MCCY/MCAW Referral Process

MCCY/MCAW Referral Process

Referrals can be taken by any SHCN staff to ensure that someone is not directed to several different places, delaying the process. MO HealthNet eligibility will be determined by the Facilitator. A Service Coordinator (SC) must review all appropriate MCCY and MCAW referrals with straight Fee-For-Service (FFS) Medicaid to determine medical eligibility for enrollment into paid services. The MCCY/MCAW Program Manager (PM) must approve all MCAW referrals prior to paid service enrollment. Please reference the MOHSAIC User Guide, eMOMED Guide and HealthTrack at a Glance resources for system assistance and the MCCY & MCAW Guidebooks for additional information on referral, initial enrollment, program eligibility and records management.

1A-Central Office

• If a referral is received by Central Office staff, forward the referral to the appropriate East/West Region Reporting Email, copying the corresponding Regional Coordinator (RC) and the MCCY/MCAW Senior Public Health Program Specialist (SPHPS), or to the main Regional Office number if the referral is received via phone. 
  • East Region: SHCNEastRegionReporting@health.mo.gov 
  • West Region: SHCNWestRegionReporting@health.mo.gov

1B-Regional Office

• Complete the MCCY & MCAW Referral Form to ensure that all applicable information is obtained from the referral source.
• If the referral is received by Regional Office staff other than the Facilitator, forward the MCCY & MCAW Referral Form to the corresponding Facilitator for processing.
• Enter an ‘Other’ Progress Note in MOHSAIC, using the following template, unless the referral was initially received by the Facilitator.
  • Template: ‘I received a referral from [name] with [agency (if applicable)].  I forwarded the referral information to [Facilitator name], Facilitator for processing.’

2-Facilitator

1. Confirm MO HealthNet (MHN) status by checking the ‘Eligibility’ and ‘Lock-In’ screens in eMOMED and the ‘Eligibility’ screen in HEALTHTRACK.  If MHN status is unable to be confirmed, the participant’s information will be forwarded to the SPHPS, copying the Program Manager (PM), to be sent to the Family Support Division (FSD) Liaison for confirmation.

3A-Facilitator 

1. If the referral is enrolled in Managed Care (MC), contact the responsible party to advise them that we are unable to accept the referral and that they will need to contact the MC provider to request services.
2. Enter the referral information in the corresponding Regional Office’s ‘Referral Log’ for the current year, located in the ‘Referrals’ folder for that office.
3. Enter an ‘Other’ Progress Note in MOHSAIC using the following template.
   • Template: ‘I received a referral from [SHCN staff title & name]. I confirmed that [participant name] is enrolled in Managed Care with [MC provider name]. I contacted [responsible party name] to notify them that we are unable to accept the referral and they will need to contact the MC Provider for assessment/authorization.’

