0815.020.00 Initial Assessment and Medical Certification – DSS Manuals

IM-56 March 25, 2019 ; IM-59 June 25, 2015 ; IM-33 March 29, 2012

All applicants or participants requesting vendor benefits must be medically certified by the Department of Health and Senior Services, Division of Senior and Disability Services for the appropriate level of care. The attending physician or facility completes the form DA-124A/B Initial Assessment – Social and Medical form and sends it along with a copy of the DA-124C Level One Nursing Facility Pre-admission Screening for Psychiatric Illness/Intellectual Disability or Related Condition form to the Central Office Medical Review Unit (COMRU). The COMRU State Medical Consultant reviews the form and certifies the level of care.

If the applicant or participant enters or wishes to enter a state psychiatric hospital, the level of care certification must be MHC. Individuals aged 22 through 64 are NOT eligible for MHC level of care based on age. Refer to manual section 0815.060.00 Applicants or Participants Between the Ages of 21 and 65 in State Mental Hospital for more information.

If the applicant or participant enters or wishes to enter a state institution for the developmentally disabled, the level of care certification must be IMR.

If the applicant or participant enters or wishes to enter a MO HealthNet certified bed in a nursing facility, the level of care certification must be NF.

Exception : For a child under age 21 who is receiving inpatient psychiatric services, medical certification is obtained on form IM-71 (Certification of Need for Psychiatric Services). See section 0815.055.00 Inpatient Psychiatric Services for Individuals Under 21 Years of Age .