EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
SENATE BILL NO. 498
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR NURRENBERN.
1606S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 208.152, RSMo, and to enact in lieu thereof two new sections relating to
payments for home blood pressure monitoring.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 208.152, RSMo, is repealed and two new 1
sections enacted in lieu thereof, to be known as sections 2
208.152 and 376.1960, to read as follows:3
208.152. 1. MO HealthNet payments shall be made on 1
behalf of those eligible needy persons as described in 2
section 208.151 who are unable to provide for it in whole or 3
in part, with any payments to be made on the basis of the 4
reasonable cost of the care or reasonable charge for the 5
services as defined and determined by the MO HealthNet 6
division, unless otherwise hereinafter provided, for the 7
following: 8
(1) Inpatient hospital services, except to persons in 9
an institution for mental diseases who are under the age of 10
sixty-five years and over the age of twenty -one years; 11
provided that the MO HealthNet division shall provide 12
through rule and regulation an exception process for 13
coverage of inpatient costs in those cases requir ing 14
treatment beyond the seventy -fifth percentile professional 15
activities study (PAS) or the MO HealthNet children's 16
diagnosis length-of-stay schedule; and provided further that 17
the MO HealthNet division shall take into account through 18 SB 498 2
its payment system for hospital services the situation of 19
hospitals which serve a disproportionate number of low - 20
income patients; 21
(2) All outpatient hospital services, payments 22
therefor to be in amounts which represent no more than 23
eighty percent of the lesser of reasonable costs or 24
customary charges for such services, determined in 25
accordance with the principles set forth in Title XVIII A 26
and B, Public Law 89 -97, 1965 amendments to the federal 27
Social Security Act (42 U.S.C. Section 301, et seq.), but 28
the MO HealthNet division may evaluate outpatient hospital 29
services rendered under this section and deny payment for 30
services which are determined by the MO HealthNet division 31
not to be medically necessary, in accordance with federal 32
law and regulations; 33
(3) Laboratory and X-ray services; 34
(4) Nursing home services for participants, except to 35
persons with more than five hundred thousand dollars equity 36
in their home or except for persons in an institution for 37
mental diseases who are under the ag e of sixty-five years, 38
when residing in a hospital licensed by the department of 39
health and senior services or a nursing home licensed by the 40
department of health and senior services or appropriate 41
licensing authority of other states or government -owned and - 42
operated institutions which are determined to conform to 43
standards equivalent to licensing requirements in Title XIX 44
of the federal Social Security Act (42 U.S.C. Section 301, 45
et seq.), as amended, for nursing facilities. The MO 46
HealthNet division may recognize through its payment 47
methodology for nursing facilities those nursing facilities 48
which serve a high volume of MO HealthNet patients. The MO 49
HealthNet division when determining the amount of the 50 SB 498 3
benefit payments to be made on behalf o f persons under the 51
age of twenty-one in a nursing facility may consider nursing 52
facilities furnishing care to persons under the age of 53
twenty-one as a classification separate from other nursing 54
facilities; 55
(5) Nursing home costs for participants receiving 56
benefit payments under subdivision (4) of this subsection 57
for those days, which shall not exceed twelve per any period 58
of six consecutive months, during which the participant is 59
on a temporary leave of absence from the hospital or nursing 60
home, provided that no such participant shall be allowed a 61
temporary leave of absence unless it is specifically 62
provided for in his plan of care. As used in this 63
subdivision, the term "temporary leave of absence" shall 64
include all periods of time durin g which a participant is 65
away from the hospital or nursing home overnight because he 66
is visiting a friend or relative; 67
(6) Physicians' services, whether furnished in the 68
office, home, hospital, nursing home, or elsewhere, 69
provided, that no funds shall be expended to any abortion 70
facility, as defined in section 188.015, or to any 71
affiliate, as defined in section 188.015, of such abortion 72
facility; 73
(7) Subject to appropriation, up to twenty visits per 74
year for services limited to examinati ons, diagnoses, 75
adjustments, and manipulations and treatments of 76
malpositioned articulations and structures of the body 77
provided by licensed chiropractic physicians practicing 78
within their scope of practice. Nothing in this subdivision 79
shall be interpreted to otherwise expand MO HealthNet 80
services; 81 SB 498 4
(8) Drugs and medicines when prescribed by a licensed 82
physician, dentist, podiatrist, or an advanced practice 83
registered nurse; except that no payment for drugs and 84
medicines prescribed on and aft er January 1, 2006, by a 85
