.005.10 MO HEALTHNET CERTIFIED BEDS IN NURSING FACILITIES:

Clarification added to accept the statement of nursing home personnel regarding an individual's placement in a MHN certified or non-certified bed. 

0815.010.00 VENDOR APPLICANTS NOT RECEIVING MHABD:

FAMIS procedures and links to I124 Guide and FACPLACE User Guide were added.

0815.010.05 Application Processing Time Frames: 

FAMIS procedures to locate application details and due dates were added.

0815.015.00 PARTICIPANT CURRENTLY RECEIVING MHABD TO VENDOR:

FAMIS procedures were added.  Time frames were added to instructions for tracking MHABD to Vendor.

0815.015.05 PARTICIPANT RETURNS TO VENDOR FACILITY:

Clarification added that if a participant returns to the vendor facility from a non-vendor situation within sixty calendar days a new DA124 A/B and COMRU level of care determination is not required.

0815.015.10 TRACKING MHABD TO VENDOR REQUESTS: 

Clarification and instructions were added to the manual process for tracking active MHABD recipients who enter a nursing facility, institution for the mentally challenged or state mental hospital, since these changes in level of care are not tracked as an application by FAMIS.

0815.020.00 INITIAL ASSESSMENT AND MEDICAL CERTIFICATION:

FAMIS procedures were added, in addition to DA-124 A/B forms hyperlinks.

0815.020.05 VERIFICATION OF MEDICAL CERTIFICATION:

FAMIS procedures were added in addition to IMNF Quick Guide hyperlink.

0815.020.10 Claimant Not Medically Certified

FAMIS procedures were added in addition to COMRU and Facility Placement and Information Placement hyperlinks.  Policy was updated to reflect MHN program name changes and terminology.  Sections 0815.020.10.05 and 0815.020.10.10 were removed.  Policy previously included in those sections has been combined with this section.

0815.020.15 MEDICAL RE-CERTIFICATIONS (UTILIZATION REVIEWS):

FAMIS procedures were added.

0815.025.00 PREADMISSION SCREENING FOR ENTRY INTO NURSING FACILITIES:

A hyperlink to the DA-124C form was added. Level I screening was defined and clarification was added that every potential resident of a MO HealthNet certified bed must a have a Level I screening.

0815.025.05 PREADMISSION SCREENING PROCESS:

The DA-124C process was clarified.

0815.025.10 VERIFICATION OF PREADMISSION SCREENING:

Clarification was added regarding when a DA-124C is needed or not needed.

0815.030.00 VENDOR SURPLUS COMPUTATION:

FAMIS procedures were added.  Clarifications were added for the procedure for cases that have been approved in FAMIS for spend down or non-spend down coverage prior to authorizing vendor benefits.

0815.030.05 DETERMINING ADJUSTED GROSS INCOME:

FAMIS procedures were added.  Clarification was added regarding OASDI income, SSI benefits for participants receiving vendor benefits, and other unearned income sources.  Updated policy to reflect MHN program name changes and removed income conversion instructions.

0815.030.10 DETERMINING TOTAL ALLOWABLE DEDUCTIONS:

FAMIS procedures were added.

0815.030.10.05 PERSONAL NEEDS ALLOWANCE:

Clarification was added regarding participants receiving VA pension.

0815.030.10.05.05 INCREASING THE PERSONAL NEEDS ALLOWANCE DUE TO CHILD SUPPORT PAYMENTS:

Clarification was added regarding the proper verification needed to allow child support payments to be used to increase the personal needs allowance.

0815.030.10.10 ALLOTMENTS:

FAMIS procedures were added and policy updated to reflect MHN program name changes and terminology.

0815.030.10.10.05 Maintenance Standards for Allotments

Policy was updated to reflect MHN program name changes and terminology.

0815.030.10.10.10 DETERMINING THE ALLOTMENT TO THE COMMUNITY SPOUSE:

Clarification was added regarding the institutionalized spouse electing the amount of allotment they will make to the community spouse.  FAMIS procedures were added.

0815.030.10.10.15 HEARING OFFICER OR COURT OF LAW SETS ALLOTMENT AMOUNT:

FAMIS procedures were added.

0815.030.10.10.20 Allotments for Minors and Dependents Living with the Community Spouse

Clarification of FAMIS procedures was added.

0815.030.10.10.25 Allotments for Minors Not Living With Community Spouse

Policy was updated to reflect MHN program name changes and terminology.

