PACE Benefit Table
Program of All-Inclusive Care for the Elderly (PACE) Benefit Table
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.
Physicians & Clinics Billing and Policy Workshop for MHD Providers
Physicians & Clinics Billing and Policy Workshop for MHD Providers
MO HealthNet Education and Training is hosting an in-person Physicians & Clinics Billing and Policy Workshop in Jefferson City.
Group Prenatal Care FAQs
Group Prenatal Care FAQs
The MO HealthNet Division (MHD) implemented coverage for Group Prenatal Care effective for dates of service on and after December 1, 2023. For more information, review the Group Prenatal Care Bulletin.
Vaccines for CHIP Participants
Vaccines for CHIP Participants
Participants enrolled in the Children’s Health Insurance Program (CHIP) are not eligible for vaccines under the Vaccines for Children (VFC) Program. In order for providers to accurately report and document vaccines for CHIP participants, they must take the following steps.
Diabetes Prevention Program
Diabetes Prevention Program
The MO HealthNet Division (MHD) has a Diabetes Prevention Program (DPP) for eligible adult participants.
GLP-1 Shortage
GLP-1 Shortage
Regarding: Anti-Diabetic Medication Shortages
MO HealthNet is aware of the continuing shortages of GLP-1 agonists in the marketplace. To avoid disruption in a participant’s diabetic therapy, please do not submit PA requests for non-preferred GLP-1 agonists if solely due to shortage or supply issues.
In the event you are unable to obtain the participant’s currently prescribed GLP-1 agonist through your wholesaler or another local pharmacy consider one of the following:
Diagnosis Code Requirement on Certain Pharmacy Claims
Diagnosis Code Requirement on Certain Pharmacy Claims
Effective January 25, 2024, the MO HealthNet Division (MHD) began requiring ICD10 diagnosis codes on pharmacy claims for select drugs and drug classes in order to gain further insight into actual real-world utilization of drug products for on and off-label indications. This will allow MHD to potentially improve the transparent processing of pharmacy claims for these select drugs and drug classes.
Prescription Drug Monitoring Program (PDMP) Survey
Survey on the SUPPORT Act's Prescription Drug Monitoring Program Mandate
MO HealthNet is conducting a survey regarding the implementation of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act's prescription drug monitoring program mandate.