licensed physician, dentist, podiatrist, or an advanced 86
practice registered nurse may be made on behalf of any 87
person who qualifies for prescription drug coverage under 88
the provisions of P.L. 108 -173; 89
(9) Emergency ambulance services and, effective 90
January 1, 1990, medically necessary transportation to 91
scheduled, physician -prescribed nonelective treatments; 92
(10) Early and periodic screening and diagnosis of 93
individuals who are under the age of twenty -one to ascertain 94
their physical or mental defects, and health care, 95
treatment, and other measures to correct or ameliorate 96
defects and chronic conditions discovered thereby. Such 97
services shall be provided in accordance with the provisions 98
of Section 6403 of P.L. 101-239 and federal regulations 99
promulgated thereunder; 100
(11) Home health care services; 101
(12) Family planning as defined by federal rules and 102
regulations; provided, that no funds shall be expended to 103
any abortion facility, as defined in sect ion 188.015, or to 104
any affiliate, as defined in section 188.015, of such 105
abortion facility; and further provided, however, that such 106
family planning services shall not include abortions or any 107
abortifacient drug or device that is used for the purpose o f 108
inducing an abortion unless such abortions are certified in 109
writing by a physician to the MO HealthNet agency that, in 110
the physician's professional judgment, the life of the 111
mother would be endangered if the fetus were carried to term; 112 SB 498 5
(13) Inpatient psychiatric hospital services for 113
individuals under age twenty -one as defined in Title XIX of 114
the federal Social Security Act (42 U.S.C. Section 1396d, et 115
seq.); 116
(14) Outpatient surgical procedures, including 117
presurgical diagnostic service s performed in ambulatory 118
surgical facilities which are licensed by the department of 119
health and senior services of the state of Missouri; except, 120
that such outpatient surgical services shall not include 121
persons who are eligible for coverage under Part B of Title 122
XVIII, Public Law 89 -97, 1965 amendments to the federal 123
Social Security Act, as amended, if exclusion of such 124
persons is permitted under Title XIX, Public Law 89 -97, 1965 125
amendments to the federal Social Security Act, as amended; 126
(15) Personal care services which are medically 127
oriented tasks having to do with a person's physical 128
requirements, as opposed to housekeeping requirements, which 129
enable a person to be treated by his or her physician on an 130
outpatient rather than on an inpat ient or residential basis 131
in a hospital, intermediate care facility, or skilled 132
nursing facility. Personal care services shall be rendered 133
by an individual not a member of the participant's family 134
who is qualified to provide such services where the se rvices 135
are prescribed by a physician in accordance with a plan of 136
treatment and are supervised by a licensed nurse. Persons 137
eligible to receive personal care services shall be those 138
persons who would otherwise require placement in a hospital, 139
intermediate care facility, or skilled nursing facility. 140
Benefits payable for personal care services shall not exceed 141
for any one participant one hundred percent of the average 142
statewide charge for care and treatment in an intermediate 143
care facility for a co mparable period of time. Such 144 SB 498 6
services, when delivered in a residential care facility or 145
assisted living facility licensed under chapter 198 shall be 146
authorized on a tier level based on the services the 147
resident requires and the frequency of the servi ces. A 148
resident of such facility who qualifies for assistance under 149
section 208.030 shall, at a minimum, if prescribed by a 150
physician, qualify for the tier level with the fewest 151
services. The rate paid to providers for each tier of 152
service shall be set subject to appropriations. Subject to 153
appropriations, each resident of such facility who qualifies 154
for assistance under section 208.030 and meets the level of 155
care required in this section shall, at a minimum, if 156
prescribed by a physician, be auth orized up to one hour of 157
personal care services per day. Authorized units of 158
personal care services shall not be reduced or tier level 159
lowered unless an order approving such reduction or lowering 160
is obtained from the resident's personal physician. Such 161
authorized units of personal care services or tier level 162
shall be transferred with such resident if he or she 163
transfers to another such facility. Such provision shall 164
terminate upon receipt of relevant waivers from the federal 165
Department of Health and Human Services. If the Centers for 166
Medicare and Medicaid Services determines that such 167
provision does not comply with the state plan, this 168
provision shall be null and void. The MO HealthNet division 169
shall notify the revisor of statutes as to whe ther the 170
relevant waivers are approved or a determination of 171
noncompliance is made; 172
(16) Mental health services. The state plan for 173
providing medical assistance under Title XIX of the Social 174
