Missouri Administrative Code
8,209 sections across 1,588 Missouri regulatory chapters.
13-70-20-13 CSR 70-20.330 Medication Therapy Management (MTM)
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Program (B) Providing medication education; (C) Providing self-care education for specific chronic PURPOSE: This rule establishes the regulatory basis for the conditions; administration of the MO HealthNet Medication Therapy (D) Contacting physicians to schedule diagnostic testin…
Chapter 13-70-20Open chapter PDF ↗13-70-20-13 CSR 70-20.340 National Drug Code Requirement
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PURPOSE: This rule implements the National Drug Code (NDC) requirement for all medications administered in the clinic or outpatient hospital setting. The Deficit Reduction Act of 2005 (DRA) requires states to collect rebates for certain physician- administered drugs. (1) Drug cha…
Chapter 13-70-20Open chapter PDF ↗13-70-25-13 CSR 70-25.100 Abortions
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tion available to eligible participants. The components of the PURPOSE: This rule complies with Federal Law and rules relating general physical examination shall include a comprehensive to abortions and maintains compliance with the requirements of health and developmental histor…
Chapter 13-70-25Open chapter PDF ↗13-70-25-13 CSR 70-25.110 Payment for Early Periodic Screening, Diagnostic, and Treatment
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Program Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 13-70-25Open chapter PDF ↗13-70-25-13 CSR 70-25.120 MO HealthNet (Medicaid) Payment for Certain Services Furnished by
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Certain Physicians in Calendar Years 2013 and 2014 (Rescinded September 30, 2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 13 CSR 70-25.130 Diabetes Prevention Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1…
Chapter 13-70-25Open chapter PDF ↗13-70-25-13 CSR 70-25.130 Diabetes Prevention Program
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one hundred twenty-five (125) mg/dl; or PURPOSE: The purpose of this rule is to establish the Department 3. Two (2) hour plasma glucose of one hundred forty (140) of Social Services’ MO HealthNet Division guidelines regarding to one hundred ninety-nine (199) mg/dl after the seven…
Chapter 13-70-25Open chapter PDF ↗13-70-25-13 CSR 70-25.140 Biopsychosocial Treatment of Obesity for
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Youth and Adults of BMI values as expressed in percentiles for age and gender as plotted on the pediatric BMI chart. PURPOSE: This rule establishes the MO HealthNet payment policy B. “Pediatric Body Mass Index (BMI) Chart” means a for the biopsychosocial treatment of obesity for …
Chapter 13-70-25Open chapter PDF ↗13-70-25-13 CSR 70-25.150 Payment Policy for Asthma Education and In-Home Environmental
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Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 13 CSR 70-25.160 Doula Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Denny Hoskins (5/31/26…
Chapter 13-70-25Open chapter PDF ↗13-70-25-13 CSR 70-25.160 Doula Services
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program and be deemed competent to provide doula services. PURPOSE: This rule establishes the Department of Social Ser- Certification is attained after evaluation by a birth professional vices’ MO HealthNet Division guidelines regarding coverage and or trainer; reimbursement for …
Chapter 13-70-25Open chapter PDF ↗13-70-26-13 CSR 70-26.010 MO HealthNet Program Benefits for Federally-Qualified Health
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Center Services................................................................................3 JOHN R. ASHCROFT (4/30/19) CODE OF STATE REGULATIONS 1 Secretary of State Chapter 26—Federally-Qualified Health Center Services 13 CSR 70-26 Title 13—DEPARTMENT OF Net charges shall i…
Chapter 13-70-26Open chapter PDF ↗13-70-3-13 CSR 70-3.020 Title XIX Provider Enrollment
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(Rescinded March 30, 2022) at which the service was rendered, unless the services were provided in the participant’s home, via a mobile unit, or AUTHORITY: sections 208.159, 208.164, and 210.924, RSMo 2000 other circumstance that would require the records be kept at and sections …
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.030 Administrative Actions for Improperly Paid, False, or Fraudulent
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Claims for MO HealthNet Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.035 Violations Attested to by the Department of Health and Senior
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Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.040 Duty of Medicaid Participating Hospitals and Other Vendors to Assist
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in Recovering Third-Party Payments (Rescinded November 30, 2018) . . . 9
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.050 Obtaining Information From Providers of Medical Services
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(Rescinded February 28, 2022) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.060 Medicaid Program Payment of Claims for Medicare Part B Services
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(Rescinded August 11, 1988) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 13 CSR 70-3.100 Filing of Claims, MO HealthNet Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 13 CSR 70-3.105 Timely Payment of MO HealthNet Claims . .…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.110 Second Opinion Requirement Before Nonemergency Elective Surgical
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Operations (Rescinded June 30, 2011) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.120 Limitations on Payment of Out-of-State Nonemergency Medical
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Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.130 Computation of Provider Overpayment by Statistical Sampling
