You need to be approved for MO HealthNet before you can receive services. If you do not currently have health care through MO HealthNet, you will need to see if you qualify and apply for services.
Per the Internal Revenue Service (IRS) guidelines, Missouri Medicaid and CHIP Responsible Individuals may receive a copy of their IRS Form 1095-B upon request. This form will no longer be automatically mailed to participants. To request a copy of your IRS Form 1095-B, you can:
High-tech and cardiac imaging procedure codes require prior authorization (PA) unless they are performed in emergency situations or while the participant is in outpatient observation.
Medicare covered services provided on participants with active Medicare Part B are also exempt from the PA requirement. Participants with Medicare Part C coverage and do not have Qualified Medicare Beneficiary (QMB) benefits are required to obtain a PA.
Schools will need the following to participate in the IEP Transportation Program:
School districts are responsible for the following functions:
The purpose of administrative claiming is to form a partnership between the DSS, MHD, and individual school districts to share in the responsibility for promoting access to health care for students in the school system. Many of the activities performed by school district staff meet the claimable criteria for MHD administrative claiming. The primary purpose of administrative claiming is to reimburse school districts for these activities.
MO HealthNet covers behavioral health services including psychotherapy/counseling services for mental health conditions and substance use disorders that are provided by licensed mental health professionals. Refer to the Behavioral Health Services Provider Manual for more information.
The MO HealthNet fee for service program has a preferred drug list (PDL). This means the agency solicits supplemental rebates from manufacturers. That economic information will be paired with evidence based clinical information to arrive at preferred drug(s) in each functional therapeutic class. Each drug class on the PDL is reviewed annually.
