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.
The Preadmission Screening and Resident Review (PASRR) is a federally mandated screening process that requires all applications (regardless of payment source) to a Medicaid Certified nursing facility bed be given a preliminary assessment to determine whether they might have a serious mental illness (SMI), an intellectual disability/developmental disability (IDD/DD), a related condition, or any combination thereof. This is called a Level I Screening.
MO HealthNet Education and Training will be hosting an in-person Hospice Billing and Policy Workshop on March 24, 2025, in Jefferson City.
Hospice providers will have the opportunity to learn from and speak to all three Managed Care Plans (United HealthCare, Home State Health, and Healthy Blue), Missouri Medicaid Audit and Compliance (MMAC), and the Mo HealthNet Division (MHD) regarding billing practices, resources, audits, and more.
When completing a nursing facility claim, providers should ensure they are using the correct Patient Status Code. Providers should ensure that when a MO HealthNet participant is leaving the nursing facility, but plans to return, they use Patient Status Code 30 (Still a patient). For example, if the participant is admitted to the hospital for three days and returns to the nursing facility on the fourth day, the Patient Status should remain 30, “Still a patient.”
Effective August 29, 2024, MO HealthNet will expand coverage of Continuous Glucose Monitors (CGMs) to participants currently diagnosed with Gestational Diabetes allowing this vulnerable population to obtain a CGM without a prior authorization. Claims for a CGM will auto-approve if the participant has had a gestational diabetes diagnosis billed to MO HealthNet recently OR if the pharmacy submits the appropriate gestational diabetes diagnosis code with the claim.
MO HealthNet Education and Training is hosting an in-person Nursing Home Billing and Policy Workshop in Jefferson City.
The Program of All-Inclusive Care for the Elderly (PACE) is administered by MO HealthNet and Medicare to provide comprehensive health care, social, recreational, and wellness services to its participants. One of the main goals of PACE is to allow older adults to live safely in their homes instead of nursing facilities. As of May 3, 2024, PACE organizations are active in St. Louis and Kansas City, with a new PACE organization coming to the Springfield area later this year.
The MO HealthNet Division (MHD) Education and Training has posted an updated resource regarding Hospice Forms and Certifications. This resource describes the standardized and non-standardized forms used in the MHD Hospice Program.
With the exception of certain hospice stays, nursing home room and board is covered under fee-for-service (FFS) regardless of whether the resident is in a Managed Care health plan. Participants who are enrolled in a Managed Care health plan, and who are seeking admission into a nursing home, will remain in a their Managed Care health plan until a nursing home level of care is determined, or for 60 calendar days, whichever comes first.
