1325.000.00  PRESUMPTIVE ELIGIBILITY (PE)

IM-5, January 18, 2013, IM-111, November 26, 2007

Presumptive Eligibility determinations for BCCT (BCCT PE) are made by SMHW providers who have signed a SMHW Participation Agreement with the Department of Health and Senior Services (DHSS). When a SMHW provider determines a woman is eligible for PE, they will issue a BCCT Temporary MO HealthNet approval letter (BCC-1) pdf file. BCCT PE coverage begins on the date the SMHW provider determines the woman is in need of treatment and issues a BCC-1. BCCT PE coverage continues until the earlier of the following dates:

The Departmental Client Number (DCN) assigned to the woman will serve as the MO HealthNet number for the BCCT PE. If a woman eligible for BCCT PE does not have a DCN, the SMHW provider will contact the Customer Relations Unit based in St. Joseph to have one assigned. A copy of the BCC-1 will be faxed to the Customer Relations Unit based in St. Joseph to enter the BCCT PE determination in the IM system.

Screen IBCC was developed to enter the BCCT PE. Upon receipt of a BCC-1 from the SMHW provider, access the screen by entering IBCC, space, and DCN. Entries are self-explanatory. Enter the diagnosis date in the START DATE field. After entering information, STORE COMPLETED, should appear.

Entering BCCT PE on the IBCC screen creates a M2 case with an "L" identifier in Field 23. The M2 category has been reserved for BCCT PE only. Individual eligibility will reflect level of care "T" with an entry of "L" in Field 13g2 of IMU5. The beginning date of eligibility will be the START DATE and eligibility will end the last day of the following month. The ending date of eligibility will appear in Field 32 of the IMU5. The only IMU5 transaction possible on M2 cases will be a closing action. The system will close the M2 case at the end of the eligibility period with reason code 68 (Time Limit Expires) unless already closed. It is necessary to close the M2 case if approving for another category of coverage with a closing reason of "39" Transferred to Other Assistance.

Error messages will appear when accessing IBCC in the following situations:

If incorrect dates were entered, it will be necessary to contact the MO HealthNet Program and Policy Unit by email to Cole.MHNPolicy@dss.mo.gov for corrections.

Once the PE decision is entered, BCCT PE cases will appear in IM system as an "M" case with a level of care "T" and reason "L" in the level of care (sanction) reason field.