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. 539
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR NURRENBERN.
1839S.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Section A. Section 208.152, RSMo, is repealed and two new 1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 539 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 539 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 539 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 539 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 539 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 539 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 539 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 539 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 539 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 539 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 539 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 and home blood pressure 353
monitoring device services. As used in this subdivision, 354
the term "home blood pressure monitoring device" means a 355
mobile device that can be used to measure blood pressure, 356
and that is validated for clinical accuracy and device 357
calibration. As used in this subdivision, the term "home 358
blood pressure monitoring device services" means patient 359
education and training services on the setup and u se of a 360
home blood pressure monitoring device, separate self - 361
measurement blood pressure readings, daily collection and 362
transmission of data reports by the patient or caregiver to 363
the health care provider in order to communicate blood 364
pressure readings, review of the reports by the health care 365
provider, and creation or modification of treatment plans 366
based on the reports; 367 SB 539 13
(6) Hospice care. As used in this subdivision, the 368
term "hospice care" means a coordinated program of active 369
professional medical attention within a home, outpatient and 370
inpatient care which treats the terminally ill patient and 371
family as a unit, employing a medically directed 372
interdisciplinary team. The program provides relief of 373
severe pain or other physical symptoms a nd supportive care 374
to meet the special needs arising out of physical, 375
psychological, spiritual, social, and economic stresses 376
which are experienced during the final stages of illness, 377
and during dying and bereavement and meets the Medicare 378
requirements for participation as a hospice as are provided 379
in 42 CFR Part 418. The rate of reimbursement paid by the 380
MO HealthNet division to the hospice provider for room and 381
board furnished by a nursing home to an eligible hospice 382
patient shall not be less th an ninety-five percent of the 383
rate of reimbursement which would have been paid for 384
facility services in that nursing home facility for that 385
patient, in accordance with subsection (c) of Section 6408 386
of P.L. 101-239 (Omnibus Budget Reconciliation Act of 1989); 387
[(6)] (7) Comprehensive day rehabilitation services 388
beginning early posttrauma as part of a coordinated system 389
of care for individuals with disabling impairments. 390
Rehabilitation services must be based on an individualized, 391
goal-oriented, comprehensive and coordinated treatment plan 392
developed, implemented, and monitored through an 393
interdisciplinary assessment designed to restore an 394
individual to optimal level of physical, cognitive, and 395
behavioral function. The MO HealthNet division s hall 396
establish by administrative rule the definition and criteria 397
for designation of a comprehensive day rehabilitation 398
service facility, benefit limitations and payment 399 SB 539 14
mechanism. Any rule or portion of a rule, as that term is 400
defined in section 536 .010, that is created under the 401
authority delegated in this subdivision shall become 402
effective only if it complies with and is subject to all of 403
the provisions of chapter 536 and, if applicable, section 404
536.028. This section and chapter 536 are nonsev erable and 405
if any of the powers vested with the general assembly 406
pursuant to chapter 536 to review, to delay the effective 407
date, or to disapprove and annul a rule are subsequently 408
held unconstitutional, then the grant of rulemaking 409
authority and any rule proposed or adopted after August 28, 410
2005, shall be invalid and void. 411
3. The MO HealthNet division may require any 412
participant receiving MO HealthNet benefits to pay part of 413
the charge or cost until July 1, 2008, and an additional 414
payment after July 1, 2008, as defined by rule duly 415
promulgated by the MO HealthNet division, for all covered 416
services except for those services covered under 417
subdivisions (15) and (16) of subsection 1 of this section 418
and sections 208.631 to 208.657 to the extent and in the 419
manner authorized by Title XIX of the federal Social 420
Security Act (42 U.S.C. Section 1396, et seq.) and 421
regulations thereunder. When substitution of a generic drug 422
is permitted by the prescriber according to section 338.056, 423
and a generic drug is substituted for a name -brand drug, the 424
MO HealthNet division may not lower or delete the 425
requirement to make a co -payment pursuant to regulations of 426
Title XIX of the federal Social Security Act. A provider of 427
goods or services described under this section must collect 428
from all participants the additional payment that may be 429
required by the MO HealthNet division under authority 430
granted herein, if the division exercises that authority, to 431 SB 539 15
remain eligible as a provider. Any payments made by 432
participants under this section shall be in addition to and 433
not in lieu of payments made by the state for goods or 434
services described herein except the participant portion of 435
the pharmacy professional dispensing fee shall be in 436
addition to and not in lieu of payments to pharmacists. A 437
provider may collect the co -payment at the time a service is 438
provided or at a later date. A provider shall not refuse to 439
provide a service if a participant is unable to pay a 440
required payment. If it is the routine business practice of 441
a provider to terminate future services to an individual 442
with an unclaimed debt, the provider may include uncollected 443
co-payments under this practice. Providers who elect not to 444
undertake the provision of services based on a histo ry of 445
bad debt shall give participants advance notice and a 446
