Need help?

Email membserv@fhp.org
Call Customer Service toll-free:
     1-800-347-9363 (MO)
     1-877-347-9363 (KS) or
Search the site (top right corner of page)

    Find or Change Provider
    Find a Hospital or Pharmacy
    Urgent Care or Emergency Care

Introduction to CMFHP

• Eligibility - Do I Qualify?
• Customer Service and ID Cards
• Interpreter Services, TDD/TYY
• FAQs
• Informacion en Espanol (coming soon)

Benefits - covered and non-covered

• Benefits eBook and Benefits Movie
• Member Handbook and Audio Handbook
• When Will I Have to Pay?
• Important Phone Numbers

Providers and Getting Medical Care

• Find or Change a Provider
• Need a Ride? - 1-800-890-6026
• 24-Hr Nurse Advice Line - 1-800-347-9369
• Appointments with Your PCP
• When Will I Have to Pay?
• Emergency Care, Urgent Care, Preventive Care
• Care Away from Home or After-Hours Care

Keeping Coverage and Changing Plans

Programs to Help You

• Disease Management Programs: Asthma, Diabetes, Depression (MO)
• Complex Health Care Needs
• Healthy Lifestyles (HeLP)
•   First Touch for Pregnant Women
•   Immunizations (shots)
• Information on Dental Care
• Special Health Care Needs
• Lead Poisoning Prevention
•   Help to Quit Tobacco Use
• Patient Safety and Decision-Making
• Community Programs and Resources

Newsletters, Brochures, and Podcasts/Audio Programs

Privacy, Your Rights, Utilization Management

• Privacy and Rights and Responsibilities
• Utilization Management (UM)
• Grievances and Appeals

CMFHP Quality and Service Standards

• Quality Improvement
• New Technology

Important Information for Members of a Federally-Recognized American Indian or Native Alaskan Tribe

Is your child a member of a federally-recognized American Indian or Native Alaskan tribe? If so, you will not have to pay a premium for your child's health care coverage.

To stop owing a premium, send a copy of the proof of your child's tribal membership to the Premium Collections Unit by mail, fax, or email. Be sure to include your child's name and MO HealthNet identification number with your proof.

• MAIL:
MO HealthNet Division
Premium Collections Unit
P.O. Box 6500
Jefferson City, MO 65102-6500

• FAX: (573) 526-2471
• EMAIL: Scan your records and email to AskMHD@dss.mo.gov. Type the words Premium Collections Unit in the subject line of your email.

Proof of membership can be a copy of a tribal membership card or letter issued by a tribe that is recognized by the United States Department of the Interior, Bureau of Indian Affairs

MO approved 10/29/09

Missouri Member Home Page!

We are glad to have you as a member!

Welcome to Children’s Mercy Family Health Partners (CMFHP)! We are a provider with MO HealthNet Managed Care.

CMFHP provides low-cost or no-cost health insurance to medically vulnerable populations through a partnership with the State of Missouri MO HealthNet Managed Care Program. CMFHP is the only non-profit health plan owned by a safety-net provider, Children’s Mercy Hospitals and Clinics.

CMFHP members live in areas of Missouri where they get most of their benefits from CMFHP. You either chose or were assigned to CMFHP.

Did You Know ...

All NEW Missouri CMFHP members should have a Healthy Children and Youth/Well Care Exam within the first 90 days of enrollment. Call Customer Service toll-free at 1-800-347-9363 for more information. Read more about Preventive Care.

Customer Service

We are live and we are local! If you need help or have questions about CMFHP, call Customer Service at 1-800-347-9363 (toll free) or 816-559-9598.

Customer Service is open Monday through Thursday, 7 a.m. to 6 p.m. and Friday from 7 a.m. to 5 p.m. For urgent needs after these hours, please call the Nurse Advice Line at 1-800-347-9369 (toll free).

Customer Service can help you:

• Select a Primary Care Provider (PCP) for you or your children.
• Make appointments to see the PCP.
• Get more information on benefits and limits of your plan.
• Help you get transportation to your medical appointments.
• Change your PCP or your children’s PCP.
• Make a complaint.

ID Cards

You will receive a white MO HealthNet Card from the state once you are eligible for MO HealthNet Managed Care. Also, CMFHP will send you a plastic member ID card. Each covered member will have their own card.

