MO
Missouri House Bill HB2626

Missouri 2024 Regular Session

Missouri House Bill HB2626 Compare Versions

OldNewDifferences
11 SECONDREGULARSESSION
2-[PERFECTED]
32 HOUSECOMMITTEESUBSTITUTEFOR
43 HOUSEBILLNOS.2626&1918
54 102NDGENERALASSEMBLY
6-5464H.02P DANARADEMANMILLER,ChiefClerk
5+5464H.02C DANARADEMANMILLER,ChiefClerk
76 ANACT
87 Torepealsection208.152,RSMo,andtoenactinlieuthereofonenewsectionrelatingtoMO
98 HealthNetcoverageofhearing-relateddevices.
109 BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
1110 SectionA.Section208.152,RSMo,isrepealedandonenewsectionenactedinlieu
1211 2thereof,tobeknownassection208.152,toreadasfollows:
1312 208.152.1.MOHealthNetpaymentsshallbemadeonbehalfofthoseeligibleneedy
1413 2personsasdescribedinsection208.151whoareunabletoprovideforitinwholeorinpart,
1514 3withanypaymentstobemadeonthebasisofthereasonablecostofthecareorreasonable
1615 4chargefortheservicesasdefinedanddeterminedbytheMOHealthNetdivision,unless
1716 5otherwisehereinafterprovided,forthefollowing:
1817 6 (1)Inpatienthospitalservices,excepttopersonsinaninstitutionformentaldiseases
1918 7whoareundertheageofsixty-fiveyearsandovertheageoftwenty-oneyears;providedthat
2019 8theMOHealthNetdivisionshallprovidethroughruleandregulationanexceptionprocessfor
2120 9coverageofinpatientcostsinthosecasesrequiringtreatmentbeyondtheseventy-fifth
2221 10percentileprofessionalactivitiesstudy(PAS)ortheMOHealthNetchildren'sdiagnosis
2322 11length-of-stayschedule;andprovidedfurtherthattheMOHealthNetdivisionshalltakeinto
2423 12accountthroughitspaymentsystemforhospitalservicesthesituationofhospitalswhich
2524 13serveadisproportionatenumberoflow-incomepatients;
2625 14 (2)Alloutpatienthospitalservices,paymentstherefortobeinamountswhich
2726 15representnomorethaneightypercentofthelesserofreasonablecostsorcustomarycharges
2827 16forsuchservices,determinedinaccordancewiththeprinciplessetforthinTitleXVIIIAand
2928 17B,PublicLaw89-97,1965amendmentstothefederalSocialSecurityAct(42U.S.C.Section
29+18301,etseq.),buttheMOHealthNetdivisionmayevaluateoutpatienthospitalservices
3030 EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
31-intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 18301,etseq.),buttheMOHealthNetdivisionmayevaluateoutpatienthospitalservices
32-19renderedunderthissectionanddenypaymentforserviceswhicharedeterminedbytheMO
31+intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 19renderedunderthissectionanddenypaymentforserviceswhicharedeterminedbytheMO
3332 20HealthNetdivisionnottobemedicallynecessary,inaccordancewithfederallawand
3433 21regulations;
3534 22 (3)LaboratoryandX-rayservices;
3635 23 (4)Nursinghomeservicesforparticipants,excepttopersonswithmorethanfive
3736 24hundredthousanddollarsequityintheirhomeorexceptforpersonsinaninstitutionfor
3837 25mentaldiseaseswhoareundertheageofsixty-fiveyears,whenresidinginahospitallicensed
3938 26bythedepartmentofhealthandseniorservicesoranursinghomelicensedbythedepartment
4039 27ofhealthandseniorservicesorappropriatelicensingauthorityofotherstatesorgovernment-
4140 28ownedand-operatedinstitutionswhicharedeterminedtoconformtostandardsequivalentto
4241 29licensingrequirementsinTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section
4342 30[301,] 1396etseq.),asamended,fornursingfacilities.TheMOHealthNetdivisionmay
4443 31recognizethroughitspaymentmethodologyfornursingfacilitiesthosenursingfacilities
4544 32whichserveahighvolumeofMOHealthNetpatients.TheMOHealthNetdivisionwhen
4645 33determiningtheamountofthebenefitpaymentstobemadeonbehalfofpersonsunderthe
4746 34ageoftwenty-oneinanursingfacilitymayconsidernursingfacilitiesfurnishingcareto
4847 35personsundertheageoftwenty-oneasaclassificationseparatefromothernursingfacilities;
4948 36 (5)Nursinghomecostsforparticipantsreceivingbenefitpaymentsundersubdivision
