MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to introduce revisions to the referral process for participants potentially eligible for Home and Community Based Services (HCB) and to the Home and Community Based Referral (IM-54A) form.

Do not delay the MO HealthNet Non-Spend Down (MHNS) or Spend Down (MHSD) eligibility determination waiting for the Department of Health and Senior Services, Division of Senior and Disability Services (DSDS) to return the IM-54A. The Family Assistance Maintenance Information System (FAMIS) will allow the approval of MHNS or MHSD while the HCB determination is pending. FAMIS will pend the HCB application if the applicant fails for MHNS and MHSD but is potentially eligible for HCB. When an individual is approved for HCB after receiving MHNS or MHSD, complete Worker Initiated Budget Calculations (WIBCA) for months the participant is eligible for HCB, but was previously approved for the other level of care.

The IM-54A is revised to better provide information from the Family Support Division (FSD) eligibility specialist (ES) to the DSDS and their Designee. The revised form and instructions are available in the Forms Manual. ES should download the new version and overwrite the existing version.

Policy has been updated to clarify when the IM-54A is sent to DSDS.

The IM-54A has been revised to include a third option in the PARTICIPANT REFERRED TO DSDS/DESIGNEE FOR field. The options are:

1. Level of Care Determination –used when referring a new HCB participant to DSDS for level of care determination, application for MHNS or MHSD approved prior to referral.
2. Authorization for Aged and Disabled Waiver services (HCB) - used when referring a participant currently receiving HCB for a determination of continued HCB eligibility.
3. Potential HCB Eligibility/Paper Referral Process- used when the applicant is ineligible for MO HealthNet coverage without a division of assets, and the application cannot be approved prior to referral.

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

• Complete entirely the “Participant” and “FSD” sections of the form;
• Confirm the correct mailing address and a current telephone number is entered for the applicant (DSDS cannot contact the applicant without this information); and
• Make a preliminary review of basic HCB eligibility factors. Do not refer individuals who are obviously ineligible.

Refer individuals to DSDS using form IM-54A only when:

• The individual is 65 years of age or  older, or 63 years of age or older AND disabled,
• The individual is in need of HCB services, and
• The individual’s income does not exceed the HCB income limit.

DSDS will use the form to notify FSD of its determination, including the date the individual was authorized for HCB waiver services.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Immediately begin referring individuals to DSDS using the revised IM-54A.
• Destroy versions of IM-54A with revision dates prior to 2/15.

AC/vb