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(Rescinded April 30, 2019) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 13 CSR 70-3.140 Direct Deposit of Provider Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . 13 13 CSR 70-3.150 Authorization To Receive Payment for Med…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.140 Direct Deposit of Provider Reimbursement
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effective March 30, 2022. PURPOSE: This rule requires the direct deposit of MO HealthNet *Original authority: 208.201, RSMo 1987, amended 2007, and 660.017, RSMo 1993, provider payments and describes the procedure by which those amended 1995. payments will be made. PUBLISHER’S NO…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.160 Electronic Submission of MO HealthNet Claims and Electronic
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Remittance Advices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Denny Hoskins (1/29/26) CODE OF STATE REGULATIONS 1 Secretary of State…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.170 Medicaid Managed Care Organization Reimbursement Allowance
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(Rescinded November 30, 2021) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 13 CSR 70-3.180 Medical Pre-Certification Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 13 CSR 70-3.190 Telehealth Services (Rescinded Janua…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.180 Medical Pre-Certification Process
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PURPOSE: This rule establishes the medical pre-certification (6) Pre-certifications for exactly the same service may be process of the MO HealthNet Program for certain covered diagnostic granted to allow provision over an extended period of time and and ancillary procedures and s…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.190 Telehealth Services
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in paragraph (1)(A)5. (Rescinded January 30, 2019) A. Exceptions. AUTHORITY: section 208.201, RSMo Supp. 2008. Original rule filed (I) For emergency ambulance providers without Jan. 2, 2008, effective Aug. 30, 2008. Amended: Filed Feb. 17, 2009, reported data, emergency transport…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.200 Ambulance Service Reimbursement
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Allowance (b) Emergency transport mileage shall be individually summed and divided by the total emergency PURPOSE: This rule establishes the formula for determining ambulance transports in the quartile to yield an average per the Ambulance Service Reimbursement Allowance each gro…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.210 Electronic Retention of Records
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written notice of the final determination of its ambulance service reimbursement allowance, may file a protest with the PURPOSE: This rule advises MO HealthNet providers of the director of the department setting forth the grounds on which opportunity to store records on an electr…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.220 Electronic Health Record Incentive Program
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(I) Their individual Medicaid patient encounters as a PURPOSE: The Health Information Technology and Clinical Health percentage of their total individual encounters; or Act (HITECH) offers incentive payments to encourage eligible (II) The practice’s total Medicaid encounters as a…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.230 Payment Policy for Provider Preventable
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Conditions the occurrence of HCACs based on the POA indicator, and calculate the payment recoupments based on the facts of each PURPOSE: This rule establishes the MO HealthNet payment policy HCAC, for hospitals reimbursed on a per diem. for services provided by acute care hospita…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.240 MO HealthNet Primary Care Health Homes
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(E) It must utilize an interoperable patient registry to input PURPOSE: This rule establishes the MO HealthNet Primary Care annual metabolic screening results, track and measure care of Health Home program for MO HealthNet participants with individuals, automate care reminders, a…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.260 Payment Policy for Asthma Education and In-Home Environmental
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Assessments (Moved to 13 CSR 70-25.150) . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 13 CSR 70-3.280 Home and Community-Based Services Waiver Definitions . . . . . . . . . . . . 24
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.280 Home and Community-Based Services
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Waiver Definitions (8) “Missouri Medicaid Audit and Compliance Unit (MMAC)” is the unit within the Department of Social Services that is PURPOSE: This rule defines terms used in 13 CSR 70-3.290, which responsible for the oversight and auditing of compliance for 24 CODE OF STATE R…
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.290 Home and Community-Based Services Waiver Setting
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Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.300 Complementary Health and Alternative Therapies for Chronic Pain
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Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 13 CSR 70-3.310 Chiropractic Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 13 CSR 70-3.320 Electronic Visit …
Chapter 13-70-3Open chapter PDF ↗13-70-3-13 CSR 70-3.320 Electronic Visit Verification (EVV)
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solution. PURPOSE: This rule sets forth requirements for use of electronic (M) “Self-Directed Services” shall mean a service delivery verification of services that the MO HealthNet Division may option in which a MO HealthNet participant employs a direct identify and provide to a …
Chapter 13-70-3Open chapter PDF ↗13-70-30-13 CSR 70-30.010 Podiatric Services Pro-
