Extended Women’s Health Services cover family planning-related services, pregnancy testing, sexually transmitted disease testing and treatment, including pap tests and pelvic exams, and follow-up services. They are covered by MO HealthNet for uninsured women who are 18-55 years of age with a Modified Adjusted Gross Income for the household size that does not exceed 201% of the Federal Poverty Level (FPL). The Medicaid Eligibility (ME) Code is “80/89”.
House Bill No. 2011, 2016 Regular Session, is the appropriations bill for the Missouri Department of Social Services for State Fiscal Year 2017. Section 11.550 of HB2011 is specific to Extended Women’s Health Services, and prohibits the disbursement of any funds, directly or indirectly, to subsidize abortion services or procedures or administrative functions, and also prohibits the use of any funds to pay an organization that provides abortion services. Qualified organizations, however, shall not be disqualified from receiving funds because of an affiliation with an organization that provides abortion services as long as the two organizations are independent of one another. The bill states that the independent affiliate providing the abortion services must be separately incorporated from any organization receiving these funds.
Missouri Medicaid Audit and Compliance (MMAC) is notifying all providers that may potentially be affected by this restriction. Providers will be notified via e-mail addresses that are on file with MMAC as well as by US Mail.
Organizations that are equipped to provide abortion services will be provided with an attestation that allows them to indicate they do not provide abortion services, if they do not. The organization will attest on behalf of any affiliated providers who submit 80/89 claims, if applicable. The attestation may be returned to DSS in order to ensure no interruption in claims processing for 80/89 claims. Affiliated organizations will also receive an informational letter so they are aware of the restriction and its potential impact on their reimbursement for 80/89 claims. This change does not affect any other Medicaid funding.
MO HealthNet providers were notified via US Mail, as indicated in the December 2, 2016, website post, above. This initial notification indicated that providers that did not submit attestations by February 1, 2017 could experience interruptions in billing.
Providers that have not yet submitted attestations may still do so. Claims for Extended Women’s Health Services (80/89) are not yet set to deny for those providers that have not submitted attestations. This means MO HealthNet providers may continue to submit attestations through April 1, 2017 without experiencing an interruption in billing.
Providers that submit attestations after April 1, 2017 may still resubmit claims that were originally denied because an attestation was not on file prior to the April 1 deadline. This means that any previously submitted claims that were denied because an attestation was not on file may be resubmitted, reprocessed and paid once the attestation is on file.
All other MO HealthNet funding is not affected by this process. Providers that do not submit attestations will only experience an effect on their 80/89 billing.