County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Number
Page
Institution for Mental Diseases IMD
63
1of 2
Revision Date
April 9 2020
BackgroundAn IMD is defined as a hospital nursing facility or other institution with more than 16 beds that is primarily engaged in providing diagnosis treatment or care of people with mental diseases If a facility functions primarily as a facility established and maintained for the care and treatment of people with mental diseases then it is an IMD it does not have to be licensed as such An institution for the developmentally disabled is not an IMD
Purpose
This section has been written in the current format the rules for people age 22 have been corrected to match the State rules The prior section stated that people age 22 could no longer get MediCal in an IMD which conflicted with the rest of the section
Policy
IMD Eligibility People between 21 and 65 years of age in IMDs can receive MediCal if otherwise eligible
Note There is no federal financial participation for these people
MediCal Covered Services in an IMD Services covered for people 21 to 65 years of age in an IMD include the following
Facility charges the daily bed rate
MediCal covered physician services
Prescription drugs
Laboratory services
Xray services
Dental services
Vision services
Psychiatrist services
Psychologist services
Note Services not related to the IMD for example hospital emergency room etc would be covered
Disability Determination Determine the MediCal eligibility of a person admitted to an IMD or who is a resident of an IMD as shown in the table below
If disability
Then
Has not been
Initiate a referral to Disability Determination Services Division DDSD for a established
disability determination Place the person in Aid Code 53 until a determination has been completed See MPG 54 for instructions on DDSD referrals Has been
Place the individual in the appropriate disability aid code established
County of San Diego Health and Human Services Agency HHSA MediCal Program Guide
Institution for Mental Diseases IMD Number Page
63 2 of 2
Individuals 21 and 22 Years of Age in an IMD If a MediCal beneficiary in an IMD has been receiving psychiatric inpatient hospital services prior to hisher 21st birthday and continues to receive these services until age 22 heshe remains entitled to receive MediCal benefits Use Aid Code 82 Medically Indigent Child A MediCal Eligibility Data System MEDS hold and an alert will be generated at age 21 indicating that a special Eligibility Status Action Code ESAC is required for this age group and age Submit an online request to the Family Resource Center FRC MEDS clerk to reactivate the person on MEDS using aid code 82 and assigning a special ESAC code of 4 or 9 Set a Case Alert for when the person turns 22 to evaluate for other MediCal programs At age 22 the above person can no longer receive MediCal in Aid Code 82 and their MediCal eligibility must be reevaluated If determined eligible activate them in the appropriate aid code Procedure See above Program ImpactsNone References MEPM 6E Sunset Date This policy will be reviewed for continuance by March 31 2023 Approval for Release Rick Wanne Director Eligibility Operations