SECONDREGULARSESSION
[TRULYAGREEDTOANDFINALLYPASSED]
SENATESUBSTITUTENO.2FOR
HOUSECOMMITTEESUBSTITUTEFOR
HOUSEBILLNO.2634
102NDGENERALASSEMBLY
5500S.04T 2024
ANACT
Torepealsections188.015,188.220,208.152,208.153,208.164,and208.659,RSMo,andto
enactinlieuthereofsevennewsectionsrelatingtohealthcare.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections188.015,188.220,208.152,208.153,208.164,and208.659,
2RSMo,arerepealedandsevennewsectionsenactedinlieuthereof,tobeknownassections
3188.015,188.207,188.220,208.152,208.153,208.164,and208.659,toreadasfollows:
188.015.Asusedinthischapter,thefollowingtermsmean:
2 (1)"Abortion":
3 (a)Theactofusingorprescribinganyinstrument,device,medicine,drug,orany
4othermeansorsubstancewiththeintenttodestroythelifeofanembryoorfetusinhisorher
5mother'swomb;or
6 (b)Theintentionalterminationofthepregnancyofamotherbyusingorprescribing
7anyinstrument,device,medicine,drug,orothermeansorsubstancewithanintentionother
8thantoincreasetheprobabilityofalivebirthortoremoveadeadunbornchild;
9 (2)"Abortionfacility",aclinic,physician'soffice,oranyotherplaceorfacilityin
10whichabortionsareperformedorinducedotherthanahospital;
11 (3)"Affiliate",apersonwhoorentitythatentersinto,withanabortionfacility,
12alegalrelationshipcreatedorgovernedbyatleastonewritteninstrument,includinga
13certificateofformation,afranchiseagreement,standardsofaffiliation,bylaws,ora
14license,thatdemonstrates:
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 15 (a)Commonownership,management,orcontrolbetweenthepartiestothe
16relationship;
17 (b)Afranchisegrantedbythepersonorentitytotheaffiliate;or
18 (c)Thegrantingorextensionofalicenseorotheragreementauthorizingthe
19affiliatetousetheotherperson'sorentity'sbrandname,trademark,servicemark,or
20otherregisteredidentificationmark;
21 (4)"Conception",thefertilizationoftheovumofafemalebyaspermofamale;
22 [(4)](5)"Department",thedepartmentofhealthandseniorservices;
23 [(5)](6)"DownSyndrome",thesamemeaningasdefinedinsection191.923;
24 [(6)](7)"Gestationalage",lengthofpregnancyasmeasuredfromthefirstdayofthe
25woman'slastmenstrualperiod;
26 [(7)](8)"Medicalemergency",aconditionwhich,basedonreasonablemedical
27judgment,socomplicatesthemedicalconditionofapregnantwomanastonecessitatethe
28immediateabortionofherpregnancytoavertthedeathofthepregnantwomanorforwhicha
29delaywillcreateaseriousriskofsubstantialandirreversiblephysicalimpairmentofamajor
30bodilyfunctionofthepregnantwoman;
31 [(8)](9)"Physician",anypersonlicensedtopracticemedicineinthisstatebythe
32stateboardofregistrationforthehealingarts;
33 [(9)](10)"Reasonablemedicaljudgment",amedicaljudgmentthatwouldbemade
34byareasonablyprudentphysician,knowledgeableaboutthecaseandthetreatment
35possibilitieswithrespecttothemedicalconditionsinvolved;
36 [(10)] (11)"Unbornchild",theoffspringofhumanbeingsfromthemomentof
37conceptionuntilbirthandateverystageofitsbiologicaldevelopment,includingthehuman
38conceptus,zygote,morula,blastocyst,embryo,andfetus;
39 [(11)](12)"Viability"or"viable",thatstageoffetaldevelopmentwhenthelifeofthe
40unbornchildmaybecontinuedindefinitelyoutsidethewombbynaturalorartificiallife-
41supportivesystems;
42 [(12)] (13)"Viablepregnancy"or"viableintrauterinepregnancy",inthefirst
43trimesterofpregnancy,anintrauterinepregnancythatcanpotentiallyresultinaliveborn
44baby.
188.207.Itshallbeunlawfulforanypublicfundstobeexpendedtoanyabortion
2facility,ortoanyaffiliateofsuchabortionfacility.
188.220.1.Anytaxpayerofthisstateoritspoliticalsubdivisionsshallhavestanding
2tobring[suitinacircuitcourtofpropervenue] acauseofactioninanycourtor
3administrativeagencyofcompetentjurisdictiontoenforcetheprovisionsofsections
4188.200to188.215.
SS#2HCSHB2634 2 5 2.Theattorneygeneralisauthorizedtobringacauseofactioninanycourtor
6administrativeagencyofcompetentjurisdictiontoenforcetheprovisionsofsections
7188.200to188.215.
8 3.Inanyactiontoenforcetheprovisionsofsections188.200to188.215bya
9taxpayerortheattorneygeneral,acourtofcompetentjurisdictionmayorderinjunctive
10orotherequitablerelief,recoveryofdamagesorotherlegalremedies,orboth,aswellas
11paymentofreasonableattorney'sfees,costs,andexpensesofthetaxpayerorthestate.
12Thereliefandremediessetforthshallnotbedeemedexclusiveandshallbeinaddition
13toanyotherrelieforremediespermittedbylaw.
208.152.1.MOHealthNetpaymentsshallbemadeonbehalfofthoseeligibleneedy
2personsasdescribedinsection208.151whoareunabletoprovideforitinwholeorinpart,
3withanypaymentstobemadeonthebasisofthereasonablecostofthecareorreasonable
4chargefortheservicesasdefinedanddeterminedbytheMOHealthNetdivision,unless
5otherwisehereinafterprovided,forthefollowing:
6 (1)Inpatienthospitalservices,excepttopersonsinaninstitutionformentaldiseases
7whoareundertheageofsixty-fiveyearsandovertheageoftwenty-oneyears;providedthat
8theMOHealthNetdivisionshallprovidethroughruleandregulationanexceptionprocessfor
9coverageofinpatientcostsinthosecasesrequiringtreatmentbeyondtheseventy-fifth
10percentileprofessionalactivitiesstudy(PAS)ortheMOHealthNetchildren'sdiagnosis
11length-of-stayschedule;andprovidedfurtherthattheMOHealthNetdivisionshalltakeinto
12accountthroughitspaymentsystemforhospitalservicesthesituationofhospitalswhich
13serveadisproportionatenumberoflow-incomepatients;
14 (2)Alloutpatienthospitalservices,paymentstherefortobeinamountswhich
15representnomorethaneightypercentofthelesserofreasonablecostsorcustomarycharges
16forsuchservices,determinedinaccordancewiththeprinciplessetforthinTitleXVIIIAand
17B,PublicLaw89-97,1965amendmentstothefederalSocialSecurityAct(42U.S.C.Section
18301,etseq.),buttheMOHealthNetdivisionmayevaluateoutpatienthospitalservices
19renderedunderthissectionanddenypaymentforserviceswhicharedeterminedbytheMO
20HealthNetdivisionnottobemedicallynecessary,inaccordancewithfederallawand
21regulations;
22 (3)LaboratoryandX-rayservices;
23 (4)Nursinghomeservicesforparticipants,excepttopersonswithmorethanfive
24hundredthousanddollarsequityintheirhomeorexceptforpersonsinaninstitutionfor
25mentaldiseaseswhoareundertheageofsixty-fiveyears,whenresidinginahospitallicensed
26bythedepartmentofhealthandseniorservicesoranursinghomelicensedbythedepartment
27ofhealthandseniorservicesorappropriatelicensingauthorityofotherstatesorgovernment-
28ownedand-operatedinstitutionswhicharedeterminedtoconformtostandardsequivalentto
SS#2HCSHB2634 3 29licensingrequirementsinTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section301,
30etseq.),asamended,fornursingfacilities.TheMOHealthNetdivisionmayrecognize
31throughitspaymentmethodologyfornursingfacilitiesthosenursingfacilitieswhichservea
32highvolumeofMOHealthNetpatients.TheMOHealthNetdivisionwhendeterminingthe
33amountofthebenefitpaymentstobemadeonbehalfofpersonsundertheageoftwenty-one
34inanursingfacilitymayconsidernursingfacilitiesfurnishingcaretopersonsundertheageof
35twenty-oneasaclassificationseparatefromothernursingfacilities;
36 (5)Nursinghomecostsforparticipantsreceivingbenefitpaymentsundersubdivision
37(4)ofthissubsectionforthosedays,whichshallnotexceedtwelveperanyperiodofsix
38consecutivemonths,duringwhichtheparticipantisonatemporaryleaveofabsencefromthe
39hospitalornursinghome,providedthatnosuchparticipantshallbeallowedatemporary
40leaveofabsenceunlessitisspecificallyprovidedforinhisplanofcare.Asusedinthis
41subdivision,theterm"temporaryleaveofabsence"shallincludeallperiodsoftimeduring
42whichaparticipantisawayfromthehospitalornursinghomeovernightbecauseheisvisiting
43afriendorrelative;
44 (6)Physicians'services,whetherfurnishedintheoffice,home,hospital,nursing
45home,orelsewhere, provided,thatnofundsshallbeexpendedtoanyabortionfacility,as
46definedinsection188.015,ortoanyaffiliate,asdefinedinsection188.015,ofsuch
47abortionfacility;
48 (7)Subjecttoappropriation,uptotwentyvisitsperyearforserviceslimitedto
49examinations,diagnoses,adjustments,andmanipulationsandtreatmentsofmalpositioned
50articulationsandstructuresofthebodyprovidedbylicensedchiropracticphysicians
51practicingwithintheirscopeofpractice.Nothinginthissubdivisionshallbeinterpretedto
52otherwiseexpandMOHealthNetservices;
53 (8)Drugsandmedicineswhenprescribedbyalicensedphysician,dentist,podiatrist,
54oranadvancedpracticeregisterednurse;exceptthatnopaymentfordrugsandmedicines
55prescribedonandafterJanuary1,2006,byalicensedphysician,dentist,podiatrist,oran
56advancedpracticeregisterednursemaybemadeonbehalfofanypersonwhoqualifiesfor
57prescriptiondrugcoverageundertheprovisionsofP.L.108-173;
58 (9)Emergencyambulanceservicesand,effectiveJanuary1,1990,medically
59necessarytransportationtoscheduled,physician-prescribednonelectivetreatments;
60 (10)Earlyandperiodicscreeninganddiagnosisofindividualswhoareundertheage
61oftwenty-onetoascertaintheirphysicalormentaldefects,andhealthcare,treatment,and
62othermeasurestocorrectoramelioratedefectsandchronicconditionsdiscoveredthereby.
63SuchservicesshallbeprovidedinaccordancewiththeprovisionsofSection6403ofP.L.
64101-239andfederalregulationspromulgatedthereunder;
65 (11)Homehealthcareservices;
SS#2HCSHB2634 4 66 (12)Familyplanningasdefinedbyfederalrulesandregulations;provided,thatno
67fundsshallbeexpendedtoanyabortionfacility,asdefinedinsection188.015,ortoany
68affiliate,asdefinedinsection188.015,ofsuchabortionfacility;andfurtherprovided,
69however,thatsuchfamilyplanningservicesshallnotincludeabortionsoranyabortifacient
70drugordevicethatisusedforthepurposeofinducinganabortionunlesssuchabortionsare
71certifiedinwritingbyaphysiciantotheMOHealthNetagencythat,inthephysician's
72professionaljudgment,thelifeofthemotherwouldbeendangeredifthefetuswerecarriedto
73term;
74 (13)Inpatientpsychiatrichospitalservicesforindividualsunderagetwenty-oneas
75definedinTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section1396d,etseq.);
76 (14)Outpatientsurgicalprocedures,includingpresurgicaldiagnosticservices
77performedinambulatorysurgicalfacilitieswhicharelicensedbythedepartmentofhealth
78andseniorservicesofthestateofMissouri;except,thatsuchoutpatientsurgicalservicesshall
79notincludepersonswhoareeligibleforcoverageunderPartBofTitleXVIII,PublicLaw89-
8097,1965amendmentstothefederalSocialSecurityAct,asamended,ifexclusionofsuch
81personsispermittedunderTitleXIX,PublicLaw89-97,1965amendmentstothefederal
82SocialSecurityAct,asamended;
83 (15)Personalcareserviceswhicharemedicallyorientedtaskshavingtodowitha
84person'sphysicalrequirements,asopposedtohousekeepingrequirements,whichenablea
85persontobetreatedbyhisorherphysicianonanoutpatientratherthanonaninpatientor
86residentialbasisinahospital,intermediatecarefacility,orskillednursingfacility.Personal
87careservicesshallberenderedbyanindividualnotamemberoftheparticipant'sfamilywho
88isqualifiedtoprovidesuchserviceswheretheservicesareprescribedbyaphysicianin
89accordancewithaplanoftreatmentandaresupervisedbyalicensednurse.Personseligible
90toreceivepersonalcareservicesshallbethosepersonswhowouldotherwiserequire
91placementinahospital,intermediatecarefacility,orskillednursingfacility.Benefitspayable
92forpersonalcareservicesshallnotexceedforanyoneparticipantonehundredpercentofthe
93averagestatewidechargeforcareandtreatmentinanintermediatecarefacilityfora
94comparableperiodoftime.Suchservices,whendeliveredinaresidentialcarefacilityor
95assistedlivingfacilitylicensedunderchapter198shallbeauthorizedonatierlevelbasedon
96theservicestheresidentrequiresandthefrequencyoftheservices.Aresidentofsuchfacility
97whoqualifiesforassistanceundersection208.030shall,ataminimum,ifprescribedbya
98physician,qualifyforthetierlevelwiththefewestservices.Theratepaidtoprovidersfor
99eachtierofserviceshallbesetsubjecttoappropriations.Subjecttoappropriations,each
100residentofsuchfacilitywhoqualifiesforassistanceundersection208.030andmeetsthe
101levelofcarerequiredinthissectionshall,ataminimum,ifprescribedbyaphysician,be
102authorizeduptoonehourofpersonalcareservicesperday.Authorizedunitsofpersonalcare
SS#2HCSHB2634 5 103servicesshallnotbereducedortierlevelloweredunlessanorderapprovingsuchreductionor
104loweringisobtainedfromtheresident'spersonalphysician.Suchauthorizedunitsofpersonal
105careservicesortierlevelshallbetransferredwithsuchresidentifheorshetransfersto
106anothersuchfacility.Suchprovisionshallterminateuponreceiptofrelevantwaiversfrom
107thefederalDepartmentofHealthandHumanServices.IftheCentersforMedicareand
108MedicaidServicesdeterminesthatsuchprovisiondoesnotcomplywiththestateplan,this
109provisionshallbenullandvoid.TheMOHealthNetdivisionshallnotifytherevisorof
110statutesastowhethertherelevantwaiversareapprovedoradeterminationofnoncompliance
111ismade;
112 (16)Mentalhealthservices.Thestateplanforprovidingmedicalassistanceunder
113TitleXIXoftheSocialSecurityAct,42U.S.C.Section301,asamended,shallincludethe
114followingmentalhealthserviceswhensuchservicesareprovidedbycommunitymental
115healthfacilitiesoperatedbythedepartmentofmentalhealthordesignatedbythedepartment
116ofmentalhealthasacommunitymentalhealthfacilityorasanalcoholanddrugabusefacility
117orasachild-servingagencywithinthecomprehensivechildren'smentalhealthservicesystem
118establishedinsection630.097.Thedepartmentofmentalhealthshallestablishby
119administrativerulethedefinitionandcriteriafordesignationasacommunitymentalhealth
120facilityandfordesignationasanalcoholanddrugabusefacility.Suchmentalhealthservices
121shallinclude:
122 (a)Outpatientmentalhealthservicesincludingpreventive,diagnostic,therapeutic,
123rehabilitative,andpalliativeinterventionsrenderedtoindividualsinanindividualorgroup
124settingbyamentalhealthprofessionalinaccordancewithaplanoftreatmentappropriately
125established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
126apartofclientservicesmanagement;
127 (b)Clinicmentalhealthservicesincludingpreventive,diagnostic,therapeutic,
128rehabilitative,andpalliativeinterventionsrenderedtoindividualsinanindividualorgroup
129settingbyamentalhealthprofessionalinaccordancewithaplanoftreatmentappropriately
130established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
131apartofclientservicesmanagement;
132 (c)Rehabilitativementalhealthandalcoholanddrugabuseservicesincludinghome
133andcommunity-basedpreventive,diagnostic,therapeutic,rehabilitative,andpalliative
134interventionsrenderedtoindividualsinanindividualorgroupsettingbyamentalhealth
135oralcoholanddrugabuseprofessionalinaccordancewithaplanoftreatmentappropriately
136established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
137apartofclientservicesmanagement.Asusedinthissection,mentalhealthprofessionaland
138alcoholanddrugabuseprofessionalshallbedefinedbythedepartmentofmentalhealth
139pursuanttodulypromulgatedrules.Withrespecttoservicesestablishedbythissubdivision,
SS#2HCSHB2634 6 140thedepartmentofsocialservices,MOHealthNetdivision,shallenterintoanagreementwith
141thedepartmentofmentalhealth.Matchingfundsforoutpatientmentalhealthservices,clinic
142mentalhealthservices,andrehabilitationservicesformentalhealthandalcoholanddrug
143abuseshallbecertifiedbythedepartmentofmentalhealthtotheMOHealthNetdivision.
144Theagreementshallestablishamechanismforthejointimplementationoftheprovisionsof
145thissubdivision.Inaddition,theagreementshallestablishamechanismbywhichratesfor
146servicesmaybejointlydeveloped;
147 (17)SuchadditionalservicesasdefinedbytheMOHealthNetdivisiontobe
148furnishedunderwaiversoffederalstatutoryrequirementsasprovidedforandauthorizedby
149thefederalSocialSecurityAct(42U.S.C.Section301,etseq.)subjecttoappropriationbythe
150generalassembly;
151 (18)Theservicesofanadvancedpracticeregisterednursewithacollaborative
152practiceagreementtotheextentthatsuchservicesareprovidedinaccordancewithchapters
153334and335,andregulationspromulgatedthereunder;
154 (19)Nursinghomecostsforparticipantsreceivingbenefitpaymentsunder
155subdivision(4)ofthissubsectiontoreserveabedfortheparticipantinthenursinghome
156duringthetimethattheparticipantisabsentduetoadmissiontoahospitalforserviceswhich
157cannotbeperformedonanoutpatientbasis,subjecttotheprovisionsofthissubdivision:
158 (a)Theprovisionsofthissubdivisionshallapplyonlyif:
159 a.Theoccupancyrateofthenursinghomeisatoraboveninety-sevenpercentofMO
160HealthNetcertifiedlicensedbeds,accordingtothemostrecentquarterlycensusprovidedto
161thedepartmentofhealthandseniorserviceswhichwastakenpriortowhentheparticipantis
162admittedtothehospital;and
163 b.Thepatientisadmittedtoahospitalforamedicalconditionwithananticipated
164stayofthreedaysorless;
165 (b)Thepaymenttobemadeunderthissubdivisionshallbeprovidedforamaximum
166ofthreedaysperhospitalstay;
167 (c)Foreachdaythatnursinghomecostsarepaidonbehalfofaparticipantunderthis
168subdivisionduringanyperiodofsixconsecutivemonthssuchparticipantshall,duringthe
169sameperiodofsixconsecutivemonths,beineligibleforpaymentofnursinghomecostsof
170twootherwiseavailabletemporaryleaveofabsencedaysprovidedundersubdivision(5)of
171thissubsection;and
172 (d)Theprovisionsofthissubdivisionshallnotapplyunlessthenursinghome
173receivesnoticefromtheparticipantortheparticipant'sresponsiblepartythattheparticipant
174intendstoreturntothenursinghomefollowingthehospitalstay.Ifthenursinghomereceives
175suchnotificationandallotherprovisionsofthissubsectionhavebeensatisfied,thenursing
SS#2HCSHB2634 7 176homeshallprovidenoticetotheparticipantortheparticipant'sresponsiblepartypriorto
177releaseofthereservedbed;
178 (20)Prescribedmedicallynecessarydurablemedicalequipment.Anelectronicweb-
179basedpriorauthorizationsystemusingbestmedicalevidenceandcareandtreatment
180guidelinesconsistentwithnationalstandardsshallbeusedtoverifymedicalneed;
181 (21)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
182coordinatedprogramofactiveprofessionalmedicalattentionwithinahome,outpatientand
183inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
184medicallydirectedinterdisciplinaryteam.Theprogramprovidesreliefofseverepainorother
185physicalsymptomsandsupportivecaretomeetthespecialneedsarisingoutofphysical,
186psychological,spiritual,social,andeconomicstresseswhichareexperiencedduringthefinal
187stagesofillness,andduringdyingandbereavementandmeetstheMedicarerequirementsfor
188participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
189paidbytheMOHealthNetdivisiontothehospiceproviderforroomandboardfurnishedbya
190nursinghometoaneligiblehospicepatientshallnotbelessthanninety-fivepercentofthe
191rateofreimbursementwhichwouldhavebeenpaidforfacilityservicesinthatnursinghome
192facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
193(OmnibusBudgetReconciliationActof1989);
194 (22)Prescribedmedicallynecessarydentalservices.Suchservicesshallbesubjectto
195appropriations.Anelectronicweb-basedpriorauthorizationsystemusingbestmedical
196evidenceandcareandtreatmentguidelinesconsistentwithnationalstandardsshallbeusedto
197verifymedicalneed;
198 (23)Prescribedmedicallynecessaryoptometricservices.Suchservicesshallbe
199subjecttoappropriations.Anelectronicweb-basedpriorauthorizationsystemusingbest
200medicalevidenceandcareandtreatmentguidelinesconsistentwithnationalstandardsshall
201beusedtoverifymedicalneed;
202 (24)Bloodclottingproducts-relatedservices.Forpersonsdiagnosedwithableeding
203disorder,asdefinedinsection338.400,reliantonbloodclottingproducts,asdefinedin
204section338.400,suchservicesinclude:
205 (a)Homedeliveryofbloodclottingproductsandancillaryinfusionequipmentand
206supplies,includingtheemergencydeliveriesoftheproductwhenmedicallynecessary;
207 (b)Medicallynecessaryancillaryinfusionequipmentandsuppliesrequiredto
208administerthebloodclottingproducts;and
209 (c)Assessmentsconductedintheparticipant'shomebyapharmacist,nurse,orlocal
210homehealthcareagencytrainedinbleedingdisorderswhendeemednecessarybythe
211participant'streatingphysician;
SS#2HCSHB2634 8 212 (25)TheMOHealthNetdivisionshall,byJanuary1,2008,andannuallythereafter,
213reportthestatusofMOHealthNetproviderreimbursementratesascomparedtoonehundred
214percentoftheMedicarereimbursementratesandcomparedtotheaveragedental
215reimbursementratespaidbythird-partypayorslicensedbythestate.TheMOHealthNet
216divisionshall,byJuly1,2008,providetothegeneralassemblyafour-yearplantoachieve
217paritywithMedicarereimbursementratesandforthird-partypayoraveragedental
218reimbursementrates.Suchplanshallbesubjecttoappropriationandthedivisionshall
219includeinitsannualbudgetrequesttothegovernorthenecessaryfundingneededtocomplete
220thefour-yearplandevelopedunderthissubdivision.
221 2.Additionalbenefitpaymentsformedicalassistanceshallbemadeonbehalfof
222thoseeligibleneedychildren,pregnantwomenandblindpersonswithanypaymentstobe
223madeonthebasisofthereasonablecostofthecareorreasonablechargefortheservicesas
224definedanddeterminedbytheMOHealthNetdivision,unlessotherwisehereinafterprovided,
225forthefollowing:
226 (1)Dentalservices;
227 (2)Servicesofpodiatristsasdefinedinsection330.010;
228 (3)Optometricservicesasdescribedinsection336.010;
229 (4)Orthopedicdevicesorotherprosthetics,includingeyeglasses,dentures,hearing
230aids,andwheelchairs;
231 (5)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
232coordinatedprogramofactiveprofessionalmedicalattentionwithinahome,outpatientand
233inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
234medicallydirectedinterdisciplinaryteam.Theprogramprovidesreliefofseverepainorother
235physicalsymptomsandsupportivecaretomeetthespecialneedsarisingoutofphysical,
236psychological,spiritual,social,andeconomicstresseswhichareexperiencedduringthefinal
237stagesofillness,andduringdyingandbereavementandmeetstheMedicarerequirementsfor
238participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
239paidbytheMOHealthNetdivisiontothehospiceproviderforroomandboardfurnishedbya
240nursinghometoaneligiblehospicepatientshallnotbelessthanninety-fivepercentofthe
241rateofreimbursementwhichwouldhavebeenpaidforfacilityservicesinthatnursinghome
242facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
243(OmnibusBudgetReconciliationActof1989);
244 (6)Comprehensivedayrehabilitationservicesbeginningearlyposttraumaaspartofa
245coordinatedsystemofcareforindividualswithdisablingimpairments.Rehabilitation
246servicesmustbebasedonanindividualized,goal-oriented,comprehensiveandcoordinated
247treatmentplandeveloped,implemented,andmonitoredthroughaninterdisciplinary
248assessmentdesignedtorestoreanindividualtooptimallevelofphysical,cognitive,and
SS#2HCSHB2634 9 249behavioralfunction.TheMOHealthNetdivisionshallestablishbyadministrativerulethe
250definitionandcriteriafordesignationofacomprehensivedayrehabilitationservicefacility,
251benefitlimitationsandpaymentmechanism.Anyruleorportionofarule,asthattermis
252definedinsection536.010,thatiscreatedundertheauthoritydelegatedinthissubdivision
253shallbecomeeffectiveonlyifitcomplieswithandissubjecttoalloftheprovisionsof
254chapter536and,ifapplicable,section536.028.Thissectionandchapter536are
255nonseverableandifanyofthepowersvestedwiththegeneralassemblypursuanttochapter
256536toreview,todelaytheeffectivedate,ortodisapproveandannularulearesubsequently
257heldunconstitutional,thenthegrantofrulemakingauthorityandanyruleproposedor
258adoptedafterAugust28,2005,shallbeinvalidandvoid.
259 3.TheMOHealthNetdivisionmayrequireanyparticipantreceivingMOHealthNet
260benefitstopaypartofthechargeorcostuntilJuly1,2008,andanadditionalpaymentafter
261July1,2008,asdefinedbyruledulypromulgatedbytheMOHealthNetdivision,forall
262coveredservicesexceptforthoseservicescoveredundersubdivisions(15)and(16)of
263subsection1ofthissectionandsections208.631to208.657totheextentandinthemanner
264authorizedbyTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section1396,etseq.)
265andregulationsthereunder.Whensubstitutionofagenericdrugispermittedbytheprescriber
266accordingtosection338.056,andagenericdrugissubstitutedforaname-branddrug,the
267MOHealthNetdivisionmaynotlowerordeletetherequirementtomakeaco-payment
268pursuanttoregulationsofTitleXIXofthefederalSocialSecurityAct.Aproviderofgoods
269orservicesdescribedunderthissectionmustcollectfromallparticipantstheadditional
270paymentthatmayberequiredbytheMOHealthNetdivisionunderauthoritygrantedherein,
271ifthedivisionexercisesthatauthority,toremaineligibleasaprovider.Anypaymentsmade
272byparticipantsunderthissectionshallbeinadditiontoandnotinlieuofpaymentsmadeby
273thestateforgoodsorservicesdescribedhereinexcepttheparticipantportionofthepharmacy
274professionaldispensingfeeshallbeinadditiontoandnotinlieuofpaymentstopharmacists.
275Aprovidermaycollecttheco-paymentatthetimeaserviceisprovidedoratalaterdate.A
276providershallnotrefusetoprovideaserviceifaparticipantisunabletopayarequired
277payment.Ifitistheroutinebusinesspracticeofaprovidertoterminatefutureservicestoan
278individualwithanunclaimeddebt,theprovidermayincludeuncollectedco-paymentsunder
279thispractice.Providerswhoelectnottoundertaketheprovisionofservicesbasedona
280historyofbaddebtshallgiveparticipantsadvancenoticeandareasonableopportunityfor
281payment.Aprovider,representative,employee,independentcontractor,oragentofa
282pharmaceuticalmanufacturershallnotmakeco-paymentforaparticipant.Thissubsection
283shallnotapplytootherqualifiedchildren,pregnantwomen,orblindpersons.IftheCenters
284forMedicareandMedicaidServicesdoesnotapprovetheMOHealthNetstateplan
285amendmentsubmittedbythedepartmentofsocialservicesthatwouldallowaproviderto
SS#2HCSHB2634 10 286denyfutureservicestoanindividualwithuncollectedco-payments,thedenialofservices
287shallnotbeallowed.Thedepartmentofsocialservicesshallinformprovidersregardingthe
288acceptabilityofdenyingservicesastheresultofunpaidco-payments.
289 4.TheMOHealthNetdivisionshallhavetherighttocollectmedicationsamplesfrom
290participantsinordertomaintainprogramintegrity.
291 5.Reimbursementforobstetricalandpediatricservicesundersubdivision(6)of
292subsection1ofthissectionshallbetimelyandsufficienttoenlistenoughhealthcare
293providerssothatcareandservicesareavailableunderthestateplanforMOHealthNet
294benefitsatleasttotheextentthatsuchcareandservicesareavailabletothegeneral
295populationinthegeographicarea,asrequiredundersubparagraph(a)(30)(A)of42U.S.C.
296Section1396aandfederalregulationspromulgatedthereunder.
297 6.BeginningJuly1,1990,reimbursementforservicesrenderedinfederallyfunded
298healthcentersshallbeinaccordancewiththeprovisionsofsubsection6402(c)andSection
2996404ofP.L.101-239(OmnibusBudgetReconciliationActof1989)andfederalregulations
300promulgatedthereunder.
301 7.BeginningJuly1,1990,thedepartmentofsocialservicesshallprovidenotification
302andreferralofchildrenbelowagefive,andpregnant,breast-feeding,orpostpartumwomen
303whoaredeterminedtobeeligibleforMOHealthNetbenefitsundersection208.151tothe
304specialsupplementalfoodprogramsforwomen,infantsandchildrenadministeredbythe
305departmentofhealthandseniorservices.Suchnotificationandreferralshallconformtothe
306requirementsofSection6406ofP.L.101-239andregulationspromulgatedthereunder.
307 8.Providersoflong-termcareservicesshallbereimbursedfortheircostsin
308accordancewiththeprovisionsofSection1902(a)(13)(A)oftheSocialSecurityAct,42
309U.S.C.Section1396a,asamended,andregulationspromulgatedthereunder.
