MFAW Guidebook

SHCN collaborates with DSDS/FOPS and DMH/DD to provide a smooth transition for HCY participants who are moving to MO HealthNet adult coverage at the age of 21 and will no longer qualify for HCY services. All three agencies offer home and community-based services for individuals 21 years of age and older. HCY SCs will begin discussing transition options at least one year prior to the participant’s 21^st birthday and follow the transition process, as outlined in the DSDS-DMH Transition Process for Participants Aging Out of HCY, to offer the participant/responsible party(ies) all available options for services after the participant’s 21^st birthday. If the participant/responsible party(ies) requests the MFAW Program, proceed with a referral to MFAW. Referral to the MFAW Program should take place at least three (3) to six (6) months prior to the participant’s 21^st birthday.

Referral to MFAW Program

• The SC enters an Incoming Referral in the Referral screen in the SHCN Information System for the date the participant/responsible party requests the MFAW Program. This date cannot be more than six (6) months prior to the participant’s 21^st birthday.
• The SC enrolls the participant in MFAW Service Coordination in the SHCN Information System, effective the date the participant/responsible party requests the MFAW Program.
• The SC completes the MFAW Referral Screening (see the MOHSAIC User Guide for details on how to complete) in the SHCN Information System.
• The SC completes a summary of the participant’s needs and services on the MFAW Enrollment Request Summary and submits it to the RC at least three to six months prior to the participant’s 21^st birthday.
  • If a referral for MFAW is received from a referral source outside of the HCY Program and the individual is already over the age of 21, the SC must obtain documentation of the individual’s medical needs prior to the age of 21 that could only be met by four (4) or more hours of continuous skilled nursing care that are equivalent to the PDN requirements for HCY.
  • The SC will outline to the referral source that they will need to submit the medical records documenting this need for MFAW eligibility review. If the individual is a previous HCY and/or MFAW participant and was authorized for PDN during their program enrollment, the SC will outline this in the MFAW Enrollment Request Summary as proof of the medical need for PDN prior to the age of 21.
• The RC will review the MFAW Enrollment Request Summary, follow up with the SC on any questions/concerns and then submit to the HCY/MFAW PM for review.
• The HCY/MFAW PM will review the MFAW Enrollment Request Summary, following up with the RC and/or SC with any questions/concerns.
• If the participant is enrolled in a DMH waiver at the time of the referral, verification of waiver termination prior to the participant’s 21^st birthday is required before MFAW Paid Service enrollment can be completed and services can begin.
  • The HCY/MFAW PM will review the participant’s DMH enrollment information in CIMOR when reviewing the MFAW Enrollment Request.
  • If there is an end-date on the DMH waiver enrollment prior to the participant’s 21^st birthday in CIMOR, the PM will note this in the response to the MFAW Enrollment Request and proceed with the approval process.
  • If there is not an end-date listed in CIMOR prior to the participant’s 21^st   birthday, the HCY/MFAW PM will notify the RC and SC to make a request to the DMH/SB40 SC for a DMH waiver termination request signed by the participant/responsible party and the DMH representative.
    • If the SC completes documented good faith attempts to obtain DMH waiver termination verification from the DMH/SB40 SC and is unsuccessful, they will contact the RC, requesting assistance no later than one month prior to the participant’s 21^st birthday
    • The RC will then contact DMH Central Office staff, copying the PM,  for assistance verifying DMH waiver termination
  • A scanned copy of the signed DMH waiver termination form is sent to the RC from the SC.
  • The RC forwards this document to the HCY/MFAW PM.
• Once the HCY/MFAW PM reviews the MFAW Enrollment Request Summary, they will send their recommendation for approval/denial to the RC. The HCY/MFAW PM makes the final determination of MFAW eligibility and authorization of services. If a DMH waiver termination is needed, the approval will be contingent on receipt of proof of the DMH waiver termination prior to the participant’s 21^st birthday.
• The RC will notify the SC of the MFAW recommendation determined by the HCY/MFAW PM.
• If the HCY/MFAW PM recommends MFAW enrollment, they will approve the MFAW Referral Screening in the SHCN Information System. If there is a pending DMH waiver termination, this will not be completed until proof is obtained.
• If the participant is approved for a MFAW slot, the SC will proceed with the steps for MFAW Enrollment.

MFAW Enrollment

• The SC completes the MFAW SCA, Level of Care (LOC), Client Assessment (CA) and has the MFAW paperwork signed by the participant/responsible party one to three months prior to the participant’s 21^st birthday or within 10 business days of receipt of the MFAW referral for individuals over the age of 21 and not currently enrolled in HCY.   
• During the MFAW SCA, the SC will review provider selection and service information. The SC should provide a copy of the MFAW provider list for the participant/family to assist with provider selection.
  • If the participant is approved to receive specialized medical supplies through MFAW, they will need to select a MFAW provider for the newly authorized services since these are not covered through HCY.
  • If the participant is approved to receive PDN, PCA, APC and/or ARN, it is likely that their current HCY provider will also be an enrolled MFAW provider and they will be able to continue using the same provider agency(ies). MFAW provider enrollment will need to be verified prior to selection and, if the provider agency is not an enrolled MFAW provider, the participant/responsible party will need to select a different agency.
• Once the participant/responsible party notifies the SC of their provider choice, the SC will complete a VC for each agency and email to the respective provider agency staff. Please see the example for a MFAW New Enrollment VC in the HCY-MFAW VC Templates, Instruction & Examples resource for how to complete a MFAW New Enrollment VC.
• Once the provider agency(ies) submit their PA supporting documentation, the Facilitator will complete the MFAW PA(s) and the SC will review and approve and the PA(s).
• If MFAW enrollment is pending receipt of DMH waiver termination information, once the DMH termination documentation is received in Central Office, the HCY/MFAW PM will then approve the MFAW Referral Screening in the SHCN Information System allowing enrollment in Paid Service in the MFAW Program.
• On the first working day on or after the participant’s 21^st birthday, the SC will enroll the participant in MFAW Paid Services, effective the date the participant turns 21. If the referral is already over the age of 21, the paid service enrollment date will be the date of approval.
• The SC should then continue to follow the MFAW home visit schedule that aligns with their MFAW SCA. Please note that the previous HCY visit schedule may need to be adjusted, dependent on how the participant’s 21^st birthday aligns with the current visit schedule.