Pending Centers for Medicare & Medicaid Services (CMS) approval, effective for dates of service on and after July 1, 2024, the MO HealthNet Division (MHD) will increase the fee-for-service maximum allowable rates for the dental services listed below. Upon approval of the State Plan amendment by CMS, MHD will update the claims processing system with the indicated maximum allowable reimbursement rates and reprocess claims paid for dates of service on or after July 1, 2024.
Medical Necessity on File for Durable Medical Equipment Program
Applies to: MO HealthNet Fee-For-Service Durable Medical Equipment (DME) Providers
Effective date: July 1, 2024
Medical Necessity on File (MNF)
Effective for dates of service on or after July 1, 2024, the MO HealthNet Division (MHD) will remove the Certificate of Medical Necessity (CMN) restriction and only require MNF (any documentation that represents the medical need for the item) for the DME c odes listed in Attachment A. The MNF restriction requires the provider to keep medical documentation on file as evidence that the item is medically necessary but does not require submission of the MNF to MHD.
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Applies to: Qualified Residential Treatment Programs (QRTP)
Effective date: July 1, 2024
Rate Update For QRTP
MO HealthNet Division plans to submit a state plan amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS) to update the fee schedule for the below billing codes. Pending CMS approval on the SPA, effective for dates of services on or after July 1, 2024, QRTP rates will no longer differ according to Medicaid institution for mental disease (IMD) status. MHD will increase the fee-for-service maximum allowable rates for QRTP facilities that also meet the definition of a Medicaid IMD to match QRTPs that are not considered IMDs.
MHD will reimburse the lower of the provider's billed charge or the maximum allowable amount for the date of service billed. Providers may not bill MHD at a higher rate than they charge their private pay patients. Providers must bill MHD their usual and customary rate.
The affected procedure codes and new maximum allowable rates are reflected below. MHD will mass adjust claims paid for dates of service on and after July 1, 2023 that process prior to updating the fee schedule.
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Rate Update for Applied Behavior Analysis (ABA) Services
Applies to: Providers of ABA Services
Effective date: July 1, 2024
- Maximum Allowable Rate Increase For Select ABA PROCEDURES
- Procedure Codes Receiving Rate Increase
Maximum Allowable Rate Increase for Select Aba Procedures
MO HealthNet Division (MHD) plans to submit a state plan amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS) to update the fee schedule for the below billing codes. Pending CMS approval on the SPA, effective for dates of services on or after July 1, 2024, MHD has increased the fee-for-service maximum allowable amount for select ABA services. These procedures are receiving an increase to align with MO HealthNet Developmental Disabilities Waiver rates.
MHD will reimburse the lower of the provider's billed charge or the maximum allowable amount for the date of service billed. Providers may not bill MHD at a higher rate than they charge their private pay patients. Providers must bill MHD their usual and customary rate.
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Home Health Provider Notice
MO HealthNet is recruiting agencies to provide private duty nursing services through MO HealthNet's Private Duty Nursing Program. Medicare certified and state licensed home health agencies are qualified to enroll as providers of private duty nursing services.
Private duty nursing is a service where either a registered nurse or a licensed practical nurse provides long-term, comprehensive hourly nursing care to children (under the age of 21) who receive MO HealthNet (Medicaid) benefits. These patients often have complex medical conditions that require skilled nursing care on a daily basis. Reimbursement is currently $60.80 per hour (or $15.20 per 15-minute unit). Please reference the MO HealthNet Private Duty Nursing information document and the MO HealthNet Private Duty Nursing Provider Manual for additional information regarding the Private Duty Nursing Program.
MHD accepts new applications from PDN providers at all times. Agencies interested in becoming a provider should contact Missouri Medicaid Audit and Compliance at mmac.providerenrollment@dss.mo.gov to obtain an enrollment application. Questions regarding the MO HealthNet Private Duty Nursing Program may be emailed to Ask.MHD@dss.mo.gov
Opioid Reversal Agents
The Opioid Crisis
In 2021, nearly 1 out of 47 deaths in Missouri were attributed to an opioid-involved overdose. Naloxone is an opioid antagonist indicated for the emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression.
Pharmacists in Missouri can dispense naloxone according to protocol upon request or upon presentation of a valid prescription. A statewide Standing Order issued by the Missouri Department of Health and Senior Services (DHSS) is available at: https://health.mo.gov/data/opioids/pdf/naloxone-standing-order.pdf
If a patient has not been to the doctor, they can go to a pharmacy in Missouri and ask for naloxone, and the pharmacist can dispense it under the standing order. Important: MO HealthNet participants have zero copays on prescriptions!
Learn more by reviewing this flyer.
PRIVATE DUTY NURSING PROVIDERS
Ordering, Prescribing, Referring Provider (OPR) Requirements
Effective for dates of service on and after July 1, 2024, claims submitted for MO HealthNet private duty nursing services must include the ordering practitioner's National Provider Identifier (NPI), and the OPR provider must be enrolled with MHD. For further information, please reference MO HealthNet Private Duty Nursing Provider Bulletin Volume 46 Number 52, dated April 19, 2024.
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