Vendor Requests from Active Non-MAGI Participants

 

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.

 

Complete the following steps:

  1. Change the individual’s address. For a single person, the new facility address is added on the Supercase Address/Supercase Transfer (ADDRESS) screen along with the new Living Arrangement code. For a couple case when the community spouse remains at the residential address, add the institutionalized spouse’s new facility address on the Person Detail (PRSNDTL) screen.
  2. Add the new facility information to the Facility Information Details screen. If the placement requires a DHSS level of care determination, a PEND or ISD will occur in Technical Eligibility.
  3. For a couple case, complete a Division of Assets (DIVISION screen). PEND or ISD will occur in Technical Eligibility until this step is completed.
  4. For individuals with dependents, explore any allotments to the community spouse and other dependents in the home or outside the home. PEND or ISD may occur in Technical Eligibility until this step is completed.
  5. Complete an Eligibility Determination Resolution (EDRES).

 

These issues may be resolved from the MHABD AG Technical Eligibility Detail screen, by selecting the line where the PEND/ISD occurs and pressing F6=DETAILS to access the screen where information must be added or updated.

 

MO HealthNet coverage continues until a decision is reached. MO HealthNet 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 request date.

 

NOTE: Since this action is not registered in FAMIS as an application for benefits, requests must be tracked carefully. The Eligibility Specialist must manually set a reminder to check the I124 screen for a level of care decision.

 

SEE IN THIS GUIDE:

Residential Address
Residing in a Care Facility – SNC
Residing in a Care Facility – Vendor
Allotments
Division of Assets