Title XII, PUBLIC HEALTH AND WELFARE

208.1410. Doula care coverage. — Any eligible participant shall be entitled to MO HealthNet coverage of the following doula care and doula services: (1) A combined total of at least six support sessions. A participant who needs more than six support sessions shall be entitled to …

208.1415. Doula eligibility. — A doula shall be eligible for participation as a provider of doula services covered by the MO HealthNet program only if the doula: (1) Is enrolled as a MO HealthNet provider; (2) Is eighteen years of age or older; (3) Holds liability insurance as an…

208.1420. Doula eligible to enroll as provider — reimbursement. — 1. Once enrolled as a MO HealthNet provider, a doula shall be eligible to enroll as a provider with fee-for-service and managed care payers affiliated with the MO HealthNet program. 2. Doula services shall be reimb…

208.1425. Rulemaking authority. — The MO HealthNet division shall promulgate all necessary rules and regulations for the administration of sections 208.1400 to 208.1425. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority…

208.143. Veterans medical services, division to determine if applicant for medical assistance is eligible. — 1. The family support division shall, in accordance with the provisions of section 208.215, determine whether persons applying for and/or receiving Medicaid benefits are e…

208.144. Medicaid reimbursement for children participating in the Part C early intervention system (First Steps). — The department of social services shall recognize the Part C early intervention system established under sections 160.900 to 160.925 as an eligible program and shal…

208.145. Medical assistance benefits, eligibility based on receipt of AFDC benefits, when. — For the purposes of the application of section 208.151, individuals shall be deemed to be recipients of aid to families with dependent children and individuals shall be deemed eligible fo…

208.146. Ticket-to-work health assurance program — eligibility — report. — 1. The program established under this section shall be known as the "Ticket to Work Health Assurance Program". Subject to appropriations and in accordance with the federal Ticket to Work and Work Incentive…

208.147. Annual income and eligibility verification required for medical assistance recipients — documentation required. — 1. The family support division shall conduct an annual income and eligibility verification review of each recipient of medical assistance. Such review shall …

208.149. Professional component of clinical pathology services recognized as distinct physician service — definitions — reimbursement — rules. — 1. As used in this section, the following terms mean: (1) "Clinical pathology services", professional medical services provided by a li…

208.150. Monthly benefits, how determined. — The maximum amount of monthly public assistance money payment benefits payable to or on behalf of a needy person shall not exceed the following: (1) Aid to families with a dependent child, or children, and needy eligible relatives cari…

208.151. Medical assistance, persons eligible — rulemaking authority — waivers — military members eligibility, temporary suspension, when. — 1. Medical assistance on behalf of needy persons shall be known as "MO HealthNet". For the purpose of paying MO HealthNet benefits and to c…

208.152. Medical services for which payment shall be made — co-payments may be required — reimbursement for services — notification upon change in interpretation or application of reimbursement — reimbursement for behavioral, social, and psychological services for physical health…

208.153. Medical assistance — regulations as to costs and manner — federal medical insurance benefits may be provided. — 1. Pursuant to and not inconsistent with the provisions of sections 208.151 and 208.152, the MO HealthNet division shall by rule and regulation define the reas…

208.154. Insufficient funds, benefits to be paid pro rata. — If the funds at the disposal or which may be obtained by the department of social services for the payment of public assistance money payment benefits or to or on behalf of any person for medical assistance benefits sha…

208.155. Records concerning applicants and recipients of medical assistance confidential. — All information concerning applicants and recipients of medical assistance shall be confidential, and any disclosure of such information shall be restricted to purposes directly connected …

208.156. Hearings granted applicants and suppliers of services, when — class action authorized for suppliers, requirements — claims may be cumulative — procedure — appeal. — 1. The family support division or the MO HealthNet division shall provide for granting an opportunity for …

208.157. Discrimination prohibited — payment refused to provider of medical assistance who discriminates because of race, color or national origin. — The department of social services shall comply with the provisions of Title VI, Public Law 88-352, The Civil Rights Act of 1964, a…

208.158. Payments to be made only when federal grants-in-aid are provided. — Payments of medical assistance in federally aided programs shall be made only during such times as grants-in-aid are provided or made available to the state on the basis of the state plan approved by the…

208.159. Payments for nursing home services, how administered — rules. — Notwithstanding the provisions of sections 207.010, 208.152, and 208.153, the department of social services shall administer payments for nursing home services authorized in sections 208.151, et seq., which …

208.160. Payment rolls, how prepared — checks and warrants, how issued. — The department of social services or its divisions shall prepare separate rolls of persons entitled to benefits or compensation for: (1) Supplemental payments; (2) Aid to dependent children; (3) Aid or publ…

208.161. Inpatient psychiatric hospital services, individuals under age twenty-one — nursing home service, any age, exception. — 1. In addition to benefit payments for medical assistance which may be made on behalf of those eligible needy persons under this chapter, benefit payme…

208.163. Direct payment on request by authorized providers of services. — The state treasurer, in making benefit payments for medical assistance on behalf of eligible needy persons as authorized in section 208.151, may, at the request of the hospital, nursing home, or other provi…

208.164. Medical assistance abuse or fraud, definitions — department's or division's powers — reports, confidential — restriction or termination of benefits, when — rules — contracts and provider agreements, termination or denial, when. — 1. As used in this section, unless the co…

208.165. Medical assistance, payments withheld for services, when — payment ordered, interest allowed. — The department or its designated division shall have authority after forty-five days written notice to the affected provider to withhold from any payments that may be or becom…

208.166. Department to facilitate cost-effective purchase of comprehensive health care, definitions — authority of department, conditions — recipient's freedom of selection of plans and sponsors not limited. — 1. As used in this section, the following terms mean: (1) "Department"…

208.167. Nursing home services, amount paid, computation — restrictions waived when, procedure. — Payment for nursing home services made pursuant to section 208.152 to a provider of services shall not exceed the provider's per diem, as set by the department of social services, ti…

208.168. Benefit payments for adult day care, intermediate care facilities, and skilled nursing homes — amount paid, how determined — effective when. — 1. Beginning July 1, 1983, in addition to those benefit payments for medical assistance for eligible needy persons authorized un…

208.169. Reimbursement rate for nursing care services — not revised on change of ownership, management, operation — assignment to new facilities entering program — calculation — determination of trend factor, effect — expiration date of certain provisions. — 1. Notwithstanding ot…

208.170. Duties of state treasurer — special funds created. — 1. The state treasurer shall be treasurer and custodian of all funds and moneys of the department and shall issue checks upon such funds or moneys in accordance with such rules and regulations as the department shall p…

208.171. Effective date of certain sections. — Sections 1, 207.010, 207.060, 208.010, 208.015, 208.030, 208.042, 208.060, 208.120, 208.150, 208.160, 208.170, and 209.040 of this act shall become effective January 1, 1974, or upon the operational date of Title XVI of Public Law 92…

208.172. Reduction or denial of benefits, basis for, restrictions on. — Increases in assessed valuations of property pursuant to sections 137.010 to 137.960 shall not be the sole basis for a reduction in or denial of benefits under this chapter. ­­-------- (L. 1985 S.B. 152) Effe…

208.173. Committee established. — The department of social services shall establish a "Medicaid Drug Prior Authorization Committee". ­­-------- (L. 1992 H.B. 899)

208.174. Director shall apply for amendment of waiver of comparability of services — promulgation of rules — procedure. — 1. Within thirty days of August 28, 1992, the director of the department of social services shall apply to the United States Secretary of Health and Human Ser…

208.175. Drug utilization review board established, members, terms, compensation, duties. — 1. The "Drug Utilization Review Board" is hereby established within the MO HealthNet division and shall be composed of the following health care professionals who shall be appointed by the…

208.176. Division to provide for prospective review of drug therapy. — By December 1, 1992, the MO HealthNet division shall, either directly or through contract with a private organization, provide for a prospective review of drug therapy. The review shall include screening for p…

208.180. Payment of benefits, to whom — disposition of benefit check of deceased person. — 1. Payment of benefits hereunder shall be made monthly in advance, at such regular intervals as shall be determined by the family support division, directly to the recipient, or in the even…

208.181. Expedited eligibility process, pregnant women. — The department of social services shall develop an expedited eligibility process for pregnant women for medical assistance benefits. The expedited process shall be in place no later than January 1, 1994. ­­-------- (L. 199…

208.182. Division to establish electronic transfer of benefits system — disclosure of information prohibited, penalty — benefits and verification to reside in one card. — 1. The family support division shall establish pilot projects in St. Louis City and in any county with a popu…

208.183. Advisory council on rare diseases and personalized medicine, purpose, members, meetings — duties. — 1. There shall be established an "Advisory Council on Rare Diseases and Personalized Medicine" within the MO HealthNet division. The advisory council shall serve as an exp…

208.184. Rare diseases, advisory council — sickle cell disease and MO HealthNet beneficiaries, annual evaluation and review — report. — 1. During at least one regularly scheduled meeting each calendar year, the advisory council on rare diseases and personalized medicine establish…

208.186. Nonresidents, no payments, add-ons, or reimbursements to health care providers, when. — The state shall not provide payments, add-ons, or reimbursements to health care providers through MO HealthNet for medical assistance services provided to persons who do not reside in…

208.190. Division to comply with acts of congress relating to Social Security benefits. — The family support division is hereby directed to comply with the provisions of any act of Congress providing for the distribution and expenditure of funds of the United States appropriated …

208.198. Same or similar services, equal reimbursement rate required. — Subject to appropriations, the department of social services shall establish a rate for the reimbursement of physicians and optometrists for services rendered to patients under the MO HealthNet program which …

208.201. Mo HealthNet division established — director, how appointed, powers and duties — powers, duties and functions of division. — 1. The "MO HealthNet Division" is hereby established within the department of social services. The director of the MO HealthNet division shall be …

208.204. Medical care for children in custody of department, payment — division may administer funds — individualized service plans developed for children in state custody exclusively based on need for mental health services. — 1. The MO HealthNet division may administer the fund…