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Missouri House Bill HB1095

Missouri 2025 Regular Session

Missouri House Bill HB1095 Compare Versions

OldNewDifferences
11 FIRSTREGULARSESSION
2-HOUSECOMMITTEESUBSTITUTEFOR
32 HOUSEBILLNO.1095
43 103RDGENERALASSEMBLY
5-0651H.02C JOSEPHENGLER,ChiefClerk
4+INTRODUCEDBYREPRESENTATIVEBOSLEY.
5+0651H.01I JOSEPHENGLER,ChiefClerk
66 ANACT
7-Torepealsections208.152and208.662,RSMo,andtoenactinlieuthereofninenewsections
8-relatingtohealthcare.
7+Torepealsections208.152and208.662,RSMo,andtoenactinlieuthereofeightnew
8+sectionsrelatingtomaternalhealthcareservices.
99 BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
10-SectionA.Sections208.152and208.662,RSMo,arerepealedandninenewsections
11-2enactedinlieuthereof,tobeknownassections191.708,208.152,208.662,208.1400,
12-3208.1405,208.1410,208.1415,208.1420,and208.1425,toreadasfollows:
13-191.708.1.Thechiefmedicalofficerorchiefmedicaldirectorofthedepartment
14-2ofhealthandseniorservices,thedepartmentofmentalhealth,ortheMOHealthNet
15-3divisionofthedepartmentofsocialservices,oranylicensedphysicianactingwiththe
16-4expresswrittenconsentofthedirectorofanysuchdepartmentordivision,may,within
17-5hisorherscopeofpractice,issue:
18-6 (1)Nonspecificrecommendationsfordoulaservices;
19-7 (2)Amedicalstandingorderforprenatalvitamins;or
20-8 (3)Amedicalstandingorderforanyotherpurpose,otherthanforcontrolled
21-9substances,thatispromulgatedbyruleincompliancewithchapter536.
22-10 2.Anystandingorderissuedunderthissectionshall:
23-11 (1)Bemadeavailableontherelevantdepartment'swebsitewhileineffect;
24-12 (2)Terminateuponremovaloftheissuingmedicalprofessional'sauthority
25-13underthissectionbyvacancyofhisorherpositionorotherwise;and
26-14 (3)Ifnotterminatedsoonerundersubdivision(2)ofthissubsection,expire
27-15withinoneyearofissuanceunlessrenewed.
28-16 3.Thechiefmedicalofficer,chiefmedicaldirector,orotherauthorizedand
29-17licensedphysiciandescribedinsubsection1ofthissectionshallbeimmunefrom
30-EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
31-intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 18criminalprosecution,disciplinaryactionfromhisorherprofessionallicensingboard,
32-19andcivilliabilityforissuingamedicalstandingorderorrecommendationinaccordance
33-20withthissection,includingforanyoutcomerelatedtothestandingorderor
34-21recommendation.
10+SectionA.Sections208.152and208.662,RSMo,arerepealedandeightnewsections
11+2enactedinlieuthereof,tobeknownassections208.152,208.662,208.1400,208.1405,
12+3208.1410,208.1415,208.1420,and208.1425,toreadasfollows:
3513 208.152.1.MOHealthNetpaymentsshallbemadeonbehalfofthoseeligibleneedy
3614 2personsasdescribedinsection208.151whoareunabletoprovideforitinwholeorinpart,
3715 3withanypaymentstobemadeonthebasisofthereasonablecostofthecareorreasonable
3816 4chargefortheservicesasdefinedanddeterminedbytheMOHealthNetdivision,unless
3917 5otherwisehereinafterprovided,forthefollowing:
4018 6 (1)Inpatienthospitalservices,excepttopersonsinaninstitutionformentaldiseases
4119 7whoareundertheageofsixty-fiveyearsandovertheageoftwenty-oneyears;providedthat
4220 8theMOHealthNetdivisionshallprovidethroughruleandregulationanexceptionprocessfor
4321 9coverageofinpatientcostsinthosecasesrequiringtreatmentbeyondtheseventy-fifth
4422 10percentileprofessionalactivitiesstudy(PAS)ortheMOHealthNetchildren'sdiagnosis
4523 11length-of-stayschedule;andprovidedfurtherthattheMOHealthNetdivisionshalltakeinto
4624 12accountthroughitspaymentsystemforhospitalservicesthesituationofhospitalswhich
4725 13serveadisproportionatenumberoflow-incomepatients;
4826 14 (2)Alloutpatienthospitalservices,paymentstherefortobeinamountswhich
4927 15representnomorethaneightypercentofthelesserofreasonablecostsorcustomarycharges
5028 16forsuchservices,determinedinaccordancewiththeprinciplessetforthinTitleXVIIIAand
51-17B,PublicLaw89-97,1965amendmentstothefederalSocialSecurityAct(42U.S.C.Section
29+EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
30+intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17B,PublicLaw89-97,1965amendmentstothefederalSocialSecurityAct(42U.S.C.Section
5231 18301,etseq.),buttheMOHealthNetdivisionmayevaluateoutpatienthospitalservices
5332 19renderedunderthissectionanddenypaymentforserviceswhicharedeterminedbytheMO
5433 20HealthNetdivisionnottobemedicallynecessary,inaccordancewithfederallawand
5534 21regulations;
5635 22 (3)LaboratoryandX-rayservices;
5736 23 (4)Nursinghomeservicesforparticipants,excepttopersonswithmorethanfive
5837 24hundredthousanddollarsequityintheirhomeorexceptforpersonsinaninstitutionfor
5938 25mentaldiseaseswhoareundertheageofsixty-fiveyears,whenresidinginahospitallicensed
6039 26bythedepartmentofhealthandseniorservicesoranursinghomelicensedbythedepartment
6140 27ofhealthandseniorservicesorappropriatelicensingauthorityofotherstatesorgovernment-
6241 28ownedand-operatedinstitutionswhicharedeterminedtoconformtostandardsequivalentto
6342 29licensingrequirementsinTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section
6443 30[301,] 1396etseq.),asamended,fornursingfacilities.TheMOHealthNetdivisionmay
6544 31recognizethroughitspaymentmethodologyfornursingfacilitiesthosenursingfacilities
6645 32whichserveahighvolumeofMOHealthNetpatients.TheMOHealthNetdivisionwhen
6746 33determiningtheamountofthebenefitpaymentstobemadeonbehalfofpersonsunderthe
68-HCSHB1095 2 34ageoftwenty-oneinanursingfacilitymayconsidernursingfacilitiesfurnishingcareto
47+34ageoftwenty-oneinanursingfacilitymayconsidernursingfacilitiesfurnishingcareto
6948 35personsundertheageoftwenty-oneasaclassificationseparatefromothernursingfacilities;
7049 36 (5)Nursinghomecostsforparticipantsreceivingbenefitpaymentsundersubdivision
7150 37(4)ofthissubsectionforthosedays,whichshallnotexceedtwelveperanyperiodofsix
7251 38consecutivemonths,duringwhichtheparticipantisonatemporaryleaveofabsencefromthe
7352 39hospitalornursinghome,providedthatnosuchparticipantshallbeallowedatemporary
7453 40leaveofabsenceunlessitisspecificallyprovidedforinhisorherplanofcare.Asusedin
7554 41thissubdivision,theterm"temporaryleaveofabsence"shallincludeallperiodsoftime
