0815.055.00 INPATIENT PSYCHIATRIC SERVICES FOR INDIVIDUALS UNDER 21 YEARS OF AGE

Individuals under the age of 21 receiving psychiatric treatment as inpatients in a state or privately owned psychiatric institution or facility may qualify for vendor MHC level of care coverage. Certain special procedures exist for these individuals.

Note: An individual who is certified for MHC level of care when s/he is under the age of 21 may continue to qualify for vendor payment as MHC level of care until age 22.

Requirements for the facility:

• The facility must be accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).
• The facility must be certified to participate in the Missouri MO HealthNet program.
• The list of facilities which meet these criteria is included in Appendix C.

To process an application for inpatient psychiatric services for an individual under the age of 21:

1. Have the applicant (if age 18 to 21), parent, legal guardian, or responsible relative complete and sign the application.
2. Verify the claimant's age and record the verification on the Birth/Death Information (BIRTH or FMAQ) screen in FAMIS
3. If a disability or blindness must be established, submit medical information to MRT (IM-61& IM-61B) and/or to State Supervising Ophthalmologist ((M-68 & IM-69).
4. Obtain a Certification of Need for Psychiatric Services (IM-71) from the facility. The form must be signed by a physician. Do not approve benefits until the IM-71 is signed and filed in the claimant's case record. The Certification of Need verifies that:
   • the required services are not available on an outpatient basis;
   • the claimant is currently being treated on an inpatient basis; and
   • the required services can reasonably be expected to improve the claimant's condition or prevent further regression.
5. Determine eligibility on all factors for prior quarter, if requested, and on-going eligibility.  To be eligible for inpatient psychiatric services in the prior quarter, the IM-71 must have been completed and signed before the approval date for psychiatric services.
6. Complete the surplus computation.

0815.055.05 Applicants or Participants Under Age 18 Receiving Inpatient Psychiatric Services

If the applicant/child is disabled:

1. Determine eligibility using MO HealthNet for Disabled Children (MHDC) criteria. See Section 0805.020.00.
2. If the child meets the definition of living with his/her parent(s) at the time s/he entered the facility (expected to remain in the facility for 30 days or less):
   1. Deem the resources of the parents when determining eligibility.
   2. Deem the income of the parent(s) according to Section 0805.020.15 when completing the surplus determination.
3. If the disabled child was not living with his/her parent at the time s/he entered the facility (expected to remain in the facility for more than 30 days):
   1. Consider only the individual child's (and their spouse's) resources when determining eligibility.  Do not deem the resources of the parents.
   2. Do not deem the income of the parent(s) when completing the surplus determination.

If the applicant/child is not disabled:

1. Determine eligibility using MO HealthNet for Families (MHF) criteria (See Section 0905.000.00) or MO HealthNet for Kids (MHK) criteria (See Section 0920.000.00).
2. When completing the surplus determination, do not include the parent's income

0815.055.10 Applicants or Participants Ages 18 to 21 Receiving Inpatient Psychiatric Services

For applicants or participants ages 18 to 21, determine eligibility using the December 1973 PTD or AB eligibility requirements.

Use only the individual's (and their spouse's) resources to determine eligibility.

Use only the individual's income to calculate the surplus.