Chapter 81. Vendor Payment for Medical Care Services
45 sections in this chapter.
13-40-81-13 CSR 40-51.150 Computer-Generated
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Drug Pricing Tape (Moved to 13 CSR 70-20.070) 13 CSR 40-81.160 Sanctions for False or Fraudulent Claims for Title XIX Services (Moved to 13 CSR 70-3.030) 13 CSR 40-81.161 Computation of Provider Overpayment by Statistical Sam- pling (Moved to 13 CSR 70-3.130) 13 CSR 40-81.162 Pro…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.005 Organization
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Description (Moved to 13 CSR 70-10.005) (Moved fo 13 CSR 70-1.010) 13 CSR 40-81.050 Inpatient Hospital Ser- .. vices Reimbunement Plan; Outpatient 13 CSR 40-81.081 Prospective Reimburse- Hospital Services Reimbursement Method- ment Plan for Long-Term Care…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.010 List of Drugs Covered
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by Medicaid (Moved to 13 CSR 70-15.010) (Moved to 13 CSR 70-20.030) 13 CSR 40-81.082 Limitation on Allowable 13 CSR 40-81.051 Limitations on Payment Capital Cost Overruns for New Institution-…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.011 Participating
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al Health Services in litle XIX Reimburse- dors (Moved to 13 CSR 70-15.030) ment Rate Setting (Moved to 13 CSR 70-20.010) (Moved to 13 CSR 70-10.100) 13 CSR 40-81.052 Second Opinion Requirement Before Nonemergency Eke. 13 CSR 40-81.012 Five Prescription Limit 13 CSR 40-81.083 Pro…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.012 Five Prescription Limit Per Month Per Recipient (Moved to 13 CSR 70-20.040). 5
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Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.013 Missouri Nonsteridal Anti-Inflammatory Drug List
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.. (Moved to 13 CSR 70-20.100) ............................................................. .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.014 Medicaid Program Coverageof Approved Drugs for Treatment of Acquired
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Immunodeficiency Syndrome(AIDS) (Moved to 13 CSR 70-20.110) ............... .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.015 Payment for Early Periodic Screening, Diagnosis and Treatment
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Program Services (Moved to 13 CSR 70-25.110). ....................................... . 13 CSR 40-81.020 Method of Filing Claim for Drug Payment (RescindedFebruary 11, 1980) ........ .5 13 CSR 40-81.030 Labeling of Medicaid Prescriptions (Moved to 13 CSR 70-20.080). .............…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.030 Labeling of Medicaid
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Prescriptions 13 CSR 40-81.060 Obtaining Information (Moved to 13 CSR 70-20.080) From Providers of Medical Servicces 13 CSR 40-81.100 Abortions (Moved to 13 CSR 70-3.050) Emwency ndefiled July 7. 1977, effecdve 13 CSR 40-81.035 Medicaid Program Ben- July 17, 1977, expired Ocr. 15…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.035 Medicaid Program Benefits for Human Organ and Bone Marrow Transplants
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and Related Medical Services (Moved to 13 CSR 70-2.200) ......................... .5 13 CSR /10-81.040 Dental Benefits and Limitations, Medicaid Program (Moved to 13 CSR 70-35.010) ............................................................. .5…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.045 Medicaid Program Benefits for Nurse-Midwife Services
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(Moved to 13 CSR 7055.010) .............................................................. 5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.050 Inpatient Hospital Services Reimbursement Plan; Outpatient Hospital
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Services Reimbursement Methodology (Moved to 13 CSR 70-15.010). ............ .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.051 Limitations on Payment for Inpatient Hospital Care
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(Moved to 13 CSR 70-15.030) ............................................................. .5 CODEOFSTATEREGULATIONS 1
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.052 Second Opinion Requirement Before NonemergencyElective
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Surgical Operations (Moved to 13 CSR 70-3.1 IO).. ., _.. . . . .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.053 Inpatient ‘Hospital Psychiatric Services for Individuals Under Age Twenty-One
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(Moved to 13 CSR 70-15.070) .............................................................. 5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.054 Copayment and Coinsurancefor Certain Medicaid-Covered Services
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(Moved to 13 CSR 70-4.050). .............................................................. .5 13 CSR 40-81.055 Copayment for Pharmacy Services (Moved to 13 CSR 70-4.051) .................... .5 13 CSR 40-81.056 Home Health Care Services (Moved to 13 CSR 70-90.010). ..............…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.055 Copayment for Phanna-
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cy Services 13 CSR 40-81.086 Preadmission Screening 13 CSR 40-81.015 Payment for Early Peri- (Moved to 13 CSR 15-9.020) (Moved to 13 CSR 70-4.051) _, odic Screenixg, Diagnosis and Treatment Program Services (Moved to :3 CSR 70-25.110) 13 CSR 40-81.056 Home Health Care Se,.- 13 CS…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.060 Obtaining Information From Providers of Medical Services
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(Moved to 13 CSR 70-3.050). .............................................................. .5 13 CSR 40-81.070 Length of Time for Submitting Claims (RescindedApril 11, 1980). ................. .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.071 Timely Filing and Processingof Claims, Medicaid Program
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(Moved to 13 CSR 70-3.100). .............................................................. .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.080 ReasonableCost-Related ReimbursementPlan for Long-Term Care
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(Moved to 13 CSR 70-10.005) ............................................................. .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.081 Prospective Reimbursement Plan for Long-Term Care
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(Moved to 13 CSR 70-10.010) .............................................................. 5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.082 Limitation on Allowable Capital Cost Overruns for New Institutional
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Health Services in Title XIX ReimbursementRate Setting (Moved to 13 CSR 70-10.100) ............................................................. .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.083 Prospective Reimbursement Plan for Nonstate Operated Facilities
