Missouri Medicaid Allows MCO Reimbursement Of Non-Network Hospital Providers At 90% Of FFS Rate

On July 1, 2018, the MO HealthNet Division, Missouri’s Medicaid plan, implemented a change that allows the MO HealthNet managed care organizations (MCOs) to reimburse non-participating hospital provider organizations at 90% of the state’s fee-for-service (FFS) rates. The amendment applies to hospitals’ inpatient and outpatient billing. Provider organizations who bill independent of the hospital will not be impacted by this language. The state says the change will “ensure efficiency, economy, quality of care, and access.”

In June 2018, there were 712,335 people enrolled in a Missouri Medicaid MCO, about 75% of the state's . . .