You should carry all of these cards with you at all times. Show them to the provider when you seek medical care, including the pharmacy.

Your ID card contains important phone numbers. Please check your ID card and make sure your PCP is correct. If it is not correct, or if you lose your card, please call Customer Service at 1-800-347-9363 (toll free) or 816-559-9599.

¡Hablamos Espanol!

Si usted no habla Inglés llame 1-800-347-9363 (numero gratis) ó 816-559-9599 para pedir ayuda.

• Lo podemos ayudar si usted no habla o entiende Inglés.
• Le proporcionare mos un interprete cuando lo necesite.

Translation/Interpreters Available

If you do not speak English, call Customer Service toll-free at 1-800-347-9363 to ask for help. We can help if you do not speak or understand English.

• We will get you a translator when needed.
• We may have this book in your language.
• We can help you find a provider.
• We will get a copy of the grievance and appeal rules in your language.

We also have the member handbook recorded on a CD and we can send it to you. This can help if you are hearing impaired.

TDD/TTY

We have a special phone number for people with poor hearing. Members who use a Telecommunications Device for the Deaf (TDD) can call 1-877-347-9361 (toll free).

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Benefits

Benefits Movie

Benefit from your benefits! Watch this movie about CMFHP benefits.

Covered Benefits

The following services are covered benefits for MO HealthNet Managed Care members of CMFHP. Please keep in mind that services and benefits change from time to time.

This list is for your general information only. Some services are excluded from coverage by the State of Missouri MO HealthNet program. Some benefits are limited to children and pregnant women. Some services require prior authorization. You can call CMFHP Customer Service for more information about specific services and benefits at 1-800-347-9363 (toll free).

Your Health Benefits in MO HealthNet Managed Care.   Some benefits are limited based on your eligibility group or age. The benefits that may be limited have a "*" next to them. Some services need prior approval before getting them. Call CMFHP Customer Service at 1-800-347-9363 or 816-559-9599 for information about your health benefits.

You may get these services from your MO HealthNet Managed Care health plan or a local 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

The following services are covered for pregnant women and children:

The following health care services are available.

  They are not covered by CMFHP. These services are covered by MO HealthNet Fee-for-Service using MO HealthNet approved providers.

The following are additional benefits covered by CMFHP.

  These additional benefits are not part of the regular benefit package, but have been approved for payment for CMFHP members.

Non Covered Benefits.

The services listed below are examples of services CMFHP does not cover. This may not include all items. It is meant to be a general list. If you have any questions, please call Customer Service toll-free at 1-800-347-9363. CMFHP will not pay for any services when they are not covered by MO HealthNet and not approved by your PCP or CMFHP.

Pharmacy

The following health care services are available. They are not covered by CMFHP. These services are covered by MO HealthNet Fee-for-Service using MO HealthNet approved providers.

Pharmacy (including prescriptions and some over the counter medications). Some copayments apply. Call MO HealthNet at 1-800-392-2161 or 1-573-751-6527 for more details on how to obtain your prescriptions.

Pharmacy Dispensing Fees

Children under 19 do not have to pay a pharmacy dispensing fee. Members nineteen (19) and older pay a pharmacy dispensing fee for each drug they get. This fee is $0.50 up to $2.00 for each drug. The amount of this fee is based on the cost of the drug. You should never pay a fee of more than $2.00 for each drug. Remember, if you get more than one drug at the same time, you will pay these fees for each drug you get.

You will not pay a dispensing fee when the medicine is for an emergency, family planning, a foster child, EPSDT/HCY services, or a pregnancy related reason.

To ask what you have to pay, call MO HealthNet Division Participant Service at 1-800-392-2161. You will be able to get your prescription even if you cannot pay. You will still owe the fee and must pay it like your other bills.

Changes in Your Benefits

CMFHP will notify you of changes in your benefits, services or service delivery office/site in writing.

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Copayments - When Will I Have to Pay?

If You Are Billed

CMFHP will pay for all covered MO HealthNet Managed Care services. You should not be getting a bill if the medical service you got is a covered MO HealthNet Managed Care benefit. If you choose to pay for a service, you must agree in writing, that you will be responsible for the payment before getting the service.

You will not have to pay for covered health care services even if:

• the State does not pay your MO HealthNet Managed Care health plan.
• your MO HealthNet Managed Care health plan does not pay your provider.
• your provider's bill is more than your MO HealthNet Managed Care health plan will pay.
• your MO HealthNet Managed Care health plan cannot pay its bills.

You may have to pay for services you get if:

• you go to another health care provider without a referral from your PCP;
• you choose to get medical services that are not covered by MO HealthNet Managed Care; or
• you go to a provider that is not a CMFHP provider without prior approval.

If you get a bill, do not wait! Call our Customer Service office at 1-800-347-9363 or 816-559-9599. CMFHP will look into this for you.

Out of Network - may incur a fee/bill
Important Notice: Please read the following information below

We want to make sure that all of our members understand that there are times you may have to pay for services.

When you see a provider, you must make sure they are in our provider network. If you go to a provider out of our network, you may have to pay for that visit.

If you have a question about whether a provider or service is covered, you should call Customer Service at 1-800-347-9363 before your health care appointment.

There are many ways to find a Primary Care Provider (PCP) in our network. You can see all of our in-network PCPs in the provider directory. If you need a specialist, your PCP's office can help you. You can also call Customer Service at 1-800-347-9363. We are here to help you!

When Will I Have to Pay?
When you sign a paper at your provider's office, you may be agreeing to pay for services if it is not covered. Carefully read everything before you sign.

CMFHP will pay most of your medical bills, but there are some services that are not covered or are limited.

• You should always ask if the service is covered. Your provider may ask you to sign a statement that you will pay for non-covered services.
• If your PCP suggests a service that is not covered, you must pay for that service if you choose to get it.
• If you request a service that is not covered, you must pay for that service.
• If you are a CMFHP member, your PCP must be an in-network provider. Check with your PCP or call our Customer Service Department.

If you go to the emergency room and it is not an emergency, you may have to pay for the care you get.

Member Handbook

Click here to view the Missouri Member Handbook

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Keeping your coverage

It is very important you let your Family Support Eligibility Specialist know when your address changes. Important letters and information will be mailed to the address you have given. You or your children could lose your MO HealthNet coverage if you do not respond to State requests for information. Please make sure that you answer all mail from the State.

Changing To Another MO HealthNet Managed Care Health Plan

You may change MO HealthNet Managed Care health plans for any reason during the first 90 days after you become a MO HealthNet Managed Care health plan m ember. You will also be able to change during your annual open enrollment time. Call the MO HealthNet Managed Care Enrollment Helpline at 1-800-348-6627 for help in changing MO HealthNet Managed Care health plans.

You may be able to change MO HealthNet Managed Care health plans after 90 days. Some reasons for changing include but are not limited to:

• you have moved out of the MO HealthNet Managed Care area;
• your PCP is no longer with Children’s Mercy Family Health Partners and is in another MO HealthNet Managed Care health plan; or
• your specialist or other health care provider you are currently getting services from is no longer with Children’s Mercy Family Health Partners and is in another MO HealthNet Managed Care health plan.

Children’s Mercy Family Health Partners cannot make you leave our MO HealthNet Managed Care health plan because of a health problem.

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Privacy, Rights and Responsibilities

Member Privacy (Notice of Health Information Practices)

CMFHP receives protected health information such as your name, address, phone number, and in some cases health information containing your diagnosis, treatment, and a plan for future care or treatment. This information is called your medical record.

It is a:

• Plan of your care and treatment;
• Way to communicate among the many health professionals caring for you;
• Legal document describing the care you received;
• Way you or an insurance company verify that services were actually provided;
• Tool in educating health professionals;
• Source of data for medical research;
• Source of information for public health officials charged with improving the health of the nation;
• Source of data for facility planning and marketing; and
• Tool to help the Hospital assess and continually work to improve the care it delivers.

Understanding what is in your record, and how your health information is used, helps you to:

• Ensure its accuracy;
• Better understand who, what, when, where, and why others may access your health information; and
• Make more informed decisions when giving permission to others to view the information.

Your Health Information Rights
Health plan information collected is the physical property of CMFHP, but the information belongs to you.

