Missouri Administrative Code

tions (Rescinded April 30, 2012) AUTHORITY: section 402.210.6., RSMo 2000, and section 402.215.1., RSMo Supp. 2004. Original rule filed July 30, 1992, effec- tive April 8, 1993. Amended: Filed Nov. 2, 1994, effective March 30, 1995. Amended: Filed April 29, 2005, effective Dec. 3…

(Rescinded April 30, 2012) .................................................................3

(Rescinded April 30, 2012) .................................................................3 ROBIN CARNAHAN (3/31/12) CODE OF STATE REGULATIONS 1 Secretary of State Chapter 4—Fees 21 CSR 10-4 Title 21—MISSOURI FAMILY TRUST Division 10—Director and Board of Trustees Chapter 4—Fee…

during the plan’s regular business hours. The tion Process PURPOSE: This rule establishes the policy of plan’s regular business hours are 8:00 a.m. the board of trustees regarding the general until 4:30 p.m., Central Time Monday PURPOSE: This rule establishes the policy of organi…

(3) Nomination Process. PURPOSE: This rule establishes standards of AUTHORITY: section 103.059, RSMo 2000.* (A) Candidates will be nominated by compliance with Chapter 610, RSMo, as it Original rule filed Dec. 19, 2003, effective means of a nominating petition. relates to public …

vision coverage per a subscriber’s voluntary request. PURPOSE: This rule establishes the policy of the board of trustees in regard to the definitions of the Missouri Consolidated Health (12) Claims administrator. An organization or group responsible Care Plan relative to state me…

child(ren) in an MCHCP dental and/or vision plan when s/ PURPOSE: This rule establishes the policy of the board of trustees he retires if s/he receives a monthly retirement benefit from in regard to the general membership provisions of the Missouri MOSERS and was employed by the …

Consolidated Health Care Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 22 CSR 10-2.030 Contributions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 22 CSR 10-2.040 PPO Plan Sum…

premium with the tobacco-free incentive and the partnership PURPOSE: This rule establishes the policy of the board of trustees incentive. The resulting product is the MCHCP contribution, in regard to the contributions made to the Missouri Consolidated which shall be subtracted fr…

(Rescinded June 30, 2003) E. Medications that exceed drug quantity and day sup- ply limitations; and AUTHORITY: section 103.059, RSMo 2000. Emergency rule filed F. Medications with costs exceeding nine thousand nine Dec. 16, 1993, effective Jan. 1, 1994, expired April 30, 1994. h…

after services have been provided to a member. The retrospec- PURPOSE: This rule establishes the policy of the board of trustees tive review is not limited to an evaluation of medical necessity, in regard to the Plan Utilization Review Policy of the Missouri reimbursement levels,…

Charges will start to pay claims at one hundred percent (100%) for that individual. Once the overall family out-of-pocket maximum is PURPOSE: This rule establishes the policy of the board of trustees met, the plan will start to pay claims at one hundred percent in regard to the P…

Covered Charges will start to pay claims at one hundred percent (100%) for that individual. Once the overall family out-of-pocket maximum is PURPOSE: This rule establishes the policy of the board of trustees met, the plan will start to pay claims at one hundred percent in regard …

(Rescinded June 30, 2011) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

(Rescinded May 30, 2019) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

(Rescinded May 30, 2019) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 22 CSR 10-2.053 Health Savings Account Plan Benefit Provisions and Covered Charges . . . . 28

Provisions and Covered Charges tomary, and reasonable (UCR) limit; the amount the member pays due to noncompliance; and charges above the maximum PURPOSE: This rule establishes the policy of the board of trustees allowed. in regard to the Health Savings Account (HSA) Plan, benefi…

(Rescinded June 30, 2014) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 22 CSR 10-2.055 Medical Plan Benefit Provisions and Covered Charges . . . . . . . . . . . . . . . . . . . 30

Limitations (Rescinded May 30, 2019) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 22 CSR 10-2.061 Plan Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Denny Hoskins (4/30/26) CODE OF ST…

(EE) Medical care and supplies to the extent that they are PURPOSE: This rule establishes the policy of the board of trustees payable under— in regard to the PPO 750 Plan, PPO 1250 Plan, and Health Savings 1. A plan or program operated by a national government Account (HSA) Plan …

(Rescinded June 30, 2003) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 22 CSR 10-2.064 HMO Summary of Medical Benefits (Rescinded June 30, 2011) . . . . . . . . . . . . 38 22 CSR 10-2.065 Staff Model Summary of Medical Benefits (Rescind…

(Rescinded June 30, 2011) (1) If a member is also covered under any other plan (as defined here) and is entitled to benefits or other services for which AUTHORITY: section 103.059, RSMo 2000. Emergency rule filed benefits are also payable under Missouri Consolidated Health Dec. 1…

Medicare Primary Members members is provided through a Pharmacy Employer Group Waiver Plan (EGWP) as regulated by the Centers for Medicare PURPOSE: This rule establishes the policy of the board of trust- & Medicaid Services, hereinafter referred to as the Medicare ees in regard t…

Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 22 CSR 10-2.090 Pharmacy Benefit Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

dollar ($100) copayment; sixty- (60-) day supply has a two hundred dollar ($200) copayment; ninety- (90-) day supply PURPOSE: This rule establishes the policy of the board of trustees at retail has a three hundred dollar ($300) copayment; and in regard to the benefit provisions, …

