Children and Youth with Special Health Care Needs Program Provider Manual

Special Health Care Needs (SHCN) will contract with providers to obtain medical care and ancillary services for participants covered by the Children and Youth with Special Health Care Needs (CYSHCN) Program. Participants enrolled in CYSHCN must receive services from a SHCN approved provider.

SHCN requires providers to be enrolled with MO HealthNet and Medicare to be considered for approval as a SHCN provider. Orthodontists and interpreters are excluded from this requirement.

Prospective providers must contact SHCN by telephone or in writing to obtain an application packet.

Inpatient

• Treatment Centers who have an accreditation certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), American Osteopathic Association, and/or Commission on Accreditation of Rehabilitation. Facilities wishing to provide comprehensive medical care must:
  • Submit the following
    • Children and Youth with Special Health Care Needs Participation Agreement,
    • Provider Application (CC-35), and
  • Register at MissouriBUYS, powered by MOVERS.

Individual Providers

• Providers who are licensed/certified by the State of Missouri and wish to receive payment in their name must:
  • Submit the following
    • Children and Youth with Special Health Care Needs Participation Agreement,
    • Provider Application (CC-35), and
  • Register at MissouriBUYS, powered by MOVERS.

Group Providers

• Providers, who are members of a provider group that is licensed/certified by the State of Missouri and submit invoices for payment under the group name, must make a group application.
• The authorized representative designated by the group must:
  • Submit the following
    • Children and Youth with Special Health Care Needs Participation Agreement,
    • Provider Application (CC-35), and
  • Register at MissouriBUYS, powered by MOVERS.
• The group provider is responsible for ensuring that appropriately certified or licensed staff provide services to CYSHCN participants.
• The Department of Health and Senior Services, Special Health Care Needs will not reimburse for services that require a license or certification if provided by individuals who are not licensed or certified by the State of Missouri.

Approval

• If the provider meets SHCN provider qualifications, approval will be sent to the provider with a copy of the approved Children and Youth with Special Health Care Needs Participation Agreement.
• If the provider does not meet SHCN provider qualifications, notification will be sent to the provider outlining the reason for denial.

Notification of Change of Information

• All providers must notify SHCN in writing when there is:
  • An official name change,
  • A change in address, and/or
  • A change in Federal Tax Identification Number.
• If needed, SHCN will request that an updated Children and Youth with Special Health Care Needs Participation Agreement and Provider Application (CC-35), be submitted.
• Providers must also update their information in MissouriBUYS, powered by MOVERS, whenever there is a change to their demographic or payment information.

Licensure Requirements

• Temporary licenses are not acceptable.
• Licensure requirements for SHCN providers: