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Thank you for reading the third quarter edition of the MO HealthNet Provider Newsletter. Our ongoing mission is to strengthen communication between the MO HealthNet Division (MHD) and healthcare providers across Missouri. We're glad you're here.
In This Edition:
MHD Pharmacy and Medical Pre-Certification Helpdesk Interactive Voice Response System Update
MHD has launched a self-service feature on the Pharmacy and Medical Pre-Certification Helpdesk Interactive Voice Response (IVR) system for drug prior authorization (PA) requests. This enhancement allows pharmacies and providers to check the status of faxed drug PA requests instantly.
To use this feature, providers will need their National Provider Identifier (NPI), the participant’s MO HealthNet ID (DCN), and the date the request was faxed. Providers can call 800-392-8030 and select:
- Option 2 for PA Fax Status
- Option 3 for Drug Edit Override Authorization
To expedite review and minimize processing delays for drug prior authorization requests:
- Use the most recent version of the drug prior authorization forms found on the provider Pharmacy page
- Download and type rather than handwrite information for better legibility
- Ensure all required fields of the forms are completed
- Submit relevant documentation (e.g., progress notes, labs) as indicated on the form or in the Pharmacy Manual
Milestone for the Program of All-Inclusive Care for the Elderly
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.
March 1, 2025 marked one year of operation for PACE KC's all-inclusive care for seniors in Jackson County, MO. After 14 months of PACE operation, PACE KC has 38 participants and continues to show steady growth each month. We are grateful for a great partnership with the PACE KC team!
Launch of Home and Community Based Services Fusion Case Management Systems
On May 5, 2025, the Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS), launched Fusion—a unified electronic case management system for home and community-based services (HCBS). Fusion will support the entire lifecycle of HCBS, from intake and eligibility to assessment, person-centered care planning, service authorization, and other ancillary case management activities.
HCBS Fusion consolidates five legacy systems into one modern platform to enhance efficiency and support Missouri’s growing HCBS population. Providers are encouraged to visit the HCBS Fusion webpage for updates and training materials.
For questions, contact DSDS at LTSS@health.mo.gov.
Path to Becoming a Registered Behavior Technician
Individuals or provider groups seeking to certify as Registered Behavior Technicians (RBTs) should begin at the Behavior Analyst Certification Board (BACB) website. The site provides a checklist, handbook, and resources for obtaining and maintaining certification.
Assisting Older Youth
The Missouri State Youth Advisory Board (SYAB) is a board that represents all children and youth who are currently in, or were previously in, out-of-home placements. Each member of the board is either currently in foster care or someone who has been placed out of their home (foster care, kinship placement, etc.). Board members are meant to represent the other youth in their area of the state. During a presentation by Show Me Healthy Kids (SMHK) to the SYAB, the group was asked if they were aware who their SMHK representative was and whether they had been in contact with them.
One enthusiastic older youth raised her hand, beaming with pride. “Jade!” she exclaimed. She went on to share how her SMHK representative, Jade, had been instrumental in her journey, helping her navigate the transportation benefit for college.
This moment truly highlighted the profound impact that dedicated advocates like Jade can have on young people's lives.
Coordinating Care: Bridging Medication Gaps
An SMHK member was recently hospitalized for behavioral concerns and their medications were adjusted during their inpatient stay. Following discharge, their scheduled appointment with their pediatrician for their necessary medications would have put the member without two medications for four days.
After multiple discussions with the parent, the SMHK Care Manager contacted the pediatrician’s office to address the issue of the member running out of psychotropic medications. The office was able to reschedule the appointment to the day the medications were set to run out, ensuring the member received the necessary prescriptions without interruption.
This is another example of how SMHK is making a difference in the lives of Missouri’s children.
2025 Optimizing Benefits for Maternal and Infant Health Meetings
All MO HealthNet providers and community partners are invited to join MHD, the Managed Care health plans, Show-Me ECHO (Extension for Community Healthcare Outcomes), and the Office of Oral Health for a unique in-person networking and training opportunity. Attendees will learn about valuable benefits, incentives, and resources available to pregnant women and their families, including individualized case management, doula coverage, Non-Emergency Medical Transportation, and more.
MHD's first three events of the year in Springfield, St. Louis, and Kansas City have been a success. Please join us at one of the following event dates and locations:
- July 17, 2025 – Jefferson City
- September 16, 2025 – Cape Girardeau
- October 22, 2025 – Joplin
Register Here – Seating is limited.
For questions, contact MHD.Education@dss.mo.gov.
MO HealthNet’s “Missouri Model” Gains National Recognition in Oral Health
Amanda Fahrendorf, MHD’s Training and Collaboration Manager, recently presented at the National Oral Health Conference in Orlando, Florida. Her session highlighted Missouri’s collaborative approach to improving access to dental care—a model developed in partnership with the Missouri Coalition for Oral Health and the Missouri Dental Association.
While many states have increased dental provider reimbursement, Missouri stands alone in achieving a significant rise in dental provider enrollment. This success, now dubbed the “Missouri Model,” is being studied and replicated by other states.
Amanda has since been invited by several national organizations, including the American Network of Oral Health Coalitions (ANOHC), to share MHD’s strategies and outcomes.
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