7655 42duringwhichaparticipantisawayfromthehospitalornursinghomeovernightbecauseheor
7756 43sheisvisitingafriendorrelative;
7857 44 (6)Physicians'services,whetherfurnishedintheoffice,home,hospital,nursing
7958 45home,orelsewhere,provided,thatnofundsshallbeexpendedtoanyabortionfacility,as
8059 46definedinsection188.015,ortoanyaffiliate,asdefinedinsection188.015,ofsuchabortion
8160 47facility;
8261 48 (7)Subjecttoappropriation,uptotwentyvisitsperyearforserviceslimitedto
8362 49examinations,diagnoses,adjustments,andmanipulationsandtreatmentsofmalpositioned
8463 50articulationsandstructuresofthebodyprovidedbylicensedchiropracticphysicians
8564 51practicingwithintheirscopeofpractice.Nothinginthissubdivisionshallbeinterpretedto
8665 52otherwiseexpandMOHealthNetservices;
87-53 (8)Drugsandmedicineswhenprescribedbyalicensedphysician,dentist,podiatrist,
66+HB1095 2 53 (8)Drugsandmedicineswhenprescribedbyalicensedphysician,dentist,podiatrist,
8867 54oranadvancedpracticeregisterednurse;exceptthatnopaymentfordrugsandmedicines
8968 55prescribedonandafterJanuary1,2006,byalicensedphysician,dentist,podiatrist,oran
9069 56advancedpracticeregisterednursemaybemadeonbehalfofanypersonwhoqualifiesfor
9170 57prescriptiondrugcoverageundertheprovisionsofP.L.108-173;
9271 58 (9)Emergencyambulanceservicesand,effectiveJanuary1,1990,medically
9372 59necessarytransportationtoscheduled,physician-prescribednonelectivetreatments;
9473 60 (10)Earlyandperiodicscreeninganddiagnosisofindividualswhoareundertheage
9574 61oftwenty-onetoascertaintheirphysicalormentaldefects,andhealthcare,treatment,and
9675 62othermeasurestocorrectoramelioratedefectsandchronicconditionsdiscoveredthereby.
9776 63SuchservicesshallbeprovidedinaccordancewiththeprovisionsofSection6403of[P.L.]
9877 64Pub.L.101-239(42U.S.C.Sections1396aand1396d),asamended,andfederal
9978 65regulationspromulgatedthereunder;
10079 66 (11)Homehealthcareservices;
10180 67 (12)Familyplanningasdefinedbyfederalrulesandregulations;provided,thatno
10281 68fundsshallbeexpendedtoanyabortionfacility,asdefinedinsection188.015,ortoany
10382 69affiliate,asdefinedinsection188.015,ofsuchabortionfacility;andfurtherprovided,
10483 70however,thatsuchfamilyplanningservicesshallnotincludeabortionsoranyabortifacient
105-HCSHB1095 3 71drugordevicethatisusedforthepurposeofinducinganabortionunlesssuchabortionsare
84+71drugordevicethatisusedforthepurposeofinducinganabortionunlesssuchabortionsare
10685 72certifiedinwritingbyaphysiciantotheMOHealthNetagencythat,inthephysician's
10786 73professionaljudgment,thelifeofthemotherwouldbeendangeredifthefetuswerecarriedto
10887 74term;
10988 75 (13)Inpatientpsychiatrichospitalservicesforindividualsunderagetwenty-oneas
11089 76definedinTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section1396d,etseq.);
11190 77 (14)Outpatientsurgicalprocedures,includingpresurgicaldiagnosticservices
11291 78performedinambulatorysurgicalfacilitieswhicharelicensedbythedepartmentofhealth
11392 79andseniorservicesofthestateofMissouri;except,thatsuchoutpatientsurgicalservicesshall
11493 80notincludepersonswhoareeligibleforcoverageunderPartBofTitleXVIII,PublicLaw89-
11594 8197,1965amendmentstothefederalSocialSecurityAct,asamended,ifexclusionofsuch
11695 82personsispermittedunderTitleXIX,PublicLaw89-97,1965amendmentstothefederal
11796 83SocialSecurityAct,asamended;
11897 84 (15)Personalcareserviceswhicharemedicallyorientedtaskshavingtodowitha
11998 85person'sphysicalrequirements,asopposedtohousekeepingrequirements,whichenablea
12099 86persontobetreatedbyhisorherphysicianonanoutpatientratherthanonaninpatientor
121100 87residentialbasisinahospital,intermediatecarefacility,orskillednursingfacility.Personal
122101 88careservicesshallberenderedbyanindividualnotamemberoftheparticipant'sfamilywho
123102 89isqualifiedtoprovidesuchserviceswheretheservicesareprescribedbyaphysicianin
124-90accordancewithaplanoftreatmentandaresupervisedbyalicensednurse.Personseligible
103+HB1095 3 90accordancewithaplanoftreatmentandaresupervisedbyalicensednurse.Personseligible
125104 91toreceivepersonalcareservicesshallbethosepersonswhowouldotherwiserequire
126105 92placementinahospital,intermediatecarefacility,orskillednursingfacility.Benefitspayable
127106 93forpersonalcareservicesshallnotexceedforanyoneparticipantonehundredpercentofthe
128107 94averagestatewidechargeforcareandtreatmentinanintermediatecarefacilityfora
129108 95comparableperiodoftime.Suchservices,whendeliveredinaresidentialcarefacilityor
130109 96assistedlivingfacilitylicensedunderchapter198,shallbeauthorizedonatierlevelbasedon
131110 97theservicestheresidentrequiresandthefrequencyoftheservices.Aresidentofsuchfacility
132111 98whoqualifiesforassistanceundersection208.030shall,ataminimum,ifprescribedbya
133112 99physician,qualifyforthetierlevelwiththefewestservices.Theratepaidtoprovidersfor
134113 100eachtierofserviceshallbesetsubjecttoappropriations.Subjecttoappropriations,each
135114 101residentofsuchfacilitywhoqualifiesforassistanceundersection208.030andmeetsthe
136115 102levelofcarerequiredinthissectionshall,ataminimum,ifprescribedbyaphysician,be
137116 103authorizeduptoonehourofpersonalcareservicesperday.Authorizedunitsofpersonalcare
138117 104servicesshallnotbereducedortierlevelloweredunlessanorderapprovingsuchreductionor
139118 105loweringisobtainedfromtheresident'spersonalphysician.Suchauthorizedunitsofpersonal
140119 106careservicesortierlevelshallbetransferredwithsuchresidentifheorshetransfersto
141120 107anothersuchfacility.Suchprovisionshallterminateuponreceiptofrelevantwaiversfrom
142-HCSHB1095 4 108thefederalDepartmentofHealthandHumanServices.IftheCentersforMedicareand
121+108thefederalDepartmentofHealthandHumanServices.IftheCentersforMedicareand
143122 109MedicaidServicesdeterminesthatsuchprovisiondoesnotcomplywiththestateplan,this
144123 110provisionshallbenullandvoid.TheMOHealthNetdivisionshallnotifytherevisorof
145124 111statutesastowhethertherelevantwaiversareapprovedoradeterminationofnoncompliance
146125 112ismade;
147126 113 (16)Mentalhealthservices.Thestateplanforprovidingmedicalassistanceunder
