MO HealthNet Vendor Application

Transcription

1 ATCHISON WORTH HARRISON MERCER PUTNAM SCHUYLER NODAWAY SCOTLAND CLARK GENTRY SULLIVAN ADAIR GRUNDY KNOX HOLT LEWIS ANDREW DAVIESS DEKALB LINN MACON SHELBY MARION BUCHANAN CLINTON CALDWELL LIVINGSTON CHARITON RALLS RANDOLPH PLATTE CARROLL MONROE RAY CLAY AUDRAIN HOWARD SALINE BOONE JACKSON LAFAYETTE CALLAWAY COOPER PETTIS JOHNSON CASS BATES VERNON BARTON HENRY ST CLAIR CEDAR DADE JASPER LAWRENCE NEWTON BARRY BENTON HICKORY POLK GREENE STONE CHRISTIAN MORGAN DALLAS TANEY CAMDEN WEBSTER MILLER LACLEDE WRIGHT DOUGLAS OZARK COLE PULASKI OSAGE MARIES TEXAS PHELPS DENT HOWELL PIKE LINCOLN CRAWFORD SHANNON OREGON WARREN FRANKLIN WASHINGTON IRON REYNOLDS CARTER RIPLEY ST FRANCOIS WAYNE MADISON BUTLER PERRY STODDARD DUNKLIN SCOTT Missouri Family Support Division Nursing Home Unit MO HealthNet Vendor Application Welcome! Presenting from Missouri FSD: Dawn Rising Manager, Specialized Processing Unit Shellie Bledsoe Program Development Specialist Umo Ironbar Assistant Special Counsel for FSD FSD Nursing Home Units Missouri s Nursing Home Units 3/15/16 North Unit Livingston.codfs@dss.mo.gov Deborah Heldenbrand, Manager 601 W Mohawk Rd Chillicothe, MO Kansas City Unit Lafayette.codfs@dss.mo.gov Deborah Heldenbrand, Manager 736 S Business Hwy 13 Lexington, MO South Unit Ozark.codfs@dss.mo.gov Dan Watson, Manager Highway 160 West PO Box 717 Gainesville, MO MCDONAL D MONITEA U MONTGOMERY GASCONADE STE GENEVIEVE BOLLINGER NEW MADRID Specialized Processing Unit Miller.codfs@dss.mo.gov Dawn Rising, Manager PO Box 410 Eldon, MO St. Louis Unit Madison.codfs@dss.mo.gov Rebecca Toppins, Manager 413 Burris St. Fredericktown, MO

2 Specialized Processing Unit/Miller Co FSD The Specialized Processing Unit (SPU) processes vendor applications that meet the following criteria: Legal Representation Trust Annuity Transfer Of Assets Division of Assets SPU also processes HCB and SNC applications submitted by Legal Representation. Where to send an application submitted by Legal Representation Legal Representation may send applications for vendor coverage, HCB or SNC directly to the SPU. Miller.CoDFS@dss.mo.gov Mail: SPU PO Box 410 Eldon, MO Fax: Submitting applications to SPU It is extremely helpful to the SPU staff for the attorney to provide a cover letter with brief history, special notes, estimated date of vendor coverage, any transfers (gifts) and estimated penalty. Tell us the story, explain the verification provided, and what outcome is expected. 2

3 Suggested order to submit application/documentation Cover letter Index/outline of pages being provided Application/Division of Assets/IM79 Authorized Representative Form/POA/Entry of Appearance Vital Stats: drivers license, social security card, insurance cards, marriage certificates Income earned, unearned, annuities etc. (both spouses) Expenses health insurance premiums and shelter expenses (rent/mortgage, electric bill, real estate taxes, home insurance) if requesting an allotment Suggested order to submit application/documentation Resources/assets Bank accounts checking/savings bank statements CD s/ira s/stocks/bonds etc. Prepaid burial Life insurance Vehicles titles to vehicles and value and debt of nonexempt vehicles Real estate copy of deeds and value and debt of nonexempt real estate Promissory Note/Contract for Deeds Transfers gifts Trust and Trust Accounting list Providing Verifications Bank accounts/cd s/ira s/stocks/bonds etc. bank statements for month of application, month of assessment and prior quarter, if applicable. If providing a bank printout be sure it identifies the bank name, owner of the account, account number and balance. Prepaid burial copy of the contract and verification if irrevocable. Life insurance verification should include owner of the policy, type of policy and verification of the cash surrender value. Vehicles titles to vehicles, verification of equity for nonexempt vehicles Real estate copy of deeds and verification of equity for nonexempt real estate Promissory Note/Contract for Deed - letter explaining the circumstance surrounding the promissory note. What was it created for? Cash or property? Who was it created by and between? Has the property changed hands? Provide copy of deed. Transfers provide verification of the following: what was transferred who it was transferred to Amount received what was the fair market value at time of transfer Date of transfer purpose 3

