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.
MO HealthNet has updated the Durable Medical Equipment (DME) Provider Manual to clarify policy related to the physician face-to-face evaluation when providing custom and power wheelchairs in a skilled nursing facility. The policy clarification can be found in Section 13.18.C of the manual located here.
MO HealthNet (MHD) and Missouri Medicaid Audit and Compliance (MMAC) are contracted with Health Management Systems (HMS) to conduct post payment reviews of claims for Hospital and Long Term Care facility Credit Balance Audits and the Commercial Insurance Disallowance Audit Cycles.
Patient surplus or “patient liability” is the participant’s income less certain deductions; i.e., personal allowance, medical insurance and any allotments to a spouse and/or eligible dependents and is computed by an FSD caseworker. It is a federal requirement that the MO HealthNet payment to a nursing home be reduced by the patient surplus. MO HealthNet payment to a nursing home is not collected by the nursing facility the first month a participant is admitted if admission is after the first day of the month.
