IM-#36, June 20, 2016, IM-#33, March 29, 2012, IM-153 December 20, 2005

When a participant currently receiving MHABD enters a MO HealthNet (MHN) certified bed (T19) in a nursing facility (SNF), an institution for the developmentally disabled (IMR), or a state mental hospital (MHC), payments may be made directly to the facility that is providing care to the individual.

A MO HealthNet Eligibility Review Information form (FA-402) or a Reinvestigation-Eligibility Statement form (IM-2D) is not required to transfer an active MHABD participant to vendor. When the annual review is due at the same time that a change to vendor is reported, complete the review as a separate action from the change to vendor care. Do not delay the change to vendor level of care, while waiting to complete an annual review.

When an individual is only included (ZP) in an active MHABD Eligibility Unit an Add a Person Request must be completed before eligibility for vendor benefits for the individual can be determined.

When a MO HealthNet participant enters a nursing facility, eligibility for vendor benefits must be explored. Vendor benefits must be authorized as soon as all necessary information, including a level of care determination, is received. See Section 0815.015.10 Tracking MHABD to Vendor Requests.

Complete the following steps within two working days of notification of the placement:

Other steps to determine vendor eligibility may include:

Complete an Eligibility Determination (EDRES) to determine eligibility for vendor benefits in FAMIS as soon as:

0815.015.05 Claimant Returns to Vendor Facility

IM-#33, March 29, 2012

If a participant returns to the vendor facility from a non-vendor situation within sixty calendar days, a new DA-124A/B and COMRU level of care determination is not required unless the participant is not currently certified for the appropriate level of care.

0815.015.10 Tracking MA and SNC to Vendor Requests

IM-#33, March 29, 2012, IM-153 December 20, 2005

Timeliness of the decision for vendor requests is critical. The participant, the nursing facility, and family members are relying on a prompt decision.

Because no application request is entered in FAMIS for an active MHABD participant who enters a nursing facility, institution for the developmentally disabled or state mental hospital, the vendor request is not tracked by FAMIS. The Eligibility Specialist is required to monitor the case to ensure that all actions are completed promptly.

See Section 0815.015.00 PARTICIPANTS Currently Receiving MHABD to Vendor above.

Within two working days of notification of the placement in a facility the Eligibility Specialist must: