reglab/statecodes huggingface dataset:
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 81 - Vendor Payment for Medical Care Services › Section 13 CSR 40-81.195 - Title XIX Procedure of Exception to Medical Care Services Limitations

Current through Register Vol. 49, No. 14, July 15, 2024
(Moved to
				  13
				  CSR 70-2.100 )
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 81 - Vendor Payment for Medical Care Services › Section 13 CSR 40-81.200 - Title XIX Recipient Lock-in Program

Current through Register Vol. 49, No. 14, July 15, 2024
(Moved to
				  13 CSR
				  70-4.070 )
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 91 - Rehabilitation Services for the Blind (RSB) › Section 13 CSR 40-91.030 - Prevention of Blindness Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the guidelines for
				  provision of services to visually impaired persons through the Prevention of
				  Blindness Program. Provision of these services is authorized by sections
				  207.010,
				  207.020,
				  209.010
				  and 209.020, RSMo.
(1)
				Prevention of Blindness Program. This program meets the cost of eye care for
				persons of all ages who meet visual eligibility requirements outlined in
				subsection (1)(A) and financial eligibility requirements outlined in subsection
				(1)(B).
(A) Visual Eligibility Requirements.
				Visual eligibility for Prevention of Blindness services is based on examination
				by an eye-care specialist that establishes one (1) of the following conditions:
				a progressive eye disease, a malformation or malfunction of all or part of an
				eye, or central visual acuity without correction of twenty/two hundred (20/200)
				or less in one (1) eye.
(B)
				Financial Eligibility Requirements. Financial eligibility for services is based
				on financial need as determined by Rehabilitation Services for the
				Blind.
(C) Priority of Services.
				When necessary, due to limitation of Prevention of Blindness funds,
				Rehabilitation Services for the Blind may initiate a priority of services plan,
				with those persons in need of emergency eye care or surgical procedures
				receiving priority.
(D) Prior
				authorization must be given for any service involving expenditure of Prevention
				of Blindness funds.
(E) Fees for
				Service. Total payment or eye care authorized by Prevention of Blindness will
				not exceed fees established by the Division of Family Services.
(F) Similar Benefits. Prevention of Blindness
				funds will be used to pay for eye care only after payment available from other
				sources has been determined. Other sources include, but are not limited to:
				Title XVIII (Medicare), Title XIX (Medicaid), vocational rehabilitation
				programs and other public or private health care programs.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 100 - Child Support Program, General Administration › Section 13 CSR 40-100.020 - Administrative Hearings

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates terminology,
				  standardizes the timeframes, and provides clarification of the process for
				  administrative hearings. This amendment also includes an explanation of
				  ex-parte communication and procedures for telephone hearings for all parties,
				  including incarcerated parties. The rule is moved from Title 13, Division
				  30-Child Support Enforcement, to Title 13, Division 40-Family Support Division
				  with this amendment.
PURPOSE: This rule sets forth procedures by which the
				  Family Support Division conducts hearings before its designated hearing
				  officers to resolve disputes between the division and persons from whom the
				  division is seeking to establish or modify an obligation for support or collect
				  an established obligation.
(1) Definitions.
(A) "Obligor" means any person who owes or is
				alleged to owe a duty of support.
(B) "Administrative hearing" means a hearing
				to dispute an action taken by the division on a child support matter that is
				heard by the Administrative Hearings Section of the Division of Legal Services,
				Department of Social Services.
(C)
				"Case" means a matter before the Administrative Hearings Section.
(D) "Division" means the Family Support
				Division and its employees.
(E)
				"Hearing request" means a request made by a party to the action, who personally
				or through a representative, requests a hearing according to the procedures set
				forth under this rule and applicable federal or Missouri statutes and
				regulations.
(F) "Administrative
				Hearing Officer" means a person designated by the Missouri Department of Social
				Services to resolve child support issues in compliance with all federal and
				state laws and regulations. The Administrative Hearing Officers have the
				authority to conduct child support hearings on behalf of the Family Support
				Division on child support matters.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 100 - Child Support Program, General Administration › Section 13 CSR 40-100.030 - Cooperation Requirement