310 9.Reimbursementratestolong-termcareproviderswithrespecttoatotalchangein
311ownership,atarm'slength,foranyfacilitypreviouslylicensedandcertifiedforparticipation
312intheMOHealthNetprogramshallnotincreasepaymentsinexcessoftheincreasethat
313wouldresultfromtheapplicationofSection1902(a)(13)(C)oftheSocialSecurityAct,42
314U.S.C.Section1396a(a)(13)(C).
315 10.TheMOHealthNetdivisionmayenrollqualifiedresidentialcarefacilitiesand
316assistedlivingfacilities,asdefinedinchapter198,asMOHealthNetpersonalcareproviders.
317 11.Anyincomeearnedbyindividualseligibleforcertifiedextendedemploymentata
318shelteredworkshopunderchapter178shallnotbeconsideredasincomeforpurposesof
319determiningeligibilityunderthissection.
320 12.IftheMissouriMedicaidauditandcomplianceunitchangesanyinterpretationor
321applicationoftherequirementsforreimbursementforMOHealthNetservicesfromthe
322interpretationorapplicationthathasbeenappliedpreviouslybythestateinanyauditofaMO
SS#2HCSHB2634 11 323HealthNetprovider,theMissouriMedicaidauditandcomplianceunitshallnotifyallaffected
324MOHealthNetprovidersfivebusinessdaysbeforesuchchangeshalltakeeffect.Failureof
325theMissouriMedicaidauditandcomplianceunittonotifyaproviderofsuchchangeshall
326entitletheprovidertocontinuetoreceiveandretainreimbursementuntilsuchnotificationis
327providedandshallwaiveanyliabilityofsuchproviderforrecoupmentorotherlossofany
328paymentspreviouslymadepriortothefivebusinessdaysaftersuchnoticehasbeensent.
329EachprovidershallprovidetheMissouriMedicaidauditandcomplianceunitavalidemail
330addressandshallagreetoreceivecommunicationselectronically.Thenotificationrequired
331underthissectionshallbedeliveredinwritingbytheUnitedStatesPostalServiceor
332electronicmailtoeachprovider.
333 13.Nothinginthissectionshallbeconstruedtoabrogateorlimitthedepartment's
334statutoryrequirementtopromulgaterulesunderchapter536.
335 14.BeginningJuly1,2016,andsubjecttoappropriations,providersofbehavioral,
336social,andpsychophysiologicalservicesfortheprevention,treatment,ormanagementof
337physicalhealthproblemsshallbereimbursedutilizingthebehaviorassessmentand
338interventionreimbursementcodes96150to96154ortheirsuccessorcodesunderthe
339CurrentProceduralTerminology(CPT)codingsystem.Providerseligibleforsuch
340reimbursementshallincludepsychologists.
341 15.Thereshallbenopaymentsmadeunderthissectionforgendertransition
342surgeries,cross-sexhormones,orpuberty-blockingdrugs,assuchtermsaredefinedinsection
343191.1720,forthepurposeofagendertransition.
208.153.1.Pursuanttoandnotinconsistentwiththeprovisionsofsections208.151
2and208.152,theMOHealthNetdivisionshallbyruleandregulationdefinethereasonable
3costs,manner,extent,quantity,quality,chargesandfeesofMOHealthNetbenefitsherein
4provided.Thebenefitsavailableunderthesesectionsshallnotreplacethoseprovidedunder
5otherfederalorstatelaworunderothercontractualorlegalentitlementsofthepersons
6receivingthem,andallpersonsshallberequiredtoapplyforandutilizeallbenefitsavailable
7tothemandtopursueallcausesofactiontowhichtheyareentitled.Anypersonentitledto
8MOHealthNetbenefitsmayobtainitfromanyproviderofservicesthatisnotexcludedor
9disqualifiedasaproviderunderanyprovisionoflawincluding,butnotlimitedto,
10section208.164,withwhichanagreementisineffectunderthissectionandwhich
11undertakestoprovidetheservices,asauthorizedbytheMOHealthNetdivision.Atthe
12discretionofthedirectoroftheMOHealthNetdivisionandwiththeapprovalofthegovernor,
13theMOHealthNetdivisionisauthorizedtoprovidemedicalbenefitsforparticipants
14receivingpublicassistancebyexpendingfundsforthepaymentoffederalmedicalinsurance
15premiums,coinsuranceanddeductiblespursuanttotheprovisionsofTitleXVIIIBandXIX,
SS#2HCSHB2634 12 16PublicLaw89-97,1965amendmentstothefederalSocialSecurityAct(42U.S.C.301,et
17seq.),asamended.
18 2.MOHealthNetshallincludebenefitpaymentsonbehalfofqualifiedMedicare
19beneficiariesasdefinedin42U.S.C.Section1396d(p).Thefamilysupportdivisionshallby
20ruleandregulationestablishwhichqualifiedMedicarebeneficiariesareeligible.TheMO
21HealthNetdivisionshalldefinethepremiums,deductibleandcoinsuranceprovidedforin42
22U.S.C.Section1396d(p)tobeprovidedonbehalfofthequalifiedMedicarebeneficiaries.
23 3.MOHealthNetshallincludebenefitpaymentsforMedicarePartAcostsharingas
24definedinclause(p)(3)(A)(i)of42U.S.C.1396donbehalfofqualifieddisabledandworking
25individualsasdefinedinsubsection(s)ofSection42U.S.C.1396dasrequiredbysubsection
26(d)ofSection6408ofP.L.101-239(OmnibusBudgetReconciliationActof1989).TheMO
27HealthNetdivisionmayimposeapremiumforsuchbenefitpaymentsasauthorizedby
28paragraph(d)(3)ofSection6408ofP.L.101-239.
29 4.MOHealthNetshallincludebenefitpaymentsforMedicarePartBcostsharing
30describedin42U.S.C.Section1396(d)(p)(3)(A)(ii)forindividualsdescribedinsubsection2
31ofthissection,butforthefactthattheirincomeexceedstheincomelevelestablishedbythe
32stateunder42U.S.C.Section1396(d)(p)(2)butislessthanonehundredandtenpercent
33beginningJanuary1,1993,andlessthanonehundredandtwentypercentbeginningJanuary
341,1995,oftheofficialpovertylineforafamilyofthesizeinvolved.