5049 37(4)ofthissubsectionforthosedays,whichshallnotexceedtwelveperanyperiodofsix
5150 38consecutivemonths,duringwhichtheparticipantisonatemporaryleaveofabsencefromthe
5251 39hospitalornursinghome,providedthatnosuchparticipantshallbeallowedatemporary
5352 40leaveofabsenceunlessitisspecificallyprovidedforinhisplanofcare.Asusedinthis
5453 41subdivision,theterm"temporaryleaveofabsence"shallincludeallperiodsoftimeduring
5554 42whichaparticipantisawayfromthehospitalornursinghomeovernightbecauseheisvisiting
5655 43afriendorrelative;
5756 44 (6)Physicians'services,whetherfurnishedintheoffice,home,hospital,nursing
5857 45home,orelsewhere;
5958 46 (7)Subjecttoappropriation,uptotwentyvisitsperyearforserviceslimitedto
6059 47examinations,diagnoses,adjustments,andmanipulationsandtreatmentsofmalpositioned
6160 48articulationsandstructuresofthebodyprovidedbylicensedchiropracticphysicians
6261 49practicingwithintheirscopeofpractice.Nothinginthissubdivisionshallbeinterpretedto
6362 50otherwiseexpandMOHealthNetservices;
6463 51 (8)Drugsandmedicineswhenprescribedbyalicensedphysician,dentist,podiatrist,
6564 52oranadvancedpracticeregisterednurse;exceptthatnopaymentfordrugsandmedicines
6665 53prescribedonandafterJanuary1,2006,byalicensedphysician,dentist,podiatrist,oran
67-HCSHBs2626&1918 2 54advancedpracticeregisterednursemaybemadeonbehalfofanypersonwhoqualifiesfor
66+54advancedpracticeregisterednursemaybemadeonbehalfofanypersonwhoqualifiesfor
6867 55prescriptiondrugcoverageundertheprovisionsofP.L.108-173;
69-56 (9)Emergencyambulanceservicesand,effectiveJanuary1,1990,medically
68+HCSHBs2626&1918 2 56 (9)Emergencyambulanceservicesand,effectiveJanuary1,1990,medically
7069 57necessarytransportationtoscheduled,physician-prescribednonelectivetreatments;
7170 58 (10)Earlyandperiodicscreeninganddiagnosisofindividualswhoareundertheage
7271 59oftwenty-onetoascertaintheirphysicalormentaldefects,andhealthcare,treatment,and
7372 60othermeasurestocorrectoramelioratedefectsandchronicconditionsdiscoveredthereby.
7473 61SuchservicesshallbeprovidedinaccordancewiththeprovisionsofSection6403ofP.L.
7574 62101-239andfederalregulationspromulgatedthereunder;
7675 63 (11)Homehealthcareservices;
7776 64 (12)Familyplanningasdefinedbyfederalrulesandregulations;provided,however,
7877 65thatsuchfamilyplanningservicesshallnotincludeabortionsoranyabortifacientdrugor
7978 66devicethatisusedforthepurposeofinducinganabortionunlesssuchabortionsarecertified
8079 67inwritingbyaphysiciantotheMOHealthNetagencythat,inthephysician'sprofessional
8180 68judgment,thelifeofthemotherwouldbeendangeredifthefetuswerecarriedtoterm;
8281 69 (13)Inpatientpsychiatrichospitalservicesforindividualsunderagetwenty-oneas
8382 70definedinTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section1396d,etseq.);
8483 71 (14)Outpatientsurgicalprocedures,includingpresurgicaldiagnosticservices
8584 72performedinambulatorysurgicalfacilitieswhicharelicensedbythedepartmentofhealth
8685 73andseniorservicesofthestateofMissouri;except,thatsuchoutpatientsurgicalservicesshall
8786 74notincludepersonswhoareeligibleforcoverageunderPartBofTitleXVIII,PublicLaw89-
8887 7597,1965amendmentstothefederalSocialSecurityAct,asamended,ifexclusionofsuch
8988 76personsispermittedunderTitleXIX,PublicLaw89-97,1965amendmentstothefederal
9089 77SocialSecurityAct,asamended;
9190 78 (15)Personalcareserviceswhicharemedicallyorientedtaskshavingtodowitha
9291 79person'sphysicalrequirements,asopposedtohousekeepingrequirements,whichenablea
9392 80persontobetreatedbyhisorherphysicianonanoutpatientratherthanonaninpatientor
9493 81residentialbasisinahospital,intermediatecarefacility,orskillednursingfacility.Personal
9594 82careservicesshallberenderedbyanindividualnotamemberoftheparticipant'sfamilywho
9695 83isqualifiedtoprovidesuchserviceswheretheservicesareprescribedbyaphysicianin
