MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to clarify MO HealthNet policy regarding residents of institutions operated by the Missouri Department of Public Safety, Missouri Veterans Commission.  Missouri Veterans Homes are authorized and operated pursuant to Missouri Code of State Regulations 11 CSR § 85-1.030.  Missouri Veterans Homes are administered by a public entity that receives both federal and state funds to support operations.  Therefore, individuals residing in Veteran’s homes do not qualify for MO HealthNet benefits, because they are residents of public institutions.

• 13 CSR 40-2.080 defines a public institution as an institution which provides shelter or care to person and is managed or controlled, in whole or in part, by or through any public instrumentality, official or employee acting in an official capacity.
• § 208.010 RSMo subsection 2. (7) states that benefits are not payable to any claimant who is an inmate of a public institution, except as a patient in a medical institution.

  NOTE: An inmate is defined as any person residing in an institution for the purpose of receiving inpatient care, whether they were committed to the institution or whether they are there on a voluntary basis.

1020.000.00 INSTITUTIONAL RESIDENCE (OAA, PTD, AND AB) prohibits payments to any claimant who is a resident of a public institution, except as a patient in a public medical institution.

1020.005.00 INMATE OF PUBLIC INSTITUTION
Missouri Veterans Homes was added to the listing of types of public institutions whose residents are not eligible to receive public assistance.

This revises IM Memorandum IM-#13 dated January 20, 2000.

ADMITTANCE TO A MEDICAL FACILITY

Admittance as an inpatient in a hospital, nursing facility, juvenile psychiatric facility or intermediate care facility interrupts or terminates the resident status for the VA Home. Explore MO HealthNet eligibility for these individuals regardless of their length of stay as an inpatient.

APPLICATION PROCESSING

Upon VA Home resident’s admittance as an inpatient to a hospital or nursing facility the individual, a relative, or an authorized representative (AR) may complete the application.  If necessary, secure medical records and submit them for a Medical Review Team (MRT) disability determination. Admittance to a nursing facility requires a pre-admission screening and level of care determination.  It is important to confine eligibility to the days in which the individual was an inpatient in the medical facility.

INPATIENT ADMISSION

If the individual is admitted inpatient to a medical facility:

• Upon receipt of an application, enter the request in FAMIS using the hospital/vendor address on the Supercase Member Clearance (SCMBR/FM0E) screen and living arrangement code HOMELESS (HL); the individual is in a medical facility and will not be released to a residential address.
• Enter the individual's mailing address at the VA Home on the Person Detail (PRSNDTL) screen to ensure the individual receives correspondence.  If there is an AR, enter the address of the AR on the Person Detail (PRSNDTL) screen to ensure the proper delivery of notices.
• Process the case as though the individual was not in a public institution. Explore eligibility on all factors.
• If necessary, secure medical records and submit for a Medical Review Team (MRT) disability determination.
• Vendor coverage requires a pre-admission screening and level of care determination.

If the individual is ineligible for MO HealthNet reject the application immediately.

If the individual is eligible for MO HealthNet:

• When the anticipated inpatient stay is 45 days or less from application date, do not approve the application; leave the application in the controlled flow until after the individual returns from the medical facility to the VA Home.
  • Verify the actual inpatient dates in the medical facility.
  • Contact the IM Program and Policy Unit MHN POLICY, COLE to enter the MHN eligibility dates in the system through an override process to ensure the correct coverage dates.
  • Enter a worker initiated rejection in FAMIS.
  • Send the individual a manual notification of approval and closing, showing the dates of coverage using the Approval Notice (IM-32) or the Notice of Approval for Medical Assistance Spend down (IM-32SPDN).
• When it is verified by hospital or vendor facility staff that the anticipated inpatient stay is more than 45 days (from application date)
  • Contact the IM Program and Policy Unit MHN POLICY, COLE to enter the initial MHN eligibility dates into the system. P&P will enter coverage from the date of admittance through the end of the first month.
  • If the individual entered the hospital on any day other than the first of the month, enter a worker initiated rejection in FAMIS for the original application (dated other than 1st).
  • The following day, enter an application for the first day of the month following admittance to the hospital.
  • Notify the individual of their approval using the Approval Notice (IM-32) or the Notice of Approval for Medical Assistance Spend down (IM-32SPDN) for the partial month.
  • Include in the notification the eligibility begin date, and the eligibility end date if available.
  • Approve the application in FAMIS for the 1st of the month following the month of admittance.
  • Advise the nursing home or other medical facility to immediately contact the Family Support Division office when the individual is discharged. Vendor offices should provide their direct phone number to the nursing home. All other offices may use the Family Support Division Information Center 1-855-373-4636 for contact.

    EXAMPLE: Mr. Veteran leaves the VA Home and is admitted inpatient to the hospital on July 3. His initial application was received July 7and registered in FAMIS the same date. Mr. Veteran is not eligible for July 1 and July 2 as he was in the VA Home. Enter a worker initiated rejection in FAMIS for the July 7 application. The following day, enter a new application dated August 1. Complete the August 1 application and approve if eligible. If Mr. Veteran is eligible on all other points for July 3 through July 30 contact IM Program and Policy to request entry of coverage for those dates.

• If the inpatient stay is less than the approved dates or if it was not possible to anticipate the date of discharge so there was no coverage end date, verify the date of discharge and immediately enter a worker initiated closing WICL with a reason of: you are in an ineligible living arrangement (ILA). Explore possible overpayment of MO HealthNet benefits for any time that the individual had active MHN coverage but was not an inpatient in a hospital or nursing facility. Complete claims when necessary.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Disregard IM Memorandum IM-#13 dated January 20, 2000.

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