Medicare Waivers
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1
2PROVIDER BULLETIN
Volume 36 Number 09
October 1, 2013
ADULT DAY CARE WAIVER, AGED AND DISABLED WAIVER,
AIDS WAIVER, INDEPENDENT LIVING WAIVER, MEDICALLY
FRAGILE ADULT WAIVER, PERSONAL CARE and
PRIVATE DUTY NURSING
CONTENTS
RATE UPDATE FOR HOME AND COMMUNITY BASED SERVICES
MAXIMUM ALLOWABLE RATE INCREASE
During the 2013 legislative session, the Department of Health and Senior Services was
appropriated funding to increase Home and Community Based Services rates as of July 1,
2013. The funding was released in September and will be effective for dates of service on or
after October 1, 2013. The MO HealthNet fee-for-service maximum allowable rates for the
services listed below have been prorated at a higher amount to fully fund the increase for
State Fiscal Year 2014 over a nine month period through June 30, 2014.
The rates effective July 1, 2014 will be adjusted down to reflect the 2013 funding increase
applied over an entire year. At that time a bulletin will be published notifying providers of the
new rates.
MO HealthNet will reimburse the lower of the provider’s billed charge or the maximum
allowable amount for the date of service billed. Providers may not bill MO HealthNet at a
higher rate than they charge their private pay patients. Providers must bill MO HealthNet
their usual and customary rate.
The affected procedure codes and amounts are as follows:
CURRENT
MAXIMUM
PROCEDURE
MAXIMUM
ALLOWABLE
CODE
DESCRIPTION
ALLOWABLE
10/1/13
$
2.14
$ 2.29
S5100 HB
Adult Day Care Waiver - (15-min unit)
Adult Day Care - Aged & Disabled Waiver –
$
2.14
$ 2.29
S5100 HC
(15-min unit)
$
4.24
$ 4.54
S5120
Chore-Aged & Disabled Waiver - (15-min unit)
Attendant Care - Medically Fragile Adult
$
4.24
$ 4.54
S5125U5
Waiver (15-min unit)
Homemaker - Aged & Disabled Waiver
$ 4.24
$ 4.54
S5130
(15-min unit)
Basic In-Home Respite - Aged & Disabled
$ 3.78
$ 4.04
S5150
Waiver (15-min unit)
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Parent category: Medical