You have the right to:

• Request limits of certain uses and disclosures of your information;
• Obtain a paper copy of Notice of Health Information Practices upon request;
• Inspect and copy your health record;
• Request amendments to your health record;
• Request a record of disclosures of information from your health record;
• Request your health information to be communicated by other means or at other locations; and
• Revoke any authorization to use or disclose your health information except to the extent that action has already been taken with that information.

Our Responsibilities
CMFHP is required to:

• Keep your health information private - this includes protecting oral, written and electronic health information throughout CMFHP;
• Provide you with a notice (this document) of the Plan's legal duties and privacy practices with respect to information it collects and maintains about you;
• Follow the terms of the notice;
• Notify you if the Plan is unable to agree to a limit requested by you on the use or disclosure of your health information; and
• Try to meet reasonable requests you may have to communicate health information by others or at other locations.

CMFHP reserves the right to change its practices and to be sure the new practices keep all health information safe. Should the Plan's health information practices change, it will post a revised notice on its web page (www.fhp.org), throughout its facilities, and will have copies available for you to take with you. The Plan will apply any changes to all health information regardless of when created or received. CMFHP will not use or disclose your health information without your permission, except as described in this notice or allowed by law.

For More Information or to Report a Problem
If you have any questions or would like additional information, you may contact the Corporate Compliance Officer at 816-559-9494.

If you believe your privacy rights have been violated, you can file a complaint with the Secretary of the United States Department of Health and Human Services. Contact the Hospital's Privacy Officer at the number above. You will not be penalized for filing a complaint.

Examples of Disclosures for Treatment, Payment, and Health Operations

CMFHP will use your health information for treatment
For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in our record and used to determine the course of treatment that should work best for you. Your physician will document in your record their expectations of the members of your healthcare team. Members of your healthcare team will record the actions they took and their observations. In that way, your physician will know how you are responding to treatment.

CMFHP will also provide our physician or other healthcare provider involved in you care with copies of various reports that will help in treating you once you are discharged.

CMFHP will use your health information for payment.
For example: A bill or other information may be sent to you or the Plan in order for providers to obtain payment. The information on or with the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

CMFHP will use your health information for regular healthcare business.
For example: Members of the health services staff, Medical Directors, or members of the quality improvement team may use information in your health record to assess the care results to compare it to others with the same condition or receiving the same care. This information will then be used to continually improve the quality and effectiveness of the healthcare and service we provide. HIPAA 3-16-05

Other Uses and Disclosures
Business associates
Additional disclosures of your health information may be made to outside parties known as business associates. There are some services provided to the Plan through contracts with these business associates. Examples include certain laboratory tests and a typing service that types medical reports. The plan may disclose your health information to a business associate so that it can perform the job it has to do. To protect your health information, the Plan requires the business associate to protect your information at all times.

Family notification
CMFHP may use or disclose information to notify or assist in notifying a family member, person representative, or another person responsible for your care and general condition.

Communication with family
Health professionals, using their best judgment, may disclose health information to a family member, other relative, close personal friend, or any other person you identify, about that person's role in your care or payment related to your care.

Research
The Plan may disclose information to researchers when an institutional review board (IRB) has approved their research. The IRB reviews research proposals and follows rules to ensure the privacy of your health information.

Coroners and funeral directors
The Plan may disclose information to coroners and funeral directors as directed by law to carry out their duties.

Organ procurement organizations
If you are an organ donor, the Plan may disclose health information to organ procurement organizations or other organizations engaged in the procurement, banking, or transportation of organs for the purpose of organ and tissue donation and transplant.

Marketing
The Plan does not use your information for marketing.

Food and Drug Administration (FDA)
The Plan may disclose to the FDA health information about adverse events caused by food, supplements, products and product defects, or information to help with product recalls, repairs, or replacement.

Workers' compensation
The Plan may disclose health information as directed by, and as necessary to comply with, laws relating to workers' compensation or other similar programs established by law.

Public health
As required by law, the Plan may disclose your health plan information to public health agencies or authorities charged with preventing or controlling disease, injury, or disability, or to report a suspected case of abuse or neglect.

Correctional institution
Should you be an inmate of a correctional institution, the Plan may disclose to that institution or its agents health information necessary for your health and the health and safety of other individuals.