9796 84accordancewithaplanoftreatmentandaresupervisedbyalicensednurse.Personseligible
9897 85toreceivepersonalcareservicesshallbethosepersonswhowouldotherwiserequire
9998 86placementinahospital,intermediatecarefacility,orskillednursingfacility.Benefitspayable
10099 87forpersonalcareservicesshallnotexceedforanyoneparticipantonehundredpercentofthe
101100 88averagestatewidechargeforcareandtreatmentinanintermediatecarefacilityfora
102101 89comparableperiodoftime.Suchservices,whendeliveredinaresidentialcarefacilityor
103102 90assistedlivingfacilitylicensedunderchapter198shallbeauthorizedonatierlevelbasedon
104-HCSHBs2626&1918 3 91theservicestheresidentrequiresandthefrequencyoftheservices.Aresidentofsuchfacility
103+91theservicestheresidentrequiresandthefrequencyoftheservices.Aresidentofsuchfacility
105104 92whoqualifiesforassistanceundersection208.030shall,ataminimum,ifprescribedbya
106-93physician,qualifyforthetierlevelwiththefewestservices.Theratepaidtoprovidersfor
105+HCSHBs2626&1918 3 93physician,qualifyforthetierlevelwiththefewestservices.Theratepaidtoprovidersfor
107106 94eachtierofserviceshallbesetsubjecttoappropriations.Subjecttoappropriations,each
108107 95residentofsuchfacilitywhoqualifiesforassistanceundersection208.030andmeetsthe
109108 96levelofcarerequiredinthissectionshall,ataminimum,ifprescribedbyaphysician,be
110109 97authorizeduptoonehourofpersonalcareservicesperday.Authorizedunitsofpersonalcare
111110 98servicesshallnotbereducedortierlevelloweredunlessanorderapprovingsuchreductionor
112111 99loweringisobtainedfromtheresident'spersonalphysician.Suchauthorizedunitsofpersonal
113112 100careservicesortierlevelshallbetransferredwithsuchresidentifheorshetransfersto
114113 101anothersuchfacility.Suchprovisionshallterminateuponreceiptofrelevantwaiversfrom
115114 102thefederalDepartmentofHealthandHumanServices.IftheCentersforMedicareand
116115 103MedicaidServicesdeterminesthatsuchprovisiondoesnotcomplywiththestateplan,this
117116 104provisionshallbenullandvoid.TheMOHealthNetdivisionshallnotifytherevisorof
118117 105statutesastowhethertherelevantwaiversareapprovedoradeterminationofnoncompliance
119118 106ismade;
120119 107 (16)Mentalhealthservices.Thestateplanforprovidingmedicalassistanceunder
121120 108TitleXIXoftheSocialSecurityAct,42U.S.C.Section[301]1396etseq.,asamended,shall
122121 109includethefollowingmentalhealthserviceswhensuchservicesareprovidedbycommunity
123122 110mentalhealthfacilitiesoperatedbythedepartmentofmentalhealthordesignatedbythe
124123 111departmentofmentalhealthasacommunitymentalhealthfacilityorasanalcoholanddrug
125124 112abusefacilityorasachild-servingagencywithinthecomprehensivechildren'smentalhealth
126125 113servicesystemestablishedinsection630.097.Thedepartmentofmentalhealthshall
127126 114establishbyadministrativerulethedefinitionandcriteriafordesignationasacommunity
128127 115mentalhealthfacilityandfordesignationasanalcoholanddrugabusefacility.Suchmental
129128 116healthservicesshallinclude:
130129 117 (a)Outpatientmentalhealthservicesincludingpreventive,diagnostic,therapeutic,
131130 118rehabilitative,andpalliativeinterventionsrenderedtoindividualsinanindividualorgroup
132131 119settingbyamentalhealthprofessionalinaccordancewithaplanoftreatmentappropriately
133132 120established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
134133 121apartofclientservicesmanagement;
135134 122 (b)Clinicmentalhealthservicesincludingpreventive,diagnostic,therapeutic,
136135 123rehabilitative,andpalliativeinterventionsrenderedtoindividualsinanindividualorgroup
137136 124settingbyamentalhealthprofessionalinaccordancewithaplanoftreatmentappropriately
138137 125established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
139138 126apartofclientservicesmanagement;
140-HCSHBs2626&1918 4 127 (c)Rehabilitativementalhealthandalcoholanddrugabuseservicesincludinghome
