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