The MO HealthNet Division would like to remind providers of the process for obtaining prior authorization for Residential Treatment and Treatment Foster Care (TFC), as outlined in the Provider Bulletin issued on September 21, 2
Effective December 1, 2025, psychiatric hospitals that meet the definition of an Institution for Mental Disease (IMD), subject to the terms of the 1115 SMI/SED/SUD waiver, must align with ASAM Criteria, 4th Edition, Level of Care 4, Medically Managed Intensive Inpatient Services.
An attending physician, hospital, or participant who disagrees with Conduent’s (MO HealthNet Division’s review authority) initial denial determination for an inpatient certification is entitled to reconsideration by Conduent. The reconsideration may be requested before or after the participant is discharged from the hospital.
The Family Support Division (FSD), Department of Health and Senior Services Central Office Medical Review Unit (DHSS COMRU), and the MO HealthNet Division (MHD) have collaborated to create a new resource for nursing facility providers. We are excited to announce, Nursing Home Reimbursement: Beginning to End.
We want to inform you that we encountered technical issues with the survey regarding the SUPPORT Act's PDMP mandate. We apologize for any inconvenience this may have caused. If you attempted to take the survey previously, please try again. If you have not participated yet, we encourage you to take the survey now. Your feedback is essential in helping us assess the implementation of this mandate. The survey will take approximately 5 minutes, and your responses will remain confidential.
