MEMORANDUM

DISCUSSION:

This memorandum introduces a new way to remove a participant for failure to cooperate with an MHABD determination.

Beginning March 27, 2017 a participant may be removed from a MHABD case when s/he fails to cooperate with Family Support Division (FSD) efforts to determine ongoing eligibility. Please follow the steps below when an individual has failed to cooperate, by not:

• returning the medical review packet, or medical releases;
• attending a scheduled medical appointment; or
• returning requested information, or taking a necessary action.

When a participant fails to take one of the actions listed above, verify the information is not in the ECM/VFR, then take the following steps to remove the individual from the case.

1. Update the individual on the Eligibility Unit Member Role (EUMEMROL) screen to pending role of ZP with one of the following pend reasons:
   1. APT - You failed to keep your appointment so that we can determine if you are disabled. (42 CFR 435.541)
   2. MIN - You failed to return requested medical releases or medical information necessary to determine eligibility for disability or vision related benefit. RSMO. 208.075, RSM0 208.990, 42 CFR 435.541(e), 13 CSR 40-13.020(7)-(8).
   3. COO - You did not cooperate when you failed to timely take a required action that is necessary for us to determine your eligibility. This includes, but is not limited to, providing information or verification on income or resources, failing to keep a scheduled appointment, etc. (42 CFR 435.911, RSMo 208.010, RSMo 208.147, RSMo 208.210)

NOTE: COO is a more general reason and should be used only when APT or MIN are not appropriate.

2. Make a comment to explain what the participant failed to do.
3. Complete an eligibility determination (EDRES).
4. Authorize the action.

NOTE:Workers have been updating the codes on the Disabled screen to force FAMIS to send a Request for Information (FA325) when a new Medical Review Team (MRT) determination is needed. FAMIS will not send the Adult MO HealthNet Adverse Action notice (FA420) in this situation after the FA325 has expired. The closing action will appear on the EU Action Log (EULOG), but no notice will be sent. This is a known issue, and cases have been assigned to specific staff for correction. Instructions have been provided to designated staff. If you have case specific questions regarding a notice that wasn’t sent, email the case information to MO HealthNet Program and Policy Unit at COLE.MHNPolicy@dss.mo.gov

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Begin using MIN, APT, or COO.

PL/vb