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gram as 13 CSR 40-81.130. Original rule filed Dec. 1, 1978, effective March 11, 1979. PURPOSE: This rule establishes the basis for Emergency amendment filed May 18, 1979, administering the podiatric service, including effective July 1, 1979, expired Sept. 13, the designation of p…
Chapter 13-70-30Open chapter PDF ↗13-70-35-13 CSR 70-35.010 Dental Benefits and
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Limitations, MO HealthNet Program shall be licensed in his/her specialty area by ticipant on the date the service is performed. the dental board of the state in which s/he is The division reserves the right to request doc- PURPOSE: This rule describes the dental practicing. In th…
Chapter 13-70-35Open chapter PDF ↗13-70-4-13 CSR 70-4.030 Participant Liability for Medical Services Not Reimbursable to the
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Provider by the MO HealthNet Agency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 13 CSR 70-4.040 Eligibility Corrective Action Participant Payments . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 13-70-4Open chapter PDF ↗13-70-4-13 CSR 70-4.040 Eligibility Corrective Action Participant
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PURPOSE: This rule establishes the guidelines for determination of Payments participant liability for medical services not reimbursable to the provider by the MO HealthNet agency. PURPOSE: This rule establishes the basis on which participants may be reimbursed by the MO HealthNet…
Chapter 13-70-4Open chapter PDF ↗13-70-4-13 CSR 70-4.050 Copayment and Coinsurance for Certain Medicaid-Covered Services
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(Rescinded March 30, 2022) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 13 CSR 70-4.051 Copayment for Pharmacy Services (Rescinded November 30, 2022) . . . . . . . 4
Chapter 13-70-4Open chapter PDF ↗13-70-4-13 CSR 70-4.051 Copayment for Pharmacy Services
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(Rescinded November 30, 2022) 13, 1989. Amended: Filed Aug. 1, 2003, effective Feb. 29, 2004. Rescinded: Filed June 8, 2018, effective Jan. 30, 2019. AUTHORITY: sections 208.153 and 208.201, RSMo 2016, and section 208.152, RSMo Supp. 2018. This rule was previously filed as 13 CSR…
Chapter 13-70-4Open chapter PDF ↗13-70-4-13 CSR 70-4.060 Required Reporting of Injuries Received by MO HealthNet
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Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 13 CSR 70-4.070 Title XIX Recipient Lock-In Program (Rescinded January 30, 2019) . . . . . . . . 4 13 CSR 70-4.080 State Children’s Health Insurance Prog…
Chapter 13-70-4Open chapter PDF ↗13-70-4-13 CSR 70-4.090 State-Funded Missouri Woman’s Health
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Services Program any applicant or participant whose claim for benefits under the State-Funded Missouri Woman’s Health Services Program PURPOSE: This rule establishes the State-Funded Missouri is denied by the MO HealthNet Division. The state hearing Woman’s Health Services Progra…
Chapter 13-70-4Open chapter PDF ↗13-70-4-13 CSR 70-4.100 Preventing Medicaid Payment of Expenses
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Used to Meet Spenddown disabled, or other medical institution, the Department of Social Services will determine if the placement of a lien against the PURPOSE: This rule establishes the basis on which the Medical property of the applicant or participant is applicable. A lien Assi…
Chapter 13-70-4Open chapter PDF ↗13-70-4-13 CSR 70-4.110 Placement of Liens on Property of Certain Institutionalized
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MO HealthNet Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Chapter 13-70-4Open chapter PDF ↗13-70-4-13 CSR 70-4.120 Department is the Payer of Last Resort, Department’s Claim for
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Recovery, Participant’s Duty of Cooperation . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Denny Hoskins (3/31/25) CODE OF STATE REGULATIONS 1 Secretary of State 13 CSR 70-4—DEPARTMENT OF SOCIAL SERVICES DIVISION 70—MO HEALTHNET DIVISION TITLE 13—DEPARTMENT OF SOCIAL SER…
Chapter 13-70-4Open chapter PDF ↗13-70-40-13 CSR 70-40.010 Optical Benefits and
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Limitations—MO HealthNet Program have a current MO HealthNet participation (K) Special lenses. agreement and provider number; (L) Miscellaneous repairs. PURPOSE: This rule establishes the basis for (B) A physician must be a duly licensed (M) Scleral cover shell, stock, or custom.…
Chapter 13-70-40Open chapter PDF ↗13-70-45-13 CSR 70-45.010 Hearing Aid Program
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assistance as outlined in the provider program The participant must receive a medical ear PURPOSE: This rule is to establish the regu- manual. The provider shall ascertain the examination for pathology or disease by a latory basis for the administration of the patient’s MO Health…
Chapter 13-70-45Open chapter PDF ↗13-70-5-13 CSR 70-5.010 Nonemergency Medical Transportation
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(NEMT) Services Feb. 1, 2008, effective Aug. 30, 2008. Amended: Filed Aug. 27, 2020, effective March 30, 2021. Amended: Filed May 23, 2022, effective PURPOSE: This rule establishes the criteria by which the MO Nov. 30, 2022. HealthNet Division (MHD) reimburses expenses for noneme…
Chapter 13-70-5Open chapter PDF ↗13-70-50-13 CSR 70-50.010 Hospice Services Pro-
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gram (A) Hospice services for a child under any subsequent election periods without a twenty-one (21) years of age may be concur- break in care as long as the individual remains PURPOSE: This rule establishes the MO rent with the care related to curative treat- in the care of the…
Chapter 13-70-50Open chapter PDF ↗13-70-55-13 CSR 70-55.010 MO HealthNet Program
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Benefits for Nurse-Midwife Services must be a currently licensed registered nurse 1967, amended 1967, 1973, 1989, 1990, 1991, 2007, 2012; 208.201, RSMo 1987, amended 2007; and 660.017, (RN) in that state and be legally authorized RSMo 1993, amended 1995. PURPOSE: This rule establ…
Chapter 13-70-55Open chapter PDF ↗