148127 114TitleXIXoftheSocialSecurityAct,42U.S.C.Section[301]1396etseq.,asamended,shall
149128 115includethefollowingmentalhealthserviceswhensuchservicesareprovidedbycommunity
150129 116mentalhealthfacilitiesoperatedbythedepartmentofmentalhealthordesignatedbythe
151130 117departmentofmentalhealthasacommunitymentalhealthfacilityorasanalcoholanddrug
152131 118abusefacilityorasachild-servingagencywithinthecomprehensivechildren'smentalhealth
153132 119servicesystemestablishedinsection630.097.Thedepartmentofmentalhealthshall
154133 120establishbyadministrativerulethedefinitionandcriteriafordesignationasacommunity
155134 121mentalhealthfacilityandfordesignationasanalcoholanddrugabusefacility.Suchmental
156135 122healthservicesshallinclude:
157136 123 (a)Outpatientmentalhealthservicesincludingpreventive,diagnostic,therapeutic,
158137 124rehabilitative,andpalliativeinterventionsrenderedtoindividualsinanindividualorgroup
159138 125settingbyamentalhealthprofessionalinaccordancewithaplanoftreatmentappropriately
160-126established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
139+HB1095 4 126established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
161140 127apartofclientservicesmanagement;
162141 128 (b)Clinicmentalhealthservicesincludingpreventive,diagnostic,therapeutic,
163142 129rehabilitative,andpalliativeinterventionsrenderedtoindividualsinanindividualorgroup
164143 130settingbyamentalhealthprofessionalinaccordancewithaplanoftreatmentappropriately
165144 131established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
166145 132apartofclientservicesmanagement;
167146 133 (c)Rehabilitativementalhealthandalcoholanddrugabuseservicesincludinghome
168147 134andcommunity-basedpreventive,diagnostic,therapeutic,rehabilitative,andpalliative
169148 135interventionsrenderedtoindividualsinanindividualorgroupsettingbyamentalhealth
170149 136oralcoholanddrugabuseprofessionalinaccordancewithaplanoftreatmentappropriately
171150 137established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
172151 138apartofclientservicesmanagement.Asusedinthissection,mentalhealthprofessionaland
173152 139alcoholanddrugabuseprofessionalshallbedefinedbythedepartmentofmentalhealth
174153 140pursuanttodulypromulgatedrules.Withrespecttoservicesestablishedbythissubdivision,
175154 141thedepartmentofsocialservices,MOHealthNetdivision,shallenterintoanagreementwith
176155 142thedepartmentofmentalhealth.Matchingfundsforoutpatientmentalhealthservices,clinic
177156 143mentalhealthservices,andrehabilitationservicesformentalhealthandalcoholanddrug
178157 144abuseshallbecertifiedbythedepartmentofmentalhealthtotheMOHealthNetdivision.
179-HCSHB1095 5 145Theagreementshallestablishamechanismforthejointimplementationoftheprovisionsof
158+145Theagreementshallestablishamechanismforthejointimplementationoftheprovisionsof
180159 146thissubdivision.Inaddition,theagreementshallestablishamechanismbywhichratesfor
181160 147servicesmaybejointlydeveloped;
182161 148 (17)SuchadditionalservicesasdefinedbytheMOHealthNetdivisiontobe
183162 149furnishedunderwaiversoffederalstatutoryrequirementsasprovidedforandauthorizedby
184163 150thefederalSocialSecurityAct(42U.S.C.Section301,etseq.)subjecttoappropriationbythe
185164 151generalassembly;
186165 152 (18)Theservicesofanadvancedpracticeregisterednursewithacollaborative
187166 153practiceagreementtotheextentthatsuchservicesareprovidedinaccordancewithchapters
188167 154334and335,andregulationspromulgatedthereunder;
189168 155 (19)Nursinghomecostsforparticipantsreceivingbenefitpaymentsunder
190169 156subdivision(4)ofthissubsectiontoreserveabedfortheparticipantinthenursinghome
191170 157duringthetimethattheparticipantisabsentduetoadmissiontoahospitalforserviceswhich
192171 158cannotbeperformedonanoutpatientbasis,subjecttotheprovisionsofthissubdivision:
193172 159 (a)Theprovisionsofthissubdivisionshallapplyonlyif:
194173 160 a.Theoccupancyrateofthenursinghomeisatoraboveninety-sevenpercentofMO
195174 161HealthNetcertifiedlicensedbeds,accordingtothemostrecentquarterlycensusprovidedto
196-162thedepartmentofhealthandseniorserviceswhichwastakenpriortowhentheparticipantis
175+HB1095 5 162thedepartmentofhealthandseniorserviceswhichwastakenpriortowhentheparticipantis
197176 163admittedtothehospital;and
198177 164 b.Thepatientisadmittedtoahospitalforamedicalconditionwithananticipated
199178 165stayofthreedaysorless;
200179 166 (b)Thepaymenttobemadeunderthissubdivisionshallbeprovidedforamaximum
201180 167ofthreedaysperhospitalstay;
202181 168 (c)Foreachdaythatnursinghomecostsarepaidonbehalfofaparticipantunderthis
203182 169subdivisionduringanyperiodofsixconsecutivemonthssuchparticipantshall,duringthe
204183 170sameperiodofsixconsecutivemonths,beineligibleforpaymentofnursinghomecostsof
205184 171twootherwiseavailabletemporaryleaveofabsencedaysprovidedundersubdivision(5)of
206185 172thissubsection;and
207186 173 (d)Theprovisionsofthissubdivisionshallnotapplyunlessthenursinghome
208187 174receivesnoticefromtheparticipantortheparticipant'sresponsiblepartythattheparticipant
209188 175intendstoreturntothenursinghomefollowingthehospitalstay.Ifthenursinghomereceives
210189 176suchnotificationandallotherprovisionsofthissubsectionhavebeensatisfied,thenursing
211190 177homeshallprovidenoticetotheparticipantortheparticipant'sresponsiblepartypriorto
212191 178releaseofthereservedbed;
213192 179 (20)Prescribedmedicallynecessarydurablemedicalequipment.Anelectronicweb-
214193 180basedpriorauthorizationsystemusingbestmedicalevidenceandcareandtreatment
215194 181guidelinesconsistentwithnationalstandardsshallbeusedtoverifymedicalneed;
216-HCSHB1095 6 182 (21)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
195+182 (21)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
217196 183coordinatedprogramofactiveprofessionalmedicalattentionwithinahome,outpatientand
218197 184inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
219198 185medicallydirectedinterdisciplinaryteam.Theprogramprovidesreliefofseverepainorother
220199 186physicalsymptomsandsupportivecaretomeetthespecialneedsarisingoutofphysical,
221200 187psychological,spiritual,social,andeconomicstresseswhichareexperiencedduringthefinal
222201 188stagesofillness,andduringdyingandbereavementandmeetstheMedicarerequirementsfor
223202 189participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
224203 190paidbytheMOHealthNetdivisiontothehospiceproviderforroomandboardfurnishedbya
225204 191nursinghometoaneligiblehospicepatientshallnotbelessthanninety-fivepercentofthe
226205 192rateofreimbursementwhichwouldhavebeenpaidforfacilityservicesinthatnursinghome
227206 193facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
228207 194(OmnibusBudgetReconciliationActof1989);
229208 195 (22)Prescribedmedicallynecessarydentalservices.Suchservicesshallbesubjectto
230209 196appropriations.Anelectronicweb-basedpriorauthorizationsystemusingbestmedical
231210 197evidenceandcareandtreatmentguidelinesconsistentwithnationalstandardsshallbeusedto
232211 198verifymedicalneed;
233-199 (23)Prescribedmedicallynecessaryoptometricservices.Suchservicesshallbe
212+HB1095 6 199 (23)Prescribedmedicallynecessaryoptometricservices.Suchservicesshallbe
234213 200subjecttoappropriations.Anelectronicweb-basedpriorauthorizationsystemusingbest
235214 201medicalevidenceandcareandtreatmentguidelinesconsistentwithnationalstandardsshall
236215 202beusedtoverifymedicalneed;
237216 203 (24)Bloodclottingproducts-relatedservices.Forpersonsdiagnosedwithableeding
238217 204disorder,asdefinedinsection338.400,reliantonbloodclottingproducts,asdefinedin
239218 205section338.400,suchservicesinclude:
240219 206 (a)Homedeliveryofbloodclottingproductsandancillaryinfusionequipmentand
241220 207supplies,includingtheemergencydeliveriesoftheproductwhenmedicallynecessary;
242221 208 (b)Medicallynecessaryancillaryinfusionequipmentandsuppliesrequiredto
243222 209administerthebloodclottingproducts;and
244223 210 (c)Assessmentsconductedintheparticipant'shomebyapharmacist,nurse,orlocal
245224 211homehealthcareagencytrainedinbleedingdisorderswhendeemednecessarybythe
246225 212participant'streatingphysician;
247226 213 (25)Doulaservicesinaccordancewithsections208.1400to208.1425;
248227 214 (26)Childbirtheducationclassesforpregnantwomenandasupportperson;
249228 215 (27)TheMOHealthNetdivisionshall,byJanuary1,2008,andannuallythereafter,
250229 216reportthestatusofMOHealthNetproviderreimbursementratesascomparedtoonehundred
251230 217percentoftheMedicarereimbursementratesandcomparedtotheaveragedental
252231 218reimbursementratespaidbythird-partypayorslicensedbythestate.TheMOHealthNet
253-HCSHB1095 7 219divisionshall,byJuly1,2008,providetothegeneralassemblyafour-yearplantoachieve
232+219divisionshall,byJuly1,2008,providetothegeneralassemblyafour-yearplantoachieve
254233 220paritywithMedicarereimbursementratesandforthird-partypayoraveragedental
255234 221reimbursementrates.Suchplanshallbesubjecttoappropriationandthedivisionshall
256235 222includeinitsannualbudgetrequesttothegovernorthenecessaryfundingneededtocomplete
257236 223thefour-yearplandevelopedunderthissubdivision.
258237 224 2.Additionalbenefitpaymentsformedicalassistanceshallbemadeonbehalfof
259238 225thoseeligibleneedychildren,pregnantwomenandblindpersonswithanypaymentstobe
260239 226madeonthebasisofthereasonablecostofthecareorreasonablechargefortheservicesas
261240 227definedanddeterminedbytheMOHealthNetdivision,unlessotherwisehereinafterprovided,
262241 228forthefollowing:
263242 229 (1)Dentalservices;
264243 230 (2)Servicesofpodiatristsasdefinedinsection330.010;
265244 231 (3)Optometricservicesasdescribedinsection336.010;
266245 232 (4)Orthopedicdevicesorotherprosthetics,includingeyeglasses,dentures,hearing
267246 233aids,andwheelchairs;
268247 234 (5)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
269248 235coordinatedprogramofactiveprofessionalmedicalattentionwithinahome,outpatientand
270-236inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
249+HB1095 7 236inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
271250 237medicallydirectedinterdisciplinaryteam.Theprogramprovidesreliefofseverepainorother
272251 238physicalsymptomsandsupportivecaretomeetthespecialneedsarisingoutofphysical,
273252 239psychological,spiritual,social,andeconomicstresseswhichareexperiencedduringthefinal
274253 240stagesofillness,andduringdyingandbereavementandmeetstheMedicarerequirementsfor
275254 241participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
276255 242paidbytheMOHealthNetdivisiontothehospiceproviderforroomandboardfurnishedbya
277256 243nursinghometoaneligiblehospicepatientshallnotbelessthanninety-fivepercentofthe
278257 244rateofreimbursementwhichwouldhavebeenpaidforfacilityservicesinthatnursinghome
279258 245facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
280259 246(OmnibusBudgetReconciliationActof1989);
281260 247 (6)Comprehensivedayrehabilitationservicesbeginningearlyposttraumaaspartofa
282261 248coordinatedsystemofcareforindividualswithdisablingimpairments.Rehabilitation
283262 249servicesmustbebasedonanindividualized,goal-oriented,comprehensiveandcoordinated
284263 250treatmentplandeveloped,implemented,andmonitoredthroughaninterdisciplinary
285264 251assessmentdesignedtorestoreanindividualtoanoptimallevelofphysical,cognitive,and
286265 252behavioralfunction.TheMOHealthNetdivisionshallestablishbyadministrativerulethe
287266 253definitionandcriteriafordesignationofacomprehensivedayrehabilitationservicefacility,
288267 254benefitlimitationsandpaymentmechanism.Anyruleorportionofarule,asthattermis
289268 255definedinsection536.010,thatiscreatedundertheauthoritydelegatedinthissubdivision
290-HCSHB1095 8 256shallbecomeeffectiveonlyifitcomplieswithandissubjecttoalloftheprovisionsof
269+256shallbecomeeffectiveonlyifitcomplieswithandissubjecttoalloftheprovisionsof
291270 257chapter536and,ifapplicable,section536.028.Thissectionandchapter536are
292271 258nonseverableandifanyofthepowersvestedwiththegeneralassemblypursuanttochapter
293272 259536toreview,todelaytheeffectivedate,ortodisapproveandannularulearesubsequently
294273 260heldunconstitutional,thenthegrantofrulemakingauthorityandanyruleproposedor
295274 261adoptedafterAugust28,2005,shallbeinvalidandvoid.
