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Referrals, Service Authorizations, and Acceptance of Participants

Sets out how the Agency receives referrals and DSDS service authorizations, records the date it receives each authorization, checks the authorization and the participant's MO HealthNet eligibility, decides on the basis of a reasonable expectation that it can meet the participant's needs whether to accept, and starts services within ten calendar days of receipt or on the beginning date the authorization specifies, whichever is later, sending DSDS a detailed written justification when it cannot.

Preview: full text with a package
About this policy
Policy number
MO-HC-ADM-01
Version
1.0
Main rule
19 CSR 15-7.021(18)(J)
Library
Missouri home care · 50 policies
Category
Service delivery
Sections
21

In short

  • We deliver only services DSDS has authorized. Never start DSDS services before the authorization arrives.
  • Write the date we received each authorization on it, the same day.
  • Services must begin within 10 calendar days of receipt, or on the start date the authorization gives, whichever is later.
  • If a start will be late, the supervisor sends DSDS a detailed written reason and keeps a copy in the file.
  • Check the participant's MO HealthNet eligibility on each day services are provided.

What's inside

21 sections. The full text comes with the One-time Policy Pack.

Full text with a package
  • Terms of Reference
  • 1. Purpose
  • 2. Scope
  • 3. Definitions
  • 4. Policy Statement (19 CSR 15-7.021(18)(J))
  • 5. How Referrals and Authorizations Reach the Agency
  • 6. Recording and Checking Each Authorization
  • 7. Deciding Whether to Accept
  • 7.1 Accepting
  • 7.2 Declining
  • 8. MO HealthNet Eligibility and Coverage
  • 9. Starting Services on Time
  • 10. When a Start Will Be Late
  • 11. Before the First Visit
  • 12. Responsibilities
  • 13. Records and Compliance Monitoring
  • 14. Staff Training
  • 15. References
  • 16. Related Policies and Forms
  • 17. Approval
  • 18. Revision History

An inspector may ask

  • Show me the date of receipt recorded on this participant's service authorization, and the first date services were delivered.
  • This start was late. Where is the written justification you sent to DSDS, and the copy in the participant's file?

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