Missouri Administrative Code

Effectiveness Values (Moved to 19 CSR 20-10.110) 13 CSR 50-90.120 General Requirements for Diagnostic X-ray Equipment (Moved to 19 CSR 20-10.120) Rebecca McDowell Cook (9/30/97) CODE OF STATE REGULATIONS 3 Secretary of State

(Moved to 19 CSR 20-10.120) ..............................................................3

(Moved to 19 CSR 20-10.130) ..............................................................3

(Moved to 19 CSR 20-10.140) ..............................................................3

(Moved to 19 CSR 20-10.150) ..............................................................3

(Moved to 19 CSR 20-10.160) ..............................................................3

(Moved to 19 CSR 20-10.170) ..............................................................3

(Moved to 19 CSR 20-10.180) ..............................................................3 Rebecca McDowell Cook (9/30/97) CODE OF STATE REGULATIONS 1 Secretary of State 13 CSR 50-90.190 Requirements for Room Shielding (Moved to 19 CSR 20-10.190) ....................3 13 CSR 50-…

Shielding

(Moved to 19 CSR 20-10.200)

(A) Ensuring reasonable access to MO (E) Granting the provider a MO HealthNet PURPOSE: This rule implements federal reg- HealthNet Program services; number. ulatory requirements promulgated by the (B) Promoting health, safety, and welfare United States Department of Health and of…

Program tal muscle relaxants, anxiolytics, or other or potential drugs of misuse; (D) Paying cash for prescribed medications PURPOSE: This rule establishes a process to (D) Use of three (3) or more providers that covered by the MO HealthNet program. safeguard against unnecessary …

Mo HealthNet Program record or electronic health record, the follow- (6) Nothing herein shall require a provider to ing requirements apply: PURPOSE: This rule establishes the basis on conduct business electronically, but if a (A) All original records shall be main- which Health C…

Program, and the Program of All-Inclusive Care for the Elderly PURPOSE: This rule states the function and general organization (PACE). The group works closely with the contracted actuary in of the MO HealthNet Division to comply with the requirements of evaluating Medicaid fee-fo…

Identifiable Health Information privacy and security concerns associated with the electronic transmission of health information, in part, through several PURPOSE: The state of Missouri, Department of Social Services, provisions that strengthen the civil and criminal enforcement M…

Plan for Long-Term Care Department of Social Services. Representatives of participating facilities will have an opportunity to make recommendations. PURPOSE: This rule establishes a payment plan for nursing All these changes will be subject to approval by the secretary home care …

Facility Reimbursement Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 13 CSR 70-10.017 Nursing Facility Invasive Ventilator Program . . . . . . . . . . . . . . . . . . . . . . . . 65

Nursing Facility Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

for ICF/IID Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Intellectually Disabled Individuals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 13 CSR 70-10.050 Pediatric Nursing Care Plan (Rescinded August 30, 2018) . . . . . . . . . . . . 105

Providers must file the cost report on forms provided by and in (Rescinded August 30, 2018) accordance with the procedures of the department. AUTHORITY: sections 208.153, 208.159 and 208.201, RSMo 2000. (C) Department. The department, unless otherwise specified, Original rule fil…

ICF/MR Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Absences Due to Hospital Admission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 13 CSR 70-10.080 Prospective Reimbursement Plan for HIV Nursing Facility Services . . . . 112

Nursing Facility Services exception of state programs such as Vocational Rehabilitation and the Missouri Crippled Children’s Services. PURPOSE: This rule establishes a payment plan for HIV nursing (E) The Medicaid reimbursement rate shall be the lower of: facility services. The p…

Health Services in Title XIX Reimbursement Rate Setting . . . . . . . . . . . .127 13 CSR 70-10.110 Nursing Facility Reimbursement Allowance . . . . . . . . . . . . . . . . . . . . . . . .127 13 CSR 70-10.120 Reimbursement for Nurse Assistant Training . . . . . . . . . . . . . . …

*Original authority: 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991, 2007 and 208.201, RSMo 1987, amended 2007. PURPOSE: This regulation is necessary to outline the provisions allowed in House Bill 1362. 13 CSR 70-10.100 Limitation on Allowable Capital Cost PUBLISHER’S …

Training to nursing facilities with valid provider agreements certified by the Department of Social Services, Missouri Medicaid Audit PURPOSE: This rule establishes a methodology for payment of and Compliance (MMAC) for participation in the MO HealthNet nurse assistant training a…

(Rescinded June 30, 2018) nursing facility must be enrolled in the Medicaid program at the time the UPL payments are calculated and made. AUTHORITY: sections 208.153, 208.159 and 208.201, RSMo 2000. 1. A public nursing facility is defined as being owned or Emergency rule filed No…

efits and Limitations PURPOSE: This rule establishes the benefits and limitations for administering the Mis- souri Rx Plan and Missouri’s State Pharmacy Assistance Program. (1) Administration. The Missouri Rx Plan shall be administered by the Department of Social Services, MO Hea…

Methodology who have insurance but are not covered for the particular services, procedures, or treatment rendered. Bad debts do PURPOSE: This rule establishes the legal basis for the administration not include the cost of caring for patients whose insurance of the state agency’s …

tionate Share Hospitals hospitals that are reimbursed under an APR-DRG reimbursement methodology for the following allowable MO HealthNet cost: Emergency rule filed April 21, 1995, effective May 1, 1995, expired 1. The increased MO HealthNet cost resulting from the FRA June 30, 1…

be calculated by dividing the hospital’s inpatient Medicaid PURPOSE: This rule provides for the calculation of the Direct days, FFS and MC, by the total inpatient hospital days from Medicaid payments made on or after July 1, 2019. the base year cost report to arrive at the Medica…

Validation Review of Hospital Admissions . . . . . . . . . . . . . . . . . . . . . . . . . . 16 13 CSR 70-15.030 Payment and Payment Limitations for Inpatient Hospital Care . . . . . . . . 20 13 CSR 70-15.040 Hospital Outpatient Settlements . . . . . . . . . . . . . . . . . . . .…

Inpatient Hospital Care 11, 1981. Amended: Filed Nov. 20, 1981, effective March 11, 1982. Amended: Filed April 14, 1982, effective July 11, 1982. Emergency PURPOSE: This rule establishes payment and payment limitations amendment filed Nov. 24, 1982, effective Dec. 4, 1982, expire…

Twenty-One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Services (Rescinded December 30, 2005) . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

and Continued Days of Stay (Rescinded May 30, 2020) . . . . . . . . . . . . . . . 25 13 CSR 70-15.100 Unreimbursed Care Payment Methodology . . . . . . . . . . . . . . . . . . . . . . . . . 25 13 CSR 70-15.110 Federal Reimbursement Allowance (FRA) . . . . . . . . . . . . . . . . …

the Cost of Care to the Uninsured Provided by Physicians Not Employed by the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Employed by the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 13 CSR 70-15.190 Out-of-State Hospital Services Reimbursement Plan . . . . . . . . . . . . . . . . . . 31 Denny Hoskins (8/31/26) CODE OF STATE REGULATIONS 1 Secretary of…

ment Plan rule filed April 15, 2004, effective Oct. 30, 2004. Emergency amendment filed June 16, 2022, effective July 1, 2022, expired Feb. PURPOSE: This rule establishes the method of reimbursing out- 23, 2023. Amended: Filed June 16, 2022, effective Jan. 30, 2023. of-state hosp…

Ambulatory Surgical Center-Acquired Condition (Rescinded June 30, 2012) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 13 CSR 70-15.220 Disproportionate Share Hospital (DSH) Payments . . . . . . . . . . . . . . . . . . . . 32 13 CSR 70-15.230…

Payments Services (CMS). FFP is not available for DSH payments that are found to exceed the hospital-specific eligible uncompensated PURPOSE: This rule implements a new state methodology for care cost limit. All hospitals that receive DSH payments are paying Disproportionate Shar…

odology E. The calculated IP UPL shall be inflated from the midpoint of the hospital’s cost report period to the midpoint PURPOSE: This rule establishes a methodology for determining of the IP UPL demonstration period using the CMS Prospective Upper Payment Limit (UPL) payments p…

(Rescinded December 30, 2005) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 13 CSR 70-2.100 Title XIX Procedure of Exception to Medical Care Services Limitations . . . . . 3

Care Services Limitations scope of a medical discipline included in the MO HealthNet program and which does not represent a departure from the PURPOSE: This rule establishes the basis, procedure, and criteria accepted standards and precepts of good medical practice; where the sta…

Marrow/Stem Cell Transplants and Related Medical Services . . . . . . . . . . . . . 4 Denny Hoskins (5/31/26) CODE OF STATE REGULATIONS 1 Secretary of State 13 CSR 70-2—DEPARTMENT OF SOCIAL SERVICES DIVISION 70—MO HEALTHNET DIVISION TITLE 13—DEPARTMENT OF SOCIAL SERVICES that spe…