3B-Facilitator

• If the referral has confirmed straight FFS MHN, enter the referral information into MOHSAIC using the following steps: 
  • Locate participant. 
    • ‘Participant Management’ – ‘Quick Search’ type in DCN, hit enter.  If the participant’s name does not pull up use ‘Advanced Participant Search’.
  • Click on ‘Medicaid Information’ then click ‘Refresh from DSS’ to ensure that MHN information is pulled from FSD/MHN.
  • Click on ‘Locators’.
    • ‘Addresses’ – click on ‘Add Address’ and enter the address. There must be a ‘MAILING’ marked as ‘PRIMARY’ address for each participant. If the mailing address is a PO Box then ensure that the physical home address is entered as ‘HOME’.
    • ‘Telephone’ – click on ‘Add Telephone’ and enter in the phone number.
    • ‘E-mail Addresses’ – click on ‘Add Email’ and enter in the email address.
  • Click on ‘Contacts’.
    • Click on ‘Add/Change Responsible Party’ and enter in the ‘Responsible Party’, ensuring that the ‘Locators’ for the contact are entered and accurate. 
    • If there are additional alternate contacts (i.e. dad, grandma, aunt, neighbor, etc.), click ‘Add Contact’.
  • Click on ‘Enrollment’.
    • Make sure that ‘MO Resident’ at the top of the screen is checked. 
      • If not checked, click ‘Update’, click the box next to ‘MO Resident’, then click ‘Save’.
    • Click on ‘Start New Enrollment’.
    • Click on ‘Add Service Coordinator.’
      • Using the Service Coordinator’s (SC) geographical assignment list provided by the Regional Coordinator, type the SC’s name in ‘Name’ using Last Name, First Name, then hit enter (If any changes to the geographical assignment list are needed, the RC will communicate the changes to the Facilitator to update).
      • Enter the ‘Begin date,’ which will be the date that the referral was initially received by SHCN.
      • Click ‘Apply’.
      • Click ‘Save’.
    • Select MCCY or MCAW from the ‘Program’ dropdown. 
    • Select ‘Level 4’ from the ‘Priority Level’ dropdown (all referrals will initially be entered as Level 4 and the SC will update accordingly once the participant is assessed).
    • Click ‘Save’.
  • Click on ‘Referrals’.
    • Click on ‘Add Referral’.
    • Type in the date the referral was initially received by SHCN.
    • Choose referral source type.
  • Click on ‘Progress Notes’ and enter an ‘Other’ Progress Note using the following template.
    • Template: ‘I received the referral for [service] from [name]. According to the confirmation of Medicaid status, [participant name] has active MO HealthNet with a start date of [date] and ME code of [code].
      • I entered [participant name] on the Caseload Tracking Sheet and referral log and entered information in the following screens in MOHSAIC:
        • Locators
        • Addresses
        • Telephones
        • Contacts
        • Enrollment
        • Referrals
      • I forwarded the referral information to SC [SC name] for review.
• Enter the referral information in the corresponding Regional Office’s ‘Referral Log’ for the current year, located in the ‘Referrals’ folder for that office.
• Save the Referral Form in the proper sub-folder of the ‘Referral Documents’ folder using the following naming template and example:
  • Template: LAST NAME, First Name – Referral [date received]
  • Example: DOE, John – Referral 9.1.2025
• Enter the information on the corresponding ‘Caseload Tracking Sheet’.
• Email the ‘Referral Form’ and any supporting documentation to the assigned SC, copying the RC and the LASA.

4-Service Coordinator

1. Contact the responsible party to schedule and complete an assessment for the participant, according to MCCY & MCAW processes and policies.
   • If the referral is for MCAW, PM approval is required prior to paid service enrollment. Please see the MCAW Guidebook for additional MCAW referral and enrollment policies and procedures. 
   • If the referral is for Skilled Nurse Visits (SNV), please see Step 6D. MCCY Skilled Nurse Visits (SNV) in the PA Process.
2. Email the enrollment or denial decision to the Facilitator, RC, and LASA, requesting the appropriate ‘New Enrollment’ or ‘Denial/Change/Reduction’, including the referral’s name, DCN and the following information for approval/denial, respectively:
   • Approval – approved service(s), including hours/week, and date of SCA/paid service enrollment.
   • Denial – requested service(s), date of SCA, justification for denial.
3. If the participant will be enrolled in paid services, use the date of the SCA to enroll the participant into Paid Services in MOHSAIC under ‘Enrollment’. 

5-Facilitator

1. If approved for paid service enrollment, update the Caseload Tracking Spreadsheet to monitor for the receipt of Prior Authorization supporting documents.
2. Update the ‘ENROLLED OR DENIED’ cells in the Referral Log.

6-LASA

1. Prepare the enrollment or denial letter, using the corresponding ‘New Enrollment’ or ‘Denial/Change/Reduction’ letter templates located under ‘Letters’ on the corresponding Guidebook and send to RC and SC for review and approval.
2. Once approved by the RC and SC, mail the letter to the responsible party using the mailing address marked as ‘primary’ in MOHSAIC. 
3. Enter the letter into MOHSAIC under ‘Forms/Letters’.
4. If the participant is enrolled, delete the ‘Referral Form’ saved in the proper sub-folder of the ‘Referral Documents’ folder and move any supporting documentation into the ‘For Print & File’ folder.
5. Create the electronic and physical record for the participant.

7-LASA

1. Retain the referral information, according to the MCCY & MCAW Guidebook’s ‘Record Retention’ policy. All referrals that have not been enrolled into Paid Services will be retained for three (3) months. After no further activity, the referral documents may be shredded/deleted the month following 90 days.
2. Enter a ‘Record Management’ Progress Note in MOHSAIC, using the following template
   1. Template: Per the Records Management retention policy, I shredded/deleted the referral information, due to inactivity.
3. Delete the saved referral document(s).