MEMORANDUM

2013 Memorandums

IM-#1      01/04/13

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
P.O. BOX 2320
JEFFERSON CITY, MISSOURI
TO:
ALL COUNTY OFFICES
FROM:
ALYSON CAMPBELL, DIRECTOR
SUBJECT:
HOME AND COMMUNITY BASED SERVICES REFERRAL (IM-54A) AND INSTRUCTIONS REVISED
FORMS MANUAL REVISION: #1

DISCUSSION:

The purpose of this memo is to introduce revisions to the Home and Community Based Referral (IM-54A) form. The IM-54A is revised for improved interagency communication between the Family Support Division (FSD) eligibility specialist (ES) and the Department of Health and Senior Services, Division of Senior and Disability Services (DSDS)  or their Designee regarding the Home and Community Based Services program. Revisions include:

Prior to making a referral for Home and Community Based (HCB) assessment, the ES must:

A referral for Home and Community Based (HCB) assessment is not appropriate if:

Individuals who are applying for MO HealthNet for the Aged, Blind, and Disabled (MHABD) and who are considering placement in a long-term care facility, or who appear to be potentially eligible for HCB waiver services, must be referred to the DHSS/DSDS for a determination.

Refer individuals to the DHSS/DSDS using form IM-54A (Home and Community Based Referral). The DHSS/DSDS will use the form to notify FSD of its decision, including the date the individual was authorized for HCB waiver services.

The revised IM-54A form and instructions are available in the Forms Manual. ES should download the new version and overwrite the existing version.

NECESSARY ACTION:

AC/vb


2013 Memorandums