139+127 (c)Rehabilitativementalhealthandalcoholanddrugabuseservicesincludinghome
141140 128andcommunity-basedpreventive,diagnostic,therapeutic,rehabilitative,andpalliative
142141 129interventionsrenderedtoindividualsinanindividualorgroupsettingbyamentalhealth
143-130oralcoholanddrugabuseprofessionalinaccordancewithaplanoftreatmentappropriately
142+HCSHBs2626&1918 4 130oralcoholanddrugabuseprofessionalinaccordancewithaplanoftreatmentappropriately
144143 131established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
145144 132apartofclientservicesmanagement.Asusedinthissection,mentalhealthprofessionaland
146145 133alcoholanddrugabuseprofessionalshallbedefinedbythedepartmentofmentalhealth
147146 134pursuanttodulypromulgatedrules.Withrespecttoservicesestablishedbythissubdivision,
148147 135thedepartmentofsocialservices,MOHealthNetdivision,shallenterintoanagreementwith
149148 136thedepartmentofmentalhealth.Matchingfundsforoutpatientmentalhealthservices,clinic
150149 137mentalhealthservices,andrehabilitationservicesformentalhealthandalcoholanddrug
151150 138abuseshallbecertifiedbythedepartmentofmentalhealthtotheMOHealthNetdivision.
152151 139Theagreementshallestablishamechanismforthejointimplementationoftheprovisionsof
153152 140thissubdivision.Inaddition,theagreementshallestablishamechanismbywhichratesfor
154153 141servicesmaybejointlydeveloped;
155154 142 (17)SuchadditionalservicesasdefinedbytheMOHealthNetdivisiontobe
156155 143furnishedunderwaiversoffederalstatutoryrequirementsasprovidedforandauthorizedby
157156 144thefederalSocialSecurityAct(42U.S.C.Section301,etseq.)subjecttoappropriationbythe
158157 145generalassembly;
159158 146 (18)Theservicesofanadvancedpracticeregisterednursewithacollaborative
160159 147practiceagreementtotheextentthatsuchservicesareprovidedinaccordancewithchapters
161160 148334and335,andregulationspromulgatedthereunder;
162161 149 (19)Nursinghomecostsforparticipantsreceivingbenefitpaymentsunder
163162 150subdivision(4)ofthissubsectiontoreserveabedfortheparticipantinthenursinghome
164163 151duringthetimethattheparticipantisabsentduetoadmissiontoahospitalforserviceswhich
165164 152cannotbeperformedonanoutpatientbasis,subjecttotheprovisionsofthissubdivision:
166165 153 (a)Theprovisionsofthissubdivisionshallapplyonlyif:
167166 154 a.Theoccupancyrateofthenursinghomeisatoraboveninety-sevenpercentofMO
168167 155HealthNetcertifiedlicensedbeds,accordingtothemostrecentquarterlycensusprovidedto
169168 156thedepartmentofhealthandseniorserviceswhichwastakenpriortowhentheparticipantis
170169 157admittedtothehospital;and
171170 158 b.Thepatientisadmittedtoahospitalforamedicalconditionwithananticipated
172171 159stayofthreedaysorless;
173172 160 (b)Thepaymenttobemadeunderthissubdivisionshallbeprovidedforamaximum
174173 161ofthreedaysperhospitalstay;
175174 162 (c)Foreachdaythatnursinghomecostsarepaidonbehalfofaparticipantunderthis
176175 163subdivisionduringanyperiodofsixconsecutivemonthssuchparticipantshall,duringthe
177-HCSHBs2626&1918 5 164sameperiodofsixconsecutivemonths,beineligibleforpaymentofnursinghomecostsof
176+164sameperiodofsixconsecutivemonths,beineligibleforpaymentofnursinghomecostsof
178177 165twootherwiseavailabletemporaryleaveofabsencedaysprovidedundersubdivision(5)of
179178 166thissubsection;and
180-167 (d)Theprovisionsofthissubdivisionshallnotapplyunlessthenursinghome
179+HCSHBs2626&1918 5 167 (d)Theprovisionsofthissubdivisionshallnotapplyunlessthenursinghome
181180 168receivesnoticefromtheparticipantortheparticipant'sresponsiblepartythattheparticipant
182181 169intendstoreturntothenursinghomefollowingthehospitalstay.Ifthenursinghomereceives
183182 170suchnotificationandallotherprovisionsofthissubsectionhavebeensatisfied,thenursing
184183 171homeshallprovidenoticetotheparticipantortheparticipant'sresponsiblepartypriorto
