1900.050.00 FAMILY SUPPORT DIVISION (FSD) FIELD OFFICE RESPONSIBILITIES

Although qualified entities (QE) are instructed to contact FSD through the above mentioned methods, if the QE contacts the local FSD Resource Center, staff should screen for past PE eligibility, search and assign DCN as needed following the same procedures given above for FSD Information Center staff.

FSD offices must develop procedures to:

• log PE documentation into ITrackRS:
  • PE-2 WORKSHEET;
  • PE-3 or PE-3 TEMP; and
  • Any other documentation submitted by applicant, including an IM-1SSL, if submitted
• scan and email all documentation to FSD.MEDES@dss.mo.gov with PE in the subject line on same or next business day.

  NOTE: All PE determinations must be sent to FSD.MEDES@dss.mo.gov and must not be entered through any other method.

The assigned MAGI Processing Center will:

• process PE cases;
• register the PE determinations into the appropriate system; and
• ensure documents are scanned to the Virtual File Room.

QEs that sign agreements to determine PE will be added to the Presumptive Eligibility Qualified Entity List found at:

• https://dssapp.dss.mo.gov/ProviderList/sprovider.asp

Contact the MO HealthNet Program and Policy at COLE.MHNPOLICY@dss.mo.gov with any issues or concerns regarding the QE's administration of the PE programs.

1900.050.10 Entering Presumptive Eligibility Determinations

Presumptive Eligibility is entered through different systems. The instructions for each system are outlined below.

1900.050.10.10 ITMP Entries for TEMP / SMHB-PE

Until MEDES has functionality to enter PE determinations, continue using the following procedure. The ITMP screen is used for TEMP / SMHB-PE determinations and is accessed by typing ITMP space DCN. Use the following steps to make entries:

• Enter the temporary number (P number) from the P-Number Spreadsheet.;
• Enter county, load, worker and supervisor numbers;
• Enter the nine (9) digit provider number for the QE;
• Enter the applicants address;
• The TEMP / SMHB-PE application date is the begin date of coverage. Enter the begin date of coverage n the following format: mmddyyyy;
• Enter income from line F7 of the PE-2 Worksheet. This field requires seven (7) characters as follows - 00000 00;
• Enter the size of the household from the PE-2 Worksheet from which the TEMP / SMHB-PE determination was made;
• Enter the estimated due date from the PE-2 Worksheet;
• SMHB indicator field requires an entry of Yes (Y)or No (N):
• Place a N if applicant qualifies for the Temporary MO HealthNet During Pregnancy (TEMP) program.
• Place a Y if applicant qualifies for the Show-Me Healthy Babies program (SMHB-PE); and
• Press control and receive case processed message.

1900.050.10.20 Presumptive Eligibility for Children (PC) Entries

Until MEDES has functionality to enter PE determinations, continue using the following procedure. Children who are screened for Presumptive Eligibility have a two-step process:

1. An application must be entered on IAPP; and
2. The application must be approved or rejected on IMU5.

1900.050.10.20.10 IAPP Entries for PC Applicants

Register a Presumptive Eligibility for Children application (PE-1SSL) via IAPP in the caretaker's name. For children this will be a P type of assistance with a C instead of sequence number. Example: PCxxxxxxxx.

1900.050.10.20.20 IMU5 Entries for Eligible PC Applicants

IM#51 May 18, 2017

Enter the Presumptive Eligibility for Children into the Legacy system via an IMU5 transaction on the date the qualified entity notifies FSD of the determination. Keep all Presumptive Eligibility documentation in the virtual fileroom.

Enter the IMU5 transaction for Presumptive Eligibility:

1. Enter "A" Case Data Update at Enter Update Selection;
2. Field 5 - Case action (use IMU5 code sheet);
3. Field 6 - Reason open (use IMU5 code sheet);
4. Field 15b - Enter the QE provider number. This must be a valid provider number for the system to accept the entry;
5. Enter "B" Individual Update at Enter Update Selection;
6. Field 13E - date of eligibility for eligible child(ren);
7. Field 13G - level of care "T" for eligible child(ren);
8. Field 13G2 - level care "T" for eligible child(ren).
9. Reject the Parent/Caretaker by entering "D" Update Application in the Enter Update Selection field.
10. Enter "D" Reject Individual(s) at Action Selection.
11. Put a "D" next to the individual to be rejected and press CTRL.

1900.050.10.20.30 IMU5 Entries for Ineligible PC Applicants

Qualified entities will also submit completed PE determinations that reflect ineligibility to the FSD county office for entry in the IMU5 system. The FSD staff will register a Presumptive Eligibility for Children application and enter the case rejection in the system.  Keep all denied Presumptive Eligibility documentation in the virtual fileroom.

The rejection entries are as follows:

1. Enter "A" Case Data Update at Enter Update Selection;
2. Field 5 - Case action 20 (reject);
3. Field 7 - Reason rejected. The system will only accept the following reason codes in field 7 of a Presumptive Eligibility rejection:
   • 01 Income exceeds limits
   • 38 Non-resident
   • 75 Received within last 12 months (system generated)
4. Field 15b - Enter the QE provider number. This must be a valid provider number for the system to accept the entry;

The qualified entity should still send the IM-1SSL even if the child is found ineligible for Presumptive Eligibility for Children. Upon receipt, register and process the MO HealthNet application.

1900.050.10.30 Entries for MHF-PE

When a Parent/Caretaker determination for PE is received the PE liaison in the FSD office will complete the following steps the same day as received:

• MAGI Processing Centers receiving the PE-1SSL and PE-1Worksheet should scan or forward these documents to the FSD.MEDES@dss.mo.gov email address with a subject line of "PE-Parent/Caretaker". Then, if received, register the IM-1SSL, process and scan into the FSD Work Site following established procedures.
• Non-MAGI offices and Resource Centers receiving a fax or scan of the PE-1SSL and PE-1Worksheet forms should scan or forward to the FSD.MEDES@dss.mo.gov email address with a subject line of "PE-Parent/Caretaker". Staff from the specified processing center will enter the PE coverage and register the IM-1 SSL into MEDES.

  NOTE: MHF-PE coverage will only be entered by a specified processing center. Until MEDES functionality exists to enter coverage, eligibility for Parents and Caretaker Relatives will be entered by submitting the appropriate information on the Bypass Method Request form.

1900.050.10.40 IBCC entries for BCCT PE

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 DCN.

1. Enter load, residence county, pay county, worker and supervisor numbers;
2. Enter the applicants address;
3. Enter diagnosis date in start date field as mm dd yy;
4. Press control and receive store completed message.

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

• Not a female,
• Over age 65,
• Cannot duplicate an active case, which appears if the individual already has active eligibility for another program.

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 "M2" case with a level of care "T" and reason "L" in the level of care (sanction) reason field.

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.