296275 262 3.TheMOHealthNetdivisionmayrequireanyparticipantreceivingMOHealthNet
297276 263benefitstopaypartofthechargeorcostuntilJuly1,2008,andanadditionalpaymentafter
298277 264July1,2008,asdefinedbyruledulypromulgatedbytheMOHealthNetdivision,forall
299278 265coveredservicesexceptforthoseservicescoveredundersubdivisions(15)and(16)of
300279 266subsection1ofthissectionandsections208.631to208.657totheextentandinthemanner
301280 267authorizedbyTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section1396,etseq.)
302281 268andregulationsthereunder.Whensubstitutionofagenericdrugispermittedbytheprescriber
303282 269accordingtosection338.056,andagenericdrugissubstitutedforaname-branddrug,the
304283 270MOHealthNetdivisionmaynotlowerordeletetherequirementtomakeaco-payment
305284 271pursuanttoregulationsofTitleXIXofthefederalSocialSecurityAct.Aproviderofgoods
306285 272orservicesdescribedunderthissectionmustcollectfromallparticipantstheadditional
307-273paymentthatmayberequiredbytheMOHealthNetdivisionunderauthoritygrantedherein,
286+HB1095 8 273paymentthatmayberequiredbytheMOHealthNetdivisionunderauthoritygrantedherein,
308287 274ifthedivisionexercisesthatauthority,toremaineligibleasaprovider.Anypaymentsmade
309288 275byparticipantsunderthissectionshallbeinadditiontoandnotinlieuofpaymentsmadeby
310289 276thestateforgoodsorservicesdescribedhereinexcepttheparticipantportionofthepharmacy
311290 277professionaldispensingfeeshallbeinadditiontoandnotinlieuofpaymentstopharmacists.
312291 278Aprovidermaycollecttheco-paymentatthetimeaserviceisprovidedoratalaterdate.A
313292 279providershallnotrefusetoprovideaserviceifaparticipantisunabletopayarequired
314293 280payment.Ifitistheroutinebusinesspracticeofaprovidertoterminatefutureservicestoan
315294 281individualwithanunclaimeddebt,theprovidermayincludeuncollectedco-paymentsunder
316295 282thispractice.Providerswhoelectnottoundertaketheprovisionofservicesbasedona
317296 283historyofbaddebtshallgiveparticipantsadvancenoticeandareasonableopportunityfor
318297 284payment.Aprovider,representative,employee,independentcontractor,oragentofa
319298 285pharmaceuticalmanufacturershallnotmakeco-paymentforaparticipant.Thissubsection
320299 286shallnotapplytootherqualifiedchildren,pregnantwomen,orblindpersons.IftheCenters
321300 287forMedicareandMedicaidServicesdoesnotapprovetheMOHealthNetstateplan
322301 288amendmentsubmittedbythedepartmentofsocialservicesthatwouldallowaproviderto
323302 289denyfutureservicestoanindividualwithuncollectedco-payments,thedenialofservices
324303 290shallnotbeallowed.Thedepartmentofsocialservicesshallinformprovidersregardingthe
325304 291acceptabilityofdenyingservicesastheresultofunpaidco-payments.
326-HCSHB1095 9 292 4.TheMOHealthNetdivisionshallhavetherighttocollectmedicationsamplesfrom
305+292 4.TheMOHealthNetdivisionshallhavetherighttocollectmedicationsamplesfrom
327306 293participantsinordertomaintainprogramintegrity.
328307 294 5.Reimbursementforobstetricalandpediatricservicesundersubdivision(6)of
329308 295subsection1ofthissectionshallbetimelyandsufficienttoenlistenoughhealthcare
330309 296providerssothatcareandservicesareavailableunderthestateplanforMOHealthNet
331310 297benefitsatleasttotheextentthatsuchcareandservicesareavailabletothegeneral
332311 298populationinthegeographicarea,asrequiredundersubparagraph(a)(30)(A)of42U.S.C.
333312 299Section1396aandfederalregulationspromulgatedthereunder.
334313 300 6.BeginningJuly1,1990,reimbursementforservicesrenderedinfederallyfunded
335314 301healthcentersshallbeinaccordancewiththeprovisionsofsubsection6402(c)andSection
336315 3026404ofP.L.101-239(OmnibusBudgetReconciliationActof1989)andfederalregulations
337316 303promulgatedthereunder.
338317 304 7.BeginningJuly1,1990,thedepartmentofsocialservicesshallprovidenotification
339318 305andreferralofchildrenbelowagefive,andpregnant,breast-feeding,orpostpartumwomen
340319 306whoaredeterminedtobeeligibleforMOHealthNetbenefitsundersection208.151tothe
341320 307specialsupplementalfoodprogramsforwomen,infantsandchildrenadministeredbythe
342321 308departmentofhealthandseniorservices.Suchnotificationandreferralshallconformtothe
343322 309requirementsofSection6406ofP.L.101-239andregulationspromulgatedthereunder.
344-310 8.Providersoflong-termcareservicesshallbereimbursedfortheircostsin
323+HB1095 9 310 8.Providersoflong-termcareservicesshallbereimbursedfortheircostsin
345324 311accordancewiththeprovisionsofSection1902(a)(13)(A)oftheSocialSecurityAct,42
346325 312U.S.C.Section1396a,asamended,andregulationspromulgatedthereunder.
347326 313 9.Reimbursementratestolong-termcareproviderswithrespecttoatotalchangein
348327 314ownership,atarm'slength,foranyfacilitypreviouslylicensedandcertifiedforparticipation
349328 315intheMOHealthNetprogramshallnotincreasepaymentsinexcessoftheincreasethat
350329 316wouldresultfromtheapplicationofSection1902(a)(13)(C)oftheSocialSecurityAct,42
351330 317U.S.C.Section1396a(a)(13)(C).
352331 318 10.TheMOHealthNetdivisionmayenrollqualifiedresidentialcarefacilitiesand
353332 319assistedlivingfacilities,asdefinedinchapter198,asMOHealthNetpersonalcareproviders.
354333 320 11.Anyincomeearnedbyindividualseligibleforcertifiedextendedemploymentata
355334 321shelteredworkshopunderchapter178shallnotbeconsideredasincomeforpurposesof
356335 322determiningeligibilityunderthissection.