To avert a serious threat to health and safety
The Plan may use or disclose health information about you when necessary to prevent a serious threat to your health or safety or the health or safety of another person. Any disclosure would only be to someone able to prevent the threat.

Appointment reminders
The Plan may contact you to remind you of your appointments.

Law enforcement The Plan may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Health oversight agencies
Federal law allows your health information to be released to an appropriate health oversight agency or attorney, provided that a work force member or business associate of the Plan believes in good faith that the Plan engaged in unlawful conduct or has otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.

The Department of Health and Human Services (DHHS)
Under privacy standards, the Plan must disclose your health information to DHHS upon request so that DHHS may determine our compliance with those standards.

Lawsuits and disputes
If you are involved in a lawsuit or dispute, the Plan may disclose health plan information about you in response to a subpoena, court order, or administrative order. Information will be disclosed to someone else involved in the dispute only after efforts have been made to tell you about the request or obtain an order protecting the information requested. As required by law, the Plan will disclose health information about you when required to do so by federal, state, or local law.

Military and veterans
If you are a member of the armed forces, the Plan may release health information about you as required by military command authorities. The Plan may also release information about foreign military personnel to appropriate foreign military authorities.

Authorizations
CMFHP may disclose your health information for other reasons that you specifically authorize in writing.

Information rights are provided by 45 CRF 164.522-164.528 of the Health Insurance Portability & Accountability Act of 1996.

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Member Rights

Your Rights as a MO HealthNet Managed Care Health Plan Member

You have the right to:

• Be treated with respect, privacy and dignity;
• Receive needed medical services;
• Privacy and confidentiality (including minors) subject to state and federal laws;
• Select your own Primary Care Provider (PCP);
• Refuse treatment;
• Receive information about your health care and treatment options;
• Have access to your medical records and to request changes, if necessary;
• Have someone act on your behalf if you are unable to do so;
• Get information on our Physician Incentive Plan, if any, by calling 816-559-9599 or toll-free 1-800-347-9363;
• Have access to your medical records and to request changes, if necessary;
• Have someone act on your behalf if you are unable to do so;
• Be free of restraint or seclusion from a provider who wants to:
- make you do something you should not do;
- punish you;
- get back at you;
- make things easier for him or her;
• Be free to exercise these rights without retaliation;
• Receive one copy of your medical records once a year at no cost to you.

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Member Responsibilities

Your Responsibilities as a MO HealthNet Managed Care Health Plan Member

As a member of CMFHP, you or your children have the following responsibilities:

• Use the emergency room only when you have an emergency;
• Show your and your child’s CMFHP ID card and red card or white MO HealthNet card each time you go for medical care;
• Keep appointments with providers or call to cancel or reschedule if unable to keep the appointment;
• Follow your PCP’s advice and treatment plan;
• Call your PCP for any medical problems;
• Supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care;
• Inform and provide information to CMFHP, your PCP and the Family Support Division of any other insurance coverage;
• Pay for any services received that are not covered benefits if you are told in advance that it is not covered and you agree in writing to pay;
• Share medical needs, ask questions and give requested information related to treatment;
• Be respectful and cooperative with providers and staff;
• Understand your health problems and participate in developing mutually-agreed-upon treatment goals, to the degree possible.

Additional Rights and Responsibilities:

• The right to receive information about CMFHP, its services, its practitioners and providers and member rights and responsibilities;
• The right to participate in decision-making about your health care, and have a candid discussion of appropriate or medically necessary treatment options for conditions, regardless of cost or benefit coverage;
• The right to voice grievances or appeals about CMFHP or the care we provide;
• The right to make recommendations regarding our member rights and responsibilities policy.
• The responsibility to follow plans and instructions for care that they have agreed to with their practitioners.

For questions or comments, please contact Customer Service at 1-800-347-9363 or 816-559-9599.

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Utilization Management (UM), Incentive Statement and Decision-Making

When you or your children are in the hospital, the Utilization Management Nurses and Medical Directors of CMFHP will work with your Primary Care Provider (PCP) or the provider caring for you in the hospital in determining how long you need to be in the hospital. CMFHP may decide you can be better cared for either at home or in another health care setting.

