Missouri Administrative Code

and Licensing Procedures and Standards PURPOSE: This rule prescribes the applica- tion process, fees, examination, and initial training for navigators. (1) Application and Fees. Application for a navigator license shall include the following, as applicable: (A) Initial Licensure.…

for Individual Navigators tion Requirements. (A) Any individual licensed as a navigator PURPOSE: This rule establishes the contin- shall complete courses or programs of uing education requirements for individual instruction equivalent to a total of at least navigators. All forms …

Entity Navigators ..........................................................................14 JOHN R. ASHCROFT (10/31/19) CODE OF STATE REGULATIONS 1 Secretary of State Chapter 11—Navigators 20 CSR 400-11 Title 20—DEPARTMENT OF COMMERCE AND INSURANCE Division 400—Life, Annuities…

ance Pool Transitional Plan of Operations 376.964, RSMo 1990, amended 2007, 2013; 376.965, RSMo 1991; 376.966, RSMo 1990, amended 2007, 2009, 2013; 376.968, RSMo 1990, amended 2013; 376.970, PURPOSE: This rule prescribes the transi- RSMo 1990, amended 2013; and 376.973, RSMo 1990…

subsection (5)(A), which shall not include adjustments that PURPOSE: This rule prescribes the form and content of the rate account for the morbidity of the population expected to information required to be submitted to the Missouri Department enroll in the plan. Such component fa…

ment may submit such a request in writing to PURPOSE: This rule outlines the procedures the director, outlining its qualifications. The by which the department will ensure access to director has sole discretion to determine binding arbitration when there is a dispute whether or n…

and Sickness Coverage from hospitalization, with cash benefits derived being payable daily, weekly or monthly or in any other manner. PURPOSE: This rule allows persons ten days following the date of delivery in which to examine accident or health insurance (2) No policy, rider en…

by Government Hospital hearing-aid programs, may be excluded from the definition of allowable expense. A plan which provides benefits only for any PURPOSE: This rule prohibits insurers from refusing to pay of these items of expense may limit its definition of allowable benefits u…

(Rescinded July 30, 2019) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

(Rescinded September 30, 2019). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 20 CSR 400-2.060 Policy Approval Criteria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 20 CSR 400-2.065 Actual Payment as Basis …

(D) No hospital reimbursement policy may exclude payment PURPOSE: This rule specifies the criteria that must be found in for services rendered in a government or state hospital if the policies of accident and health insurance before the director insured is legally required to pay…

property and casualty insurance policy; (Rescinded September 30, 2019) (E) “Health services,” any service or product for which provision for benefits has been made under a health plan, AUTHORITY: sections 354.120, 374.045, 376.395, 376.397, 376.398, including but not limited to, …

(Rescinded September 30, 2019) to the following: John R. Ashcroft (4/30/24) CODE OF STATE REGULATIONS 13 Secretary of State DIVISION 400—LIFE, ANNUITIES 20 CSR 400-2—DEPARTMENT OF COMMERCE AND HEALTH AND INSURANCE (A) Any coverage solicited or sold in this state, whether by direc…

(Rescinded September 30, 2019). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Infection (Rescinded September 30, 2019) . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 20 CSR 400-2.130 Group Health Filings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Employers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 20 CSR 400-2.140 Speech and Hearing Disorders—Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . 23 John R. Ashcroft (4/30/24) CODE OF STATE REGUL…

(Voided: December 27, 1995) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 20 CSR 400-2.160 Mental Health Services Allowed Out-of-Network . . . . . . . . . . . . . . . . . . . . . 24 20 CSR 400-2.165 Access to Providers for Treatment of Mental He…

that claims submitted by First Steps are not denied, delayed, or PURPOSE: This rule implements the requirements of section reduced for reasons related to network participation. 376.1218, RSMo, with respect to the Missouri early intervention system and clarifies insurance carriers…

#641 in October 2007, or any form which (Form LTC-7), revised on March 10, 2008, PURPOSE: This rule prescribes the general substantially comports with the specified or any form which substantially comports filing requirements for the rules in this chap- form; with the specified f…

Care Partnership Program alternative inflation protection method so additional benefits under the insurer’s new long as such method is submitted to the direc- business, long-term care, underwriting guide- PURPOSE: This rule prescribes the addition- tor with an explanation and dem…

Computation of Reserves 354.080, RSMo financial reserve require- ments pursuant to section 374.055, RSMo. PURPOSE. This regulation specifies that cur- PURPOSE: This regulation describes the rent bylaws must be filed with the Department method of establishment and computation of A…

(Rescinded September 30, 2019)...........................................................3 20 CSR 400-6.300 Ambulatory Surgical Centers (Rescinded September 30, 2019) .......................3 20 CSR 400-6.400 Benefit Payment Standards (Rescinded September 30, 2019) ..............…

bership contract. Any factors which would Centers provide security for payment comparable to (Rescinded September 30, 2019) the reserve will be considered. (B) The director will consider the fact that AUTHORITY: sections 197.240, 354.085, a newly formed corporation might increase…

(Rescinded September 30, 2019)............................................................3

of Authority (Rescinded May 30, 2019) ...................................................3 20 CSR 400-7.030 Mandatory Provisions—All Contracts.......................................................3

(7) Eligibility. A statement of the eligibility All Contracts sion stating that the contract and any attach- requirements for coverage including: ments constitute the entire contract between (A) The condition under which dependent PURPOSE: This rule sets forth the provisions the …

of Coverage .....................................................................................4

Evidences of Coverage........................................................................4 20 CSR 400-7.060 Integration With Other Benefits (Rescinded September 30, 2019).....................5 20 CSR 400-7.070 Bonding Requirements (Rescinded September 30, 2019)...............…

Benefits administrative arrangements and other perti- nent information; 4. Population figures shall be based on (Rescinded September 30, 2019) (B) Biographical data sheets for the man- census data as reported in the latest edition of agement staff assigned to the new area; the Of…

the new service area have produced a net ment of Commerce and Insurance. (Rescinded September 30, 2019) income for twelve (12) consecutive months (E) Distance standard—The travel distance and proposed advertising and sales materials; standards set forth in Exhibit A, which is AUT…

visions jections for the period from the beginning of area. (Rescinded September 30, 2019) operations until operations in the new area (F) Employer specific network—A network will have produced a net income for twelve created for a specific employer group that dif- AUTHORITY: sec…

(Rescinded September 30, 2019) making body shall be those selected by either copy of the binder or a letter signed by an an enrollee advisory committee, the composi- officer of the reinsurer explaining the cir- AUTHORITY: sections 354.430 and 354.485, tion of which is set forth i…

(Rescinded September 30, 2019) ..........................................................13 20 CSR 400-7.120 Health Maintenance Organizations—Enrollee Participation............................13

Organizations—Enrollee Participation 20 CSR 400-7.130 Authorization for Emer- gency Medical Services (5) Discipline. The director of the Depart- PURPOSE: This rule sets forth the health (Rescinded September 30, 2019) ment of Commerce and Insurance may insti- maintenance organizat…

(Rescinded September 30, 2019) ..........................................................13 20 CSR 400-7.140 Health Maintenance Organizations—Reinsurance Agreements ........................13 JOHN R. ASHCROFT (10/31/19) CODE OF STATE REGULATIONS 1 Secretary of State…

(Rescinded September 30, 2019) ..........................................................13 20 CSR 400-7.160 Multiple Names Prohibited (Rescinded September 30, 2019).........................14

the Council for Affordable Quality Health- ited duction in paper, electronic, or Internet based care, 601 Pennsylvania Avenue NW, South (Rescinded September 30, 2019) formats. Health carriers and their agents shall Building, Suite 500, Washington, DC 20004, has been adopted and s…

(Rescinded September 30, 2019) ..........................................................14 20 CSR 400-7.180 Standard Form To Establish Credentials ..................................................14 20 CSR 400-7.200 Provider Selection Standards (Rescinded September 30, 2019)...…

Establish Credentials submitted by the Missouri health care profes- *Original authority: 354.442, RSMo 1997 and 354.485, RSMo 1983, amended 2007. sional is Form UCDS or any other form PURPOSE: This rule sets forth the standard approved pursuant to this rule. Requests for form whi…

Community-Based Health Maintenance Organization (Rescinded September 30, 2019) ..........................................................14 20 CSR 400-7.400 Pharmacies and Prescription Drugs (Rescinded September 30, 2019)...............14 2 CODE OF STATE REGULATIONS (10/31/19) JO…

(Rescinded September 30, 2019) (Rescinded September 30, 2019) AUTHORITY: sections 287.310, RSMo Supp. AUTHORITY: section 374.184, RSMo 1992, 374.045, RSMo Supp. 1993, 374.230, (1994). Original rule filed Nov. 29, 1993, RSMo Supp. 1989, 375.920, 376.405, effective Jan. 1, 1995. Am…

or Health Policies, Contracts, or Related Forms (Rescinded September 30, 2019)...........................................................3 20 CSR 400-8.300 Uniform Health Care Billing Forms (Rescinded September 30, 2019)...............3 JOHN R. ASHCROFT (8/31/19) CODE OF STATE RE…

(Rescinded September 30, 2019) AUTHORITY: sections 143.999 and 374.045, RSMo 1994. Original rule filed March 23, 1995, effective Nov. 30, 1995. Rescinded: Filed March 8, 2019, effective Sept. 30, 2019. JOHN R. ASHCROFT (8/31/19) CODE OF STATE REGULATIONS 3 Secretary of State…

records, memoranda, books and papers designated by the PURPOSE: This rule provides for the keeping of certain public util- commission for inspection and examination of the commission ity accounts, records, memoranda, books and papers required by or its officers and employees, at …

times, duration and cause of each interruption. These records PURPOSE: This rule prescribes standards of quality for electric, gas shall be filed, made available for inspection by the commission, and water utilities operating under the jurisdiction of the Public and preserved for…

Customers of Electric, Gas, Water, and Steam Heat Utilities . . . . . . . . . 10 20 CSR 4240-10.060 Gross Receipts Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 20 CSR 4240-10.075 Staff Assisted Rate Case Procedure . . . . …

Utilities records relating to contributions in aid of construction (CIAC) amounts, including: PURPOSE: The purpose of this proposed rule is to create a process A. Accounting records and other relevant documenta- for a water or sewer utility to propose an acquisition incentive to …

(Rescinded March 30, 2025) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Heating Utility Applications for Authority to Sell, Assign, Lease, or Transfer Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15