Security Act, 42 U.S.C. Section 301, as amended, shall 175
include the following mental health services when such 176 SB 498 7
services are provided by community mental health facilities 177
operated by the department of mental health or designated by 178
the department of mental health as a community mental health 179
facility or as an alcohol and drug abuse facility or as a 180
child-serving agency within the comprehensive children's 181
mental health service system established in section 182
630.097. The department of mental health shall establish by 183
administrative rule the definition an d criteria for 184
designation as a community mental health facility and for 185
designation as an alcohol and drug abuse facility. Such 186
mental health services shall include: 187
(a) Outpatient mental health services including 188
preventive, diagnostic, therap eutic, rehabilitative, and 189
palliative interventions rendered to individuals in an 190
individual or group setting by a mental health professional 191
in accordance with a plan of treatment appropriately 192
established, implemented, monitored, and revised under th e 193
auspices of a therapeutic team as a part of client services 194
management; 195
(b) Clinic mental health services including 196
preventive, diagnostic, therapeutic, rehabilitative, and 197
palliative interventions rendered to individuals in an 198
individual or group setting by a mental health professional 199
in accordance with a plan of treatment appropriately 200
established, implemented, monitored, and revised under the 201
auspices of a therapeutic team as a part of client services 202
management; 203
(c) Rehabilitative mental health and alcohol and drug 204
abuse services including home and community -based 205
preventive, diagnostic, therapeutic, rehabilitative, and 206
palliative interventions rendered to individuals in an 207
individual or group setting by a mental health or alc ohol 208 SB 498 8
and drug abuse professional in accordance with a plan of 209
treatment appropriately established, implemented, monitored, 210
and revised under the auspices of a therapeutic team as a 211
part of client services management. As used in this 212
section, mental health professional and alcohol and drug 213
abuse professional shall be defined by the department of 214
mental health pursuant to duly promulgated rules. With 215
respect to services established by this subdivision, the 216
department of social services, MO HealthNe t division, shall 217
enter into an agreement with the department of mental 218
health. Matching funds for outpatient mental health 219
services, clinic mental health services, and rehabilitation 220
services for mental health and alcohol and drug abuse shall 221
be certified by the department of mental health to the MO 222
HealthNet division. The agreement shall establish a 223
mechanism for the joint implementation of the provisions of 224
this subdivision. In addition, the agreement shall 225
establish a mechanism by which rate s for services may be 226
jointly developed; 227
(17) Such additional services as defined by the MO 228
HealthNet division to be furnished under waivers of federal 229
statutory requirements as provided for and authorized by the 230
federal Social Security Act (42 U .S.C. Section 301, et seq.) 231
subject to appropriation by the general assembly; 232
(18) The services of an advanced practice registered 233
nurse with a collaborative practice agreement to the extent 234
that such services are provided in accordance with chapt ers 235
334 and 335, and regulations promulgated thereunder; 236
(19) Nursing home costs for participants receiving 237
benefit payments under subdivision (4) of this subsection to 238
reserve a bed for the participant in the nursing home during 239
the time that the participant is absent due to admission to 240 SB 498 9
a hospital for services which cannot be performed on an 241
outpatient basis, subject to the provisions of this 242
subdivision: 243
(a) The provisions of this subdivision shall apply 244
only if: 245
a. The occupancy rate of the nursing home is at or 246
above ninety-seven percent of MO HealthNet certified 247
licensed beds, according to the most recent quarterly census 248
provided to the department of health and senior services 249
which was taken prior to when the participant is admitted to 250
the hospital; and 251
b. The patient is admitted to a hospital for a medical 252
condition with an anticipated stay of three days or less; 253
(b) The payment to be made under this subdivision 254
shall be provided for a maximum of three day s per hospital 255
stay; 256
(c) For each day that nursing home costs are paid on 257
behalf of a participant under this subdivision during any 258
period of six consecutive months such participant shall, 259
during the same period of six consecutive months, be 260
ineligible for payment of nursing home costs of two 261
otherwise available temporary leave of absence days provided 262
under subdivision (5) of this subsection; and 263
(d) The provisions of this subdivision shall not apply 264
unless the nursing home receives not ice from the participant 265
or the participant's responsible party that the participant 266
intends to return to the nursing home following the hospital 267
