| April 10, 2023
Updates have been made to the MO HealthNet Provider Rehabilitation Manual as follows:
Updates have been made to the MO HealthNet Provider Behavioral Health Services Manual as follows: - Section 13 The following changes have been made to the MO HealthNet Division Behavioral Health Services Provider Manual, Section 13
- Changed references to other sections of manual throughout
- Updated copay section to remove copay requirements
- Added information about new services/new procedure codes effective 7/1/2022 – multi-family group, psychological testing, psychotherapy for crisis add on code
- Clarified precertification requirements for participants with Medicare Advantage Plans
- Clarified precertification exemptions
- Clarified telehealth reporting in settings exempt from precertification
- Updated description of psychiatric diagnostic evaluation
- Clarified limits to psychological testing
- Clarified monthly limits for individual therapy in inpatient and residential settings
- Clarified clinical exception request for multiple family therapy precertification's per household
- Removed obsolete language/links
- Added section for evidence-based practices for children with trauma histories
- Updated precertification maximum hours to reflect continued therapy requests
- Clarified that ABA services not in an IEP are not covered in place of service school
- Added cost settlement information for school district IEP services
- Updated TMS services to include advanced practice psychiatric nurses
- Added list of standardized rating scales for depression
- Removed or updated obsolete language
- Updated eligible telemedicine providers to be consistent with state regulation
- Added mobile unit to the list of places of service
Medication Therapy Management and Direct Care Pro - The MO HealthNet Division (MHD) is adding additional Pharmacist Provider Services (PPS). PPS allows pharmacist providers to receive reimbursement for services that fall within their scope of practice as defined by the Missouri Board of Pharmacy. These separately reimbursable services are beyond the scope of dispensing medication to participants covered under 13 CSR 70-20.060 Professional Dispensing Fee. Read more...
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 Read more...
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.
Contact Us - For questions about pharmacy or MORx, please email: MHD.PharmacyAdmin@dss.mo.gov.
- For psychology, exceptions, or medical pre-certifications, please email: Clinical.Services@dss.mo.gov
- For all other questions or comments email: Ask.MHD@dss.mo.gov
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