185184 172releaseofthereservedbed;
186185 173 (20)Prescribedmedicallynecessarydurablemedicalequipment.Anelectronicweb-
187186 174basedpriorauthorizationsystemusingbestmedicalevidenceandcareandtreatment
188187 175guidelinesconsistentwithnationalstandardsshallbeusedtoverifymedicalneed;
189188 176 (21)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
190189 177coordinatedprogramofactiveprofessionalmedicalattentionwithinahome,outpatientand
191190 178inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
192191 179medicallydirectedinterdisciplinaryteam.Theprogramprovidesreliefofseverepainorother
193192 180physicalsymptomsandsupportivecaretomeetthespecialneedsarisingoutofphysical,
194193 181psychological,spiritual,social,andeconomicstresseswhichareexperiencedduringthefinal
195194 182stagesofillness,andduringdyingandbereavementandmeetstheMedicarerequirementsfor
196195 183participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
197196 184paidbytheMOHealthNetdivisiontothehospiceproviderforroomandboardfurnishedbya
198197 185nursinghometoaneligiblehospicepatientshallnotbelessthanninety-fivepercentofthe
199198 186rateofreimbursementwhichwouldhavebeenpaidforfacilityservicesinthatnursinghome
200199 187facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
201200 188(OmnibusBudgetReconciliationActof1989);
202201 189 (22)Prescribedmedicallynecessarydentalservices.Suchservicesshallbesubjectto
203202 190appropriations.Anelectronicweb-basedpriorauthorizationsystemusingbestmedical
204203 191evidenceandcareandtreatmentguidelinesconsistentwithnationalstandardsshallbeusedto
205204 192verifymedicalneed;
206205 193 (23)Prescribedmedicallynecessaryoptometricservices.Suchservicesshallbe
207206 194subjecttoappropriations.Anelectronicweb-basedpriorauthorizationsystemusingbest
208207 195medicalevidenceandcareandtreatmentguidelinesconsistentwithnationalstandardsshall
209208 196beusedtoverifymedicalneed;
210209 197 (24)Bloodclottingproducts-relatedservices.Forpersonsdiagnosedwithableeding
211210 198disorder,asdefinedinsection338.400,reliantonbloodclottingproducts,asdefinedin
212211 199section338.400,suchservicesinclude:
213-HCSHBs2626&1918 6 200 (a)Homedeliveryofbloodclottingproductsandancillaryinfusionequipmentand
212+200 (a)Homedeliveryofbloodclottingproductsandancillaryinfusionequipmentand
214213 201supplies,includingtheemergencydeliveriesoftheproductwhenmedicallynecessary;
215214 202 (b)Medicallynecessaryancillaryinfusionequipmentandsuppliesrequiredto
216215 203administerthebloodclottingproducts;and
217-204 (c)Assessmentsconductedintheparticipant'shomebyapharmacist,nurse,orlocal
216+HCSHBs2626&1918 6 204 (c)Assessmentsconductedintheparticipant'shomebyapharmacist,nurse,orlocal
218217 205homehealthcareagencytrainedinbleedingdisorderswhendeemednecessarybythe
219218 206participant'streatingphysician;
220219 207 (25)Medicallynecessarycochlearimplantsandhearinginstruments,asdefined
221220 208insection345.015,thatare:
222221 209 (a)Prescribedbyanaudiologist,asdefinedinsection345.015;or
223222 210 (b)Dispensedbyahearinginstrumentspecialist,asdefinedinsection346.010;
224223 211 (26)TheMOHealthNetdivisionshall,byJanuary1,2008,andannuallythereafter,
225224 212reportthestatusofMOHealthNetproviderreimbursementratesascomparedtoonehundred
226225 213percentoftheMedicarereimbursementratesandcomparedtotheaveragedental
227226 214reimbursementratespaidbythird-partypayorslicensedbythestate.TheMOHealthNet
228227 215divisionshall,byJuly1,2008,providetothegeneralassemblyafour-yearplantoachieve
229228 216paritywithMedicarereimbursementratesandforthird-partypayoraveragedental
230229 217reimbursementrates.Suchplanshallbesubjecttoappropriationandthedivisionshall
231230 218includeinitsannualbudgetrequesttothegovernorthenecessaryfundingneededtocomplete
232231 219thefour-yearplandevelopedunderthissubdivision.
233232 220 2.Additionalbenefitpaymentsformedicalassistanceshallbemadeonbehalfof
234233 221thoseeligibleneedychildren,pregnantwomenandblindpersonswithanypaymentstobe
235234 222madeonthebasisofthereasonablecostofthecareorreasonablechargefortheservicesas
236235 223definedanddeterminedbytheMOHealthNetdivision,unlessotherwisehereinafterprovided,
237236 224forthefollowing:
238237 225 (1)Dentalservices;
239238 226 (2)Servicesofpodiatristsasdefinedinsection330.010;
240239 227 (3)Optometricservicesasdescribedinsection336.010;
241240 228 (4)Orthopedicdevicesorotherprosthetics,includingeyeglasses,dentures,[hearing
242241 229aids,] andwheelchairs;
243242 230 (5)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
244243 231coordinatedprogramofactiveprofessionalmedicalattentionwithinahome,outpatientand
245244 232inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
246245 233medicallydirectedinterdisciplinaryteam.Theprogramprovidesreliefofseverepainorother
247246 234physicalsymptomsandsupportivecaretomeetthespecialneedsarisingoutofphysical,
248247 235psychological,spiritual,social,andeconomicstresseswhichareexperiencedduringthefinal
249248 236stagesofillness,andduringdyingandbereavementandmeetstheMedicarerequirementsfor
250-HCSHBs2626&1918 7 237participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
249+237participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
251250 238paidbytheMOHealthNetdivisiontothehospiceproviderforroomandboardfurnishedbya
252251 239nursinghometoaneligiblehospicepatientshallnotbelessthanninety-fivepercentofthe
253252 240rateofreimbursementwhichwouldhavebeenpaidforfacilityservicesinthatnursinghome
254-241facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
253+HCSHBs2626&1918 7 241facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
255254 242(OmnibusBudgetReconciliationActof1989);
256255 243 (6)Comprehensivedayrehabilitationservicesbeginningearlyposttraumaaspartofa
257256 244coordinatedsystemofcareforindividualswithdisablingimpairments.Rehabilitation
258257 245servicesmustbebasedonanindividualized,goal-oriented,comprehensiveandcoordinated
259258 246treatmentplandeveloped,implemented,andmonitoredthroughaninterdisciplinary
260259 247assessmentdesignedtorestoreanindividualtooptimallevelofphysical,cognitive,and
261260 248behavioralfunction.TheMOHealthNetdivisionshallestablishbyadministrativerulethe
262261 249definitionandcriteriafordesignationofacomprehensivedayrehabilitationservicefacility,
263262 250benefitlimitationsandpaymentmechanism.Anyruleorportionofarule,asthattermis
264263 251definedinsection536.010,thatiscreatedundertheauthoritydelegatedinthissubdivision
265264 252shallbecomeeffectiveonlyifitcomplieswithandissubjecttoalloftheprovisionsof
266265 253chapter536and,ifapplicable,section536.028.Thissectionandchapter536are
267266 254nonseverableandifanyofthepowersvestedwiththegeneralassemblypursuanttochapter
268267 255536toreview,todelaytheeffectivedate,ortodisapproveandannularulearesubsequently
269268 256heldunconstitutional,thenthegrantofrulemakingauthorityandanyruleproposedor
270269 257adoptedafterAugust28,2005,shallbeinvalidandvoid.
