Department of Social Services Fiscal Year 2023 Budget Request MO HealthNet Division

2021·3.6 MB·English

by  Missouri Department of Social Services

Department of Social Services
MO HealthNet Division
Fiscal Year 2023 Budget Request
Book 6 of 7
Jennifer Tidball, Acting Director

Table of Contents

TABLE OF CONTENTS
MO HEALTHNET DIVISION – VOLUME 1
Department Request Summary ...................................................................................................................................................... 1
NDI – Managed Care Actuarial Rate Increase............................................................................................................................... 5
NDI – CHIP Authority Cost to Continue ........................................................................................................................................ 14
Core – MO HealthNet Administration ............................................................................................................................................ 21
Core – Clinical Services Program Management ........................................................................................................................... 35
Core – MO HealthNet Transformation .......................................................................................................................................... 45
Core – Third Party Liability (TPL) Contracts ................................................................................................................................. 56
Core – Information Systems ......................................................................................................................................................... 65
NDI – MMIS Operational Costs ..................................................................................................................................................... 78
NDI – MMIS BIS - EDW ................................................................................................................................................................ 82
NDI – MMIS Health Information Exchange ................................................................................................................................... 86
NDI – MMIS Component Upgrades .............................................................................................................................................. 90
NDI – MMIS Interoperability Requirements .................................................................................................................................. 94
NDI – MMIS Identity and Access Management Requirements..................................................................................................... 98
Core – Electronic Health Records Incentives ............................................................................................................................. 102
Core – Hospital Information Technology (HIT) ........................................................................................................................... 113
Core – HITECH ........................................................................................................................................................................... 120
Core – Money Follows the Person .............................................................................................................................................. 127
NDI – Money Follows the Person CTC ....................................................................................................................................... 137
Core – Pharmacy ........................................................................................................................................................................ 141
NDI – Pharmacy PMPM Increase Specialty ............................................................................................................................... 162
NDI – Pharmacy PMPM Increase Non-Specialty ....................................................................................................................... 167
Core – Pharmacy Clawback ....................................................................................................................................................... 172
Core – Missouri RX Plan ............................................................................................................................................................. 182
Core – Pharmacy FRA (PFRA) ................................................................................................................................................... 191
Core – Physician ......................................................................................................................................................................... 198
Core - PACE ............................................................................................................................................................................... 218
Core – CCBHO ........................................................................................................................................................................... 226
Core – Dental .............................................................................................................................................................................. 233
Core – Premium Payments ......................................................................................................................................................... 244
NDI – Premium Increase ............................................................................................................................................................. 257
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TABLE OF CONTENTS

MO HEALTHNET DIVISION – VOLUME 2
Core – Nursing Facilities ............................................................................................................................................................. 261
Core – Home Health ................................................................................................................................................................... 277
Core – Nursing Facilities Reimbursement Allowance (NFRA).................................................................................................... 288
Core – Long Term Support Payments ........................................................................................................................................ 295
Core – Rehab and Specialty Services ........................................................................................................................................ 302
NDI – Hospice Rate Increase ..................................................................................................................................................... 325
Core – Non-Emergency Medical Transportation (NEMT) ........................................................................................................... 329
NDI – NEMT Actuarial Increase .................................................................................................................................................. 342
Core – Ground Emergency Medical Transportation (GEMT) ..................................................................................................... 346
Core – Complex Rehab Technology ........................................................................................................................................... 354
Core – Managed Care................................................................................................................................................................. 364
Core – Hospital Care ................................................................................................................................................................... 380
Core – Physician Payments for Safety Net Hospitals ................................................................................................................. 395
Core – Federally Qualified Health Centers (FQHC) Distribution ................................................................................................ 402
Core – Health Homes .................................................................................................................................................................. 419
Core – Federal Reimbursement Allowance (FRA) ..................................................................................................................... 430
Core – IGT Safety Net Hospitals ................................................................................................................................................. 438
Core – Children’s Health Insurance Program (CHIP) ................................................................................................................. 446
Core – Show-Me Healthy Babies ................................................................................................................................................ 458
Core – School District Medicaid Claiming ................................................................................................................................... 471
NDI – School District Claiming Authority ..................................................................................................................................... 482
Core – Blind Pension Medical ..................................................................................................................................................... 486
Core – IGT DMH Medicaid Program ........................................................................................................................................... 496
Core – MHD Non-Count Transfers ............................................................................................................................................. 503
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Department Request
Summary