35 5.ForanindividualeligibleforMOHealthNetunderTitleXIXoftheSocialSecurity
36Act,MOHealthNetshallincludepaymentofenrolleepremiumsinagrouphealthplanandall
37deductibles,coinsuranceandothercost-sharingforitemsandservicesotherwisecovered
38underthestateTitleXIXplanunderSection1906ofthefederalSocialSecurityActand
39regulationsestablishedundertheauthorityofSection1906,asmaybeamended.Enrollment
40inagrouphealthplanmustbecosteffective,asestablishedbytheSecretaryofHealthand
41HumanServices,beforeenrollmentinthegrouphealthplanisrequired.Ifallmembersofa
42familyarenoteligibleforMOHealthNetandenrollmentoftheTitleXIXeligiblemembersin
43agrouphealthplanisnotpossibleunlessallfamilymembersareenrolled,allpremiumsfor
44noneligiblemembersshallbetreatedaspaymentforMOHealthNetofeligiblefamily
45members.Paymentfornoneligiblefamilymembersmustbecosteffective,takinginto
46accountpaymentofallsuchpremiums.Non-TitleXIXeligiblefamilymembersshallpayall
47deductible,coinsuranceandothercost-sharingobligations.Eachindividualasaconditionof
48eligibilityforMOHealthNetbenefitsshallapplyforenrollmentinthegrouphealthplan.
49 6.AnySocialSecuritycost-of-livingincreaseatthebeginningofanyyearshallbe
50disregardeduntilthefederalpovertylevelforsuchyearisimplemented.
51 7.IfaMOHealthNetparticipanthaspaidtherequestedspenddownincashforany
52monthandsubsequentlypaysanout-of-pocketvalidmedicalexpenseforsuchmonth,such
SS#2HCSHB2634 13 53expenseshallbeallowedasadeductiontofuturerequiredspenddownforuptothreemonths
54fromthedateofsuchexpense.
208.164.1.Asusedinthissection,unlessthecontextclearlyrequiresotherwise,the
2followingtermsmean:
3 (1)"Abuse",adocumentedpatternofinducing,furnishing,orotherwisecausinga
4recipienttoreceiveservicesormerchandisenototherwiserequiredorrequestedbythe
5recipient,attendingphysicianorappropriateutilizationreviewteam;adocumentedpatternof
6performingandbillingtests,examinations,patientvisits,surgeries,drugsormerchandisethat
7exceedlimitsorfrequenciesdeterminedbythedepartmentforlikepractitionersforwhich
8thereisnodemonstrableneed,orforwhichtheproviderhascreatedtheneedthrough
9ineffectiveservicesormerchandisepreviouslyrendered.Thedecisiontoimposeanyofthe
10sanctionsauthorizedinthissectionshallbemadebythedirectorofthedepartment,following
11adeterminationofdemonstrableneedoracceptedmedicalpracticemadeinconsultationwith
12medicalorotherhealthcareprofessionals,orqualifiedpeerreviewteams;
13 (2)"Department",thedepartmentofsocialservices;
14 (3)"Excessiveuse",theact,byapersoneligibleforservicesunderacontractor
15provideragreementbetweenthedepartmentofsocialservicesoritsdivisionsandaprovider,
16ofseekingand/orobtainingmedicalassistancebenefitsfromanumberoflikeprovidersand
17inquantitieswhichexceedthelevelsthatareconsideredmedicallynecessarybycurrent
18medicalpracticesandstandardsfortheeligibleperson'sneeds;
19 (4)"Fraud",aknownfalserepresentation,includingtheconcealmentofamaterial
20factthattheproviderkneworshouldhaveknownthroughtheusualconductofhisprofession
21oroccupation,uponwhichtheproviderclaimsreimbursementunderthetermsandconditions
22ofacontractorprovideragreementandthepoliciespertainingtosuchcontractorprovider
23agreementofthedepartmentoritsdivisionsincarryingouttheprovidingofservices,or
24underanyapprovedstateplanauthorizedbythefederalSocialSecurityAct;
25 (5)"Healthplan",agroupofservicesprovidedtorecipientsofmedicalassistance
26benefitsbyprovidersunderacontractwiththedepartment;
27 (6)"Medicalassistancebenefits",thosebenefitsauthorizedtobeprovidedbysections
28208.152and208.162;
29 (7)"Priorauthorization",approvaltoaprovidertoperformaserviceorservicesfor
30aneligiblepersonrequiredbythedepartmentoritsdivisionsinadvanceoftheactualservice
31beingprovidedorapprovedforarecipienttoreceiveaserviceorservicesfromaprovider,
32requiredbythedepartmentoritsdesignateddivisioninadvanceoftheactualserviceor
33servicesbeingreceived;
34 (8)"Provider",anyperson,partnership,corporation,not-for-profitcorporation,
35professionalcorporation,orotherbusinessentitythatentersintoacontractorprovider
SS#2HCSHB2634 14 36agreementwiththedepartmentoritsdivisionsforthepurposeofprovidingservicesto
37eligiblepersons,andobtainingfromthedepartmentoritsdivisionsreimbursementtherefor;
38 (9)"Recipient",apersonwhoiseligibletoreceivemedicalassistancebenefits
39allocatedthroughthedepartment;
40 (10)"Service",thespecificfunction,act,successiveacts,benefits,continuing
41benefits,requestedbyaneligiblepersonorprovidedbytheproviderundercontractwiththe
42departmentoritsdivisions.
43 2.Thedepartmentoritsdivisionsshallhavetheauthoritytosuspend,revoke,or
44cancelanycontractorprovideragreementorrefusetoenterintoanewcontractorprovider
45agreementwithanyproviderwhereitisdeterminedtheproviderhascommittedorallowedits
46agents,servants,oremployeestocommitactsdefinedasabuseorfraudinthissection.
47 3.Thedepartmentoritsdivisionsshallhavetheauthoritytoimposeprior
48authorizationasdefinedinthissection:
49 (1)Whenithasreasonablecausetobelieveaproviderorrecipienthasknowingly
50followedacourseofconductwhichisdefinedasabuseorfraudorexcessiveusebythis
51section;or
52 (2)Whenitdeterminesbyrulethatpriorauthorizationisreasonableforaspecified
53serviceorprocedure.