271270 258 3.TheMOHealthNetdivisionmayrequireanyparticipantreceivingMOHealthNet
272271 259benefitstopaypartofthechargeorcostuntilJuly1,2008,andanadditionalpaymentafter
273272 260July1,2008,asdefinedbyruledulypromulgatedbytheMOHealthNetdivision,forall
274273 261coveredservicesexceptforthoseservicescoveredundersubdivisions(15)and(16)of
275274 262subsection1ofthissectionandsections208.631to208.657totheextentandinthemanner
276275 263authorizedbyTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section1396,etseq.)
277276 264andregulationsthereunder.Whensubstitutionofagenericdrugispermittedbytheprescriber
278277 265accordingtosection338.056,andagenericdrugissubstitutedforaname-branddrug,the
279278 266MOHealthNetdivisionmaynotlowerordeletetherequirementtomakeaco-payment
280279 267pursuanttoregulationsofTitleXIXofthefederalSocialSecurityAct.Aproviderofgoods
281280 268orservicesdescribedunderthissectionmustcollectfromallparticipantstheadditional
282281 269paymentthatmayberequiredbytheMOHealthNetdivisionunderauthoritygrantedherein,
283282 270ifthedivisionexercisesthatauthority,toremaineligibleasaprovider.Anypaymentsmade
284283 271byparticipantsunderthissectionshallbeinadditiontoandnotinlieuofpaymentsmadeby
285284 272thestateforgoodsorservicesdescribedhereinexcepttheparticipantportionofthepharmacy
286285 273professionaldispensingfeeshallbeinadditiontoandnotinlieuofpaymentstopharmacists.
287-HCSHBs2626&1918 8 274Aprovidermaycollecttheco-paymentatthetimeaserviceisprovidedoratalaterdate.A
286+274Aprovidermaycollecttheco-paymentatthetimeaserviceisprovidedoratalaterdate.A
288287 275providershallnotrefusetoprovideaserviceifaparticipantisunabletopayarequired
289288 276payment.Ifitistheroutinebusinesspracticeofaprovidertoterminatefutureservicestoan
290289 277individualwithanunclaimeddebt,theprovidermayincludeuncollectedco-paymentsunder
291-278thispractice.Providerswhoelectnottoundertaketheprovisionofservicesbasedona
290+HCSHBs2626&1918 8 278thispractice.Providerswhoelectnottoundertaketheprovisionofservicesbasedona
292291 279historyofbaddebtshallgiveparticipantsadvancenoticeandareasonableopportunityfor
293292 280payment.Aprovider,representative,employee,independentcontractor,oragentofa
294293 281pharmaceuticalmanufacturershallnotmakeco-paymentforaparticipant.Thissubsection
295294 282shallnotapplytootherqualifiedchildren,pregnantwomen,orblindpersons.IftheCenters
296295 283forMedicareandMedicaidServicesdoesnotapprovetheMOHealthNetstateplan
297296 284amendmentsubmittedbythedepartmentofsocialservicesthatwouldallowaproviderto
298297 285denyfutureservicestoanindividualwithuncollectedco-payments,thedenialofservices
299298 286shallnotbeallowed.Thedepartmentofsocialservicesshallinformprovidersregardingthe
300299 287acceptabilityofdenyingservicesastheresultofunpaidco-payments.
301300 288 4.TheMOHealthNetdivisionshallhavetherighttocollectmedicationsamplesfrom
302301 289participantsinordertomaintainprogramintegrity.
303302 290 5.Reimbursementforobstetricalandpediatricservicesundersubdivision(6)of
304303 291subsection1ofthissectionshallbetimelyandsufficienttoenlistenoughhealthcare
305304 292providerssothatcareandservicesareavailableunderthestateplanforMOHealthNet
306305 293benefitsatleasttotheextentthatsuchcareandservicesareavailabletothegeneral
307306 294populationinthegeographicarea,asrequiredundersubparagraph(a)(30)(A)of42U.S.C.
308307 295Section1396aandfederalregulationspromulgatedthereunder.
309308 296 6.BeginningJuly1,1990,reimbursementforservicesrenderedinfederallyfunded
310309 297healthcentersshallbeinaccordancewiththeprovisionsofsubsection6402(c)andSection
311310 2986404ofP.L.101-239(OmnibusBudgetReconciliationActof1989)andfederalregulations
312311 299promulgatedthereunder.