4 Trust - provide complete copy of trust and any amendments. Let us know what type of trust it is. Self settled We will request a list of assets in the trust. Third party Indicate if it is a Tidrow or Wilson or Testamentary type trust etc. Special Needs Who s assets were used to create the trust? Who is the grantor? What is the relationship between the Grantor and the Beneficiary? We will request verification of age of the beneficiary and that they meet the definition of disabled. Transfer exemption Trust - Indicate the trust is a Transfer Exemption Trust and verification will be necessary. Annuity - Complete copy of the annuity contract including the application page. Irrevocable Annuities Must Include the following information: Date of issue Type of contract Premium paid for contract Payment schedule Name of the owner and annuitant Name of the Beneficiary Non- Assignable and Non-Transferrable? Revocable Annuities must include the following: Name of Owner and CSV of the policy for all months in question MHABD Forms IM-1MA Application for Benefits Couple cases IM78 Declaration and Assessment of Assets IM79 Intent to Transfer IM6-AR Appointment of Authorized Representative IM6-ARR Representative Revocation Tips for Completing the IM-1MA Application Ensure that the type of application is marked, i.e. disabled, over 65, blind/visually impaired, living in a nursing home. Provide Name and Address of the Facility. Check the box if prior quarter is needed. If the client does not have unpaid medical bills prior to the month of application, it may not be necessary for you to go through the need of obtaining information for the months prior. 4

5 If married and living together, both spouses must be listed on the application. All types of income, earned or unearned and all resources/assets, should be listed on the application for the institutionalized and community spouse. Ensure the application is signed and dated by either the applicant or someone authorized to act on their behalf. Please make sure we receive the completed application as soon as possible, especially if it is late in the month For example, if the client fills out the application and it is dated for March 30, but we don t receive it until April 1, then April will be the month of application. If application is received after normal business hours, on a weekend or Holiday, the application date is the following business day. Division of Assets for Married Couples Married Couples may request an assessment by completing the Declaration and Assessment of Assets (IM-78). When an individual applies for vendor coverage and is a married person, always complete the IM78 along with the IM-1MA, Application for Mo HealthNet. The IM78 should be completed with assets owned by the couple in the month he/she was first institutionalized for more than 30 days. The IM79 Intent To Transfer form will need to be signed when application is made for vendor coverage. Division of Assets for Married Couples Example: Admit to Nursing Home 2/04/16 and was previously in the hospital for 7/01/15 7/31/15, 31 days. The month of assessment would be July 2015, therefore the resources owned in July 2015 would be listed on the IM78. Example: Admit to hospital on 1/15/16, admitted to nursing home from hospital on 2/04/16, the month of assessment would be January 2016, therefore resources owned in January 2016 would be listed on the IM78. 5

6 Division of Assets for Married Couples The Division of Assets determines the spousal share which is usually one-half of all countable assets. The minimum spousal share is $23,844. The maximum spousal share is $119,220. (These figures are increased according to federal regulation.) Once a division is complete and spousal share has been determined, the application for vendor coverage is evaluated. If the couples total non-exempt resources owned in the month of application or prior quarter months are below the spousal share, the institutionalized spouse is initially eligible for vendor coverage and will be given 90 days to remove their name from all nonexempt assets. IM6-AR Appointment of Authorized Representative Provide IM-6AR with the application. If a POA signs the IM-6AR, provide copy of the Durable Power of Attorney. For Couple case, authorization is needed for both spouses. Ending Representation Submit IM-6ARR Authorized Representative Revocation Form to end authorized representative. You may the IM6ARR to Miller.CoDFS@dss.mo.gov 6

