Department of Social Services Fiscal Year 2024 Budget Request MO HealthNet Division, Book 8 of 8

2022·3.7 MB·English

by  Missouri Department of Social Services

Department of Social Services
MO HealthNet Division
Fiscal Year 2024 Budget Request
Book 8 of 8
Robert Knodell, Acting Director

Table of Contents

TABLE OF CONTENTS
MO HEALTHNET DIVISION – VOLUME 1
Department Request Summary ..................................................................................................................................................... 1
NDI – MHD Cost to Continue ......................................................................................................................................................... 9
NDI – Managed Care Actuarial Rate Increase ............................................................................................................................. 31
NDI – Pharmacy PMPM Increase Specialty ................................................................................................................................. 42
NDI – Pharmacy PMPM Increase Non-Specialty ......................................................................................................................... 52
Core – MO HealthNet Administration ............................................................................................................................................ 62
NDI – MMIS FTE Re-Procurement ............................................................................................................................................... 77
Core – Clinical Services Program Management ........................................................................................................................... 83
Core – MO HealthNet Transformation .......................................................................................................................................... 93
Core – Third Party Liability (TPL) Contracts ............................................................................................................................... 105
Core – Information Systems ....................................................................................................................................................... 114
NDI – MMIS Operational Costs ................................................................................................................................................... 126
NDI – MMIS TMSIS ..................................................................................................................................................................... 130
NDI – MMIS Transition and Turnover ......................................................................................................................................... 135
Core – Closed Loop Social Service Referral Program ............................................................................................................... 139
Core – Electronic Health Records Incentives ............................................................................................................................. 147
Core – HITECH ........................................................................................................................................................................... 158
Core – Health Data Utility ........................................................................................................................................................... 168
Core – Show Me Home ............................................................................................................................................................... 175
Core – Pharmacy ........................................................................................................................................................................ 185
Core – Pharmacy Clawback ....................................................................................................................................................... 203
Core – Missouri RX Plan ............................................................................................................................................................. 213
Core – Pharmacy FRA (PFRA) ................................................................................................................................................... 222
Core – Physician ......................................................................................................................................................................... 229
Core - PACE ............................................................................................................................................................................... 248
Core – CCBHO ........................................................................................................................................................................... 256
Core – Dental .............................................................................................................................................................................. 263
Core – Premium Payments ......................................................................................................................................................... 274
NDI – Premium Increase ............................................................................................................................................................. 287
Core – Nursing Facilities ............................................................................................................................................................. 291
NDI – Nurse Aid Training Reimbursement.................................................................................................................................. 309
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TABLE OF CONTENTS

MO HEALTHNET DIVISION – VOLUME 2
Core – Home Health ................................................................................................................................................................... 314
Core – Nursing Facilities Reimbursement Allowance (NFRA) .................................................................................................... 325
Core – Long Term Support Payments ........................................................................................................................................ 332
Core – Rehab and Specialty Services ........................................................................................................................................ 339
NDI – Hospice Rate Increase ..................................................................................................................................................... 358
Core – Non-Emergency Medical Transportation (NEMT) ........................................................................................................... 363
NDI – NEMT Actuarial Increase .................................................................................................................................................. 375
Core – Ground Emergency Medical Transportation (GEMT) ..................................................................................................... 380
Core – Complex Rehab Technology ........................................................................................................................................... 388
Core – Managed Care ................................................................................................................................................................. 398
NDI – MO MAPS ......................................................................................................................................................................... 414
Core – Managed Care Specialty Plan ......................................................................................................................................... 419
Core – Hospital Care ................................................................................................................................................................... 429
Core – Pediatric Pilot Program ................................................................................................................................................... 442
Core – Physician Payments for Safety Net Hospitals ................................................................................................................. 449
Core – Federally Qualified Health Centers (FQHC) Distribution ................................................................................................ 456
Core – Health Homes .................................................................................................................................................................. 473
Core – Federal Reimbursement Allowance (FRA) ..................................................................................................................... 483
Core – IGT Safety Net Hospitals ................................................................................................................................................. 491
Core – Children’s Health Insurance Program (CHIP) ................................................................................................................. 499
Core – Show-Me Healthy Babies ................................................................................................................................................ 512
Core – School District Medicaid Claiming ................................................................................................................................... 524
Core – Blind Pension Medical ..................................................................................................................................................... 535
Core – Adult Expansion Group ................................................................................................................................................... 545
Core – IGT DMH Medicaid Program ........................................................................................................................................... 554
Core – MHD Non-Count Transfers ............................................................................................................................................. 561
NDI – DSS Federal Stimulus Transfer to GR.............................................................................................................................. 602
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Core - Home Health

