Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 70 - Therapy Program › Section 13 CSR 70-70.010 - Adjustments to the Distribution of St Louis County Cigarette Tax Funds Pursuant to the Federal Decennial Census

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This proposed amendment will allow the
				  provision of speech, occupational, and physical therapy services by licensed
				  and enrolled speech, occupational, and physical therapy assistants. The
				  proposed amendment will also allow occupational therapists to provide medically
				  necessary covered behavioral health services within the scope of their practice
				  to MO HealthNet participants.
(1) Administration. The MO HealthNet therapy
				program shall be administered by the Department of Social Services, MO
				HealthNet Division. The therapy services covered and not covered, the
				limitations under which services are covered, and the maximum allowable fees
				for all covered services shall be determined by the MO HealthNet Division and
				shall be included in the
Therapy Provider Manual
, which is
				incorporated by reference and made a part of this rule as published by the
				Department of Social Services, MO HealthNet Division, 615 Howerton Court,
				Jefferson City, MO 65109, at its website at
http://manuals.momed.com/collections/collection_the/print. pdf
,
				January 31, 2023. This rule does not incorporate any subsequent amendments or
				additions. Therapy services shall include only those which are clearly shown to
				be medically necessary as determined by the physician, advanced practice
				registered nurse, or other practitioner of the healing arts. The division
				reserves the right to effect changes in services, limitations, and fees with
				notification to therapy providers by amending this rule.
(2) Participants Eligible. Medically
				necessary therapy services as determined by the physician, advanced practice
				registered nurse, or other practitioner of the healing arts are covered for
				individuals under the age of twenty-one (21). The Healthy Children and Youth
				(HCY) Program (also known as Early and Periodic Screening, Diagnostic, and
				Treatment (EPSDT)) ensures a comprehensive, preventive health care program for
				MO HealthNet eligible children under the age of twenty-one (21) years. The
				Omnibus Budget Reconciliation Act of 1989 (OBRA-89) mandated that MO
				HealthNet-covered services be provided, based on medical necessity as
				identified in a HCY (EPSDT) well-visit and interperiodic screening. These
				services include physical, occupational, and speech/language therapy services.
				The participant must be eligible on the date the service is furnished.
				Participants may have specific limitations to therapy program services
				according to the type of assistance for which they have been determined
				eligible. It is the provider's responsibility to determine the coverage
				benefits for a participant based on their type of assistance as outlined in the
Therapy Provider Manual
. The provider shall ascertain the
				patient's MO HealthNet status before any service is performed. The
				participant's eligibility shall be verified in accordance with methodology
				outlined in the therapy provider program manual.
(3) Provider Participation.
(A) To be eligible for participation in the
				MO HealthNet therapy program, a provider must meet the criteria specified for
				his or her profession as outlined in the therapy provider program manual and be
				an enrolled MO HealthNet provider.
(B) To be eligible for participation in the
				MO HealthNet therapy program as a therapy assistant, a provider must be
				licensed according to state law and provide services under the direction of a
				qualified therapist.
(C) The
				enrolled MOHealthNet provider shall agree to-
1. Keep any records necessary to disclose the
				extent of services the provider furnishes to participants; and
2. On request furnish to the Department of
				Social Services or state Medicaid Fraud Control Unit any information regarding
				payments claimed by the provider for furnishing services under the
				plan.