7 Specific Medicaid Issues Prior Quarter Coverage Pre-Eligibility Medical Expenses Reporting Changes in Circumstances after Application Transfers Responding to Requests for Information Prior Quarter Coverage MO HealthNet may cover outstanding medical costs incurred by the applicant (or spouse) in the 3 months prior to the month application is received Indicate on the application whether or not prior quarter coverage is needed. Ensure all types of income (earned or unearned) received in prior quarter months are on the application. Ensure all resources/assets owned in prior quarter months are on the application and provide verification. Pre-Eligibility Medical Expenses (PEME) Who is eligible for a PEME? Anyone determined eligible for vendor coverage and who owes a monthly surplus. PEME s are paid by reducing the current surplus owed to zero to allow the customer to apply the surplus to unpaid medical expenses. The expense must have been incurred no earlier than three months prior to the month of the customer s most recent application. Expenses incurred prior to that period are not allowable deduction. Expenses incurred during a transfer penalty period are not allowed. Covered services beyond the amount of the Medicaid State Plan that are medically necessary are limited to the Medicaid State Plan rates. Request PEME at anytime. However, the individual must be approved for vendor coverage and a surplus must be owed. 7

8 Reporting Change in Circumstances Mo Healthnet recipients are to report any change in circumstances while receiving benefits. These changes should be reported to the Nursing Home Unit that covers the county the nursing home is located in. (Refer to map of Vendor Units) Northern Region Nursing Home Unit Livingston County Southern Region Nursing Home Unit Ozark County St. Louis Region Nursing Home Unit Madison County Kansas City Region Nursing Home Unit Lafayette County Transfers Transfer Exemption Home may be transferred to o Spouse of such individual o Child under the age of 21 or child who is blind or disabled o Provide verification of relationship, age and disability/blind o Sibling with equity interest in the home and who resided in the home for at least one year prior to the individual being institutionalized o Provide verification of relationship, equity interest, reside for 1 year prior o Child of such individual residing in the home for two years prior to individual becoming institutionalized and who provided care allowing them to remain at home o Provide verification of relationship, residence of two years and dr. statement Transfers Assets besides the home may be transferred to o Community Spouse or to another for sole benefit of the Community Spouse. o From the Community Spouse to another for sole benefit of the Community Spouse. o A trust for the sole benefit of individuals disabled child. o Provide relationship to child and proof of disability. o A trust for the sole benefit of a disabled person under age 65 o Provide relationship to child and proof of disability 8

9 Responding to Request for Information During the application process, communicate with the Eligibility Specialist. requested verification to SPU holds the application for 30 days after approval/reject then forward it to the respective Nursing Home Unit. Contact SPU Supervisor Amanda Durran or Manager Dawn Rising of issues at Dawn ext. 257 Amanda ext. 249 SPU Eligibility Specialist Marie H Allen Ext 251 Marie.H.Allen@dss.mo.gov Stephanie Barrett Ext 229 Stephanie.L.Barrett@dss.mo.gov Peggy Bodenstein Ext 254 Peggy.Bodenstein@dss.mo.gov Christy Marcolla Ext 247 Christy.L.Marcolla@dss.mo.gov Tammy Hurst Ext 250 Tammy.Hurst@dss.mo.gov Lisa Otto Ext 246 Lisa.Otto@dss.mo.gov Tracey Rayhart Ext 248 Tracey.Rayhart@dss.mo.gov Nicolas Runyan Ext 245 Nicolas.Runyan@dss.mo.gov Mary Shirley Ext 262 Mary.Shirley@dss.mo.gov Candy Trusty Ext 239 Candy.J.Trusty@dss.mo.gov Other Forms 9

10 DA 124 Initial Assessment Social/Medical Timely submission of the DA 124 Ways the DA 124 can be submitted The DA 124 can be ed to By mail COMRU, PO Box 570 Jefferson City MO Note! Submitting the DA 124 by will shorten the processing time by 7-10 days. IM-9 Insurance and Prepaid Burial Letter This form may be used to assist in verifying cash surrender values of life insurance or burial policies. To be signed by the client. Provide the name of the company. The company address is requested, if available IM-7 Financial Information Request This form may be used to assist the applicant in providing verification of their account balances. If the individual has access to their information, please have them attempt to obtain the information themselves, as some banks charge a fee for filling out the IM-7 10

