Medicaid State Plan Amendments

This state plan amendment updates the MO Healthnet fee schedule to add reimbursement for manual and electric breast pumps.

This plan amendment proposes to reimburse other licensed practitioners at 100% of the Medicaid fee schedule and implement an increase of three percent for services rendered by Medicaid Providers.

This amendment is to update the Alternative Benefit Plan to ensure that it is consistent with the Medicaid State Plan.

This amendment proposes to amend requirements for individuals receiving targeted case management (TCM) services, specifically for members experiencing homelessness, by adding the allowance that a member may also have a history of homelessness and a Service Prioritization Decision Assistance Tool (SPDAT) score of 20-60 and qualify for this level of TCM services.

This plan amendment updates the Direct Graduate Medical Education (DGME) supplemental payment.

This SPA adds authority for the state to engage in value-based purchasing contracts under the pharmacy benefit.

This Alternative Benefit Plan (ABP) amendment aligns the Affordable Care Act (ACA) adult benefit plan with Medicaid State Plan.

This SPA changes the MO HealthNet Dental Program to allow eligible MO HealthNet participants aged 21 and older to receive periodic oral evaluations. The SPA also allows MO HealthNet-enrolled dental providers to provide and receive reimbursement for the evaluations rendered.

Changes to the early and periodic screening, diagnostic and treatment benefits, and related payment methodologies. The proposed changes will more accurately align payments for direct medical services, which are outlined in an individualized education plan and supplied in a school-based setting, to actual costs for providing these services in a school setting.

This plan amendment will pay a $12 direct care add‐on to private (non-state) owned intermediate care facilities for individuals with intellectual disabilities (ICF/IID) for increased costs related to retaining and hiring direct care staff.