208.895. Referral for services, department duties. - Missouri Statutes

Referral for services, department duties.

208.895. Upon receipt of a properly completed referral for MOHealthNet-funded home- and community-based care containing a nurseassessment or physician's order, the department of health and seniorservices shall:

(1) Review the recommendations regarding services and process thereferral within fifteen business days;

(2) Issue a prior-authorization for home and community-based serviceswhen information contained in the referral is sufficient to establisheligibility for MO HealthNet-funded long-term care and determine the levelof service need as required under state and federal regulations;

(3) Arrange for the provision of services by an in-home provider;

(4) Reimburse the in-home provider for one nurse visit to conduct anassessment and recommendation for a care plan and, where necessary based oncase circumstances, a second nurse visit may be authorized to gatheradditional information or documentation necessary to constitute a completedreferral;

(5) Notify the referring entity upon the authorization of MOHealthNet eligibility and provide MO HealthNet reimbursement for personalcare benefits effective the date of the assessment or physician's order,and MO HealthNet reimbursement for waiver services effective the date thestate reviews and approves the care plan;

(6) Notify the referring entity within five business days ofreceiving the referral if additional information is required to process thereferral; and

(7) Inform the provider and contact the individual when informationis insufficient or the proposed care plan requires additional evaluation bystate staff that is not obtained from the referring entity to schedule anin-home assessment to be conducted by the state staff within thirty days.

(L. 2009 H.B. 395 § 1)