Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 99 - Comprehensive Day Rehabilitation › Section 13 CSR 70-99.010 - Comprehensive Day Rehabilitation Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This proposed amendment removes outdated
				  language and updates the incorporation by reference in section
				  (1).
(1) Administration. The
				MO HealthNet Comprehensive Day Rehabilitation Program shall be administered by
				the Department of Social Services, MO HealthNet Division. The Comprehensive Day
				Rehabilitation 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
				MO HealthNet provider manuals, which are 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
http://manuals.momed.com/manuals/,
				September 6, 2019
. This rule does not incorporate any subsequent
				amendments or additions. Comprehensive Day Rehabilitation Program services
				shall include only those services that are prior authorized by the MO HealthNet
				Division or its designee.
(2)
				Persons Eligible. Prior authorized Comprehensive Day Rehabilitation services
				are covered for individuals with disabling impairments as the result of a
				traumatic head injury that are under the age of twenty-one (21), blind, or
				pregnant. The program provides intensive, comprehensive services designed to
				prevent or minimize chronic disabilities while restoring the individual to an
				optimal level of physical, cognitive, and behavioral function. Emphasis in the
				program is on functional living skills, adaptive strategies for cognition,
				memory or perceptual deficits, and appropriate interpersonal skills. The
				participant must be eligible on the date the service is furnished. It is the
				provider's responsibility to determine the coverage benefits for a participant
				based on their type of assistance as outlined in the Comprehensive Day
				Rehabilitation Program manual. The provider shall ascertain the patient's MO
				HealthNet/managed care status before any service is performed. The
				participant's eligibility shall be verified in accordance with methodology
				outlined in the Comprehensive Day Rehabilitation Program manual.
(3) Provider Participation. To be eligible
				for participation in the MO HealthNet Comprehensive Day Rehabilitation Program,
				a provider must have the certificate of accreditation (CARF) from the
				Rehabilitation Accreditation Commission, employ and retain qualified/licensed
				head injury professionals qualified to render the services covered through the
				Comprehensive Day Rehabilitation Program, be a free standing rehabilitation
				center or in an acute hospital setting with space dedicated to head injury
				rehabilitation, and be an enrolled MO HealthNet provider.
(4) Prior Authorization. Comprehensive Day
				Rehabilitation services must be prior authorized by the MO HealthNet Division
				or its designee in order for the provider to receive reimbursement. The request
				is reviewed by a medical consultant, and the provider is notified if the
				request is approved or, if not approved, the reason for denial. No more than
				six (6) months of services will be approved. It is possible to receive an
				additional six (6)-month authorization if the patient is showing progress
				toward treatment goals. The maximum period of Comprehensive Day Rehabilitation
				services covered is one (1) year.
(5) Covered Services. Comprehensive Day
				Rehabilitation Program services are covered for half-day (three (3) to four (4)
				hours) and full day (five (5) or more hours) units when the participant meets
				the admission criteria and is prior authorized by the MO HealthNet Division or
				its designee.
(6) Reimbursement.
				Payment will be made in accordance with the fee per unit of service as defined
				and determined by the MO HealthNet Division. Providers must bill their usual
				and customary charge for Comprehensive Day Rehabilitation services.
				Reimbursement will not exceed the lesser of the maximum allowed amount
				determined by the MO HealthNet Division or the provider's billed charges.
				Comprehensive Day Rehabilitation Program services are only payable to the
				enrolled, eligible, participating provider. The MO HealthNet program cannot
				reimburse for services performed by non-enrolled providers.
(7) Documentation Requirements for
				Comprehensive Day Rehabilitation Program.
(A)
				The following must be maintained in the participant's clinical record:
1. Presenting complaint/request for
				assistance;
2. Relevant treatment
				history and background information;
3. Reported
				physical/medical/cognitive/psychological complaints;
4. Pertinent functional weaknesses and
				strengths;
5. Findings from formal
				assessments;
6. Plan of
				care;
7. Interview and behavioral
				observations;
8. Diagnostic
				formulation;
9. Recommendations for
				further evaluation and/or treatment needs; and
10. Dates of periodic review of the plan of
				care.