reasonable opportunity for payment. A provider, 447
representative, employee, independent contractor, or agent 448
of a pharmaceutical manufacturer shall not make co -payment 449
for a participant. This subsection shall not apply to other 450
qualified children, pregnant women, or blind persons. If 451
the Centers for Medicare and Medicaid Services does not 452
approve the MO HealthNet state plan amendment submitted by 453
the department of social services that wou ld allow a 454
provider to deny future services to an individual with 455
uncollected co-payments, the denial of services shall not be 456
allowed. The department of social services shall inform 457
providers regarding the acceptability of denying services as 458
the result of unpaid co-payments. 459
4. The MO HealthNet division shall have the right to 460
collect medication samples from participants in order to 461
maintain program integrity. 462 SB 539 16
5. Reimbursement for obstetrical and pediatric 463
services under subdivision ( 6) of subsection 1 of this 464
section shall be timely and sufficient to enlist enough 465
health care providers so that care and services are 466
available under the state plan for MO HealthNet benefits at 467
least to the extent that such care and services are 468
available to the general population in the geographic area, 469
as required under subparagraph (a)(30)(A) of 42 U.S.C. 470
Section 1396a and federal regulations promulgated thereunder. 471
6. Beginning July 1, 1990, reimbursement for services 472
rendered in federall y funded health centers shall be in 473
accordance with the provisions of subsection 6402(c) and 474
Section 6404 of P.L. 101 -239 (Omnibus Budget Reconciliation 475
Act of 1989) and federal regulations promulgated thereunder. 476
7. Beginning July 1, 1990, the de partment of social 477
services shall provide notification and referral of children 478
below age five, and pregnant, breast -feeding, or postpartum 479
women who are determined to be eligible for MO HealthNet 480
benefits under section 208.151 to the special supplemen tal 481
food programs for women, infants and children administered 482
by the department of health and senior services. Such 483
notification and referral shall conform to the requirements 484
of Section 6406 of P.L. 101 -239 and regulations promulgated 485
thereunder. 486
8. Providers of long-term care services shall be 487
reimbursed for their costs in accordance with the provisions 488
of Section 1902 (a)(13)(A) of the Social Security Act, 42 489
U.S.C. Section 1396a, as amended, and regulations 490
promulgated thereunder. 491
9. Reimbursement rates to long -term care providers 492
with respect to a total change in ownership, at arm's 493
length, for any facility previously licensed and certified 494 SB 539 17
for participation in the MO HealthNet program shall not 495
increase payments in excess of the increase that would 496
result from the application of Section 1902 (a)(13)(C) of 497
the Social Security Act, 42 U.S.C. Section 1396a (a)(13)(C). 498
10. The MO HealthNet division may enroll qualified 499
residential care facilities and assisted living facil ities, 500
as defined in chapter 198, as MO HealthNet personal care 501
providers. 502
11. Any income earned by individuals eligible for 503
certified extended employment at a sheltered workshop under 504
chapter 178 shall not be considered as income for purposes 505
of determining eligibility under this section. 506
12. If the Missouri Medicaid audit and compliance unit 507
changes any interpretation or application of the 508
requirements for reimbursement for MO HealthNet services 509
from the interpretation or application t hat has been applied 510
previously by the state in any audit of a MO HealthNet 511
provider, the Missouri Medicaid audit and compliance unit 512
shall notify all affected MO HealthNet providers five 513
business days before such change shall take effect. Failure 514
of the Missouri Medicaid audit and compliance unit to notify 515
a provider of such change shall entitle the provider to 516
continue to receive and retain reimbursement until such 517
notification is provided and shall waive any liability of 518
such provider for recou pment or other loss of any payments 519
previously made prior to the five business days after such 520
notice has been sent. Each provider shall provide the 521
Missouri Medicaid audit and compliance unit a valid email 522
address and shall agree to receive communica tions 523
electronically. The notification required under this 524
section shall be delivered in writing by the United States 525
Postal Service or electronic mail to each provider. 526 SB 539 18
13. Nothing in this section shall be construed to 527
abrogate or limit the dep artment's statutory requirement to 528
promulgate rules under chapter 536. 529
14. Beginning July 1, 2016, and subject to 530
appropriations, providers of behavioral, social, and 531
psychophysiological services for the prevention, treatment, 532
or management of physical health problems shall be 533
reimbursed utilizing the behavior assessment and 534
intervention reimbursement codes 96150 to 96154 or their 535
successor codes under the Current Procedural Terminology 536
(CPT) coding system. Providers eligible for such 537
reimbursement shall include psychologists. 538
15. There shall be no payments made under this section 539
for gender transition surgeries, cross -sex hormones, or 540
puberty-blocking drugs, as such terms are defined in section 541
191.1720, for the purpose of a gender transition. 542
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, and that 6
is validated for clinical accuracy and device calibration; 7
(3) "Home blood pressure monitoring device services", 8
patient education and training services on the setup and use 9
of a home blood pres sure monitoring device, separate self - 10
measurement blood pressure readings, daily collection and 11
transmission of data reports by the patient or caregiver to 12
the health care provider in order to communicate blood 13
pressure readings, review of the reports by the health care 14
provider, and creation or modification of treatment plans 15
based on the reports. 16 SB 539 19
2. Health benefit plans delivered, issued for 17
delivery, continued or renewed in this state on or after 18
January 1, 2026, and providing for maternity benefits, shall 19
provide coverage for a home blood pressure monitoring device 20
and home blood pressure monitoring device services for 21
pregnant and postpartum women. 22