(Rescinded May 30, 2013) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 22 CSR 10-2.092 Dental Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 22 CSR 10-2.093 Vision Cove…

eligible to participate in the Tobacco-Free Incentive: PURPOSE: This rule establishes the policy of the board of trust- (A) Active employee subscribers; (B) Non-Medicare spouses covered by a Tobacco-Free ees in regard to dental coverage for members of the Missouri Incentive eligi…

sions continuously covered on the plan for the child of the depen- dent to remain eligible; or PURPOSE: This rule establishes the policy of the board of trustees (X) Child for whom the subscriber or spouse is re- in regard to the general membership provisions for foster parents q…

Limitations (G) The Partnership Incentive shall begin January 1 and end December 31 of each plan year. PURPOSE: This rule establishes the policy of the board of trustees in regards to the Strive for Wellness® Partnership Incentive and the (6) A waiver may be granted, in whole or …

(Rescinded January 30, 2014) (A) The following MCHCP eligibles are not able to utilize the health center: AUTHORITY: section 103.059, RSMo 2000, and section 103.080.3., 1. Active employees and members who are not enrolled in RSMo Supp. 2012. Emergency rule filed Oct. 30, 2012, ef…

5. Pharmacy services; PURPOSE: This rule establishes the policy of the board of trustees 6. Occupational, speech, and physical therapy services; in regard to a subscriber’s objection to contraception coverage due and to religious or moral objections. 7. Chiropractic services. (1)…

sions, Charges, and Services 29, 2025. Amended: Filed Oct. 25, 2024, effective May 30, 2025. PURPOSE: This rule establishes the policy of the board of trustees *Original authority: 103.059, RSMo 1992. in regard to provisions, charges, and services available to mem- bers of the Mi…

(Rescinded May 30, 2017) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 22 CSR 10-2.160 Pharmacy Lock-In Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60 2 CODE OF STATE REGULATIONS Denny Hos…

; and PURPOSE: This rule establishes the policy of the board of trustees (C) Pharmacy change requests will be reviewed and decided to implement a method to limit or restrict a member’s use of his or by the PBM. her pharmacy benefit to a designated pharmacy. AUTHORITY: section 103…

vision coverage per a subscriber’s voluntary request. PURPOSE: This rule establishes the policy of the board of trustees in regard to the definitions of the Missouri Consolidated Health (12) Claims administrator. An organization or group responsible Care Plan relative to public e…

2. An employer-sponsored (but no contribution made by Participation Period employer) retirement plan in which the employee is currently PURPOSE: This rule establishes the policy of the board of trustees participating or from which the employee is eligible to receive in regard to …

(Rescinded June 30, 2011). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

(Rescinded June 30, 2011) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

(Rescinded June 30, 2011). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

(Rescinded May 30, 2019). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

(Rescinded June 30, 2014) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 22 CSR 10-3.055 Health Savings Account Plan Benefit Provisions and Covered Charges . . . . 18

Provisions and Covered Charges include, but are not limited to charges above the usual, customary, and reasonable (UCR) limit; the amount the PURPOSE: This rule establishes the policy of the board of trustees member pays due to noncompliance; and charges above the in regard to th…

(Rescinded May 30, 2019). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 22 CSR 10-3.057 Medical Plan Benefit Provisions and Covered Charges . . . . . . . . . . . . . . . . . . 20 22 CSR 10-3.058 PPO 750 Plan Benefit Provisions and Cover…

Charges 10. Chiropractic services—manipulation and adjunct therapeutic procedures/modalities; PURPOSE: This rule establishes the policy of the board of trustees 11. Clinical trials. Routine member care costs incurred as in regard to the medical plan benefit provisions and covered…

Limitations (Rescinded May 30, 2019) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 22 CSR 10-3.061 Plan Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Denny Hoskins (4/30/26) CODE OF ST…

writing prior to reducing or ending a previously approved PURPOSE: This rule establishes the policy of the board of trustees course of treatment in sufficient time to allow the member, or in regard to review and appeals procedures for participation in, the member’s provider, to a…

seven dollars and fifty cents ($37.50) for up to a ninety- (90-) day PURPOSE: This rule establishes the policy of the board of trustees supply for a generic drug on the formulary; in regard to the Pharmacy Benefit Summary for the PPO 750 Plan, (b) Preferred formulary brand drug c…

if such items or procedures are contrary to his/her religious PURPOSE: This rule establishes the policy of the board of trustees in beliefs or moral convictions. regard to vision coverage for members of the Missouri Consolidated (2) A subscriber must notify Missouri Consolidated …

2018. PURPOSE: This rule establishes the policy of the board of trustees *Original authority: 103.059, RSMo 1992 and 103.080, RSMo 2007, amended 2011. in regard to the fully-insured plan provisions of the Missouri Consolidated Health Care Plan relative to public entities and publ…

(Rescinded January 30, 2014) Consolidated Health Care Plan’s (MCHCP) non-Medicare primary medical plan members that have been identified as AUTHORITY: section 103.059, RSMo 2000, and section 103.080.3., misutilizing pharmacy benefits. RSMo Supp. 2012. Emergency rule filed Oct. 30…