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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
