Expand Your Referral Base for Participants with Prediabetes and Offer Participants Diabetes Education
Expand Your Referral Base for Participants with Prediabetes and Offer Participants Diabetes Education
Diabetes Prevention Program
Diabetes Prevention Program (DPP) services for eligible adult participants are covered through the MO HealthNet Program. DPP is a structured, lifestyle change program specifically developed and recognized by the Centers for Disease Control (CDC) to prevent or delay Type 2 diabetes. The program is intended for people who have prediabetes or are at risk for Type 2 diabetes, but who do not already have diabetes.
Nursing Home Reimbursement: Beginning to End
Nursing Home Reimbursement: Beginning to End
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.
COMRU PASRR LOC Training
COMRU PASRR LOC Training
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.
Hospice Billing and Policy Workshop, March 24, 2025
Hospice Billing and Policy Workshop, March 24, 2025
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.
Nursing Facility Patient Status Codes
Nursing Facility Patient Status Codes
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.”
Updates to Coverage of Continuous Glucose Monitors (CGMs)
Updates to Coverage of Continuous Glucose Monitors (CGMs):
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.