stay. If the nursing home receives such notification and 268
all other provisions of this subsection have bee n satisfied, 269
the nursing home shall provide notice to the participant or 270
the participant's responsible party prior to release of the 271
reserved bed; 272 SB 498 10
(20) Prescribed medically necessary durable medical 273
equipment. An electronic web-based prior authorization 274
system using best medical evidence and care and treatment 275
guidelines consistent with national standards shall be used 276
to verify medical need; 277
(21) Hospice care. As used in this subdivision, the 278
term "hospice care" means a coordinated pr ogram of active 279
professional medical attention within a home, outpatient and 280
inpatient care which treats the terminally ill patient and 281
family as a unit, employing a medically directed 282
interdisciplinary team. The program provides relief of 283
severe pain or other physical symptoms and supportive care 284
to meet the special needs arising out of physical, 285
psychological, spiritual, social, and economic stresses 286
which are experienced during the final stages of illness, 287
and during dying and bereavement and m eets the Medicare 288
requirements for participation as a hospice as are provided 289
in 42 CFR Part 418. The rate of reimbursement paid by the 290
MO HealthNet division to the hospice provider for room and 291
board furnished by a nursing home to an eligible hospice 292
patient shall not be less than ninety -five percent of the 293
rate of reimbursement which would have been paid for 294
facility services in that nursing home facility for that 295
patient, in accordance with subsection (c) of Section 6408 296
of P.L. 101-239 (Omnibus Budget Reconciliation Act of 1989); 297
(22) Prescribed medically necessary dental services. 298
Such services shall be subject to appropriations. An 299
electronic web-based prior authorization system using best 300
medical evidence and care and treatment gu idelines 301
consistent with national standards shall be used to verify 302
medical need; 303 SB 498 11
(23) Prescribed medically necessary optometric 304
services. Such services shall be subject to 305
appropriations. An electronic web-based prior authorization 306
system using best medical evidence and care and treatment 307
guidelines consistent with national standards shall be used 308
to verify medical need; 309
(24) Blood clotting products -related services. For 310
persons diagnosed with a bleeding disorder, as defined in 311
section 338.400, reliant on blood clotting products, as 312
defined in section 338.400, such services include: 313
(a) Home delivery of blood clotting products and 314
ancillary infusion equipment and supplies, including the 315
emergency deliveries of the product wh en medically necessary; 316
(b) Medically necessary ancillary infusion equipment 317
and supplies required to administer the blood clotting 318
products; and 319
(c) Assessments conducted in the participant's home by 320
a pharmacist, nurse, or local home healt h care agency 321
trained in bleeding disorders when deemed necessary by the 322
participant's treating physician; 323
(25) The MO HealthNet division shall, by January 1, 324
2008, and annually thereafter, report the status of MO 325
HealthNet provider reimbursement rates as compared to one 326
hundred percent of the Medicare reimbursement rates and 327
compared to the average dental reimbursement rates paid by 328
third-party payors licensed by the state. The MO HealthNet 329
division shall, by July 1, 2008, provide to the gen eral 330
assembly a four-year plan to achieve parity with Medicare 331
reimbursement rates and for third -party payor average dental 332
reimbursement rates. Such plan shall be subject to 333
appropriation and the division shall include in its annual 334
budget request to the governor the necessary funding needed 335 SB 498 12
to complete the four -year plan developed under this 336
subdivision. 337
2. Additional benefit payments for medical assistance 338
shall be made on behalf of those eligible needy children, 339
pregnant women and blind persons with any payments to be 340
made on the basis of the reasonable cost of the care or 341
reasonable charge for the services as defined and determined 342
by the MO HealthNet division, unless otherwise hereinafter 343
provided, for the following: 344
(1) Dental services; 345
(2) Services of podiatrists as defined in section 346
330.010; 347
(3) Optometric services as described in section 348
336.010; 349
(4) Orthopedic devices or other prosthetics, including 350
eye glasses, dentures, hearing aids, and wheelchairs ; 351
(5) For pregnant and postpartum women, a home blood 352
pressure monitoring device. As used in this subdivision, 353
the term "home blood pressure monitoring device" means a 354
mobile device that can be used to measure blood pressure. 355
[(5)] (6) Hospice care. As used in this subdivision, 356
the term "hospice care" means a coordinated program of 357
active professional medical attention within a home, 358
outpatient and inpatient care which treats the terminally 359
ill patient and family as a unit, employing a medically 360
directed interdisciplinary team. The program provides 361