If you or your provider do not agree with the decision of CMFHP, you may appeal the utilization review decision. To appeal the utilization review decision you should follow the appeal process outlined on page 35 of your Member Handbook.

Medical Review Process
Medical review is done to confirm the medical necessity of treatments or services provided, as well as the appropriateness of the care setting. Medical review requires review of specific clinical information onsite, over the telephone, or via written communication. Medical Review Nurses gather all pertinent clinical information gathered from the treating providers, review against the medical necessity decision criteria and consider individual member needs, as well as the local healthcare delivery system. Once the review is complete, the Medical Review Nurse confirms medical necessity, the appropriateness of the care setting, and authorizes the requested service. When the Medical Review Nurse is not able to confirm the medical necessity and appropriateness of care setting, the case is referred to a Board Certified physician who has an active medical license in Missouri for review. Any denial decisions are done by a Board Certified provider.

Providers and members have the right to a copy of the criteria used in making decisions about requests. If you would like a copy of the criteria, please contact the Prior Authorization Department at 1-888-691-4872 or fax your request to 1-877-347-9366. CMFHP will mail or fax you a written copy of the criteria within three (3) business days of your request.

Utilization staff members are available for questions related to prior authorization and coverage: Monday – Friday; 8:00am – 5:00pm. They can be reached by toll free phone at 1-888-691-4872 or toll free fax at 1-877-347-9366. The same toll free phone number and toll free fax number are available 24/7 for communication of utilization management issues. Information left after normal business hours should include; caller's name, caller's contact number, member name, and member ID number. The request will be responded to the next business day.

CMFHP makes all UM decisions based only on the appropriateness of care and service, the existence of coverage for the member, and his or her unique health necessities. CMFHP never rewards or provides financial incentives to its employees, practitioners, providers, or any other individual to deny services or to make decisions that result in underutilization. This information is also available on our website, www.fhp.org.

If your provider would like to discuss a decision with a CMFHP Medical Director, your provider may call the Prior Authorization Department at 1-888-691-4872 and ask to speak with the Medical Director.

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Grievances and Appeals

You may not always be happy with CMFHP. We want to hear from you.

CMFHP has people who can help you. CMFHP cannot take your benefits away because you make a grievance, appeal or ask for a State Fair Hearing.

There are two (2) ways to tell CMFHP about a problem: GRIEVANCE or APPEAL

A grievance is a way for you to show dissatisfaction about things like:

• The quality of care or services you received;
• The way you were treated by a provider; or
• A disagreement you may have with a MO HealthNet Managed Care health plan policy.

An appeal is a way for you to ask for a review when your MO HealthNet Managed Care health plan takes action to:

• Deny or give a limited approval of a requested service;
• Deny, reduce, suspend, or end a service already approved;
• Deny payment for a service

or fails to:
• Act within required time frames for getting a service;
• Make a grievance decision within thirty (30) days of receipt of request;
• Make an expedited decision within three (3) days of receipt of request;
• Make an appeal decision within forty-five (45) days of receipt of request.

CMFHP must give you a written Notice of Action if any of these actions happen. The Notice of Action will tell you what we did and why and give you your rights to appeal or ask for a State Fair Hearing.

You Have Some Special Rights When Making a Grievance or Appeal

1. A qualified clinical professional will look at medical grievances or appeals.
2. If you do not speak or understand English, call 1-800-347-9363 or 816-559-9599 to get help from someone who speaks your language.
3. You may ask anyone such as a family member, your minister, a friend, or an attorney to help you make a grievance or an appeal.
4. If your physical or behavioral health is in danger, a review will be done within 3 working days or sooner. This is called an expedited review. Call CMFHP and tell CMFHP if you think you need an expedited review.
5. CMFHP may take up to 14 days longer to decide if you request the change of time or if we think it is in your best interest. If CMFHP changes the time we must tell you in writing the reason for the delay.
6. If you have been getting medical care and your MO HealthNet Managed Care health plan reduces, suspends, or ends the service, you can appeal. In order for medical care not to stop while you appeal the decision you must appeal within 10 days from the date the notice of action was mailed and tell us not to stop the service while you appeal. If you do not win your appeal you may have to pay for the medical care you got during this time.
7. You may request enrollment in another MO HealthNet Managed Care health plan if the issue cannot be resolved.

Additional Appeal Information:
CMFHP must make and give written notice of an appeal decision within thirty (30) days of receipt of request for pre-service appeals.

How to Make a Grievance or Appeal or Ask for a State Fair Hearing
1. GRIEVANCE – You may file a grievance on the telephone, in person, or in writing. Call CMFHP at 1-800-347-9363 or 816-559-9599 to file a grievance.

• CMFHP will write you within 10 days and let you know we got your grievance.
• CMFHP must give written notice of a decision within 30 days.

2. APPEAL – You may file an appeal orally or in writing to CMFHP. Unless you need an expedited review, you must complete a written request even if you filed orally.

• You must appeal within 90 days from the date of our Notice of Action.
• For help on how to make an appeal, call CMFHP at 1-800-347-9363 or 816-559-9599.
• Send your written appeal to: QM Appeals Nurse, Chldren's Mercy Family Health Partners, P.O. Box 411806, Kansas City, MO 64141
  
• CMFHP must write you within 10 days and let you know we got your appeal.
• CMFHP must give written notice of a decision within 45 days unless it is an expedited review.

3. STATE FAIR HEARING – You have the right to ask for a State Fair Hearing when your MO HealthNet Managed Care health plan takes an action or when your appeal is not decided in your favor. You may ask for a State Fair Hearing orally or in writing. Unless you need an expedited review, you must complete a written request even if you asked orally.

• You must ask for a State Fair Hearing within 90 days from the date of the MO HealthNet Managed Care health plan's written Notice of Action or Appeal Decision Letter.
• For help on how to ask for a State Fair Hearing, call the MO HealthNet Division at 1-800-392-2161.
• If you do not speak or understand English, call 1-800-392-2161 to get help from someone who speaks your language.
• You can send your written request to:
Participant Services Unit, MO HealthNet Division, P.O. Box 6500, Jefferson City, MO 65102-6500.
• You will be sent a form to complete. Once you send the form back, a date will be set for your hearing.
• You may ask anyone such as a family member, your minister, a friend, or an attorney to help you with a State Fair Hearing.
• A decision will be made within 90 days from the date you asked for a hearing.
• If your physical or behavioral health is in danger, a decision will be made within 3 working days. This is called an expedited hearing. Call 1-800-392-2161 if you think you need an expedited hearing.
• If you have been getting medical care and your MO HealthNet Managed Care health plan reduces, suspends, or ends the service, you can ask for a State Fair Hearing. In order for medical care not to stop you must ask for a State Fair Hearing within 10 days of the date the written notice of action was mailed and tell us not to stop the service while you appeal. If you do not win, you may have to pay for the medical care you got during this time.

Advocates For Family Health
Advocates for Family Health is an ombudsman service. An ombudsman is a problem solver who can advise you and help you.

Advocates for Family Health can help you if:

• You need help understanding your rights and benefits under MO HealthNet Managed Care.
• You feel your rights to health care are being denied.
• You are not able to solve the problem by talking to a provider, a nurse, or your MO HealthNet Managed Care health plan.
• You need to talk to someone outside of your MO HealthNet Managed Care health plan.
• You want help when filing a grievance.
• You need help when appealing a decision by your MO HealthNet Managed Care health plan.
• You need help getting a State Fair Hearing.

You can get legal help at no cost to you by contacting the legal aid office for your county.

For Clay, Jackson and Platte counties:
Call Legal Aid of Western Missouri at (816) 474-6750.
Ask for Advocates for Family Health.

For Benton, Camden, Cass, Henry, Johnson, Lafayette, Morgan, Pettis, Ray, Saline and St. Clair counties:
Call Legal Aid of Western Missouri at 1 (800) 892-2943.
Ask for Advocates for Family Health.

For Bates and Vernon counties:
Call Legal Aid of Western Missouri at 1 (800) 492-7095.
Ask for Advocates for Family Health.

For Cedar, Casconade, Laclede, Maries, Phelpes, Polk and Pulaski counties:
Call Legal Aid Services of Southern Missouri at 1 (417) 881-0533 or 1 (800) 444-4863
Ask for Advocates for Family Health.

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