Missouri Administrative Code

Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 13 CSR 70-3.310 Chiropractic Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 13 CSR 70-3.320 Electronic Visit …

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 …

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…

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…

Provider by the MO HealthNet Agency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 13 CSR 70-4.040 Eligibility Corrective Action Participant Payments . . . . . . . . . . . . . . . . . . . . . . 3

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…

(Rescinded March 30, 2022) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 13 CSR 70-4.051 Copayment for Pharmacy Services (Rescinded November 30, 2022) . . . . . . . 4

(Rescinded November 30, 2022) 13, 1989.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 Rescinded: Filed June 8, 2018, effective Jan. 30, 2019.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…

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 . 4 13 CSR 70-4.070 Title XIX Recipient Lock-In Program (Rescinded January 30, 2019) .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…

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…

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…

MO HealthNet Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Recovery, Participant’s Duty of Cooperation . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Denny Hoskins (7/31/26) 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…

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.…

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…

(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…

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…

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…

gram in effect with the Missouri Department of Social Services, PURPOSE: This rule establishes the regulatory basis for the admin- MO HealthNet Division. istration of the emergency ambulance program. This rule provides for such methods and procedures relating to the utilization o…

Reimbursement Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Denny Hoskins (5/31/26) CODE OF STATE REGULATIONS 1 Secretary of State 13 CSR 70-6—DEPARTMENT OF SOCIAL SERVICES DIVISION 70—MO HEALTHNET DIVISION TITLE 13—DEPARTMENT…

ment Program 6, 2019. This rule does not incorporate any (5) Provider Participation. subsequent amendments or additions. (A) The following types of providers may PURPOSE: This rule establishes the regula- be reimbursed by MO HealthNet for items tory basis for the administration o…

Program to rehabilitation center providers by amend- Division. Providers must bill their usual and ing this rule. customary charge for rehabilitation center PURPOSE: This rule establishes the regulato- services. Reimbursement will not exceed the ry basis for the administration of…

the Therapy Provider Manual. The provider shall ascertain the PURPOSE: This rule establishes the regulatory basis for the patient’s MO HealthNet status before any service is performed. administration of the therapy program. This rule provides for The participant’s eligibility sha…

A. A Medicaid managed-care program other than PACE; PURPOSE: This rule establishes the requirements for agencies B. A hospice program; contracting to provide services to eligible participants through the C. A Medicaid 1915(c) home and community-based MO HealthNet Division’s (MHD)…

Providers 1991, 2007, 2012, 2024; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995. PURPOSE: This rule establishes a process of cooperation between the MO HealthNet Division (MHD) and Program of All-Inclusive Care for the Elderly (PACE) organizations and the…

(D) Intermittent home health aide; and PURPOSE: This rule provides the regulatory basis for payment (E) Supplies identified as specific and necessary to the de- for home health-care services provided to MO HealthNet-eligible livery of a participant’s nursing care and prescribed i…

per month. Any service plan developed in accordance with PURPOSE: Personal care services are medically-oriented services paragraphs (1)(B)2. and 3. is a state-approved service plan. provided in the individual’s home, or in a licensed Residential 4. The participant will be informe…

(Rescinded June 30, 2018). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 13 CSR 70-91.030 Personal Care Assistance (Rescinded December 30, 2010). . . . . . . . . . . . . . . 8 John R. Ashcroft (7/31/23) CODE OF STATE REGULATIONS 1 Secretary…

Program (Rescinded December 30, 2015) AUTHORITY: sections 208.153 and 208.201, RSMo Supp. 2007 and sections 208.159 and 208.168, RSMo 2000. This rule was previ- ously filed as 13 CSR 40-81.126. Original rule filed May 13, 1983, effective Aug. 11, 1983. Amended: Filed June 3, 1993…

