MFAW Guidebook

Specialized medical supplies authorized through MFAW include medically necessary items that are typically non-covered through state plan services for adults, such as gloves, briefs/diapers and chux/underpads. Additional medically necessary items not covered by the state plan should be submitted to the MHD Exceptions Unit for consideration. If items are not covered by the MHD Exceptions Unit, prior authorization of the items should then be requested through MFAW. All other funding sources that include specialized medical supply coverage, such as Medicare or private insurance, must be exhausted prior to consideration of authorization through MFAW. If a MFAW participant has Medicare, the items should be requested through the Medicare Exceptions process prior to submitting to the MHD Exceptions Unit and then for further MFAW authorization consideration.

Program Manager Authorization Approval

PM approval through a PM Change Request is required for MFAW specialized medical supplies for the following:

• Initial supply authorizations upon MFAW enrollment,
• Increases in supply authorizations, and
• Requests for specialized medical supplies, aside from gloves, briefs/diapers and chuxs/underpads.

Decreases in supplies, provider and/or packaging changes, general cost increases and supply size, brand and/or type changes that are not a result of a change in the SC authorized supplies do not require a PM Change Request.

Provider Selection

MO HealthNet enrolled DME providers may furnish specialized medical supplies. The SC will provide the participant, parent(s), and/or responsible party(ies) with a regional provider list that includes current DME provider contact information.

• The participant, parent(s), and/or responsible party(ies) will select a provider agency within 30 days of receipt of the provider list
• When initially providing the list, the SC will offer to assist the participant/responsible party(ies) with connecting with provider agencies in their region, if such assistance is needed
• The participant, parent(s), and/or responsible party(ies) is considered to have selected a provider agency when they inform the SC of the name of the agency with whom they are working to secure supplies

Service Authorization

Once a provider agency is chosen by the participant, parent(s), and/or responsible party(ies), the SC contacts the provider agency to discuss the service authorization. A MFAW Confirmation of Verbal Service Authorization (VC) is sent to the provider agency to be signed and returned to SHCN. This form is filed in the participant’s chart. An updated VC will be sent with any change in service authorization and on an annual basis. All authorized disposable supplies must be delivered at a maximum of every six (6) months, while reusable supplies must be delivered on a maximum of an annual basis.

Invoice of Cost and Physician’s Order

All MFAW supplies must be ordered by a physician. If the participant has an active PDN provider agency, the ordered supplies should be specified in the PDN Plan of Care (POC) that is signed by the physician. If a participant does not have an active PDN provider and PDN POC that specifies the ordered supplies, a separate order signed by a physician must be obtained for the authorized supplies.

The provider agency is responsible for submitting an invoice of cost (IOC) upon initial authorization and every six (6) months for renewal of authorization that includes the following information:

• Provider name,
• Amount of all authorized supplies,
• Description of all authorized supplies, and
• Cost of all authorized supplies.

Discontinuation of Specialized Medical Supplies

SCs should notify DME providers of the discontinuation of specialized medical supplies with a MFAW Confirmation of Verbal Service Authorization (VC) for reasons that include, but are not limited to, the following:

• The participant, parent(s), and/or responsible party(ies) demonstrates an unwillingness to cooperate with MFAW requirements,
• Participant does not meet eligibility criteria,
• Participant, parent(s), and/or responsible party(ies) request closure of MFAW services,
• Unable to locate after good faith efforts,
• Participant becomes institutionalized or can no longer be maintained in the home utilizing MFAW benefits,
• The participant no longer requires waiver services,
• The participant’s needs could be better served through another Home and Community Based Services (HCBS) waiver,
• The participant moves out of the state of Missouri,
• The participant is no longer MO HealthNet eligible, and/or
• The participant expires.

If the provider agency initiates closure, they must give notification to the parent(s) and/or responsible party(ies) and SHCN prior to the discontinuation of services. The DME provider shall notify the parent(s) and/or responsible party(ies) in writing of the decision to discharge a participant for reasons that include, but are not limited to, the following:

• The participant, parent(s), and/or responsible party(ies) are non-compliant with the agreed upon Plan of Care, and/or
• The provider is no longer able to meet the service needs of the participant

The DME provider shall notify the SHCN within 72 hours of DME discontinuation due to the following circumstances:

• Death of the participant,
• Participant’s admission to a health care facility,
• Participant is no longer in need of care, and/or
• Parent(s) and/or responsible party(ies) request to discontinue services