54 4.Ifaproviderorrecipientreportstothedepartmentoritsdivisionsthenameor
55namesofprovidersorrecipientswho,basedupontheirpersonalknowledgehasreasonable
56causetobelieveanactoractsarebeingcommittedwhicharedefinedasabuse,fraudor
57excessiveusebythissection,suchreportshallbeconfidentialandthereporter'snameshall
58notbedivulgedtoanyonebythedepartmentoranyofitsdivisions,exceptatajudicial
59proceedinguponaproperprotectiveorderbeingenteredbythecourt.
60 5.Paymentsforservicesunderanycontractorprovideragreementbetweenthe
61departmentoritsdivisionsandaprovidermaybewithheldbythedepartmentoritsdivisions
62fromtheproviderforactsoromissionsdefinedasabuseorfraudbythissection,untilsuch
63timeasanagreementbetweenthepartiesisreachedorthedisputeisadjudicatedunderthe
64lawsofthisstate.
65 6.Thedepartmentoritsdesignateddivisionshallhavetheauthoritytoreviewall
66casesandclaimrecordsforanyrecipientofpublicassistancebenefitsandtodeterminefrom
67theserecordsiftherecipienthas,asdefinedinthissection,committedexcessiveuseofsuch
68servicesbyseekingorobtainingservicesfromanumberoflikeprovidersofservicesandin
69quantitieswhichexceedthelevelsconsiderednecessarybycurrentmedicalorhealthcare
70professionalpracticestandardsandpoliciesoftheprogram.
71 7.Thedepartmentoritsdesignateddivisionshallhavetheauthoritywithrespectto
72recipientsofmedicalassistancebenefitswhohavecommittedexcessiveusetolimitorrestrict
SS#2HCSHB2634 15 73theuseoftherecipient'sMedicaididentificationcardtodesignatedprovidersandfor
74designatedservices;theactualmethodbywhichsuchrestrictionsareimposedshallbeatthe
75discretionofthedepartmentofsocialservicesoritsdesignateddivision.
76 8.Thedepartmentoritsdesignateddivisionshallhavetheauthoritywithrespectto
77anyrecipientofmedicalassistancebenefitswhoseusehasbeenrestrictedundersubsection7
78ofthissectionandwhoobtainsorseekstoobtainmedicalassistancebenefitsfromaprovider
79otherthanoneoftheprovidersfordesignatedservicestoterminatemedicalassistance
80benefitsasdefinedbythischapter,whereallowedbytheprovisionsofthefederalSocial
81SecurityAct.
82 9.Thedepartmentoritsdesignateddivisionshallhavetheauthoritywithrespectto
83anyproviderwhoknowinglyallowsarecipienttoviolatesubsection7ofthissectionorwho
84failstoreportaknownviolationofsubsection7ofthissectiontothedepartmentofsocial
85servicesoritsdesignateddivisiontoterminateorotherwisesanctionsuchprovider'sstatusas
86aparticipantinthemedicalassistanceprogram.Anypersonmakingsuchareportshallnotbe
87civillyliablewhenthereportismadeingoodfaith.
88 10.Inordertocomplywiththeprovisionsof42U.S.C.Section1320a-7(a)
89relatingtomandatoryexclusionofcertainindividualsandentitiesfromparticipationin
90anyfederalhealthcareprogram,andinfurtheranceofthestate'sauthorityunder
91federallaw,asimplementedby42CFR1002.3(b),toexcludeanindividualorentity
92fromMOHealthNetforanyreasonorperiodauthorizedbystatelaw,thedepartmentor
93itsdivisionsshallsuspend,revoke,orcancelanycontractorprovideragreementor
94refusetoenterintoanewcontractorprovideragreementwithanyproviderwhereitis
95determinedthatsuchproviderisnotqualifiedtoperformtheserviceorservices
96required,asdescribedin42U.S.C.Section1396a(a)(23),becausesuchprovider,orsuch
97provider'sagent,servant,oremployeeactingundersuchprovider'sauthority:
98 (1)Hasaconvictionrelatedtothedeliveryofanyitemorserviceunder
99Medicareorunderanystatehealthcareprogram,asdescribedin42U.S.C.Section
1001320a-7(a)(1);
101 (2)Hasaconvictionrelatedtotheneglectorabuseofapatientinconnection
102withthedeliveryofanyhealthcareitemorservice,asdescribedin42U.S.C.Section
1031320a-7(a)(2);
104 (3)Hasafelonyconvictionrelatedtohealthcarefraud,theft,embezzlement,
105breachoffiduciaryresponsibility,orotherfinancialmisconduct,asdescribedin42
106U.S.C.Section1320a-7(a)(3);
107 (4)Hasafelonyconvictionrelatedtotheunlawfulmanufacture,distribution,
108prescription,ordispensationofacontrolledsubstance,asdescribedin42U.S.C.Section
1091320a-7(a)(4);
SS#2HCSHB2634 16 110 (5)Hasbeenfoundguiltyof,orcivillyliablefor,apatternofintentional
111discriminationinthedeliveryornondeliveryofanyhealthcareitemorservicebasedon
112therace,color,ornationaloriginofrecipients,asdescribedin42U.S.C.Section2000d;
113or
114 (6)Isanabortionfacility,asdefinedinsection188.015,oranaffiliate,asdefined
115insection188.015,ofsuchabortionfacility.
208.659.TheMOHealthNetdivisionshallrevisetheeligibilityrequirementsforthe
2uninsuredwomen'shealthprogram,asestablishedin13CSRSection70-4.090,toinclude
3womenwhoareatleasteighteenyearsofageandwithanetfamilyincomeofatorbelowone
4hundredeighty-fivepercentofthefederalpovertylevel.Inordertobeeligibleforsuch
5program,theapplicantshallnothaveassetsinexcessoftwohundredandfiftythousand
6dollars,norshalltheapplicanthaveaccesstoemployer-sponsoredhealthinsurance.Such
7changeineligibilityrequirementsshallnotresultinanychangeinservicesprovidedunderthe
8program.Nofundsshallbeexpendedtoanyabortionfacility,asdefinedinsection
9188.015,ortoanyaffiliate,asdefinedinsection188.015,ofsuchabortionfacility.
âś”
SS#2HCSHB2634 17