(Rescinded August 30, 2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

(Rescinded August 30, 2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 JOHN R. ASHCROFT (7/31/18) CODE OF STATE REGULATIONS 1 Secretary of State Chapter 93—Medicaid Clinic Program 13 CSR 70-93 Title 13—DEPARTMENT OF SOCIAL SERVICES Division 70—MO HealthN…

provided by the division for that purpose. PURPOSE: This rule establishes the regulatory basis for Title XIX A. An independent RHC may be exempt from filing a Medicaid payment for Independent Rural Health Clinic Services. Medicaid cost report if there is no MO HealthNet reimburse…

Health (ToRCH) due to better condition management; (H) “Rural community health hub” shall mean a partnership PURPOSE: This rule establishes the Transformation of Rural among the ToRCH entity, primary care, behavioral health, Community Health (ToRCH) program. The purpose of ToRCH …

emergency situations. Services reimbursed by MO HealthNet PURPOSE: This rule establishes the basis for MO HealthNet may not exceed the prior authorization approved by the enrollment and reimbursement of providers of private duty Bureau of Special Health Care Needs, therefore, any…

(Rescinded June 30, 2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 JOHN R. ASHCROFT (5/31/18) CODE OF STATE REGULATIONS 1 Secretary of State Chapter 96—Medicaid Primary and Prenatal Care Clinic Program 13 CSR 70-96 Title 13—DEPARTMENT OF SOCIAL SERVI…

Program terminated unless good cause for failure to cooperate is estab- lished. Good cause for failure to cooperate shall be established PURPOSE: This rule establishes that the Department of Social when the applicant, participant, parent, guardian, or caretaker Services, MO Healt…

(C) Use of the DSM-5-TRTM will be allowed when assessing PURPOSE: This rule establishes the regulatory basis for the pro- children zero through five (0–5) years of age until January 1, gram requirements of the MO HealthNet behavioral health ser- 2029, at which time the DC:0-5TM w…

Health Services (Rescinded November 30, 2024) . . . . . . . . . . . . . . . . . . . . . 3 13 CSR 70-98.030 Applied Behavior Analysis Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Denny Hoskins (6/30/26) CODE OF STATE REGULATIONS 1 Secretary of State…

Rehabilitation Program MO HealthNet Division or its designee. for half-day (three (3) to four (4) hours) and full day (five (5) or more hours) units when PURPOSE: This rule establishes the regula- (2) Persons Eligible. Prior authorized Com- the participant meets the admission cri…

(Moved to 19 CSR 73-1.010) MATT BLUNT (7/31/03) CODE OF STATE REGULATIONS 3 Secretary of State

(Moved to 19 CSR 73-2.010)

(Moved to 19 CSR 73-2.015) 13 CSR 73-2.060 Registration of Training 13 CSR 73-2.020 Procedures and Require- Agencies and Single Offering Providers ments for Licensure of Nursing Home (Moved to 19 CSR 73-2.060) Administrators (Moved to 19 CSR 73-2.020) 13 CSR 73-2.065 Reciprocity …

Nursing Home Administrators (Moved to 19 CSR 73-2.020)..........................3 13 CSR 73-2.025 Licensure by Reciprocity (Moved to 19 CSR 73-2.025) .................................3 13 CSR 73-2.030 Examination (Rescinded August 11, 1980)........................................…

(Moved to 19 CSR 73-2.025) AUTHORITY: section 344.070, RSMo Supp. 1993. Original rule filed April 18, 1990,

(Rescinded August 11, 1980) Jan. 31, 1996, effective July 30, 1996. AUTHORITY: section 344.070, RSMo 1978. Original rule filed March 5, 1974, effective 13 CSR 73-2.070 Examination March 15, 1974. Rescinded: Filed May 13, (Moved to 19 CSR 73-2.070) 1980, effective Aug. 11, 1980.…

Instruction and Training (Moved to 19 CSR 73-2.080) (Moved to 19 CSR 73-2.031)

(Rescinded August 11, 1980) AUTHORITY: section 344.070, RSMo 1978. 13 CSR 73-2.090 Disciplinary Action Original rule filed March 5, 1974, effective (Moved to 19 CSR 73-2.090) March 15, 1974. Rescinded: Filed May 13, 1980, effective Aug. 11, 1980.