Residing in a Care Facility – Vendor
Memorandum: IM-119 July 27, 2020 Approving MO HealthNet for the Aged, Blind and Disabled (MHABD) Nursing Home Care on a Date Other Than the Date of Admission to Allow Participant to Deplete Resources Below the Resource Limit
Submitting Preadmission Screening
Level of care assessment is now automated. More information is located on the COMRU’s webpage: https://health.mo.gov/seniors/nursinghomes/pasrr.php
- Level One Form or Level One Nursing Facility Pre-Admission Screening is for mental illness, intellectual disability, or related condition.
- Level of Care Form or Nursing Facility Level of Care Assessment is used to determine if the participant is in the correct placement for care.
REQUIREMENT:
When an individual enters a nursing facility (NF), state mental hospital (MHC), or institution for the mentally retarded (IMR), payments may be made directly to the facility that is providing care to the individual.
To be eligible for vendor benefits, the individual must:
- Occupy a Medicaid certified bed, also known as a Title XIX bed (T19 in FAMIS).
- Have received a preadmission screening.
- Be certified as needing the level of care the facility provides.
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. Vendor eligibility would be established and benefits issued under the type of assistance the individual is already receiving.
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 “Vendor 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.
*Refer to the memorandum above (IM-119 July 27, 2020) for additional uses for the Payment start date field.
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: