The MO HealthNet Division publishes Hot Tips to supply information to clarify and assist in receiving timely reimbursement for services provided and claims disposition.

MO HealthNet has developed an index for historical and ongoing Hot Tips and a COVID-19 index for associated Hot Tips. The non-COVID-19 index location has not moved; it is also located below for quick reference.   Please share these Hot Tips with your billing staff.

Home and Community Based Services Miscellaneous Payment

May 25, 2023

Home and Community Based Services (HCBS) providers may be issued a payment coded as MIS (Miscellaneous) in May 2023. As a reminder, this payment is the Electronic Visit Verification (EVV) Value Based Incentive Payment. The incentive payments are based on criteria outlined in INFO 10-22-01. The payment was issued for all HCBS providers with visit data in the Electronic Aggregator System (EAS) during the March 1, 2023 – March 31, 2023 time frame. To review how payments were calculated, review INFO 05-23-02. Questions regarding this should be directed to the Bureau of Long Term Services and Supports (BLTSS) via e-mail at LTSS@health.mo.gov.

MO HealthNet Case Management for Pregnant Women

May 18, 2023

MO HealthNet Education and Training is hosting a webinar to discuss case management for pregnant women on Medicaid. The webinar will review resources, policy and billing information for providers. Please join us on Thursday, June 22, 2023 at 10:00 am. Register today!

National Maternal Mental Health Hotline

May 16, 2023

The US Department of Health and Human Services (DHHS) Health Resources and Services Administration (HRSA) is celebrating the first anniversary of the National Maternal Mental Health Hotline. Since its launch on Mother’s Day 2022, professional counselors have assisted almost 12,000 pregnant and postpartum individuals.

Additionally, HRSA is introducing an updated toll-free number for the hotline: 1-833-TLCMAMA (852-6262). The former number will continue to work for a year. HRSA encourages all providers to help spread the word about the new number. Promotional materials and more information is available for download.

Telemedicine after the COVID-19 Public Health Emergency (PHE)

May 16, 2023

MO HealthNet will continue to allow Telemedicine services after the COVID-19 PHE ends on May 11, 2023. If you have questions related to Telemedicine originating and distant site reimbursement please see our Telemedicine Originating & Distant Site Reimbursement Scenarios document.  Please also see our Telemedicine Billing PowerPoint.  If you have additional Telemedicine billing questions, please contact Provider Communications via eMOMED or by phone: 573-751-2896.

New Resources for Asthma Awareness Month and Beyond

May 15, 2023

The US Environmental Protection Agency has provided an Asthma Awareness one-page resource, convenient for handing out at events, that includes guides for asthma triggers, tips for controlling asthma and a checklist for finding triggers in homes. The resource allows you to scan QR codes to easily access several available resources. Spread the word to help improve indoor air quality for people with asthma.

Free Child-Parent Psychotherapy Learning Collaborative Opportunity

The Central Missouri- Child Trauma Initiative (CM-CTI), funded by the National Child Traumatic Stress Network (NCTSN), will host a free 18-month long Child-Parent Psychotherapy (CPP) Learning Collaborative in July (July 17, 18, 19, 20 and 21st from 9am-1pm (CST) by Zoom). CPP is an evidenced-based treatment for children ages 0-6 who have experienced traumatic events and/or are experiencing mental health, attachment, and/or behavioral problems. The CPP training will be led by Dr. Vilma Reyes, from the CPP developers at University of California- San Francisco

Applications are due Friday, May 19th.

Key Training Eligibility:

• CM-CTI typically trains agency teams rather than individual therapists as they believe that working with young children who have experienced trauma requires the support of a team. However, solo practitioners are welcome to apply, as they may combine individual trainees into teams to support one another.
• All clinical team members seeking to complete training and be eligible for the CPP roster must be master’s or doctoral-level therapists with a degree in a mental health discipline and be fully or provisionally licensed.
• If any participating team members are provisionally licensed, they must be supervised by a fully licensed team member who also participates in the training.

Please have one person from your team (usually the supervisor) complete the Readiness to Implement survey for the whole team/agency. CM-CTI welcomes applications from solo practitioners. Please contact Rachel or Vicki if you have any questions.

To apply to the CPP LC, please complete the following application:

Readiness to Implement CPP Survey

The Survey page also provides an overview of the Missouri 2023 LC.

Questions? Contact:

COVID-19: Registered Behavior Technician Extension

On March 20, 2020, in response to the COVID-19 outbreak and due to the closure of testing centers administering the Registered Behavior Technician (RBT) exam, the MO HealthNet Division (MHD) published a provider hot tip temporarily waiving the RBT requirement for technicians who met all other requirements but had not taken the RBT exam.

MHD is temporarily extending the waiver of this requirement until November 11, 2023. MHD urges impacted individuals to schedule RBT exams as soon as possible in order to avoid any disruption to applied behavior analysis services. No further extensions of this flexibility will be considered.

Information about RBT testing is available here: https://www.bacb.com/examination-information/

If you have questions, please email MHD.EDUCATION@dss.mo.gov or call (573) 751-6683.

Comprehensive Community Support Billing Tips– Residential Treatment and Treatment Foster Care

The information in this provider hot tip applies to services for MO HealthNet fee-for-service covered participants.

Please remember that prior authorization is required for residential treatment, treatment foster care. Below are tips to help speed the approval process:

• Requests for prior authorization must include the facility NPI and the taxonomy code associated with the agency’s Community Psychiatric provider type.
• Documentation accompanying the prior authorization form must include recent clinical records such as the treatment plan and prescriber progress notes.
• The Prior Authorization Request form has been updated. Please indicate in box 1 if the request is for an initial authorization or re-authorization. Prior authorization requests should be faxed to (573) 659-0207.
• Please include the dates requested (fields 19-20) and the number of units (days) requested (field 22). There are online tools to assist with calculating the number of days in a date span, here is one example. Be sure to include the end day for accuracy.
• Prior authorization is not required for six months of residential aftercare.

Questions about prior authorization may be emailed to MHD.BehavioralHealth@dss.mo.gov

In eMOMED, when billing for residential treatment or treatment foster care services (e.g., H0019, H2020, H2022), after entering the facility NPI, providers must select the taxonomy code associated with the Community Psychiatric provider type (if the NPI is also associated with other provider types such as Clinic). Contact Provider Communications at (573) 751-2896 for questions about filing claims or claims disposition.

Evidence-Based Nicotine Treatment Strategies

May 4, 2023

The Behavioral Health & Wellness Program introduces the Missouri Tobacco Health Systems Change Behavioral Health Community of Practice webinar series. The first webinar in this series will review evidence-based strategies for treating Tobacco Use Disorder. This webinar will present an overview of co-treatment of polysubstance use utilizing FDAapproved medications and behavioral therapies. This webinar is Thursday, May 18, 2023 from 12:00 pm to 1:00 pm and is free! Pre-registration is required. Register here.

Electronic Visit Verification E-Learning Course

April 28, 2023

MO HealthNet has created an EVV E-Learning Course to provide additional education to Personal Care Services (PCS) and Home Health Care Services (HHCS) providers. This course is a quick and simple tool to explain Electronic Visit Verification (EVV) requirements and the use of the MO EVV Aggregator Solution (EAS). EVV related bulletins, administrative rules and other announcements are available on MO HealthNet’s website at https://dss.mo.gov/mhd/providers/electronic-visit-verification.htm.

Third Party Liability Contact Information

May 1, 2023

MO HealthNet Division (MHD) has created a Third Party Liability (TPL) resource to assist providers with contacting specific carriers with billing/claim submission questions. This list is not all encompassing but may provide providers with helpful contact information. As a reminder, MHD and Show Me Healthy Kids are the payers of last resort when there is a possibility of a third party resource (i.e., private insurance). There is a TPL E-Learning Course and a TPL Information for Providers flyer that explains TPL in more detail if you need more information. For questions on TPL, contact (573) 751-2005.

Provider Enrollment Snapshot

April 21, 2023

Providers must enroll with Missouri Medicaid Audit and Compliance (MMAC) in order to be reimbursed for medical services provided to MO HealthNet participants. In an effort to assist a provider with enrollment, MMAC is excited to announce the Provider Enrollment Snapshot. This document provides an overview of the major requirements to become a MO HealthNet provider. For additional information, providers should review the MMAC Provider Enrollment website. For questions regarding Medicaid enrollment, email MMAC.ProviderEnrollment@dss.mo.gov>.

Webinar: National Childhood Lead Poisoning Prevention Education Webinar for Pediatricians

April 21, 2023

Childhood lead exposure and poisoning is a sustained public health concern that affects half a million children in the United States. Consequences associated with lead exposure include decreased impulse control, learning difficulties, and conduct disorders. Pediatricians are in a unique position to offer anticipatory guidance, identify and treat the condition, educate, and advocate for policies that protect children. This webinar from the Childhood Lead Poisoning Prevention Program (CLPPP) will build awareness of and capacity for lead screening among pediatricians and pediatric and non-physician clinicians. Specifically, this webinar will address: pediatric lead exposure as a present-day public health concern, the importance of screening and testing, and community level approaches to decreasing pediatric lead exposure. This Webinar is free of charge, however prior registration is required.

Date and time: Thursday, May 4, 2023 2:00 -3:30 PM Eastern Time (US & Canada)

Bring Smiles Back to Missouri: Become a Medicaid Provider

April 11, 2023

Dentists: Please watch this video to hear from current and participating Missouri dental Medicaid providers, as well as others who are here to help and be resources for you! You can also visit our MO HealthNet Education and Training pageto sign up for Provider Trainings and other useful educational resources. Contact Education and Training for more information.

Screening Adolescents for Depression

April 10, 2023

Major depression in adolescents is recognized as a serious psychiatric illness with extensive acute and chronic morbidity and mortality. According to the American Academy of Pediatrics (AAP) research shows that only 50% of adolescents with depression are diagnosed before reaching adulthood. As many as two in three youth with depression are not identified by their primary care providers and fail to receive any kind of care.

This is a reminder of the importance of universal annual screening of adolescents age 12 and older for depression and suicide risk as outlined in the Bright Futures/AAP Periodicity Schedule. Although MO HealthNet Division does not endorse any particular screening tool, one commonly used tool that is available in the public domain is the PHQ-9: Modified for Teens. For further information about depression screening tools, providers may download the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) Toolkit.

Outpatient Hospital Services

April 5, 2023

Reminder: Effective for dates of service beginning July 20, 2021, all outpatient hospital services are reimbursed based on the Outpatient Simplified Fee Schedule (OSFS). Payment under the OSFS methodology is final, without cost settlement.

Hospitals must report all outpatient services and associated charges at the claim line level using Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) procedure codes and the number of units appropriate to the services rendered. Complete fee schedules of outpatient hospital procedure codes with the MO HealthNet allowed amount under the OSFS methodology can be found at the following links:

• Effective 7/20/2021
• Effective 7/01/2022

Behavioral Health Services Request for Precertification

April 5, 2023

Effective immediately, providers should begin using the updated Behavioral Health Services Request for Precertification form for psychotherapy/counseling services that require precertification. This form was updated slightly with no significant content changes. Any outdated form submitted as of May 5, 2023 will be returned with a request to submit using the new form. Questions may be directed to (866) 771-3350. As a reminder, an approved precertification approves only the medical necessity of the service and does not guarantee payment.

Dental – Credentialing, Policy and Claims Processing Webinars

March 28, 2023

The Missouri Coalition for Oral Health is hosting a series of webinars to assist dental providers with credentialing, policy and claims processing.

There will be four webinars, each one featuring a different MO HealthNet Managed Care health plan. Each plan, including MO HealthNet, has their own credentialing, policy, and claim processing guidelines. The Managed Care health plan will present information specific to their plan, and answer questions during their scheduled webinar. MO HealthNet will also present information and resources on May 12, 2023, and be available to answer questions.

This is an excellent learning opportunity for dental providers to access resources and gain knowledge to be successful with billing Medicaid while providing services to Missouri’s most vulnerable citizens.

Sign up today!

Healthy Blue – Friday, April 14, 2023 - 12:00 p.m. to 1:00 p.m.

Home State Health – Friday, April 21, 2023 - 12:00 p.m. to 1:00 p.m.

United Healthcare – Friday, April 28, 2023 - 12:00 p.m. to 1:00 p.m.

MO HealthNet – Friday, May 12, 2023 - 12:00 p.m. to 1:00 p.m.

COVID-19: Registered Behavior Technician

March 27, 2023

On March 20, 2020, in response to the COVID-19 outbreak and due to the closure of testing centers administering the Registered Behavior Technician (RBT) exam, the MO HealthNet Division (MHD) published a provider hot tip temporarily waiving the RBT requirement for technicians who met all other requirements but had not taken the RBT exam.

The COVID Public Health Emergency will expire on May 11, 2023. Effective May 12, 2023, this requirement will no longer be waived.

Information about RBT testing is available here: https://www.bacb.com/examination-information/

Extended/Uninsured Women’s Health Services COVID-19 Testing

March 27, 2023

During the COVID-19 public health emergency (PHE), MO HealthNet Division covered COVID-19 testing for participants in the State-funded categories of assistance for Extended/Uninsured Women’s Health Services (Medicaid eligibility codes 80 and 89).

The COVID-19 PHE will expire on May 11, 2023. Effective May 12, 2023, MO HealthNet Division will no longer cover COVID-19 testing for participants in the State-funded categories of assistance for Extended/Uninsured Women’s Health Services (Medicaid eligibility codes 80 and 89).

COVID-19: Private Duty Nursing

March 27, 2023

The federal declaration of the COVID-19 public health emergency will terminate on May 11, 2023. Due to the expiration of the federal COVID-19 public health emergency, the following Private Duty Nursing Program flexibilities described in the MO HealthNet Provider Bulletin Volume 42, Number 32 dated March 17, 2020 will terminate.

ANNUAL PERFORMANCE EVALUATIONS

Annual performance evaluations that come due will not be required to have any on-site visits performed. This flexibility will end effective May 11, 2023. Performance evaluations due between May 11, 2023 and November 11, 2023 must have a least one on-site visit. Annual performance evaluations due after November 11, 2023 must have two on-site evaluations.

RN SUPERVISORY VISITS

RN supervisory visits for participants receiving LPN services will not be required. This flexibility will end on May 11, 2023.

PERSONNEL TRAINING

The four hours of orientation training for new employees is waived with the exception of child abuse/neglect indicators and reporting, and universal precaution procedures. This flexibility will end on May 11, 2023. Employees are not required to retroactively complete the four hours of orientation training waived between March 17, 2020 and May 11, 2022.

GRADUATE NURSES

Nursing care by a graduate LPN or graduate RN will be allowed. A graduate LPN or graduate RN may provide nursing services (during this public health emergency) until receipt of the results of the first licensure examination taken by the graduate nurse or until ninety (90) days after graduation, whichever comes first. This flexibility will end on May 11, 2023.

PROVIDER REASSESSMENTS

Provider 60 day assessments to reestablish the plan of care and resumption of care assessments following a hospitalization may be completed through telehealth as determined appropriate by the PDN provider. This flexibility will end on May 11, 2023.

PLANS OF CARE (485)

For initial assessments and reassessments, verbal or written orders for care/services must be obtained prior to delivery of service. The submission of the 485 Plan of Care form may be delayed; however, it must be submitted within 30 days after the end of the public health emergency. Prior authorization will be completed by the Bureau of Special Health Care Needs upon receipt of the 485 Plan of Care. This flexibility will end on May 11, 2023.

COVID-19: Home Health

March 27, 2023

The federal declaration of the COVID-19 public health emergency will terminate on May 11, 2023. Due to the expiration of the federal COVID-19 public health emergency, the following will occur regarding Home Health Program flexibilities described in the MO HealthNet hot tips dated May 14, 2020 and April 17, 2020:

Plans of Care and Certifying/Recertifying Patient Eligibility: An advanced practice registered nurse who is working in accordance with State law, or a physician assistant who is working in accordance with State law may: (1) order home health services; (2) establish and periodically review a plan of care for home health services (e.g., sign the plan of care), (3) certify and re-certify that the patient is eligible for home health services. This will provide the flexibility needed for more timely initiation of services for home health patients, while allowing providers and patients to practice social distancing. This flexibility was made permanent. See the MO HealthNet Home Health Provider Bulletin dated August 24, 2022.

Initial Assessments: Home health agencies, as appropriate, can perform initial assessments remotely or by record review. This will allow patients to be cared for in the best environment for them while supporting infection control and reducing impact on acute care and long-term care facilities. This will allow for maximizing coverage if there are limited physician and advanced practice clinicians, and will allow those clinicians to focus on caring for patients with the greatest acuity. This flexibility will end on May 11, 2023.

Onsite Visits for HHA Aide Supervision: The onsite nurse visit is not required. This includes waiving the requirement for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan, as this may not be physically possible for a period of time. This waiver also temporarily suspends the 2-week aide supervision requirement by a registered nurse for home health agencies, but virtual supervision is encouraged during the period of the waiver. This flexibility will end on May 11, 2023.

Occupational Therapists (OTs), Physical Therapists (PTs) and Speech and Language Pathologists (SLPs): OTs, PTs and SLPs may perform the initial and comprehensive assessment for all patients. The requirement that OTs, PTs and SLPs may only perform the initial and comprehensive assessment when only therapy services are ordered is waived. This modification allows an OT, PT, or SLP to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether or not the service establishes eligibility for the patient to be receiving home care. OTs, PTs and SLPs are not permitted to perform assessments in nursing only cases. HHAs are expected to continue to match the appropriate discipline that performs the assessment to the needs of the patient to the greatest extent possible. On May 11, 2023, MHD will follow CMS’ guidance for Medicare related to this flexibility. Per CMS’ informational document titled “Home Health Agencies: CMS’ Flexibilities to Fight Covid-19”, CMS finalized changes to § 484.55(a) and (b)(2) to permanently allow occupational therapists to complete the initial and comprehensive assessments for patients, in accordance with Division CC, section 115 of CAA 2021.

COVID-19 Vaccines

March 27, 2023

During the COVID-19 public health emergency (PHE), if a participant was enrolled in a Managed Care Organization (MCO), the administration of the COVID-19 vaccine was billed to the MO HealthNet Fee-for-Service program, and not to the MCO.

The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023, the administration of the COVID-19 vaccine will be billed to the MCO.

If a participant is not enrolled in an MCO, the administration of the COVID-19 vaccine will be billed to the MO HealthNet Fee-for-Service program.

COVID-19: DME: Prescription Signature:

March 27, 2023

During the COVID-19 Public Health Emergency (PHE), MO HealthNet (MHD) allowed prescriptions to be accepted by telephone from the MHD enrolled ordering/prescribing physician or staff member.

The COVID-19 PHE will expire on May 11, 2023. Effective May 12, 2023, a written prescription is required for Durable Medical Equipment (DME) supplies and equipment.

COVID-19: DME: Multi-Function Ventilator:

March 27, 2023

During the COVID-19 Public Health Emergency (PHE), MO HealthNet (MHD) allowed temporary coverage and reimbursement for a multi-function ventilator; HCPCS code E0467, with a restriction specifically for the ventilator.

The COVID-19 PHE will expire on May 11, 2023. Effective May 12, 2023, MHD will no longer cover this item.

COVID-19: Radiology – Chest CT Scans

March 27, 2023

During the COVID-19 public health emergency (PHE), MO HealthNet (MHD) did not require providers to obtain prior authorization for Chest CT Scan HCPCS codes 71250, 71260, and 71270 when the following COVID-19 related diagnosis codes were present: B34.2, B97.29, J12.89, J20.8, J22, J40, J80, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.8, P22.0, P28.5, R05, R06.02, R09.02, R50.9, Z03.818, Z09, Z20.828, Z86.19, Z11.52, Z20.822, Z86.16, M35.81, M35.89 and J12.82.

The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023, MO HealthNet will require providers to obtain prior authorization for the above listed Chest CT Scan HCPCS codes when the above listed COVID-19 related diagnosis codes are present.

During the COVID-19 PHE, MO HealthNet also allowed prior authorizations for all procedures managed by the MHD’s Radiology Benefit Manager (RBM) to be approved for 90 days.

Effective May 12, 2023, prior authorizations for all procedure codes managed by the MHD’s Radiology Benefit Manager (RBM) will be approved for 30 days.

COVID-19: Telemedicine Services

March 27, 2023

During the COVID-19 public health emergency (PHE), MO HealthNet (MHD) reminded providers of program policies around telemedicine services.

The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023 MO HealthNet, will continue to allow any licensed health care provider, enrolled as a MO HealthNet provider, to provide telehealth services if the services are within the scope of practice for which the health care provider is licensed. The services must be provided with the same standard of care as services provided in person.

Telehealth services may be provided to a MHD participant, while the participant is at an originating site, and the provider is at another location (the distant site.) The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.

There is not a separate telehealth fee schedule. Reimbursement to health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided.

MHD also allowed the use of telephone for telehealth services, and allowed quarantined providers and/or providers working from alternate sites or facilities to provide and bill for telehealth services. These services should be billed as distant site services using the physician’s and/or clinic provider number. MHD did not require additional CMS flexibility for these options, and they will continue.

During the Public Health Emergency, MHD waived some requirements, including:

• The requirement that physicians must have an established relationship with the patient before providing services via telehealth, per RSMo 191.1146
• The requirement that, in order to treat patients in this state with telehealth, health care providers shall be fully licensed to practice in this state. The flexibility allowed providers to treat patients in this state if they are licensed in the state in which they practice.

Effective May 12, 2023 MO HealthNet will discontinue the two flexibilities above.

COVID-19: Certificate of Medical Necessity Form (CMN) Signature Requirement:

March 27, 2023

During the COVID PHE, MO HealthNet temporarily waived the original signature requirement on Certificate of Medical Necessity Form (CMN) that requires an original signature.

The COVID PHE will expire on May 11, 2023. Effective May 12, 2023, this requirement will no longer be waived.

Certain DME requires a CMN. Original signatures are required for Fields 7 and 14. Refer to the DME Provider Manual Section 13.15.B for details on the Direct Delivery Requirements and Section 7.2 for details on the CMN process.

COVID-19: COVID-19 Testing and Specimen Collection Reimbursement

March 27, 2023

During the COVID-19 public health emergency, effective with dates of service on or after March 1, 2020, the state plan allowed MO HealthNet to reimburse all providers 100% of the Medicare rate for COVID-19 testing and specimen collection codes.

The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023, the state plan will require MO HealthNet to reimburse for COVID-19 testing and specimen collection codes performed in the outpatient setting 90% of the Medicare rate and independent laboratories 80% of the Medicare rate.

COVID-19: 1135 Waiver for Pre-Admission Screening and Resident Review (PASRR):

March 27, 2023

During the COVID-19 Public Health Emergency (PHE), MO HealthNet waived the requirement for participants that may require a Level II evaluation (have a qualifying mental illness (MI) or intellectual disability (ID) diagnosis).

The COVID-19 PHE will expire on May 11, 2023. Effective May 12, 2023, participants seeking admission into a Medicaid Certified bed in a nursing facility that may require a Level II evaluation must complete the Application for Level One Form and Level of Care Assessment online prior to placement. If an individual has an MI, ID, or related condition, a Level II review must be completed by the state mental health authority and/or the contract agent of the state mental health authority prior to admission.

The online PASRR process is automated and can be found on COMRU’s webpage: https://health.mo.gov/seniors/nursinghomes/pasrr.php

MO HealthNet’s Preadmission Screening and Resident Review (PASRR) policy is accessible in Section 13.7 of the MO HealthNet Nursing Home manual at: http://manuals.momed.com/collections/collection_nur/print.pdf

DMH PASRR information is accessible at https://dmh.mo.gov/dev-disabilities/programs/pasrr-level-ii-assessments

COVID-19: COVID-19 Testing and Specimen Collection

March 27, 2023

During the COVID-19 public health emergency, effective with dates of service on or after March 1, 2020, MO HealthNet did not require a referring physician for claims submitted by independent laboratories for COVID-19 testing. MO HealthNet required providers who performed other laboratory services on the same date as the COVID-19 test to bill for the COVID-19 test on a separate claim in order to be reimbursed.

The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023, MO HealthNet will require a referring physician for claims submitted by independent laboratories for all COVID-19 testing.

COVID-19: DME: Delivery Slip Signature Requirement:

March 27, 2023

During the COVID-19 Public Health Emergency (PHE), MO HealthNet (MHD) temporarily waived the signature of the participant or their designee on the delivery slip when DME is delivered to the participant’s home.

The COVID-19 PHE will expire on May 11, 2023. Effective May 12, 2023, the signature of the participant or their designee is required on the delivery slip.

What is MO HealthNet Presumptive Eligibility? …and how to make it work in my pharmacy

by ANGELA WILSON – Pharmacy Program Manager, MO HealthNet & ERICA MAHN, PharmD, BC-ADM – Executive Director of Community Pharmacy Services at Alps Pharmacy

Presumptive Eligibility (PE) makes it possible for eligible individuals to gain immediate access to medical services temporarily while they submit an application to the Family Support Division for ongoing MO HealthNet coverage. Participants benefit from PE because they can start on the medications they need instead of waiting for the Family Support Division to process their application. These medications include mental and behavioral health medications, heart failure treatments, and prenatal vitamins for pregnant moms, among many other medications.

PE programs include Temporary MO HealthNet during Pregnancy (TEMP), PE for children ages 0-18, Show-Me Healthy Babies-PE (SMHB-PE), and PE for Parents/Caretaker Relatives and Former Foster Care Youth. These groups receive MO HealthNet pharmacy coverage for a temporary period of time under PE. The PE form will list the participant’s case number (DCN) for claim processing. This 8 or 10-digit number will remain the participant’s processing information for MO HealthNet services for life, so once this information is received, the pharmacy can build insurance coverage into the pharmacy system for processing. Potentially, the claim will not process immediately, but the information can be used for reprocessing the claim in the coming days.

PE ensures reimbursement to MO HealthNet pharmacy providers for any covered medication dispensed to the patient. If a patient presents a pharmacy provider with a PE-3 or PE-3 TEMP, the pharmacy can bill for covered medications provided to the patient. Make sure to only dispense a 30-day supply and attempt to identify medications consistent with MO HealthNet’s preferred drug lists (PDL) when possible.

These can be found at: https://dss.mo.gov/mhd/cs/pharmacy/pages/clinedit.htm

A searchable database for MO HealthNet’s Preferred Drug List is also available at: https://mopdl.gainwelltechnologies.com/

PE eligibility is not immediately entered into the MO HealthNet system and is not directly available in eMOMED® or the point-of-sale pharmacy system. The forms, however, are valid once issued and guarantee eligibility after the date on the form. When billing MO HealthNet for services provided to PE patients, pharmacy providers should make a copy of the PE-3 and PE3TEMP forms and maintain a copy in the pharmacy files for documentation of eligibility. As long as the date you provide a service is after the date on the PE-3 and PE-3 TEMP forms, MO HealthNet will guarantee reimbursement for any covered medication dispensed, including medications that generally require prior authorization.

Once the DCN is active you should reprocess any unpaid claims for the individual from the date range on the PE forms. If a denial occurs when reprocessing call or submit a backdate request to MO HealthNet Pharmacy Administration. By establishing a process for this participant group at your pharmacy, participants will be able to receive necessary care during the transition period.

If you have questions or your pharmacy has difficulty processing claims for individuals with PE, contact MO HealthNet Pharmacy Administration at (573) 751-6963 or MHD.PharmacyAdmin@dss.mo.gov.

**A quick reference table similar to the one below would be helpful to share with staff along with sample PE form **

Be sure to:

Train staff on how to recognize the document and best assist the participant

Keep a copy of the PE document presented at the pharmacy counter.

Review the MO HealthNet PDL resources https://dss.mo.gov/mhd/cs/pharmacy/pages/clinedit.htm https://mopdl.gainwelltechnologies.com/

Only process a 30-day supply

Establish a process for transmitting claims and reprocessing when the participant is not currently active. One example could include: Running the claim for “cash” and putting it on a patient account for future reprocessing Create consistent documentation for claims affected Set a reminder to reprocess (as soon as 5 days later or up to 30 days later)

Have the MO HealthNet Pharmacy Administration phone number readily available for follow-up. (573) 751-6963

Behavioral Health Services – Reminder on Maximum Quantity Changes Effective July 1, 2022

March 21, 2023

Effective July 1, 2022, MO HealthNet Division (MHD) implemented changes to maximum daily quantities for certain procedure codes. MHD’s fee schedules will continue to show the previous maximum daily quantity until July 1, 2024. This is to allow claims for dates of service prior to July 1, 2022 to pay correctly. Claims for dates of service July 1, 2022 and forward with units above the new maximum daily quantity will deny. For any questions, please contact Provider Communications using the Provider Management tool on eMOMED or by calling (573) 751-2896.

UNIT AND DAILY MAXIMUM QUANTITY CHANGES FOR PSYCHOTHERAPY SERVICES
		Through 06/30/2022		Effective 07/01/2022
Proc Code	Description	Unit	Daily Max Qty	Unit	Daily Max Qty
90791	Psych Diagnostic Eval	30 min	6	Untimed	1
90792	Psych Diagnostic Eval with Medical	30 min	6	Untimed	1
90853	Group psychotherapy	30 min	3	Untimed	1
90839	Psychotherapy for crisis	60 min	6	60 min	1
96105	Assessment of aphasia	60 min	4	60 min	3
96116	Neurobehavioral status exam	60 min	4	60 min	1
96146	Automated psych or neuropsych testing and result	Untimed	4	Untimed	1

 

DAILY Maximum Quantity Changes for Applied Behavior Analysis Services
		Through 06/30/2022		Effective 07/01/2022
Proc Code	Description	Unit	Daily Max Quantity	Unit	Daily Max Quantity
97151	Behavior identification assessment	15 min	8	15 min	32
97152	Behavior identification supporting assessment	15 min	32	15 min	16
97155	Adaptive behavior treatment with protocol modification	15 min	32	15 min	24
97156	Family adaptive behavior treatment guidance	15 min	40	15 min	16
0362T	Behavior identification supporting assessment, 2 or more techs	15 min	32	15 min	16
0373T	Adaptive behavior treatment with protocol modification, 2 or more techs, for destructive behavior	15 min	34	15 min	32

Nursing Home Coverage for Participants within the Adult Expansion Group (E2) and Managed Care

March 13, 2023

MO HealthNet Education and Training will be holding two webinars for MO HealthNet providers in order to clarify billing and policy for nursing home coverage when participants are eligible through the Adult Expansion Group (E2) and enrolled in a Managed Care Health Plan. The information to be covered was posted in a Bulletin on August 31, 2022, Nursing Home Coverage – Revised. Please join us for one of the scheduled webinars, which will also include an opportunity to ask questions on this topic.

Topics Covered:

• Billing for Nursing Home Room and Board
• The 60 Day Rule
• Prior Authorizations Not Required
• Participant Surplus
• Participants Admitted While on Hospice

Register for a webinar today:
March 23, 2023 10:30AM to 11:30AM Register
April 11, 2023 9:00AM to 10:00AM Register

Maternity Stays and Post-Discharge Home Visits

March 3, 2023

Coverage through the MO HealthNet Program is available for a minimum of 48 hours of inpatient care following a vaginal delivery and a minimum of 96 hours of inpatient care following a cesarean section for a mother and newly born child. A shorter length of hospital stay for services related to maternity and newborn care may be approved if the shorter stay meets with the approval of the attending physician after consulting with the mother. In which case, post-discharge care is required.

MO HealthNet reimburses up to two post-discharge skilled nurse visits in the home within two weeks of an early inpatient discharge for a stay of less than 48 hours for a vaginal delivery and for a stay of less than 96 hours for a cesarean section delivery when provided by a home health agency.

Visits must be physician ordered and included in a plan of care. The criteria for an early inpatient discharge and the post-discharge visits must be met.

The first post-discharge visit shall be provided within 48 hours of an inpatient discharge unless otherwise ordered by a physician and the second post-discharge visit, if appropriate (e.g., breast feeding not well established) shall be provided within two weeks of an inpatient discharge. These services are exempt from the home-bound requirement. The post discharge visit(s) covers both the mother and newborn.

The home health agency shall make a report to the attending physician within 24 hours of the post-discharge visit.

The post-discharge visit(s) must be billed using the mother’s Departmental Client Number (DCN).

How to File a Claim with MHD as the Tertiary Payer

March 2, 2023

Occasionally, providers must file a Medicare crossover claim for a MO HealthNet participant who has a supplemental and/or secondary insurance policy. When this occurs, the provider can review Tertiary Payer Claims on the MO HealthNet Education and Training webpage for step-by-step instructions. For questions, providers can contact Provider Communications using the Provider Communications Management direct messaging tool on eMOMED or call (573) 751-2896.

More information on post-discharge visits can be found in Section 13.15 of the Home Health Manual found at: https://manuals.momed.com/collections/collection_hom/print.pdf

Maternal Depression Screening

March 3, 2023

Maternal depression is a serious and widespread condition that not only affects the mother, but may have a lasting, detrimental impact on the child’s health. The MO HealthNet Division (MHD) covers maternal depression screening procedure code 96161, which may be billed under the child’s Departmental Client Number (DCN), for administering a maternal depression screening tool during a well-child visit.

Bright Futures

March 3, 2023

The Healthy Children and Youth (HCY) Program in Missouri is a comprehensive, primary and preventive health care program for MO HealthNet eligible children and youth under the age of 21 years. The program is also known as the Early Periodic Screening, Diagnostic and Treatment (EPSDT) program. It covers regular screening services for infants, children and adolescents. These screenings are designed to identify health and developmental issues as early as possible. The MO HealthNet Division (MHD) requires that providers follow the Bright Futures/ American Academy of Pediatrics (AAP) Periodicity Schedule, which is available at https://www.aap.org/en/practice-management/).

Bright Futures is a national health promotion and prevention initiative, led by the American Academy of Pediatrics (AAP) and supported by the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA). Information about Bright Futures screening services can be found on their website at: https://brightfutures.aap.org/clinical-practice/Pages/default.aspx

Case Management for Pregnant Women

March 3, 2023

Case management services are available for MO HealthNet eligible pregnant women who are “at risk” of poor pregnancy outcomes and are intended to reduce infant mortality and low birth weight by encouraging adequate prenatal care and adherence to the recommendations of the prenatal caregiver.

A risk appraisal is a set of criteria to be used in identifying pregnant women who are at risk of poor pregnancy outcomes, and children who have or are at risk of developing physical, psychosocial and/or developmental problems. All appropriate MO HealthNet participating providers are urged to perform risk appraisals on pregnant women during the initial visit and as changes in the patient's medical condition indicate. Completion of the Risk Appraisal for Pregnant Women is mandatory in order to establish the “at risk” status of the patient and to bill the global prenatal or global delivery procedure code. No additional payment is made for performing the risk appraisal as it is included in the global reimbursement for prenatal care or delivery.

The Risk Appraisal for Pregnant Women form must be sent directly to the enrolled MO HealthNet Case Management Provider of the patient's choice and a copy filed in the patient's medical record. Any eligible pregnant woman who meets any one of the identified risk factors, as determined by the administration of the Risk Appraisal for Pregnant Women, is eligible for prenatal case management services and a referral should be made to a MO HealthNet participating prenatal case management provider.

Providers who are interested in becoming case managers should contact the Provider Enrollment Unit for more information at MMAC.ProviderEnrollment@dss.mo.gov.

Maternal infant Health Prenatal Vitamins

February 27, 2023

MO HealthNet wants to ensure that participants who are pregnant or hoping to conceive get the nutrition they need before and during pregnancy. Ideally, mothers-to-be would take prenatal vitamins before conception as brain development starts during the first month of pregnancy, often before mothers even know they are pregnant. During pregnancy, mothers also need more folic acid and iron than usual. A healthy diet is the best way to get the vitamins and minerals mothers need for a healthy pregnancy and the baby’s development. Still, mothers may fall short on critical nutrients even with a healthy diet during pregnancy. Some benefits of taking prenatal vitamins include:

• Reduces the risk of spina bifida and neural tube defects;
• May reduce the risk of other birth defects, like cleft lip, cleft palate, or certain heart birth defects;
• May reduce the risk of developing preeclampsia and gestational diabetes;
• Helps prevent iron-deficiency anemia;
• Reduces the risk of pre-term delivery, low birth weight, and infant mortality;
• Helps provide enough calcium for strong teeth and bones, a healthy heart, nerves, and muscles, normal heart rhythm, and blood clotting.

MO HealthNet covers most prescription prenatal vitamins, folic acid, and over-the-counter oral iron, with a prescription from a healthcare provider. Find a list of covered prescription prenatal vitamins here. Additional prescription prenatal vitamins not on the list, may be available with prior authorization

Opioids and CGMs may not need a PA

February 27, 2023

MO HealthNet does not require a prior authorization for opioid prescriptions less than 50 MME per day. Please note, for patients who have not filled an opioid through MO HealthNet in the past 90 days, the pharmacy will still need to run a 7-day fill prior to a full 30-day prescription, regardless of the MME.

MO HealthNet covers the continuous glucose monitor (CGM) Dexcom without prior authorization for ALL participants prescribed a daily regimen of rapid-acting or short-acting insulin. MO HealthNet auto-approves the Dexcom CGM at the pharmacy if the participant has filled rapid or short-acting insulin within the past 45 days. MO HealthNet requires no additional paperwork from your office to cover the Dexcom GCM for eligible participants.

The 2022 – 2023 Respiratory Syncytial Virus (RSV) season is winding down

February 28, 2023

Based on close monitoring of local RSV activity MHD will end the RSV prophylaxis prior authorizations of Synagis on 2/28/2023. MHD will not cover any Synagis doses administered after February 28, 2023.

The Missouri RSV season started earlier than usual and ended earlier than expected, with a peak in November 2022. RSV virology for Missouri has been less than 3% positivity for several weeks, indicating the season is ending, reducing the need for RSV prophylaxis.

Providers with questions may call the MO HealthNet Pharmacy and Medical Pre-Certification Helpdesk at 800-392-8030.

Herceptin Billing Policy Change

February 28, 2023

Effective for dates of service on or after April 1, 2023, MO HealthNet will require the product Herceptin by Genentech to be billed by the number of vials. Herceptin is available in a single-dose, powder-filled vial, and providers must bill by whole vials; no partial vials are allowed. Previously pricing for Herceptin was calculated per milligram and is now calculated per vial, necessitating this change. MO HealthNet has taken proactive steps to ensure claims no longer pay when billed by the milligram. Providers may contact Pharmacy Administration at (573) 751-6963 or email MHD.PharmacyAdmin@dss.mo.gov if they have questions.

Baby & Me – Tobacco Free Program

February 23, 2023

Receive free diapers and baby wipes by quitting smoking! Enroll in Baby & Me-Tobacco Free and access one-onone phone or video counseling from the comfort of your home, a plan to support and help you quit smoking and up to $350 in gift cards for diapers and baby wipes. If you are up to 36 weeks pregnant, a current tobacco user, quit since becoming pregnant or quit within three months of becoming pregnant, enroll now!

If you are a Missouri healthcare provider or agency, refer your pregnant tobacco users today.

