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Missouri Application for the State Children’s Health Insurance Program Proposed Effective Date: 05/01/2009 Approval Date: Bolded/Italics Added Information Prior Approval Date: 09/28/2007 Strikethrough Deleted Information - 13B -  Skilled nursing visits  Administrative Case Management Service Monitoring: Service coordinators monitor services through regular home visits MO HealthNet Managed Care Delivery System The standard MO HealthNet, SCHIP 1, SCHIP 2 utilization review policies and procedures are encompassed in the currently certified and operational MO HealthNet Management Information System (MMIS) Surveillance/Utilization Review Subsystem (SURS). Under the MO HealthNet Managed Care delivery system, the MCOs are required by contract to have Utilization Management Programs and written prior authorization, certification, utilization management, and care management policies and procedures. The policies and procedures include protocols and criteria for evaluating medical necessity, authorizing services, case management, care coordination, disease management, and detecting and addressing over and under utilization. Such protocols and criteria comply with federal and state laws and regulations. The MCOs provide assistance to enrollees and providers to ensure the appropriate utilization of resources using prior authorization; prospective, concurrent and retrospective review; discharge planning; provider and patient profiling; and use of clinical practice guidelines.