You receive your pharmacy benefits directly by using your red MC+ card. Remember to take your Red ID card with you when you go to the pharmacy.

Members 19 and older pay a pharmacy dispensing fee for each drug they get. This fee is $.50 up to $2.00 for each drug. Some exceptions apply.

Yes, there are some over the counter medications that are covered by your Red MC+ card. You can find this information by going to http://www.dss.missouri.gov/dms/pharmacy/pdf/otc_coveredproducts.pdf or by calling 1-800-392-2161 for a complete listing.

The members must provide their Red MC+ card to the pharmacist. If the member doesn't have their red MC+ card, the pharmacy can still fill the prescription by using the member's Children's Mercy Family Health Partners ID number as well as the following information:

BIN - 004047
PCN 43-1754897.

They can contact the Family support office in the County they live. The numbers are:

Office	Phone
Cass County	(816) 380-3597
Clay County	(816) 781-8900
Henry County	(660) 885-5531
Jackson County:
Downtown	(816) 889-2000
Independence	(816) 325-5800
Midtown	(816) 929-7100
South	(816) 325-1012
Johnson County	(660) 543-7900
Lafayette County	(660) 259-2294
Platte County	(816) 858-3740
Ray County	(816) 776-6964
St. Clair	(417) 646-8165

The state has a website specific to pharmacy which is http://www.dss.mo.gov/dms/cs/index.htm which can provide you with this information.

The state has a website specific to pharmacy which is http://www.dss.mo.gov/dms/cs/index.htm which can provide you with this information.

You can get your covered diabetic supplies from a company called Edgepark. You can contact them at 1 (800) 321-0591. Emergency diabetic supplies can be obtained by calling the CMFHP Prior Authorization line at 1-888-691-4872. Members can no longer receive supplies or equipment at the local pharmacy.

All coverage for medications are set by the State as of 7/1/06. If you have questions you can go to the State web site at http://www.dss.mo.gov/dms/cs/index.htm or call 1-800-392-2161.

MC+ for Kids, part of the Children's Health Insurance Program, is a health insurance program for uninsured children of low-income families who do not have access to affordable health insurance.

• Expands the availability of affordable health insurance for uninsured children.
• Provides children with a Primary Care Provider (PCP). Someone to coordinate all aspects of their health care and preventive services; and
• Increases efficient delivery of health care services and controls costs.

Uninsured children, ages birth to 19, whose family's gross income is up to 300% of the federal poverty level are eligible. Pregnant women whose family's gross income is under 185% of the federal poverty level can apply. Insured children with lower family income may also be eligible.

Based on income, some members will have to pay monthly premiums for professional services and prescriptions.

Families will pay no more than 5% of their yearly income for premiums in a year. If out-of-pocket expenses reach the 5% limit, the family will not have to pay the premium for the rest of the year.

Some benefits are limited based on your eligibility group or age. The benefits that may be limited have an "*" next to them. Some services need prior approval before getting them. Call Children's Mercy Family Health Partners at 1-800-347-9363 for information about your health benefits.

• Adult day health care*
• Ambulance
• Ambulatory surgical center, birthing center
• Dental services related to trauma (to the teeth or mouth as a result of injury.)
• Durable Medical Equipment (DME): limited to prosthetic devices (with the exception of an artificial larynx), respiratory equipment and oxygen, wheelchairs, diabetic supplies and equipment, and ostomy supplies.
• Emergency room
• Eye Exam every two (2) years
• Family planning
• Home health care includes DME that is part of your home health plan of care, (with the exception of CPAP, BiPAP, and Nebulizers).
• Hospice, if you are in the last six months of your life
• Hospital, when an overnight stay is required
• Laboratory tests and x-rays
• Maternity benefits, including certified nurse midwife
• Mental health and substance abuse
• Outpatient hospital, when an overnight stay is not required
• Personal care
• Limited Podiatry, medical services for your feet
• Primary Care Provider (PCP) services
• Specialty care with PCP referral
• Transplant related services
• Transportation to medical appointments

Children's Mercy Family Health Partners will notify you of changes in your benefits, services or service delivery office/site in writing.