313312 300 7.BeginningJuly1,1990,thedepartmentofsocialservicesshallprovidenotification
314313 301andreferralofchildrenbelowagefive,andpregnant,breast-feeding,orpostpartumwomen
315314 302whoaredeterminedtobeeligibleforMOHealthNetbenefitsundersection208.151tothe
316315 303specialsupplementalfoodprogramsforwomen,infantsandchildrenadministeredbythe
317316 304departmentofhealthandseniorservices.Suchnotificationandreferralshallconformtothe
318317 305requirementsofSection6406ofP.L.101-239andregulationspromulgatedthereunder.
319318 306 8.Providersoflong-termcareservicesshallbereimbursedfortheircostsin
320319 307accordancewiththeprovisionsofSection1902(a)(13)(A)oftheSocialSecurityAct,42
321320 308U.S.C.Section1396a,asamended,andregulationspromulgatedthereunder.
322321 309 9.Reimbursementratestolong-termcareproviderswithrespecttoatotalchangein
323322 310ownership,atarm'slength,foranyfacilitypreviouslylicensedandcertifiedforparticipation
324-HCSHBs2626&1918 9 311intheMOHealthNetprogramshallnotincreasepaymentsinexcessoftheincreasethat
323+311intheMOHealthNetprogramshallnotincreasepaymentsinexcessoftheincreasethat
325324 312wouldresultfromtheapplicationofSection1902(a)(13)(C)oftheSocialSecurityAct,42
326325 313U.S.C.Section1396a(a)(13)(C).
327-314 10.TheMOHealthNetdivisionmayenrollqualifiedresidentialcarefacilitiesand
326+HCSHBs2626&1918 9 314 10.TheMOHealthNetdivisionmayenrollqualifiedresidentialcarefacilitiesand
328327 315assistedlivingfacilities,asdefinedinchapter198,asMOHealthNetpersonalcareproviders.
329328 316 11.Anyincomeearnedbyindividualseligibleforcertifiedextendedemploymentata
330329 317shelteredworkshopunderchapter178shallnotbeconsideredasincomeforpurposesof
331330 318determiningeligibilityunderthissection.
332331 319 12.IftheMissouriMedicaidauditandcomplianceunitchangesanyinterpretationor
333332 320applicationoftherequirementsforreimbursementforMOHealthNetservicesfromthe
334333 321interpretationorapplicationthathasbeenappliedpreviouslybythestateinanyauditofaMO
335334 322HealthNetprovider,theMissouriMedicaidauditandcomplianceunitshallnotifyallaffected
336335 323MOHealthNetprovidersfivebusinessdaysbeforesuchchangeshalltakeeffect.Failureof
337336 324theMissouriMedicaidauditandcomplianceunittonotifyaproviderofsuchchangeshall
338337 325entitletheprovidertocontinuetoreceiveandretainreimbursementuntilsuchnotificationis
339338 326providedandshallwaiveanyliabilityofsuchproviderforrecoupmentorotherlossofany
340339 327paymentspreviouslymadepriortothefivebusinessdaysaftersuchnoticehasbeensent.
341340 328EachprovidershallprovidetheMissouriMedicaidauditandcomplianceunitavalidemail
342341 329addressandshallagreetoreceivecommunicationselectronically.Thenotificationrequired
343342 330underthissectionshallbedeliveredinwritingbytheUnitedStatesPostalServiceor
344343 331electronicmailtoeachprovider.
345344 332 13.Nothinginthissectionshallbeconstruedtoabrogateorlimitthedepartment's
346345 333statutoryrequirementtopromulgaterulesunderchapter536.
347346 334 14.BeginningJuly1,2016,andsubjecttoappropriations,providersofbehavioral,
348347 335social,andpsychophysiologicalservicesfortheprevention,treatment,ormanagementof
349348 336physicalhealthproblemsshallbereimbursedutilizingthebehaviorassessmentand
350349 337interventionreimbursementcodes96150to96154ortheirsuccessorcodesunderthe
351350 338CurrentProceduralTerminology(CPT)codingsystem.Providerseligibleforsuch
352351 339reimbursementshallincludepsychologists.
353352 340 15.Thereshallbenopaymentsmadeunderthissectionforgendertransition
354353 341surgeries,cross-sexhormones,orpuberty-blockingdrugs,assuchtermsaredefinedinsection
355354 342191.1720,forthepurposeofagendertransition.
356355 ✔
357356 HCSHBs2626&1918 10