relief of severe pain or other physical symptoms and 362
supportive care to meet the special needs arising out of 363
physical, psychological, spiritual, social, and economic 364
stresses which are experienced during the final stages of 365
illness, and during dying and bereavement and meets the 366
Medicare requirements for participation as a hospice as are 367 SB 498 13
provided in 42 CFR Part 418. The rate of reimbursement paid 368
by the MO HealthNet division to the hospice provider for 369
room and board furnished by a nursing home to an eligible 370
hospice patient shall not be less than ninety -five percent 371
of the rate of reimbursement which would have been paid for 372
facility services in that nursing home facility for th at 373
patient, in accordance with subsection (c) of Section 6408 374
of P.L. 101-239 (Omnibus Budget Reconciliation Act of 1989); 375
[(6)] (7) Comprehensive day rehabilitation services 376
beginning early posttrauma as part of a coordinated system 377
of care for individuals with disabling impairments. 378
Rehabilitation services must be based on an individualized, 379
goal-oriented, comprehensive and coordinated treatment plan 380
developed, implemented, and monitored through an 381
interdisciplinary assessment designed to r estore an 382
individual to optimal level of physical, cognitive, and 383
behavioral function. The MO HealthNet division shall 384
establish by administrative rule the definition and criteria 385
for designation of a comprehensive day rehabilitation 386
service facility, benefit limitations and payment 387
mechanism. Any rule or portion of a rule, as that term is 388
defined in section 536.010, that is created under the 389
authority delegated in this subdivision shall become 390
effective only if it complies with and is subject to all of 391
the provisions of chapter 536 and, if applicable, section 392
536.028. This section and chapter 536 are nonseverable and 393
if any of the powers vested with the general assembly 394
pursuant to chapter 536 to review, to delay the effective 395
date, or to disapprove and annul a rule are subsequently 396
held unconstitutional, then the grant of rulemaking 397
authority and any rule proposed or adopted after August 28, 398
2005, shall be invalid and void. 399 SB 498 14
3. The MO HealthNet division may require any 400
participant receiving MO HealthNet benefits to pay part of 401
the charge or cost until July 1, 2008, and an additional 402
payment after July 1, 2008, as defined by rule duly 403
promulgated by the MO HealthNet division, for all covered 404
services except for those services cov ered under 405
subdivisions (15) and (16) of subsection 1 of this section 406
and sections 208.631 to 208.657 to the extent and in the 407
manner authorized by Title XIX of the federal Social 408
Security Act (42 U.S.C. Section 1396, et seq.) and 409
regulations thereund er. When substitution of a generic drug 410
is permitted by the prescriber according to section 338.056, 411
and a generic drug is substituted for a name -brand drug, the 412
MO HealthNet division may not lower or delete the 413
requirement to make a co -payment pursuant to regulations of 414
Title XIX of the federal Social Security Act. A provider of 415
goods or services described under this section must collect 416
from all participants the additional payment that may be 417
required by the MO HealthNet division under authority 418
granted herein, if the division exercises that authority, to 419
remain eligible as a provider. Any payments made by 420
participants under this section shall be in addition to and 421
not in lieu of payments made by the state for goods or 422
services described he rein except the participant portion of 423
the pharmacy professional dispensing fee shall be in 424
addition to and not in lieu of payments to pharmacists. A 425
provider may collect the co -payment at the time a service is 426
provided or at a later date. A provider shall not refuse to 427
provide a service if a participant is unable to pay a 428
required payment. If it is the routine business practice of 429
a provider to terminate future services to an individual 430
with an unclaimed debt, the provider may include uncollecte d 431 SB 498 15
co-payments under this practice. Providers who elect not to 432
undertake the provision of services based on a history of 433
bad debt shall give participants advance notice and a 434
reasonable opportunity for payment. A provider, 435
representative, employee, i ndependent contractor, or agent 436
of a pharmaceutical manufacturer shall not make co -payment 437
for a participant. This subsection shall not apply to other 438
qualified children, pregnant women, or blind persons. If 439
the Centers for Medicare and Medicaid Serv ices does not 440
approve the MO HealthNet state plan amendment submitted by 441
the department of social services that would allow a 442
provider to deny future services to an individual with 443
uncollected co-payments, the denial of services shall not be 444
allowed. The department of social services shall inform 445
providers regarding the acceptability of denying services as 446
the result of unpaid co -payments. 447
4. The MO HealthNet division shall have the right to 448
