Application Process

PURPOSE: This rule establishes how individuals apply for participation in the Metabolic Formula Program. (1) Application for participation in the Metabolic Formula Program (MFP) shall be made on forms designated by the Department of Health and Senior Services. Application forms may be requested from the Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102-0570. (2) The applicant, or if the applicant is a minor or incapacitated, the applicant’s parent(s) or legal guardian, shall: (A) Submit a copy of their most current federal 1040 tax form and complete a Metabolic Formula Program application that includes: the applicant’s last name, first, middle initial; date of birth; gender; race; marital status; Social Security number; address (street, city, state, zip); county of residence; home telephone number; cell telephone number; work telephone number; responsible party (last, first, middle initial), relationship and phone number; a copy of any applicable court appointed guardian/custodian document; dependents claimed on fed- eral income tax filing (last, first, middle initial), relationship to the applicant and social security number of the dependents; alternate contact (last, first, middle initial), relationship to the applicant and phone number; MO HealthNet number (if applicable); amount of MO HealthNet spend down per month (if applicable); copy of the front and back on any third party payors (if applicable); other proof of income if the most recent federal income tax filing is not reflective of the current financial status; yearly amount of child support received; and yearly amount of child support paid. (B) Submit a copy of the previous month’s utility bill with the applicant’s home address clearly printed as proof of residency. (C) Report any major changes in income, household composition, insurance, MO HealthNet coverage or address within ten (10) working days after the date the applicant or the applicant’s parent(s) or legal guardian becomes aware of the change. (3) When the applicant is eligible, payments shall be made for such services through MO HealthNet or other insurance benefits available to the applicant to the fullest possible extent. The benefits available under the provisions of section 191.331, RSMo Supp. 2007 shall not replace those provided under other federal or state law or under other contractual or legal entitlements of the persons receiving them. (4) The applicant is responsible for paying for any amount of debt incurred above the program amount paid by the department based on the established sliding fee scale in 19 CSR 40-7.050. (5) The applicant or the applicant’s parent(s) or legal guardian shall provide the department with complete and accurate information concerning their financial status. (6) To maintain eligibility, an applicant shall submit a new application prior to the end of the eligibility period. The eligibility period shall be the state fiscal year, July 1 through June 30. Each new application submitted must meet the eligibility requirements and the most recent federal 1040 tax form must be submitted with the application. Applications may be accepted any time during the fiscal year. (7) If the applicant or the applicant’s parent(s) or legal guardian does not meet the requirements of sections (1)–(3) of this rule, the MFP shall discontinue services. The applicant may retain eligibility for service coordination services if the applicant’s income exceeds income eligibility guidelines. (8) Any applicant determined ineligible for the MFP may reapply based on changes, which may make them eligible. AUTHORITY: section 191.315, RSMo 2000 and sections 191.331 and 191.332, RSMo Supp. 2007.* Emergency rule filed Sept. 7, 2007, effective Sept. 17, 2007, expired March 14, 2008. Original rule filed Nov. 1, 2007, effective May 30, 2008. *Original authority: 191.315, RSMo 1985, amended 1993, 1995; 191.331, RSMo 1965, amended 1985, 1992, 1993, 1995, 1997, 2007; and 191.332, RSMo 2001, amended 2005. Table: Sliding Fee Scale for those Applicants Age 6 through 18 Years Based on Family Adjusted Gross Income Adjusted Gross Income is: Approximate Family Monthly Premium for Formula* 299% of poverty or below 0 300% – 399% of poverty 25% 400 – 499% of poverty 40% 500% of poverty and above 50%