0815.005.00 Eligibility for Vendor Payments

IM-#33, March 29, 2012

Vendor payment may only be made in behalf of MO HealthNet for the Aged, Blind, and Disabled (MHABD) participants who meet the following requirements:

A surplus determination must be made to determine the portion of the eligible participant's income which is available to pay towards the cost of their care.

0815.005.05 December 1973 Eligibility Requirements

IM-#33, March 29, 2012

To be eligible for MHABD Vendor, an adult (age 18 and older) applicant or participant must meet the December, 1973 eligibility requirements for Old Age Assistance (OAA), Permanent and Total Disability (PTD), or Aid to the Blind (AB). The determination of eligibility is always based on whichever eligibility factors in effect in December 1973 best meets the applicant's or participant's situation. These eligibility factors are explained in manual Section 1000.000.00.

When December 1973 eligibility is based on Permanent and Total Disability (PTD) or Aid to the Blind (AB) requirements, additional medical information may be required. If MHABD Vendor eligibility is based on PTD requirements, verification of disability must be obtained. See Section 1060.005.00. If a Medical Review Team's (MRT) decision is required, obtain medical information and Medical Report Including Physician's Certification/Disability Evaluation, form IM-60A (if available), Social Information Summary, formIM-61, and Disability Questionnaire, form IM-61B, to establish disability. Submit this information to MRT for their determination while waiting for the level of care decision from COMRU.

If MHABD vendor eligibility is based on AB requirements, verification of visual impairment must be obtained. See Section 1055.015.00 . Obtain the Visual Disability Examination Report, form IM-68, to establish eligibility based on visual impairment. Submit this information to the State Supervising Ophthalmologist while waiting for the level of care decision from COMRU.

0815.005.10 MO HealthNet Certified Beds in Nursing Facilities

IM-#33, March 29, 2012

Nursing facilities (SNF) may designate some or all of their beds as MO HealthNet (MHN) certified beds (T19). This designation means that the facility must accept vendor payments for the individual assigned to that bed.

In a nursing facility with all MHN certified beds, vendor payments MUST be given to eligible participants. Supplemental Nursing Care (SNC) cash payments cannot be made to participants in a nursing facility where all beds are MHN certified.

In a nursing facility with only some MHN certified beds, SNC cash payments cannot be given to an individual in a MHN certified bed. Vendor benefits must be authorized if the individual is eligible and in a MHN certified bed, or at the time they are placed in a certified bed. However, if the eligible individual is not in a MHN certified bed and is not going to be transferred to one, approve for SNC even if there is an unoccupied MHN certified bed in the facility. See Section 0600.000.00 for information on SNC. Accept the statement of nursing home personnel regarding the individual's placement in a MHN certified bed or a non-certified bed.

If the nursing facility places the individual in a Medicare certified bed (T18) and the facility states it will bill MO HealthNet for coinsurance and deductibles only, the individual should be treated as if s/he is in a MHN certified bed.