CORE DECISION ITEM
Department: Social Services Budget Unit: 90564C
Division: MO HealthNet
Core: Home Health HB Section: 11.730
1. CORE FINANCIAL SUMMARY
FY 2024 Budget Request FY 2024 Governor's Recommendation
GR Federal Other Total GR Federal Other Total
PS 0 0 0 0 PS 0 0 0 0
EE 0 0 0 0 EE 0 0 0 0
PSD 1,780,905 3,748,636 159,305 5,688,846 PSD 0 0 0 0
TRF 0 0 0 0 TRF 0 0 0 0
Total 1,780,905 3,748,636 159,305 5,688,846 Total 0 0 0 0
FTE 0.00 0.00 0.00 0.00 FTE 0.00 0.00 0.00 0.00
.._____ _ _ _ _I I...____ _ _ __
Est. Fringe 0 0 0 0 Est. Fringe 0 0 0 0
Note: Fringes budgeted in House Bill 5 except for certain fringes budgeted Note: Fringes budgeted in House Bill 5 except for certain fringes budgeted
directly to MoDOT, Highway Patrol, and Conservation. directly to MoDOT, Highway Patrol, and Conservation.
Other Funds: Health Initiatives Fund (HIF) (0275) - $159,305 Other Funds:
2. CORE DESCRIPTION
This item funds payments for services provided through the Home Health program for the fee-for-service MO HealthNet population. This program is designed to
help MO HealthNet participants remain in their home instead of seeking institutional care through the provision of clinical (or “skilled”) medical services. Home
Health services are also available through the MO HealthNet Managed Care health plans (see program description in the Managed Care tab for more information).
3. PROGRAM LISTING (list programs included in this core funding)
Home Health Services
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CORE DECISION ITEM
Department: Social Services Budget Unit: 90564C
Division: MO HealthNet
Core: Home Health HB Section: 11.730
4. FINANCIAL HISTORY
FY 2020 FY 2021 FY 2022 FY 2022 Actual Expenditures (All Funds)
Actual Actual Actual Current Yr. 4,500,000
Appropriation (All Funds) 5,358,047 4,325,837 7,048,757 7,042,757
Less Reverted (All Funds) 0 0 0 0
4,000,000
Less Restricted (All Funds) 0 0 0 0 3,759,029
Budget Authority (All Funds) 5,358,047 4,325,837 7,048,757 7,042,757 3,945,119
3,381,292
3,500,000
Actual Expenditures (All Funds) 3,759,029 3,945,119 3,381,292 N/A
Unexpended (All Funds) 1,599,018 380,718 3,667,465 N/A
3,000,000
Unexpended, by Fund:
General Revenue 565,713 45,634 247,113 N/A
Federal 1,033,305 269,254 3,420,352 N/A
2,500,000
Other 0 65,830 0 N/A
(1) (2) (3)
2,000,000
FY 2020 FY 2021 FY 2022
*Current Year restricted amount is as of 9/01/2022.
Reverted includes statutory reserve amounts (when applicable).
Restricted includes Governor's expenditure restrictions which remained at the end of the fiscal year.
NOTES:
(1) FY21 - New Decision Items funded for FMAP Adjustment ($21,898 GR), Asset Limit CTC ($2,687 GR; $5,020 Fed), Asset Limit Phase-In ($669 GR; $1,250 Fed).
(2) FY22 - New Decision Items funded for FMAP Adjustement ($31,711 Fed), Asset Limit CTC ($3,733 GR; $7,251 Fed), Health Pilot Program ($2,901,385 Fed).
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