Quitting is the most important thing you can do for your health and the health of your baby. For more information, visit the Baby & Me-Tobacco Free Program website.

Children’s Division Legal Custody Youth and Inpatient Stay When Not Medically Necessary

February 17, 2023

If a child who is in the legal custody of the Department of Social Services Children’s Division (CD) is hospitalized but is no longer in need of medical care at the hospital, and that child is pending a placement, CD will reimburse the provider at the same rate the hospital would receive per day for an inpatient admission.

When this occurs, providers should send the following to CD.AskRehab@dss.mo.gov:

• Invoice (not a CMS-1500) for the non-medically necessary/non-covered days that clearly itemizes the daily room and board rate
• Denial from Show Me Healthy Kids/Home State Health or the MO HealthNet Division (MHD) or MHD’s vendor Conduent, or similar documentation, with a clear indication of when the MO HealthNet coverage ended

For additional information, contact CD.AskRehab@dss.mo.gov with questions.

Participant Annual Review Date

February 16, 2023

Very soon, the Family Support Division (FSD) will be required to check the eligibility of all MO HealthNet participants, which include Managed Care health plan members of Healthy Blue, Home State Health, and United Healthcare.

We are asking providers to help spread the word so Missourians can stay informed. You can help by reminding participants about their upcoming annual review dates.

Providers can find a participant’s annual review date in one of two ways:

• Utilize the Participant Annual Review Date option in eMOMED
• Contact Provider Communications’ Interactive Voice Response (IVR) system at (573) 751-2896.

For questions regarding the annual review date, providers can contact Provider Communications at 573-751-2896. Participants can find additional information on the Renewing Your Medicaid Eligibility website.

The Education and Training Unit offers a variety of training opportunities and resources for providers. Email MHD.Education@dss.mo.gov or call (573) 751-6683 for more information on training.

Nursing Home Room & Board

January 31, 2023

With the exception of certain hospice stays, nursing home room and board is covered under fee-for-service (FFS) regardless of whether the resident is in a Managed Care health plan. Participants who are enrolled in a Managed Care health plan, and who are seeking admission into a nursing home, will remain in a their Managed Care health plan until a nursing home level of care is determined, or for 60 calendar days, whichever comes first. MHD must have verification that a DA-124 has been issued initiating the Department of Health and Senior Services level of care review before the 60 day process can begin. For more information, refer to Provider Bulletin, Volume 45, Number 22: Nursing Home Program – Revised.

Rural Citizens Access to Telehealth

February 1, 2023

The Rural Citizens Access to Telehealth (RCAT) project is a partnership between the Missouri Telehealth Network and MO HealthNet. Together, we will provide funding, education and training opportunities to introduce or enhance existing telehealth services for rural providers accepting Medicaid patients. If you are a provider that serves primarily rural populations in Missouri, are enrolled in MO HealthNet and provide primary and/or behavioral health care, please take our survey for more information.

Annual Reviews Coming: Partners & Providers: Help Spread the Word!

January 26, 2023

Very soon, the Family Support Division (FSD) will be required to check the eligibility of all MO HealthNet (Missouri Medicaid) participants, including Managed Care health plan members of Healthy Blue, Home State Health, and United Healthcare. This is called a Medicaid eligibility renewal (or annual renewal).

Partners & Providers: Help Spread the Word

More than 1.4 million Missourians have healthcare coverage through MO HealthNet and will be impacted by this change. We are asking partners, advocates, providers, and friends to help spread the word so Missourians can stay informed. You can help by:

• Directing individuals to our website: mydss.mo.gov/renew
• Help us spread the word by sharing our outreach material
• Explore our communications plan, along with helpful tools and resources, in our Communications Toolkit
• Reminding individuals to update their contact information online or by phone at 855-373-4636
• Helping members update their contact information if they need assistance

To learn more about the Medicaid eligibility renewals, visit Frequently Asked Questions. You can also subscribe for email alerts, continue to check this website, or follow the Department of Social Services on Facebook, Instagram, or Twitter for updated information as it becomes available.

2023 Relias Training Schedule

January 23, 2023

MO HealthNet is offering FREE continuing education (CE) sessions for doctors, nurses, and pharmacists. Each session is created and presented by Relias and all are available as live webinars and will be recorded so you can earn continuing education credit on your own time. The list of topics and schedule is included in the attachment and on our MO HealthNet Provider Training Calendar. You do not need to be a MO HealthNet provider to register.

As trainings are confirmed, speakers and registration links will be added to the MO HealthNet Provider Training calendar.

• To register: click on the Webinar Topic link of your choice in this training schedule.

Visit https://mhdtrainingacademy.training.reliaslearning.com.

Relias helps healthcare leaders, human service providers, and their staff take better care of people, lower costs, reduce risk, and achieve better results.

Provider Communications Interactive Voice Response (IVR) Update

January 10, 2023

The Provider Communications IVR line has been updated! Providers call (573) 751-2896 for questions regarding claims, eligibility and more. When calling, there are five options to choose from:

1 – MO HealthNet Participant Eligibility
2 – Check Amount Information
3 – Claim Information
4 – Provider Enrollment Status
5 – MO HealthNet Participant Annual Review Date

Occasionally, providers have a question that is not covered by one of these options. MHD has added option 6 to be transferred directly to a representative. Option 6 is only for questions that do not fall in to the five categories above. As a reminder, you also have the option to message Provider Communications directly using the Provider Communications Management function on eMOMED. These messages will be responded to within three business days of receipt.

MO HealthNet participants can reach Participant Services at (800) 392-2161 or by emailing Ask.MHD@dss.mo.gov.

MHD Education and Training educates providers on proper billing methods and procedures for claim
filing and more. Contact Education and Training at MHD.Education@dss.mo.gov or (573) 751-
6683. For additional resources, visit the Education and Training Resources page.