357336 323 12.IftheMissouriMedicaidauditandcomplianceunitchangesanyinterpretationor
358337 324applicationoftherequirementsforreimbursementforMOHealthNetservicesfromthe
359338 325interpretationorapplicationthathasbeenappliedpreviouslybythestateinanyauditofaMO
360339 326HealthNetprovider,theMissouriMedicaidauditandcomplianceunitshallnotifyallaffected
361340 327MOHealthNetprovidersfivebusinessdaysbeforesuchchangeshalltakeeffect.Failureof
362341 328theMissouriMedicaidauditandcomplianceunittonotifyaproviderofsuchchangeshall
363-HCSHB1095 10 329entitletheprovidertocontinuetoreceiveandretainreimbursementuntilsuchnotificationis
342+329entitletheprovidertocontinuetoreceiveandretainreimbursementuntilsuchnotificationis
364343 330providedandshallwaiveanyliabilityofsuchproviderforrecoupmentorotherlossofany
365344 331paymentspreviouslymadepriortothefivebusinessdaysaftersuchnoticehasbeensent.
366345 332EachprovidershallprovidetheMissouriMedicaidauditandcomplianceunitavalidemail
367346 333addressandshallagreetoreceivecommunicationselectronically.Thenotificationrequired
368347 334underthissectionshallbedeliveredinwritingbytheUnitedStatesPostalServiceor
369348 335electronicmailtoeachprovider.
370349 336 13.Nothinginthissectionshallbeconstruedtoabrogateorlimitthedepartment's
371350 337statutoryrequirementtopromulgaterulesunderchapter536.
372351 338 14.BeginningJuly1,2016,andsubjecttoappropriations,providersofbehavioral,
373352 339social,andpsychophysiologicalservicesfortheprevention,treatment,ormanagementof
374353 340physicalhealthproblemsshallbereimbursedutilizingthebehaviorassessmentand
375354 341interventionreimbursementcodes96150to96154ortheirsuccessorcodesunderthe
376355 342CurrentProceduralTerminology(CPT)codingsystem.Providerseligibleforsuch
377356 343reimbursementshallincludepsychologists.
378357 344 15.Thereshallbenopaymentsmadeunderthissectionforgendertransition
379358 345surgeries,cross-sexhormones,orpuberty-blockingdrugs,assuchtermsaredefinedinsection
380359 346191.1720,forthepurposeofagendertransition.
381-347 16.Thedepartmentofsocialservicesshallstudytheimpactthatthechildbirth
360+HB1095 10 347 16.Thedepartmentofsocialservicesshallstudytheimpactthatthechildbirth
382361 348educationclassesprovidedundersubdivision(26)ofsubsection1ofthissectionhaveon
383362 349infantandmaternalmortalityamongpregnantwomen.Thedepartmentofsocial
384363 350servicesshallsubmitareporttothegeneralassemblywiththeresultsofthestudybefore
385364 351January1,2028.
386365 208.662.1.Thereisherebyestablishedwithinthedepartmentofsocialservicesthe
387366 2"Show-MeHealthyBabiesProgram"asaseparatechildren'shealthinsuranceprogram
388367 3(CHIP)foranylow-incomeunbornchild.Theprogramshallbeestablishedunderthe
389368 4authorityofTitleXXIofthefederalSocialSecurityAct,theStateChildren'sHealth
390369 5InsuranceProgram,asamended,and42CFR457.1.
391370 6 2.Foranunbornchildtobeenrolledintheshow-mehealthybabiesprogram,hisor
392371 7hermothershallnotbeeligibleforcoverageunderTitleXIXofthefederalSocialSecurity
393372 8Act,theMedicaidprogram,asitisadministeredbythestate,andshallnothaveaccessto
394373 9affordableemployer-subsidizedhealthcareinsuranceorotheraffordablehealthcarecoverage
395374 10thatincludescoveragefortheunbornchild.Inaddition,theunbornchildshallbeinafamily
396375 11withincomeeligibilityofnomorethanthreehundredpercentofthefederalpovertylevel,or
397376 12theequivalentmodifiedadjustedgrossincome,unlesstheincomeeligibilityissetlowerby
398377 13thegeneralassemblythroughappropriations.Incalculatingfamilysizeasitrelatestoincome
399-HCSHB1095 11 14eligibility,thefamilyshallinclude,inadditiontootherfamilymembers,theunbornchild,or
378+14eligibility,thefamilyshallinclude,inadditiontootherfamilymembers,theunbornchild,or
400379 15inthecaseofamotherwithamultiplepregnancy,allunbornchildren.
401380 16 3.Coverageforanunbornchildenrolledintheshow-mehealthybabiesprogram
402381 17shallincludeallprenatalcareandpregnancy-relatedservicesthatbenefitthehealthofthe
403382 18unbornchildandthatpromotehealthylabor,delivery,andbirth, includingchildbirth
404383 19educationclasses. Coverageneednotincludeservicesthataresolelyforthebenefitofthe
405384 20pregnantmother,thatareunrelatedtomaintainingorpromotingahealthypregnancy,andthat
406385 21providenobenefittotheunbornchild.However,thedepartmentmayincludepregnancy-
407386 22relatedassistanceasdefinedin42U.S.C.Section1397ll.
408387 23 4.Thereshallbenowaitingperiodbeforeanunbornchildmaybeenrolledinthe
409388 24show-mehealthybabiesprogram.Inaccordancewiththedefinitionofchildin42CFR
410389 25457.10,coverageshallincludetheperiodfromconceptiontobirth.Thedepartmentshall
411390 26developapresumptiveeligibilityprocedureforenrollinganunbornchild.Thereshallbe
412391 27verificationofthepregnancy.
413392 28 5.Coverageforthechildshallcontinueforuptooneyearafterbirth,unlessotherwise
414393 29prohibitedbylaworunlessotherwiselimitedbythegeneralassemblythroughappropriations.
415394 30 6.(1)Pregnancy-relatedandpostpartumcoverageforthemothershallbeginonthe
416395 31daythepregnancyendsandextendthroughthelastdayofthemonththatincludesthesixtieth
417396 32dayafterthepregnancyends,unlessotherwiseprohibitedbylaworunlessotherwiselimited
418-33bythegeneralassemblythroughappropriations.Thedepartmentmayincludepregnancy-
397+HB1095 11 33bythegeneralassemblythroughappropriations.Thedepartmentmayincludepregnancy-
419398 34relatedassistanceasdefinedin42U.S.C.Section1397ll.