11 Unusual or difficult assets Jewelry 2 vehicles for a couple case Farm equipment Exempt real estate Income producing land Homes Helpful Websites - access to the State of Missouri Department of Social Services Website. Information regarding benefits and how to apply for services. Applications can be accessed from this site. access to Nursing Home forms and applications. Forms available are: IM-1MA- Application for MoHealthNet/Nursing Care Benefits. IM-78 Declaration and Assessment of Assets Form IM-6AR Appointment of Authorized Representative IM-7 Financial Information Request IM-9 Insurance and Prepaid Burial Map of Nursing Home Units Lafayette Co Contact Info Family Support Division Kansas City Region Nursing Home Unit 736 S. Bus Hwy 13 Lexington, MO Phone: /Fax: Lafayette.CoDFS@dss.mo.gov The preferred way to contact our office is by Lafayette.CoDFS@dss.mo.gov You may also send documents via fax to (660) Through this address or fax number, you can send us inquiries and correspondence! If you prefer to contact our office by telephone: After dialing (660) , press zero to speak with a receptionist who will direct your call to the appropriate team member. If the Eligibility Team Member who answers this extension is on the phone with someone when you call, please leave a message. Your call will be returned within 48 hours. If you are not contacted within 48 hours or you feel you need to speak to a supervisor, you may contact Cara Newham at (660) ext. 251 or by at Cara.Newham@dss.mo.gov If it has been three business days and you haven t received a response on an issue, you can elevate your concern to Debbie Heldenbrand, County Manager, by Deborah.Heldenbrand@dss.mo.gov. 11

12 Livingston Co Contact Info Family Support Division Northern Missouri Nursing Home Unit PO Box 1080 Chillicothe, MO Phone: /Fax: The preferred way to contact our office is by to or by fax to Through this address or fax number, you can: Scan and send us applications, annual reviews and any other information for residents. Send any questions you have about pending status of residents. If a response is needed, our office will send a response to s or faxes within 24 hours. If you prefer to contact our office by telephone: After dialing , extension 221 is designated as a line for nursing homes, Public Administrators, and attorneys. If the Eligibility Team Member who answers this extension is on the phone with someone when you call, please leave a message on this extension. Your call will be returned within 24 hours. If you are not contacted within 24 hours or you feel you need to speak to a supervisor, you may contact : Diane Dinwiddie at extension 234 or by at Diane.D.Dinwiddie@dss.mo.gov, or If it has been three business days and you haven t received a response on an issue, you can elevate your concern to Debbie Heldenbrand, County Manager, at extension 232 or by at Deborah.Heldenbrand@dss.mo.gov. Madison Co Contact Info Family Support Division St. Louis Region Nursing Home Unit 413 Burris St. Fredericktown, MO Phone: /Fax: Madison.CoDFS@dss.mo.gov The preferred way to contact our office is by to Madison.CoDFS@dss.mo.gov, or by fax to Through this address or fax number, you can: Scan and send us applications, annual reviews and any other information for residents. If you prefer to contact our office by telephone: After dialing , press zero to speak with a receptionist who will direct your call to the appropriate team member. If the Eligibility Team Member who answers this extension is on the phone with someone when you call, please leave a message. Your call will be returned within 48 hours. If you are not contacted within 48 hours or you feel you need to speak to a supervisor, you may contact : Violet Boswell at extension 232 or by at Violet.B.Boswell@dss.mo.gov If it has been three business days and you haven t received a response on an issue, you can elevate your concern to Rebecca Toppins, County Manager by Rebecca Toppins at extension 237 or by at Rebecca.S.Toppins@dss.mo.gov Ozark Co Contact Info Family Support Division Southern Missouri Nursing Care Office P. O. Box 717 Gainesville MO Phone: /Fax: Ozark.CoDFS@dss.mo.gov The preferred way to contact our office is by to Ozark.CoDFS@dss.mo.gov, or by fax to Through this address or fax number, you can: Scan and send us applications, annual reviews and any other information for residents. If you prefer to contact our office by telephone: After dialing , press zero to speak with a receptionist who will direct your call to the appropriate team member. If the Eligibility Team Member who answers this extension is on the phone with someone when you call, please leave a message. Your call will be returned within 48 hours. If you are not contacted within 48 hours or you feel you need to speak to a supervisor, you may contact : Frances (Arlene) Merriman at extension 234 or by at Frances.A.Merriman@dss.mo.gov or Gayla Hillhouse-Murphy at extension 250 or by at Gayla.Hillhouse-Murphy@dss.mo.gov If it has been three business days and you haven t received a response on an issue, you can elevate your concern to Dan Watson, County Manager by Dan.Watson@dss.mo.gov 12

13 Miller Co Contact Info Family Support Division Specialized Nursing Home Processing Unit P. O. Box 410 Eldon, MO Phone: (573) /Fax: (573) Processes the following type vendor applications Trust Transfer of Property Annuities Legal Representation Division of Assets Specialized Nursing Home Processing Unit Management Staff Dawn Rising, Manager Amanda Durran, Supervisor Ext. 257 Ext Shellie Bledsoe, PDS Ext