MFAW Guidebook
Referral and Initial Enrollment
Referrals may be accepted from many sources. Examples of these sources may include health care providers, families, other state and/or local government agencies, schools, and advocacy organizations. Pertinent information is gathered at the time a referral is received.
When a referral for MFAW services is received, participant information, including the referral source, should be entered into the SHCN Information System. The participant is then enrolled in Service Coordination status. The date for enrollment in Service Coordination is the date the referral was received.
Determining MFAW eligibility is a multi-step process that begins upon receipt of a referral and is based on the criteria listed below.
The participant must:
- Be MO HealthNet eligible,
- Have a federally matched ME code,
- Require medical care equivalent to the level of care received in an ICF-IID,
- NOT be living in any type of facility,
- NOT be receiving services through another waiver,
- Receive, or have previously received or been eligible to receive Private Duty Nursing services through the Healthy Children and Youth Program,
- Maintain cost-effective alternative care at the ICF-IID level, and
- Score at least 18, meet three functional and meet three medical criteria on the Level of Care Determination Form.
Once the above criterion has been met, the SC will contact the participant/family to gather additional information. The RC will notify the PM of the receipt of the referral and advise them of assessment plans. The SC will arrange a home visit (as indicated) if the needs of the participant/family may be met through services authorized by the MFAW Program. The initial contact and home visit will occur within 10 business days of the receipt of the referral. If it is not possible to make a visit within these time frames due to participant/family circumstances, the reason for the delay and the plan for scheduling a visit will be documented in the SHCN Information System.
After assessment, the SC will complete the MFAW Enrollment Request Form and submit it to the RC for review. Once reviewed, the RC will submit the request to the PM to make a final determination of eligibility and services available.
Note: For participants transitioning from the HCY Program to the MFAW Program, see section on MFAW Transition Process.