420399 35 (2)(a)Subjecttoapprovalofanynecessarystateplanamendmentsorwaivers,
421400 36beginningonJuly6,2023,motherseligibletoreceivecoverageunderthissectionshall
422401 37receivemedicalassistancebenefitsduringthepregnancyandduringthetwelve-monthperiod
423402 38thatbeginsonthelastdayofthewoman'spregnancyandendsonthelastdayofthemonthin
424403 39whichsuchtwelve-monthperiodends,consistentwiththeprovisionsof42U.S.C.Section
425404 401397gg(e)(1)(J).Thedepartmentshallseekanynecessarystateplanamendmentsorwaivers
426405 41toimplementtheprovisionsofthissubdivisionwhenthenumberofineligibleMOHealthNet
427406 42participantsremovedfromtheprogramin2023pursuanttosection208.239exceedsthe
428407 43projectednumberofbeneficiarieslikelytoenrollinbenefitsin2023underthissubdivision
429408 44andsubdivision(28)ofsubsection1ofsection208.151,asdeterminedbythedepartment,by
430409 45atleastonehundredindividuals.
431410 46 (b)Theprovisionsofthissubdivisionshallremainineffectforanyperiodoftime
432411 47duringwhichthefederalauthorityunder42U.S.C.Section1397gg(e)(1)(J),asamended,or
433412 48anysuccessorstatutesorimplementingregulations,isineffect.
434413 49 7.Thedepartmentshallprovidecoverageforanunbornchildenrolledintheshow-
435414 50mehealthybabiesprograminthesamemannerinwhichthedepartmentprovidescoverage
436-HCSHB1095 12 51forthechildren'shealthinsuranceprogram(CHIP)inthecountyoftheprimaryresidenceof
415+51forthechildren'shealthinsuranceprogram(CHIP)inthecountyoftheprimaryresidenceof
437416 52themother.
438417 53 8.Thedepartmentshallprovideinformationabouttheshow-mehealthybabies
439418 54programtomaternityhomesasdefinedinsection135.600,pregnancyresourcecentersas
440419 55definedinsection135.630,andothersimilaragenciesandprogramsinthestatethatassist
441420 56unbornchildrenandtheirmothers.Thedepartmentshallconsiderallowingsuchagenciesand
442421 57programstoassistintheenrollmentofunbornchildrenintheprogram,andinmaking
443422 58determinationsaboutpresumptiveeligibilityandverificationofthepregnancy.
444423 59 9.WithinsixtydaysafterAugust28,2014,thedepartmentshallsubmitastateplan
445424 60amendmentorseekanynecessarywaiversfromthefederalDepartmentofHealthandHuman
446425 61Servicesrequestingapprovalfortheshow-mehealthybabiesprogram.
447426 62 10.Atleastannually,thedepartmentshallprepareandsubmitareporttothe
448427 63governor,thespeakerofthehouseofrepresentatives,andthepresidentprotemporeofthe
449428 64senateanalyzingandprojectingthecostsavingsandbenefits,ifany,tothestate,counties,
450429 65localcommunities,schooldistricts,lawenforcementagencies,correctionalcenters,health
451430 66careproviders,employers,otherpublicandprivateentities,andpersonsbyenrollingunborn
452431 67childrenintheshow-mehealthybabiesprogram.Theanalysisandprojectionofcostsavings
453432 68andbenefits,ifany,mayincludebutneednotbelimitedto:
454-69 (1)Thehigherfederalmatchingrateforhavinganunbornchildenrolledintheshow-
433+HB1095 12 69 (1)Thehigherfederalmatchingrateforhavinganunbornchildenrolledintheshow-
455434 70mehealthybabiesprogramversusthelowerfederalmatchingrateforapregnantwoman
456435 71beingenrolledinMOHealthNetorotherfederalprograms;
457436 72 (2)Theefficacyinprovidingservicestounbornchildrenthroughmanagedcare
458437 73organizations,grouporindividualhealthinsuranceprovidersorpremiumassistance,or
459438 74throughothernontraditionalarrangementsofprovidinghealthcare;
460439 75 (3)Thechangeintheproportionofunbornchildrenwhoreceivecareinthefirst
461440 76trimesterofpregnancyduetoalackofwaitingperiods,byallowingpresumptiveeligibility,
462441 77orbyremovalofotherbarriers,andanyresultingorprojecteddecreaseinhealthproblems
463442 78andotherproblemsforunbornchildrenandwomenthroughoutpregnancy;atlabor,delivery,
464443 79andbirth;andduringinfancyandchildhood;
465444 80 (4)Thechangeinhealthybehaviorsbypregnantwomen,suchasthecessationofthe
466445 81useoftobacco,alcohol,illicitdrugs,orotherharmfulpractices,andanyresultingorprojected
467446 82short-termandlong-termdecreaseinbirthdefects;poormotorskills;vision,speech,and
468447 83hearingproblems;breathingandrespiratoryproblems;feedinganddigestiveproblems;and
469448 84otherphysical,mental,educational,andbehavioralproblems;and
470449 85 (5)Thechangeininfantandmaternalmortality,pretermbirthsandlowbirthweight
471450 86babiesandanyresultingorprojecteddecreaseinshort-termandlong-termmedicalandother
472451 87interventions.
473-HCSHB1095 13 88 11.Theshow-mehealthybabiesprogramshallnotbedeemedanentitlement
452+88 11.Theshow-mehealthybabiesprogramshallnotbedeemedanentitlement
474453 89program,butinsteadshallbesubjecttoafederalallotmentorotherfederalappropriationsand
475454 90matchingstateappropriations.
476455 91 12.Nothinginthissectionshallbeconstruedasobligatingthestatetocontinuethe
477456 92show-mehealthybabiesprogramiftheallotmentorpaymentsfromthefederalgovernment
478457 93endorarenotsufficientfortheprogramtooperate,orifthegeneralassemblydoesnot
479458 94appropriatefundsfortheprogram.
480459 95 13.NothinginthissectionshallbeconstruedasexpandingMOHealthNetor
481460 96fulfillingamandateimposedbythefederalgovernmentonthestate.
482461 208.1400.Sections208.1400to208.1425shallbeknownandmaybecitedasthe
483462 2"MissouriDoulaReimbursementAct".
484463 208.1405.Forpurposesofsections208.1400to208.1425,thefollowingterms
485464 2mean:
486-3 (1)"Community-basednetwork",anetworkthatisrepresentativeofa
487-4communityorsignificantsegmentsofacommunityandengagedinmeetingthat
488-5community'sneedsintheareaofsocial,human,orhealthservices;
489-6 (2)"Communitynavigationservices",servicesthatconnectpregnant
490-7individualsandtheirfamilieswithavailableresourcesusingacommunity-based
491-8approachincluding,butnotlimitedto,anapproachthatunderstandstheservicesand
492-9supportsavailabletopregnantandpostpartumindividualsreceivingMOHealthNet
493-10benefitsandfacilitatesaccesstothoseresourcesbaseduponanassessmentofsocial
494-11serviceneeds;
495-12 (3)"Doula",atrainedprofessionalprovidingcontinuousphysical,emotional,
496-13andinformationalsupporttoapregnantindividual,fromtheprenatal,theintrapartum,
497-14anduptothefirsttwelvemonthsofthepostpartumperiods.Doulasalsoprovide
498-15assistancebyreferringpregnantindividualstocommunity-basednetworksandcertified
499-16andlicensedperinatalprofessionalsinmultipledisciplines;
500-17 (4)"Doulaservices",servicesprovidedbyadoula;
501-18 (5)"Fee-for-service",apaymentmodelwhereservicesareunbundledandpaid
502-19forseparately;
503-20 (6)"Intrapartum",theperiodofpregnancyduringlaboranddeliveryor
504-21childbirth.Servicesprovidedduringthisperiodarerenderedtothepregnant
505-22individual;
506-23 (7)"Managedcare",thedeliveryofMedicaidhealthbenefitsandadditional
507-24servicesthroughcontractedarrangementsbetweenstateMedicaidagenciesand
508-25managedcareorganizationsthatacceptasetpermemberpermonth(capitation)
509-26paymentfortheseservices;
510-HCSHB1095 14 27 (8)"Postpartum",theone-yearperiodafterapregnancyends;
511-28 (9)"Prenatal",theperiodofpregnancybeforelabororchildbirth.Services
512-29providedduringthisperiodarerenderedtothepregnantindividual.
