Residing in a Care Facility – SNC

FORMS:

DA-124 A/B and DA-124C – required for ICF or SNF only (Used by the nursing facility only to exchange information with DHSS/COMRU)

(When counties are contacted by nursing care facility staff, inform them that these forms may be accessed online at www.dhss.mo.gov. Facility staff may complete, print, sign, and mail the form(s) to COMRU for processing.)

 

ONLINE RESOURCES:
IM-4 Supplemental Nursing Care

 

GUIDES:
Type of Facility and Type of Bed Combinations

 

REQUIREMENT:

To be eligible for Supplemental Nursing Care (SNC), an individual must reside in a basic Residential Care Facility (RCF-I or RCF-II); an Assisted Living Facility; or an Intermediate or Skilled Nursing Facility, when ineligible for vendor payments.

 

For persons not receiving any type of assistance, a MHA application would be taken and eligibility for Vendor would be established based on MHA requirements. Participants currently receiving benefits from one of the Adult programs (not conversion cases) need not make a new application. Eligibility would be established and benefits issued under the type of assistance they are receiving.

 

SNC grant amounts are based on levels of licensure for the nursing facility. See Maximum Grants in 7.3.4 SNC Payment and Grant Amount:

  • Skilled nursing facility or intermediate care facility (substantiated by level of care determination from DHSS DA-124)–$390 monthly benefit
  • Skilled nursing facility or intermediate care facility (NOT substantiated by level of care determination)–$292 monthly benefit
  • Assisted living facility or Residential care facility II (still in compliance with former RCF II requirements)–$292 monthly benefit
  • Residential care facility (formerly residential care facility/RCF I)–$156 monthly benefit

 

SNC participants also receive MHA coverage and a Supplemental Nursing Care Personal Expense Allowance of $50.

 

PROCEDURE:

When the driver question for residing in a care facility is answered yes, the dynamic screen “Facility and Placement Information Detail” appears in the flow. Entries on this screen determine whether FAMIS explores Vendor or SNC.

 

The top half of the screen is displayed first. The following fields must be completed:

  • DVN – promptable field which populates facility name and address
  • Facility Type – promptable, verified by the nursing facility
  • Date Entered Facility – as verified by the nursing facility
  • Date Left Facility (if applicable)
  • End Reason (if individual has left the facility) promptable for reason code
  • Type of Bed – promptable, verified by the nursing facility
  • DMH Placement – (Y/N) verified by the nursing facility
  • Placement Detail Verification – verification code for information in these fields
  • Expected to Stay Less Than 30 Days – (Y/N) verified by DA-124 or doctor’s statement

 

After completing these fields, press control and additional fields appear, with a message in purple “SNC benefits will be explored”. Those fields that will appear are:

  • DA-124 A/B Level of Care
  • FSD Date
  • Payment start date
  • Payment stop date

 

These fields are completed with information obtained from DHSS by pressing F14=I124. Print the I124 (DA-124) information for the case file, and press F12=RETURN, using the printed information to complete FAMIS entries. If the information is not available from DHSS, set a reminder to check back for a DHSS medical determination.

 

DHSS level of care is only needed when a person is in a skilled nursing facility or intermediate care facility.

 

Two additional fields display when a person is less than 22 years of age, resides in a medical facility, and is in need of psychiatric care. Complete the entries to document the IM-71 Certification of Need for Psychiatric Services.

 

NOTE: While the DHSS determination is pending, the applicant may be approved for other MHABD coverage. FAMIS will not generate a reminder to follow up and complete an eligibility determination for vendor benefits upon receipt of the DA-124 information. The Eligibility Specialist must manually set a reminder to check the I124 screen for a level of care decision. Non Spend Down or Spend Down benefits do not pay for Vendor, HCB or SNC care costs. When the DHSS level of care determination is received, approve the Vendor, HCB or SNC benefit back to the original application date.

 

SNEAK PREVIEW:

Facility and Placement Information Details