collect medication samples from participants in ord er to 449
maintain program integrity. 450
5. Reimbursement for obstetrical and pediatric 451
services under subdivision (6) of subsection 1 of this 452
section shall be timely and sufficient to enlist enough 453
health care providers so that care and services are 454
available under the state plan for MO HealthNet benefits at 455
least to the extent that such care and services are 456
available to the general population in the geographic area, 457
as required under subparagraph (a)(30)(A) of 42 U.S.C. 458
Section 1396a and federal regulations promulgated thereunder. 459
6. Beginning July 1, 1990, reimbursement for services 460
rendered in federally funded health centers shall be in 461
accordance with the provisions of subsection 6402(c) and 462 SB 498 16
Section 6404 of P.L. 101 -239 (Omnibus Budget Reconciliation 463
Act of 1989) and federal regulations promulgated thereunder. 464
7. Beginning July 1, 1990, the department of social 465
services shall provide notification and referral of children 466
below age five, and pregnant, breast -feeding, or postpart um 467
women who are determined to be eligible for MO HealthNet 468
benefits under section 208.151 to the special supplemental 469
food programs for women, infants and children administered 470
by the department of health and senior services. Such 471
notification and referral shall conform to the requirements 472
of Section 6406 of P.L. 101 -239 and regulations promulgated 473
thereunder. 474
8. Providers of long-term care services shall be 475
reimbursed for their costs in accordance with the provisions 476
of Section 1902 (a)(13 )(A) of the Social Security Act, 42 477
U.S.C. Section 1396a, as amended, and regulations 478
promulgated thereunder. 479
9. Reimbursement rates to long -term care providers 480
with respect to a total change in ownership, at arm's 481
length, for any facility previo usly licensed and certified 482
for participation in the MO HealthNet program shall not 483
increase payments in excess of the increase that would 484
result from the application of Section 1902 (a)(13)(C) of 485
the Social Security Act, 42 U.S.C. Section 1396a (a)(13 )(C). 486
10. The MO HealthNet division may enroll qualified 487
residential care facilities and assisted living facilities, 488
as defined in chapter 198, as MO HealthNet personal care 489
providers. 490
11. Any income earned by individuals eligible for 491
certified extended employment at a sheltered workshop under 492
chapter 178 shall not be considered as income for purposes 493
of determining eligibility under this section. 494 SB 498 17
12. If the Missouri Medicaid audit and compliance unit 495
changes any interpretation or a pplication of the 496
requirements for reimbursement for MO HealthNet services 497
from the interpretation or application that has been applied 498
previously by the state in any audit of a MO HealthNet 499
provider, the Missouri Medicaid audit and compliance unit 500
shall notify all affected MO HealthNet providers five 501
business days before such change shall take effect. Failure 502
of the Missouri Medicaid audit and compliance unit to notify 503
a provider of such change shall entitle the provider to 504
continue to receive an d retain reimbursement until such 505
notification is provided and shall waive any liability of 506
such provider for recoupment or other loss of any payments 507
previously made prior to the five business days after such 508
notice has been sent. Each provider shall provide the 509
Missouri Medicaid audit and compliance unit a valid email 510
address and shall agree to receive communications 511
electronically. The notification required under this 512
section shall be delivered in writing by the United States 513
Postal Service or electronic mail to each provider. 514
13. Nothing in this section shall be construed to 515
abrogate or limit the department's statutory requirement to 516
promulgate rules under chapter 536. 517
14. Beginning July 1, 2016, and subject to 518
appropriations, providers of behavioral, social, and 519
psychophysiological services for the prevention, treatment, 520
or management of physical health problems shall be 521
reimbursed utilizing the behavior assessment and 522
intervention reimbursement codes 96150 to 96154 or their 523
successor codes under the Current Procedural Terminology 524
(CPT) coding system. Providers eligible for such 525
reimbursement shall include psychologists. 526 SB 498 18
15. There shall be no payments made under this section 527
for gender transition surgeries, cross -sex hormones, or 528
puberty-blocking drugs, as such terms are defined in section 529
191.1720, for the purpose of a gender transition. 530
376.1960. 1. As used in this section, the following 1
terms mean: 2
(1) "Health benefit plan", the same meaning given to 3
the term in section 376.1350; 4
(2) "Home blood pressure monitoring device", a mobile 5
device that can be used to measure blood pressure. 6
2. Health benefit plans delivered, issued for 7
delivery, continued or renewed in this sta te on or after 8
January 1, 2026, and providing for maternity benefits, shall 9
provide coverage for a home blood pressure monitoring device 10
for pregnant and postpartum women. 11