465+3 (1)"Accountablecarepayer",anaccountablecareorganizationthathelps
466+4coordinatethemedicalcareprovidedtopatientseligibleforMOHealthNetbenefits;
467+5 (2)"Community-basednetwork",anetworkthatisrepresentativeofa
468+6communityorsignificantsegmentsofacommunityandengagedinmeetingthat
469+7community'sneedsintheareaofsocial,human,orhealthservices;
470+HB1095 13 8 (3)"Communitynavigationservices",servicesthatconnectpregnant
471+9individualsandtheirfamilieswithavailableresourcesusingacommunity-based
472+10approachincluding,butnotlimitedto,anapproachthatunderstandstheservicesand
473+11supportsavailabletopregnantandpostpartumindividualsreceivingMOHealthNet
474+12benefitsandfacilitatesaccesstothoseresourcesbaseduponanassessmentofsocial
475+13serviceneeds;
476+14 (4)"Doula",atrainedprofessionalprovidingcontinuousphysical,emotional,
477+15andinformationalsupporttoapregnantindividual,fromtheprenatal,theintrapartum,
478+16anduptothefirsttwelvemonthsofthepostpartumperiods.Doulasalsoprovide
479+17assistancebyreferringpregnantindividualstocommunity-basednetworksandcertified
480+18andlicensedperinatalprofessionalsinmultipledisciplines;
481+19 (5)"Doulaservices",servicesprovidedbyadoula;
482+20 (6)"Fee-for-service",apaymentmodelwhereservicesareunbundledandpaid
483+21forseparately;
484+22 (7)"Intrapartum",theperiodofpregnancyduringlaboranddeliveryor
485+23childbirth.Servicesprovidedduringthisperiodarerenderedtothepregnant
486+24individual;
487+25 (8)"Managedcare",thedeliveryofMedicaidhealthbenefitsandadditional
488+26servicesthroughcontractedarrangementsbetweenstateMedicaidagenciesand
489+27managedcareorganizationsthatacceptasetpermemberpermonth(capitation)
490+28paymentfortheseservices;
491+29 (9)"Postpartum",theone-yearperiodafterapregnancyends;
492+30 (10)"Prenatal",theperiodofpregnancybeforelabororchildbirth.Services
493+31providedduringthisperiodarerenderedtothepregnantindividual.
513494 208.1410.ThefollowingdoulaservicesshallbecoveredbytheMOHealthNet
514495 2program:
515496 3 (1)Acombinedtotalofsixprenatalandpostpartumsupportsessions;
516497 4 (2)Onebirthattendance;
517498 5 (3)Uptotwovisitsforgeneralconsultationonlactationatanytimeduringthe
518499 6prenatalandpostpartumperiods;and
519500 7 (4)Communitynavigationservices,exceptthatanycommunitynavigation
520501 8servicesprovidedoutsideanyvisitorsessionbilledundersubdivisions(1)to(3)ofthis
521502 9sectionshallbebilledonlyuptotentimestotaloverthecourseofthepregnancyand
522503 10postpartumperiod.
523504 208.1415.Adoulashallbeeligibleforparticipationasaproviderofdoula
524505 2servicescoveredbytheMOHealthNetprogramonlyifthedoula:
525506 3 (1)IsenrolledasaMOHealthNetprovider;
526-4 (2)Iseighteenyearsofageorolder;
507+HB1095 14 4 (2)Iseighteenyearsofageorolder;
527508 5 (3)Holdsliabilityinsuranceasanindividualorthroughasupervising
528509 6organization;and
529510 7 (4)Either:
530511 8 (a)PossessesacurrentcertificateissuedbyanationalorMissouri-baseddoula
531512 9trainingorganizationwhosecurriculummeetsguidelinesestablishedbytheMO
532513 10HealthNetdivisionbyrule;or
533514 11 (b)Receivedtrainingfromasourcenotdescribedinparagraph(a)ofthis
534515 12subdivision,orfrommultiplesources,whosecurriculummeetstheguidelines
535516 13establishedunderparagraph(a)ofthissubdivisionasverifiedbyapublicroster
536517 14maintainedbyastatewideorganizationcomposedofdoulatrainersfromthreeormore
537518 15independent,well-establisheddoulatrainingorganizationslocatedinMissouriwhose
538519 16purposeincludesthevalidationofcorecompetenciesoftraining.
539520 208.1420.1.OnceenrolledasaMOHealthNetprovider,adoulashallbeeligible
540-2toenrollasaproviderwithfee-for-serviceandmanagedcarepayersaffiliatedwiththe
541-3MOHealthNetprogram.
521+2toenrollasaproviderwithfee-for-service,managedcare,andaccountablecarepayers
522+3affiliatedwiththeMOHealthNetprogram.
542523 4 2.Doulaservicesshallbereimbursedonafee-for-serviceschedule.
543524 208.1425.TheMOHealthNetdivisionshallpromulgateallnecessaryrulesand
544525 2regulationsfortheadministrationofsections208.1400to208.1425.Anyruleorportion
545526 3ofarule,asthattermisdefinedinsection536.010,thatiscreatedundertheauthority
546527 4delegatedinthissectionshallbecomeeffectiveonlyifitcomplieswithandissubjectto
547-HCSHB1095 15 5alloftheprovisionsofchapter536and,ifapplicable,section536.028.Thissectionand
528+5alloftheprovisionsofchapter536and,ifapplicable,section536.028.Thissectionand
548529 6chapter536arenonseverableandifanyofthepowersvestedwiththegeneralassembly
549530 7pursuanttochapter536toreview,todelaytheeffectivedate,ortodisapproveandannul
550531 8arulearesubsequentlyheldunconstitutional,thenthegrantofrulemakingauthority
551532 9andanyruleproposedoradoptedafterAugust28,2025,shallbeinvalidandvoid.
552533 âś”
553-HCSHB1095 16
534+HB1095 15