You may get these services from your MC+ Managed Care health plan or a public health agency:

• screening, testing and treatment for sexually transmitted diseases
• screening and testing for HIV
• screening, testing and treatment for tuberculosis
• immunizations (shots) for children
• screening, testing and treatment for lead poisoning

Eligible children will be enrolled through MC+ for Kids, Missouri's health insurance program for children. Families in certain areas of the State will choose coverage through a MC+ managed care health plan. Others will receive services from MC+ approved providers.

• Call your local Family Support Division office to apply or go to http://www.dss.mo.gov/mcplus/appl.htm
• Pick-up a simple, two-page application form. It is available at all Family Support Division offices in each county, and at many hospitals, community centers, local public health agencies, mental health sites and schools.

• Proof of income (check stub, federal income tax return, or other income verification);
• Social Security numbers of those applying for MC+ for Kids;
• Proof of Citizenship for those applying for MC+ for Kids
• Immigration status of those applying for MC+ for Kids will be required;

A PCP is a physician or a provider who specializes in the delivery of primary care services. The PCP is responsible for coordinating all of a member's healthcare needs.

Your PCP is the provider that you selected as your personal health care provider. If you did not select a provider, one was selected for you. The name and phone number of your PCP is listed on your membership card.

You can change your Primary Care Provider twice a year. To change your PCP, select a participating PCP. Then call Children's Mercy Family Health Partners Customer Service at 1-800-347-9363 You can also change your PCP online by going to our web site at: www.fhp.org

PCP's sometimes will be open to established patient's only. That means the PCP has limited the number of Children's Mercy Family Health Partners members for whom they can provide care. They will only see those that have been treated in their office already. Providers also limit their panels. They do this to ensure their current patients are able to continue to have access to care. Providers who are accepting only established patients are indicated in the Provider Directory. If you have a question about a provider that is accepting established patients only, call Children's Mercy Family Health Partners Customer Service at 1-800-347-9363.

All providers must be participating providers with Children's Mercy Family Health Partners. If you need care other than what your PCP can provide, you must have a referral from your PCP.

Yes. The services you can receive without a PCP approval are:

• Family planning or birth control
• Dental services
• Mental Health care (must use participating providers)
• Health Department Services - immunizations, lead screening, tests and treatment for sexually transmitted diseases, tuberculosis or HIV/AIDS
• Vision services (must use participating providers)

Children's Mercy Family Health Partners is contracted through the State of Missouri for a specific program. This program has specific income guidelines which determines eligibility. For more information about possible eligibility, you can call Children's Mercy Family Health Partners Customer Service at 1-800-347-9363. If you want to apply by phone call 1-877-KIDS-NOW.

Children's Mercy Family Health Partners does not determine eligibility for MC+. If you have lost coverage, please contact your eligibility specialist at your local Family Support Division office.

If your situation is an emergency, go directly to the nearest Emergency Room or dial 911. Be sure to call your PCP the following day and schedule follow-up care.

If your situation is not an emergency you should call either your PCP or the Nurse Advice Line. Either your PCP or Nurse Advice can give approval for you to seek urgent care if needed. The Nurse Advice Line for CMFHP members is 1-800-347-9369.

MC+ members can self-refer, meaning you can select a participating provider within our network and go without a referral. You may get up to four (4) visits in a year without our OK. If you need assistance in making an appointment you may call 1-800-409-2225.

Most members may see any dentist in our network. Simply select a participating dentist. Then call them to make an appointment. Dental services for many adults is limited. If you need help finding a dentist, you may call Children's Mercy Family Health Partners Customer Service at 1-800-347-9363.

You can file a grievance or appeal by calling Customer Service and request the Quality Management Nurse in charge of appeals at 1-800-347-9363.

NEMT stands for Non-Emergency Medical Transportation. NEMT can be used when you do not have a way to your health care appointment. There is no charge to you for this service. We may use public transportation or bus tokens, vans, or a taxi to get you to your health care appointment. Children's Mercy Family Health Partners will give you a ride that meets your needs. You do not get to choose what kind of car or van or the company that will give you the ride. You may be able to get help with gas costs if you have a friend or a neighbor who can take you. This must be okayed before your appointment.

Call 1-800-890-6026 to set up transportation or gas reimbursement. You must call at least 2 days before the day of the appointment or you may not get transportation. You may be able to get a ride sooner if your doctor gives you an urgent care appointment. You can call this number 1-800-347-9369 to talk with a nurse. If you have an emergency, dial 911, or the local emergency phone number.

