Service Coordinators and DHSS Bureau of Special Health Care Needs (SHCN) Family Partners refer participants and families to MO HealthNet for determination of eligibility and services, and assist participants and families in navigating the Medicaid system. The SHCN information system links with the DSS data system to obtain the current Medicaid status of participants. The information system for the Missouri Balanced Incentive Program, also referred to as Missouri Community Options and Resources (MOCOR), refers children and youth with special health care needs (CYSHCN) under the age of 21 to SHCN for services. SHCN administers the CYSHCN Program; Medicaid referral or verification of active enrollment is a requirement of CYSHCN Program participants. SHCN also administers the Healthy Children and Youth (HCY) Program through a cooperative agreement with MO HealthNet. This cooperative agreement also enables SHCN to obtain some funding support for service coordination activities in the CYSHCN Program. The SHCN HCY Program provides service coordination and authorization for medically necessary services for MO HealthNet state plan fee for service system (not enrolled in the MO HealthNet Managed Care Plans) recipients with special health care needs from birth to age 21. The SHCN HCY Program implements a portion of the Early Periodic Screening Diagnosis Treatment (EPSDT) requirements, including assessing the need for in-home nursing services (such as personal care, private duty nursing and skilled nursing visits) for children and youth with serious and complex medical needs. SHCN Nurse Service Coordinators conduct individual assessments with participants and families in HCY during home visits and link participants and families with services and resources that enable participants to remain safely in their homes. An individual plan of care is created for participants to ensure the unique needs of each person are met. In addition, SHCN administers the Medically Fragile Adult Waiver (MFAW) Program, which serves medically complex individuals age 21 and over, who have ‘aged out’ of the HCY Program. MO HealthNet is the Single State Medicaid Agency; SHCN administers the MFAW Program through an interagency agreement with MO HealthNet. An interagency agreement will be developed with MO HealthNet for SHCN to administer the recently approved Brain Injury Waiver (BIW) Program. The BIW is designed to provide home and community based services to participants ages 21 to 65 with traumatic brain injuries.

Current operations of SHCN involve three separate MOUs with DSS. DHSS and DSS are in the process of exploring the possibility of combining agreements for programs with similar authorities. Revised MOUs have been drafted and are in process for review.

SHCN staff collaborate with MO HealthNet staff in developing and updating policies and processes related to CYSHCN. Examples of these collaborative efforts include: developing systems to comply with electronic visit verification requirements; ensuring transitions for compliance with the Centers for Medicare and Medicaid Services (CMS) Final Rule addressing home and community-based services; as well as participating in the state’s Governance Board for the CMS Transformed Medicaid Statistical Information System.

Another example is the exploration of changing from fee for service reimbursement for in home providers to value based payment reimbursement. Missouri received technical assistance through the Medicaid Innovation Accelerator Program to explore value-based payment options for Personal Care. Multiple state agencies were involved in the project including: MO HealthNet; Department of Mental Health, Division of Developmental Disabilities; DHSS, Division of Senior and Disability Services; DHSS, Division of Community and Public Health, Bureau of HIV, STD, and Hepatitis, as well as SHCN. The group crafted a driver diagram and aim statement. Data was obtained from all entities and analysis was conducted. The project was shared with stakeholders to obtain input on concepts, challenges, and possible implementation strategies. Another example of extensive collaboration between SHCN and MO HealthNet is related to the implementation of statewide managed care Medicaid. In an effort to minimize negative impact to children receiving in-home services, SHCN management staff members were included in conversations with MO HealthNet staff, Managed Care Companies, and MO HealthNet providers during the transition to implement managed care statewide. SHCN shared processes and forms to promote continuity of statewide operations, regardless of Managed Care/fee for service status. SHCN also provided MO HealthNet with a listing of HCY participants prior to the statewide implementation to ensure the participants were appropriately identified and given a choice of receiving services through Managed Care or fee for service. In addition, SHCN staff contacted participants/families receiving services through the HCY Program who were identified as possibly transitioning from fee for service Medicaid to Managed Care to inform them of changes regarding authorization of in- home services and to provide them with information about who to contact with questions regarding their Medicaid status. Ongoing communication between MO HealthNet, Managed Care Companies, provider agencies, and SHCN is required post implementation to ensure effective service provision as individuals change Managed Care Companies and/or fee for service Medicaid, which inadvertently impacts their services. For participants enrolled in the SHCN HCY Program, SHCN assists with authorization of in-home services to avoid gaps in services when there are changes in coverage. In addition, SHCN provides MO HealthNet with enrollment information on a weekly basis to ensure participants of the CYSHCN Program are provided an opportunity to choose between Managed Care Medicaid and fee-for-service Medicaid. SHCN collaborated extensively with MO HealthNet through the COVID experience to coordinate services for the HCY and MFAW Programs– including substantial work to allow Missouri flexibility for implementation due to the public health emergency.

Data Sharing

Additional data sharing agreements between DHSS and DSS include:

• Vital Records shares birth and death data with DSS to determine eligibility for services. DHSS shares opioid data from hospitals for maternal opioid misuse with DSS.
• Agreement for DHSS and LPHA’s to perform lead screening and home assessments for children who test positive.
• DHSS receives Medicaid data to determine eligibility for WIC.