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for ICF/MR Services (Moved to 13 CSR 70-10.030). ................................. .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.084 Evaluation and AssessmentMeasuresfor Title XIX Residents
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in Long-Term Care Facilities (Moved to 13 CSR 15-9.030) .......................... .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.085 Prospective Reimbursement System for Long-Term Care
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(RescindedAugust 11, 1984). ............................................................... . 13 CSR 40-81.086 Preadmission Screening (Moved to 13 CSR 15-9.020) ................................. .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.090 Duty of Medicaid Participating Hospitals and Other Vendors to Assist
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in Recovering Third Party Payments(Moved to 13 CSR 70-3.040) ................. .5
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.092 Required Reporting of Injuries Receivedby Title XIX Recipients
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(Moved to 13 CSR 70-4.060). .............................................................. .5 13 CSR 40-81.100 Abortions ........................................................................................ .5 13 CSR 40-81.101 Abortions (Moved to 13 CSR 70.2,5.100)............…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.110 Quality Standardsfor Approving Manufacturers for the Medicaid Drug
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Program (RescindedJanuary 12, 1980)................................................... .6 13 CSR 40-81.120 Hearing Aid Program (Moved to 13 CSR 70-45.010) .................................. .6 13 CSR 40-81.125 Personal Care Program (Moved to 13 CSR 70-91.010). ...................…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.120 Hearing Aid Program
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(Moved to 13 CSR 70-45.010) vices for General Relief Recipients (Moved fo 13 CSR 70-2.020)
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.125 Personal Care Program
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(Moved to 13 CSR 70-91.010) 13 CSR 40-81.190 Limitations on Payment of Out-of-State Nonemergency Medical SePiWS
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.126 Adult Day He&h
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Program (Moved to 13 CSR 70-92.010) 13 CSR 40-81.195 Title XIX Procedure of Exception to Medical Care Services Limi-
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.130 Podiatric
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g=m (Moved to 13 CSR 70-2.100) (Moved to 13 CSR 70-30.010) 13 CSR 40-81.200 Title XIX Recipient 13 CSR 40-81.140 Procedures for Medical Lock-in Program Services Provider Hearings (Moved to 13 CSR 70-4.070) (Moved to 13 CSR 70-4.030)…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.140 Proceduresfor Medical Services Provider Hearings (Moved to 13 CSR 70-4.030) 6
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13 CSR 40-81.141 Eligibility Corrective Action Recipient Payment (Moved to 13 CSR 70-4.040) .... .6 13 CSR 40-81.150 Computer-GeneratedDrug Pricing Tape (Moved to 13 CSR 70-20.070) ............ .6
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.141 Eligibility
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Section Recipient Payments (Moved to 13 CSR 70-4.040)
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.160 Sanctions for False or Fraudulent Claims for Title XIX Services
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Surgical Operations (Moved to 13 CSR 70-3.030) ..................................... .6
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.161 Computation of Provider Overpayment by Statistical Sampling
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(Moved to 13 CSR 70-3.130). ............................................................... 6
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.162 Proceduresfor Evaluation of Appropriate Hospital Admissions and
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Continued Days of Stay (Moved to 13 CSR 70-15.090) ............................... .6 13 CSR 40-81.165 Title XIX Provider Enrollment (Moved to 13 CSR 70-3.020). ........................ .6
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.165 Title XIX
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Enrollment (Moved to 13 CSR 70-3.020) 13 CSR 40-81.170 Optical Care Benefits and Limitations, Medicaid Program (Moved to 13 CSR 7040.010) 6 CODEOFSTATEREGULATIONS (214191)’ Rebecca McDowell Cook secretary Ofstate…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.170 Optical Care Benefits and Limitations, Medicaid Program
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(Moved to 13 CSR 70-40.010) ............................................................. .6
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.180 Payment Method for General Relief Recipient Hospital Outpatient Services
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(Moved to 13 CSR 70-15.080) ............................................................. .6
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.181 Scope of Medical Services for General Relief Recipients
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(Moved to 13 CSR 70-2.020). .............................................................. .6
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.190 Limitations on Payment of Out-of-State Nonemergency Medical Services
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(Moved to 1~3CSR 70-3.120). .............................................................. .6
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.195 Title XIX Procedure of Exception to Medical Care Services Limitations
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,.--- (Moved to 13 CSR 70-2.100). .............................................................. .6
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-81.200 Title XIX Recipient Lock-In Program (Moved to 13 CSR 70-4.070)
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CODEOFSTATEREGULATKINS 3 Chapter El-Vendor Payment for Medical Care Services 13 CSR 40-81 Title 13-DEPARTMENT OF 13 CSR 40-81.040 Dental Benefits and 13 CSR 40-81.071 lamely Filing and Pro- SOCIAL SERVICES Limitations, Medicaid Program cessing of Claims, Medicaid Program Division…
Chapter 13-40-81Open chapter PDF ↗13-40-81-13 CSR 40-82.013 Mi~issouri Nonsteroidal
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Anti-Inflammatory Drug List Age Twenty-One 13 CSR 40-81.084 Evaluation and Assess- (Moved to 13 CSR 70-20.100) (Moved to 13 CSR 70-15.070) ment Measures for Title XIX Residents in Long-Term Care Facilities (Moved to 13 CSR 15-9.030) 13 CSR 40-81.014 Medicaid Program Cov- 13 CSR 4…
Chapter 13-40-81Open chapter PDF ↗