Consumer Eligibility. PROVIDER is responsible for identifying a consumer’s active eligibility for Medicaid/HMP reimbursement through the REMI system at the time of admission to treatment and every 30 days thereafter. PROVIDER is responsible for assisting any non-insured or under-insured consumer with Medicaid/HMP eligibility application within 30-days of admission (or within 30-days of loss of coverage). Block grant eligibility shall be determined at the time of admission to services. Financial information needed to determine ongoing ability to pay (financial responsibility) must be reviewed every 90 days or at a change in an individual’s financial status, whichever occurs sooner, and uploaded into REMI. Please see MSHN website Finance Policies and ProceduresFinance Policies and Procedures for the most current version of the SUD Income Eligibility & FeesSUD Income Eligibility & Fees Policy and Procedure.
Consumer Eligibility. The consumer is eligible for In-Home Services The Participation Agreement has been signed The service plan and budget has been created The consumer lives in a stable living situation The consumer has demonstrated the ability to manage money and can manage their ICP benefit or has designated a representative to manage their ICP benefit on their behalf Form SDS 0541 Notice of Eligibility and Responsibility has been sent to the consumer Form SDS 0546IC2Wk Independent Choices Benefit Calculation has been sent to the ICP Coordinator and the consumer Form SDS 0548 Independent Choices Program Employee Provider(s) Information has been completed, signed and sent to the ICP Coordinator Form SDS 0353 Workers’ Compensation Consent and Agreement has been completed and signed Form DHS 7262i Direct Deposit and an original voided check has been sent to the address indicated on the form to Salem (Note: Originals must be sent. Emails/Faxes are not sufficient). The coding has been updated in the Mainframe to include the ICP Case Descriptor The consumer is complying with their legal and financial employer responsibilities Natural supports have been adequately addressed The consumer has a back-up plan Does the consumer have a representative? Yes / No (If no, you may skip this section) If yes, did the representative complete a criminal history check? The representative is ensuring the consumer’s health and well-being needs are met The representative can manage the service plan and budget The Representative Agreement has been signed The representative is NOT getting paid for their services Form SDS 0546IC2Wk Independent Choices Benefit Calculation has been sent to the representative The representative is complying with the legal and financial employer responsibilities on behalf of the consumer All employee provider(s) have submitted a criminal history check The employee provider(s) are ensuring the consumer’s health and well-being needs are met The consumer is making regular payments to their employee provider(s)
Consumer Eligibility. 1. Prior to billing the Region and/or Department, the provider must determine if the consumer is financially eligible for the Division of Behavioral Health to pay for services. The Division of Behavioral Health and/or the Network Manager may request verification of consumers’ financial eligibility from any provider.
2. To determine if a consumer meets financial eligibility criteria, on the HHS/Division of Behavioral Health Financial Eligibility & Fee Schedule:
a. Complete the Eligibility Worksheet for the consumer to determine the Adjusted Monthly Income amount.
b. Locate the adjusted monthly income amount on the schedule.
c. Locate the total number of family members dependent on the taxable income.
d. Consumers who by Adjusted Monthly Income and number of family members dependent on the taxable income fall within the shaded areas on the chart are eligible for services funded by Division of Behavioral Health. Costs (as defined in Section II) associated with performance of services to eligible consumers may be billed to the Division.
e. Consumers who by Adjusted Monthly Income and number of family members dependent on the taxable income fall within the un-shaded area of the HHS/Division of Behavioral Health Financial Eligibility Schedule are not financially eligible for payment by the State. No costs associated with performance of these services may be billed to the Division.
Consumer Eligibility. PROVIDER is responsible for identifying a consumer’s Block Grant eligibility at the time of admission to services. Financial information needed to determine ongoing ability to pay (financial responsibility) must be reviewed every 90 days or at a change in an individual’s financial status, whichever occurs sooner. Please see MSHN website Finance Policies and Procedures for the most current version of the SUD Income Eligibility & Fees Policy and Procedure.
