Missouri

Updated on October 12, 2023

This data is meant to be used for educational purposes to inform providers, patients, insurers, and state Medicaid agencies what genetic services may or may not be written into each state’s Medicaid policy. The database is not meant to indicate or imply whether a certain program will cover a specific service, since many decisions are made on a case by case basis. If you have specific questions about whether a service is covered, you should reach out to your plan administrator. Please see this disclaimer below for more information.

Medicaid Coverage Information Published

Yes

State Contact Information

Todd Richardson
Director, MO HealthNet Division
Missouri Department of Social Services
615 Howerton Court, PO Box 6500
Jefferson City, MO 65102
Phone: (573) 751-6922

https://medicaiddirectors.org/wp-content/uploads/2023/06/Public_DirectorsList_June2023-1.pdf

General Genetic Testing Criteria

Genetic Testing Not Covered

State Specific Definition

Genetic Services for Children

Genetic Counseling Requirement

No requirement.

Metabolic Formula Coverage Legislation

19 CSR 40-7.050

Metabolic Formula Coverage & Criteria

The Department of Health and Senior Services (DHSS) provides low-protein formula, a special dietary product, to individuals diagnosed as having phenylketonuria (PKU), maple syrup urine disease (MSUD) and other metabolic conditions as approved by the Newborn Screening Standing Committee, a subcommittee of the Missouri Genetic Advisory Committee which makes recommendations to the department on newborn screening issues. This rule establishes the criteria by which the Metabolic Formula Program accepts clients for service.

Conditions of eligibility for the Metabolic Formula Program (MFP) include:

  1. An applicant must be diagnosed as having phenylketonuria (PKU), maple syrup urine disease (MSUD) or other metabolic conditions as approved by the Newborn Screening Standing Committee and recommended to the department. The diagnosis must be made by a physician who practices at a metabolic treatment center;
  2. An applicant must be a resident of Missouri and cannot reside in a state facility. Proof of residency will consist of submitting a copy of the previous month’s utility bill with the applicant’s home address clearly printed;
  3.  The physician treating the applicant must submit the following information to the department:
    1. A letter requesting the applicant be placed on the MFP;
    2. The name and address of the applicant; and
    3. A prescription, signed by the treating physician, stating the name of the low-protein formula, a special dietary product the individual will be using

Prior Authorization Requirements

Prior Authorization Forms

https://mydss.mo.gov/media/pdf/prior-auth-request

Fee Schedule

https://apps.dss.mo.gov/fmsFeeSchedules/DLFiles.aspx

BRCA Testing Coverage

Coverage is available, but criteria is unknown.

Requirements for BRCA

Cystic Fibrosis Screening

Hereditary Cancer Testing Coverage

Coverage is available, but criteria is unknown.

Lynch Syndrome Testing Coverage

Coverage is available, but criteria is unknown.

Microarray Testing

Newborn Screening

Panel Testing

Coverage is available for a variety of genetic conditions. Criteria is unknown.

Pharmacogenetic Testing

Coverage is available, but criteria is unknown.

Prenatal Testing Offered

Whole Exome Sequencing

Other Tests Covered

Genome rapid sequence analysis is listed as a covered benefit.

For a full list of genetic testing covered, see the fee schedule for independent labs.

Other Information

Resources

Newborn Screening Reimbursement

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Disclaimer: The information contained in the database has been obtained from sources believed to be reliable but NCC has not attempted to validate or confirm the information. The database may be updated periodically. However, the accuracy and completeness of the information contained in the database cannot be, and is not, guaranteed. NCC makes no warranty of the accuracy, completeness or timeliness of this information, and shall not be liable for any decision made in reliance on this information. It is the user’s responsibility to verify this information by contacting the state Medicaid agency directly.

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