Children's Division Legal Custody Youth and Inpatient Stay When Not Medically Necessary
If a child who is in the legal custody of the Department of Social Services Children’s Division (CD) is hospitalized but is no longer in need of medical care at the hospital, and that child is pending a placement, CD will reimburse the provider at the same rate the hospital would receive per day for an inpatient admission.
When this occurs, providers should send the following to CD.AskRehab@dss.mo.gov:
Herceptin Billing Policy Change
Effective for dates of service on or after April 1, 2023, MO HealthNet will require the product Herceptin by Genentech to be billed by the number of vials. Herceptin is available in a single-dose, powder-filled vial, and providers must bill by whole vials; no partial vials are allowed. Previously pricing for Herceptin was calculated per milligram and is now calculated per vial, necessitating this change. MO HealthNet has taken proactive steps to ensure claims no longer pay when billed by the milligram.
Opioids and CGMs may not need a PA
MO HealthNet does not require a prior authorization for opioid prescriptions less than 50 MME per day. Please note, for patients who have not filled an opioid through MO HealthNet in the past 90 days, the pharmacy will still need to run a 7-day fill prior to a full 30-day prescription, regardless of the MME.