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MO HealthNet Managed Care Expansion

Effective January 1, 2008, the State of Missouri will introduce the MO HealthNet Managed Care Program in Bates, Benton, Cedar, Laclede, Linn, Macon, Madison, Maries, Marion, Perry, Phelps, Pike, Polk, Pulaski, Ralls, Shelby, and Vernon counties. The MO HealthNet Managed Care Program will provide service for approximately 36,000 additional participants. Providers must verify a participant's eligibility and MO HealthNet Managed Care health plan information prior to providing a service, except in the case of emergency medical services. Services covered by the MO HealthNet Managed Care Program which are provided to participants after they are enrolled in a MO HealthNet Managed Care health plan will not be covered by MO HealthNet on a fee-for-service basis beginning January 1, 2008.

The MO HealthNet Managed Care Program is a way for Missouri's low income and vulnerable eligibles to receive health care services. The goal is to improve the accessibility and quality of health care services for the MO HealthNet Managed Care eligible population, while controlling the costs of providing that care.

Populations

The mandatory populations included in an MO HealthNet Managed Care health plan are divided into three groups:

• Parents/Caretaker, Children, Pregnant Women, and Refugees;
• Other MO HealthNet children who are in the care and custody of the state of Missouri and receiving Adoption Subsidy Assistance; and
• Children eligible under the State Children's Health Insurance Program (SCHIP).

Enrollment

When approved for health care services, and the participant lives in a MO HealthNet Managed Care area, they must choose a MO HealthNet Managed Care health plan and a Primary Care Provider (PCP). Members will receive health care services through their MO HealthNet Managed Care health plan. All members of a family are encouraged to select the same MO HealthNet Managed Care health plan. Participants will continue to receive their health care services through the MO HealthNet Fee-For-Service delivery system until January 1, 2008.

Policy Studies, Inc., the MO HealthNet Managed Care Enrollment Broker, will mail enrollment packets to MO HealthNet Fee-for-Service participants in the identified expansion counties. Participants can call the MO HealthNet Managed Care Enrollment Helpline at 1-800-348-6627 for assistance when it is time to enroll in a MO HealthNet Managed Care health plan.

The State will conduct open enrollment in the identified MO HealthNet Managed Care expansion counties from November 19, 2007 to January 17, 2008. If the participant does not make a voluntary selection of a MO HealthNet Managed Care health plan by January 17, 2008, a MO HealthNet Managed Care health plan will be automatically assigned. Once enrolled in a MO HealthNet Managed Care health plan, enrollees have a 90-day change period to transfer to a different MO HealthNet Managed Care health plan for any reason. Once the 90-day change period ends, the enrollee is locked into the MO HealthNet Managed Care health plan for one year.

The new counties will be included in the following MO HealthNet Managed Care regions:

• Eastern Region Additional Counties: Madison, Perry, and Pike.
• Central Region Additional Counties: Benton, Laclede, Linn, Macon, Maries, Marion, Phelps, Pulaski, Ralls, and Shelby.
• Western Region Additional Counties: Bates, Cedar, Polk, and Vernon.

Refer to the listing below to determine which MO HealthNet Managed Care health plans will provide services for the MO HealthNet Managed Care Program in the expanded MO HealthNet Managed Care counties.

Eastern Region MO HealthNet Managed Care Health Plans

The three health plans listed below will continue to serve MO HealthNet Managed Care members in the ten original Eastern Region counties.

Central Region MO HealthNet Managed Care Health Plans

The three health plans listed below will continue to serve MO HealthNet Managed Care members in the eighteen original Central Region counties.

Western Region  MO HealthNet Managed Care Health Plans

The three health plans listed below and Blue Advantage Plus of Kansas City will continue to serve MO HealthNet Managed Care members in the nine original Western Region counties.

Transition of MO HealthNet Fee-for-Service Participants to MO HealthNet Managed Care

MO HealthNet Fee-for-Service eligible participants who are residents in the identified expansion counties will be newly enrolled in a MO HealthNet Managed Care health plan, effective January 1, 2008. The provider must verify a participant's eligibility and MO HealthNet Managed Care health plan information prior to providing a service, except in the case of emergency medical services. Services covered by the MO HealthNet Managed Care Program which are provided to participants after they are enrolled in a MO HealthNet Managed Care health plan will not be covered by MO HealthNet on a fee-for-service basis beginning January 1, 2008. Refer to www.dss.mo.gov/mhd/mc/index.htm for information about the MO HealthNet Managed Care Program, a listing of services covered by the MO HealthNet Managed Care health plan, and a listing of services provided outside the MO HealthNet Managed Care Program. The provider can determine that the participant is enrolled in a MO HealthNet Managed Care health plan when verifying eligibility via the Interactive Voice Response (IVR) system at 573-635-8908 or at www.emomed.com.

Current MO HealthNet fee-for-service providers must contact the MO HealthNet Managed Care health plan selected by the participant to make arrangements to continue providing services which have transitioned from the MO HealthNet Fee-For-Service delivery system to services provided by the MO HealthNet Managed Care health plan on January 1, 2008 and after. Providers must seek reimbursement for services included as a MO HealthNet Managed Care health plan benefit from the MO HealthNet Managed Care health plan in which the individual is enrolled. Claims for services provided to MO HealthNet Managed Care enrollees will not be reimbursed if submitted to the MO HealthNet Fee-For-Service program.

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