Reminder of Prior Authorization Process for Residential Treatment and Treatment Foster Care
The MO HealthNet Division would like to remind providers of the process for obtaining prior authorization for Residential Treatment and Treatment Foster Care (TFC), as outlined in the Provider Bulletin issued on September 21, 2023. It provides instructions for submitting authorization requests, lists the required documentation for initial and continued stay requests, and explains how medical necessity is determined.
Residential Aftercare services and Transition TFC do not require prior authorization for the first six (6) months. Requests to extend services beyond six months require prior approval and may be authorized for up to 30 days at a time. Providers should submit the child’s updated Transition/Discharge Plan, along with supporting documentation, to MHD/SMHK.
Aftercare/Transition Services | |||
|---|---|---|---|
Proc Code | Mod 1 | Mod 2 | Description |
| H2022 | HK |
| Aftercare, Non-QRTP |
| H2022 | HA |
| Aftercare, QRTP |
| H2022 | HE |
| Transition TFC |
When a child is discharged, the residential provider must complete a written discharge summary within 30 days of the child's discharge date. The discharge summary should be faxed to MHD at (573) 659-0207 for Fee for Service participants and submitted via fax to 833-966-0769 or portal for SMHK participants.
If the provider receives a denial for CCS services for a child in foster care due to not meeting medical necessity requirements, the provider must immediately contact the child’s Children’s Division (CD) or contracted foster care case management (FCCM) caseworker and residential care screening team Coordinator. If the provider receives a denial for CCS services for a child with an adoption/guardianship subsidy due to not meeting medical necessity requirements, the provider should immediately contact the child’s parents/guardian and the Adoption Subsidy Caseworker.
The MHD Education and Training Unit educates providers on proper billing methods and procedures for claim filing. Contact Education and Training at MHD.Education@dss.mo.gov or (573)751-6683. For additional resources, visit the Education and Training Resources page.