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE. This amendment defines genetic testing,
				  clarifies and updates terminology, and moves this rule from Title 13, Division
				  30- Child Support Enforcement to Title 13, Division 40-Family Support
				  Division.
PURPOSE. This rule sets forth the requirement for
				  individuals who are applicants for or recipients of public assistance benefits
				  (applicants/recipients) to cooperate with the Family Support Division in its
				  efforts to establish paternity and establish, modify, and enforce child support
				  orders.
(1) Definitions. For
				the purposes of this rule the following definitions are applicable:
(A) "Division" means the Family Support
				Division;
(B) "Good cause" means
				the circumstances under which cooperation is not in the best interest of the
				child or custodian who has applied for or is receiving public assistance
				benefits;
(C) "Cooperation" means
				the duty of applicants/recipients to provide, within their ability to do so,
				all requested information and assistance to the division to enable it to
				establish paternity and establish, modify, and enforce child support and
				medical support orders;
(D) "Public
				assistance" means any benefits from a program funded pursuant to Part A or Part
				E of Title IV of the Social Security Act, Title XIX of the Social Security Act,
				or the Food Stamp Act;
(E)
				"Applicant/recipient" is a person who has applied for or is receiving public
				assistance;
(F) "NCP" means
				noncustodial parent;
(G) "AF" means
				alleged father;
(H) "Genetic
				Testing" means testing for paternity using blood cells, other tissue, or
				fluid.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 100 - Child Support Program, General Administration › Section 13 CSR 40-100.040 - State Directory of New Hires

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: For new hire reporting purposes under
				  section
				  285.300,
				  RSMo, this rule defines "newly hired employee" in accordance with The Trade
				  Adjustment Assistance Extension Act of 2011 (
				  Public
				  Law 112-40 ) amendment to section 453A(a)(2) of
				  the Social Security Act.
(1)
				"Newly hired employee" means an employee who-
(A) Has not previously been employed by the
				employer; or
(B) Was previously
				employed by the employer but has been separated from such prior employment for
				at least sixty (60) consecutive days.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 102 - Child Support, Establishment › Section 13 CSR 40-102.010 - Child Support Obligation Guidelines

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment will make this rule comply
				  with New Missouri Supreme Court Guidelines. Additionally, amendment of this
				  rule is necessary to update terminology and to move the rule from Title 13,
				  Division 30-Child Support Enforcement to Title 13, Division 40-Family Support
				  Division.
PURPOSE: This rule sets forth the guidelines to be
				  followed by the Family Support Division to determine the current amount of
				  support due when establishing or modifying child support
				  obligations.
(1) General
				Provisions.
(A) Definitions-as used in this
				rule:
1. "Director" means the director of the
				Family Support Division or his/her designee;
2. "Division" means the Family Support
				Division; and
3. "Form 14" means
				Missouri Supreme Court Civil Procedure Rule Form 14 and accompanying Schedule
				of Basic Child Support Obligations.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 104 - Child Support Program, Enforcement › Section 13 CSR 40-104.020 - Reporting of Child Support Debts to Consumer Reporting Agencies

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates terminology. This
				  rule is also moved from Title 13, Division 30-Child Support Enforcement, to
				  Title 13, Division 40-Family Support Division, with this
				  amendment.
PURPOSE: The purpose of this rule is to establish
				  procedures where a consumer reporting agency may request debt information from
				  the Family Support Division (FSD). It also contains procedures for FSD to
				  report an obligor who has an arrearage of $1000 or more to consumer reporting
				  agencies. This rule references 13 CSR 40-100.020, regarding procedures where an
				  obligor, whose debt is to be reported to a consumer reporting agency, may
				  request and receive an administrative hearing regarding the report. The
				  information given to consumer reporting agencies will be used to update
				  individual consumer records.
(1) Definitions.
(A) "Consumer reporting agency" (CRA), or a
				credit bureau, is any person, corporation, association, partnership or other
				entity which, for monetary fees, dues or on a cooperative nonprofit basis,
				regularly engages in assembling and/or evaluating consumer credit information
				or other information on consumers for the purpose of furnishing credit reports
				to third parties and which uses any means or facility of interstate commerce
				for the purpose of preparing or furnishing consumer reports.
(B) "Division" means the Missouri Family
				Support Division (FSD) and its employees.
(C) "Arrearage" means an amount of money owed
				for past-due child support, spousal support, or a state debt arising from
				Temporary Assistance for Needy Families (TANF), which includes, but is not
				limited to, a cash grant, funds expended for medical services, and alternative
				care payments.
(D) "Obligor" means
				any person who is ordered to pay support by a court or administrative
				authority.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 106 - Child Support, Modification › Section 13 CSR 40-106.010 - Review and Modification of Child and/or Medical Support Orders