0815.030.10.15 Medical Deductions (Health Insurance Premiums)

FAMIS procedures were added.

0815.030.10.20 OTHER DEDUCTIONS:

Clarification was added regarding current and arrearage child support payments used as deductions.

0815.030.15 EFFECTIVE DATE OF SURPLUS:

FAMIS procedures were added and updated policy to reflect MHN program name changes and terminology.

0815.030.20 CHANGES IN SURPLUS AMOUNT:

FAMIS procedures were added and updated policy to reflect MHN program name changes and terminology.

0815.035.00 EFFECTIVE DATE OF VENDOR COVERAGE FOR CLAIMANTS IN A NURSING FACILITY:

FAMIS procedures were added and updated policy to reflect MHN program name changes and terminology.  The DA-124 and DA-625 form names were added.

0815.035.05 EFFECTIVE DATE OF VENDOR COVERAGE FOR CLAIMANTS IN A NURSING FACILITY WHEN NO LEVEL II SCREENING IS REQUIRED:

A hyperlink to manual section 0815.025.05 was added for reference of when a Level II screening is required.  FAMIS procedures were added and updated policy to reflect MHN program name changes and terminology.

0815.035.10 EFFECTIVE DATE OF VENDOR COVERAGE FOR CLAIMANTS IN A NURSING FACILITY WHEN LEVEL II SCREENING IS REQUIRED AND CLAIMANT IS NOT FOUND TO BE MR, MI OR DD:

A hyperlink to manual section 0815.025.05 was added for reference of when a Level II screening is required.  FAMIS procedures were added and updated policy to reflect MHN program name changes and terminology.

0815.035.15 EFFECTIVE DATE OF VENDOR COVERAGE FOR CLAIMANTS IN A NURSING FACILITY WHEN LEVEL II SCREENING IS REQUIRED AND THE CLAIMANT IS FOUND TO BE MR, MI OR DD:

A hyperlink to manual section 0815.025.05 was added for reference of when a Level II screening is required.  FAMIS procedures were added and updated policy to reflect MHN program name changes and terminology.

0815.040.00 EFFECTIVE DATE OF VENDOR COVERAGE FOR MHC OR IMR LEVEL OF CARE:

Policy was updated to reflect MHN program name change and terminology.

0815.045.00 PRIOR QUARTER VENDOR:

FAMIS procedures were added and updated policy to reflect MHN program name changes and terminology.

0815.050.00 APPLICANT OR PARTICIPANT NOT IN VENDOR FACILITY ON THE FIRST DAY OF THE MONTH OF APPLICATION:

FAMIS procedures were added and updated policy to reflect MHN program name changes and terminology.

0815.050.05 APPLICANT OR PARTICIPANT NOT IN VENDOR FACILITY IN THE PRIOR QUARTER HAS MEDICAL EXPENSES IN THE PRIOR QUARTER:

FAMIS procedures were added and updated policy to reflect MHN program name changes and terminology.

0815.055.00 INPATIENT PSYCHIATRIC SERVICES FOR INDIVIDUALS UNDER 21 YEARS OF AGE:

FAMIS procedures were added and updated policy to reflect MHN program name changes and terminology.

0815.055.05 APPLICANTS UNDER AGE 18 RECEIVING INPATIENT PSYCHIATRIC SERVICES:

Policy was updated to reflect MHN program name change and terminology.

0815.055.10 APPLICANTS OR PARTICIPANTS AGES 18 TO 21 RECEIVING INPATENT PSYCHIATRIC SERVICES:

Policy was updated to reflect MHN program name changes and terminology.

0815.060.00 APPLICANTS OR PARTICIPANTS BETWEEN THE AGES OF 21 AND 65 IN STATE MENTAL HOSPITAL:

Policy was updated to reflect MHN program name changes and terminology.

0815.065.00 INDIVIDUALS UNDER AGE 18 IN AN INSTITUTION FOR THE MENTALLY RETARDED OR NURSING FACILITY:

Policy was updated to reflect MHN program name changes and terminology.

APPENDIX A

The appendix was updated to show information on how to locate a vendor number, the steps to take when a vendor facility address changes, and information on resolving vendor billing issues.

APPENDIX B

The appendix was updated to show current standards through January 1, 2012.

NECESSARY ACTION:

• Review this memorandum with all appropriate staff
• Reference MHABD policy manual as needed.

HA