You must choose a PCP. If you do not, we will choose one for you. Your PCP will manage your health care. Your PCP's phone number is on the front of your member ID card. The PCP knows Children's Mercy Family Health Partners network and can guide you to specialists if you need one. You may ask for a specialist as your PCP if you have a chronic illness or disabling condition. We will work out a plan to make sure you get the care you need. You have a right to change PCPs in our MC+ Managed Care health plan twice a year.

You should have received a red plastic insurance card from Medicaid and a white card from Children's Mercy Family Health Partners. This shows that you are assigned to Children's Mercy Family Health Partners.

To find out if your coverage is active you can contact Children's Mercy Family Health Partners Customer Service at 1-800-347-9363.

You can also call your local Family Support Division or call the Medicaid and MC+ Recipient Services Unit at 1-800-392-2161 or 1-573-751-6527.

If you have a touch tone telephone the 800 number can be used to find out if you are eligible by choosing option 1 and entering your eight digit Medicaid or MC+ number.

You should first ask the provider to bill Children's Mercy Family Health Partners. It is your duty to be sure the provider knows you have Medicaid or MC+. If they billed Medicaid and still billed you, send the bill or a copy of the bill to Children's Mercy Family Health Partners, PO Box 411806, Kansas City, Mo. 64141-1806. Include a note with the patient name and member ID number.

To report the loss of your Children's Mercy Family Health Partners ID card, call Customer Service at 1-800-347-9363.

To report the loss of your Red MC+ card, you should contact your local Family Support Division office in the county where you live. Check your telephone book under the name of your county or the FSD Web site at http://www.dss.mo.gov/fsd for a list of Family Support offices.

Services outside the United States, District of Columbia, and the following territories: Northern Mariana Islands, American Samoa, Guam, Puerto Rico, and the Virgin Islands are not covered.

Emergency: Emergency services are covered if the out of state treating provider agrees to enroll and accept the Missouri Medicaid amount. Emergency medical services are those health care items and services furnished that are required to evaluate or stabilize a sudden and unforeseen situation or occurrence or a sudden onset of a medical or mental health condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that the failure to provide immediate medical attention could reasonably be expected by a prudent lay person, possessing average knowledge of health and medicine, to result in:

• placing the patient's physical or mental health (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; or
• serious impairment of bodily functions; or
• serious dysfunction of any bodily organ or part; or
• serious harm to self or others due to an alcohol or drug abuse emergency; or
• injury to self or bodily harm to others; or
• with respect to a pregnant woman who is having contractions: (a) there is inadequate time to effect a safe transfer to another hospital before delivery or, (b) transfer may pose a threat to the health or safety of the woman or the unborn.

Non-Emergency: Non-Emergency: Out of state is defined as "not within the physical boundaries of Missouri or any of the states that border Missouri." All non-emergent, Medicaid covered services that are to be obtained out of state must be approved before the services are received. To get the approval for out of state services a written request must be sent by a physician to:

Children's Mercy Family Health Partners, PO Box 411806, Kansas City, Mo. 64141-1806 or by calling our Prior Authorization line at 1-800-691-4872.

The written request must include a brief past medical history, services attempted in Missouri, where the services are being requested and who will provide them, and why the service cannot be done in Missouri. The out of state provider must agree to enroll and accept the Missouri Medicaid amount.

You may have private insurance with your Medicaid or MC+ as long as being uninsured is not a condition of your eligibility. It is your duty to report a private insurance plan to your Family Support Division Eligibility Specialist. You can also report your private insurance plan information to the Medicaid and MC+ Recipient Services Unit at 1-800-392-2161 or 1-573-751-6527. If you have a touch tone telephone the 800 number can be used to hear the private insurance plan listed by choosing option 2 and entering your eight digit Medicaid or MC+ number.

The Medicaid and MC+ program may be able to help pay your private insurance plan premiums. For information about the Health Insurance Premium Payment (HIPP) program, you should contact the Third Party Liability Unit at 573-751-2005.

It is very important to report address changes. It is important to report an address change so you will get important notices about your eligibility or services. You should report every address change to your local Family Support Division office. You should also contact Children's Mercy Family Health Partners Customer Service at 1-800-347-9363.