☰ Revisor of Missouri

Title XII PUBLIC HEALTH AND WELFARE

Chapter 208

Effective - 28 Aug 2009, 3 histories, see footnote (history) bottom

  208.895.  Referral for services, department duties. — Upon receipt of a properly completed referral for MO HealthNet-funded home- and community-based care containing a nurse assessment or physician's order, the department of health and senior services shall:

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

  (2) Issue a prior-authorization for home and community-based services when information contained in the referral is sufficient to establish eligibility for MO HealthNet-funded long-term care and determine the level of 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 an assessment and recommendation for a care plan and, where necessary based on case circumstances, a second nurse visit may be authorized to gather additional information or documentation necessary to constitute a completed referral;

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

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

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

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(L. 2009 H.B. 395 § 1)


---- end of effective   28 Aug 2009 ----

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Effective End
208.895 8/28/2013
208.895 8/28/2010 8/28/2013
208.895 8/28/2009 8/28/2010

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