Exceptions Process

The Exception Process reviews requests for non-covered items and services. Under certain conditions of medical need, MO HealthNet Division may authorize payment for an eligible participant to receive an essential medical service or item of equipment that otherwise exceeds the benefits and limitations of any one of the medical service programs administered by the Division. Under specific criteria and on a case-by-case basis, an administrative exception may be made to limitations and restrictions set by agency policy. No exception can be made where requested items or services are restricted or specifically prohibited by state or federal law or regulation, or excluded under the restrictions section of this rule.