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates terminology and
				  provides clarification of timeframes in the review process, timeframes and
				  requirements for withdrawing a request for review, and timeframes for rebutting
				  denial of a modification review that determines modification is inappropriate.
				  In addition, incarceration of an obligated parent for more than 180 days is
				  considered a substantial change in circumstance for an early review and is no
				  longer considered voluntary unemployment.
PURPOSE: This rule sets forth the Family Support
				  Division's procedures for review and modification of existing child and/or
				  medical support orders in accordance with sections
				  454.400,
				  454.496,
				  and
				  454.500,
				  RSMo, and
				  42
				  U.S.C. 666.
(1) Definitions.
(A) "Administrative order" means a child
				and/or medical support order established through the administrative process in
				accordance with sections 454.470-454.520, RSMo.
(B) "Temporary Assistance for Needy Families
				(TANF) case" means a case in which an applicant for or recipient of assistance
				has assigned to the state his/her rights to support as a condition of
				eligibility for public assistance under Title IV-A of the Social Security
				Act.
(C) "Division" means the
				Missouri Family Support Division .
(D) "Medicaid case" means a case in which a
				custodial parent or custodian has assigned to the state his/her rights to
				medical support to receive public assistance, but has not assigned to the state
				his/her rights to child support.
(E)
				"Review" means an objective evaluation of complete, accurate, up-to-date
				information necessary for application of the child support guidelines and
				criteria for support set forth in Missouri Supreme Court Rule 88.01 and other
				applicable law.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 108 - Child Support Program, Counties under Cooperative Agreement › Section 13 CSR 40-108.010 - Reimbursable Expenditures

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates terminology and
				  moves the rule from Title 13, Division 40-Family Support Division, Chapter 3 to
				  Title 13, Division 40-Family Support Division, Chapter 108.
(1) Definitions.
(A) "Division" means the Family Support
				Division.
(B) "State agency" means
				the Missouri Department of Social Services.
(C) "Director" means the person serving as
				director of the Missouri Family Support Division.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 108 - Child Support Program, Counties under Cooperative Agreement › Section 13 CSR 40-108.020 - Minimum Record-Keeping Requirements for County Reimbursement and Standardization of Claims Submissions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment moves this rule from chapter
				  3 to chapter 108. This will allow it to be grouped with the other rules
				  regarding child support.
PURPOSE: The purpose of this rule is to establish minimum
				  record-keeping require- ments to document reimbursement claims received from
				  county and city governing bod- ies under cooperative agreement with the Family
				  Support Division (IV-D) and to stan- dardize claims submissions.
(1) County government units which enter into
				cooperative agreements to provide child sup- port enforcement (IV-D) services
				under sec- tion 454.405, RSMo, and federal regulations and which submit
				reimbursement claims under those agreements, will maintain records, available
				for audit, for five (5) years from the date the claims are presented to the
				Family Support Division for payment. If any litigation, claim, negotiation,
				audit, or other action involving the records is started before the end of the
				five (5)-year period, the coun- ty will keep the records until the action is
				completed and all issues which arise from it are resolved, or until the end of
				the regular five (5)-year period, whichever is later. For documentation, the
				records will include at a minimum:
(A) All
				receipts or vouchers for expenses claimed under operating and overhead (direct
				and indirect costs);
(B) Any
				employee who is compensated for both IV-D- and non-IV-D-related activities must
				maintain detailed daily time records supporting personnel costs claimed,
				includ- ing actual time and date, IV-D case name and case activity. In place of
				this requirement, a county may request permission from the divi- sion to sample
				personnel time using a method prescribed by the division. If approved by the
				division, these sampling results may be used to allocate IV-D personnel costs
				on a quarter- ly basis; and
(C)
				All records required by this rule must be available and adequate to verify
				expendi- tures. When documentation is not adequate, reimbursement may be denied
				or recovered if already paid. For the purpose of this rule, the term adequate
				records means that the required documents are legible and that the information
				they contain can be readily dis- cerned through reasonably careful examina-
				tion without resort to extrinsic sources of data or special explanations not
				contained in the documents.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 108 - Child Support Program, Counties under Cooperative Agreement › Section 13 CSR 40-108.030 - Incentives

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment moves this rule to the Family
				  Support Division and groups it in a chapter with other child support rules. It
				  also updates terminology throughout.
PURPOSE: This rule defines how the Family Support
				  Division will share available federal incentive funds with counties for
				  allowable expenses not to exceed one hundred percent (100%) of counties'
				  reasonable and necessary costs.
(1) Definitions.
(A) "Division" means the Family Support
				Division.
(B) "Director" means the
				director of the Family Support Division.
(C) "Formula" means the amount otherwise
				payable to a state as federal incentives under Section 458A of the Social
				Security Act.
(D) "Counties" means
				all counties and all cities not located within a county.
(E) "Allowable expenses" means expenses that may be
				claimed pursuant to 13 CSR 40-108.010.
(F) "TANF" means temporary assistance for needy
				families.
(G) "County incentives"
				means the total amount of money counties are entitled to receive from the
				federal incentives received by the state as set forth in Section 458A of the
				Social Security Act. County incentives are equal to six percent (6%) of their
				counties' TANF collections plus six percent (6%) of their counties' non-TANF
				collections (not to exceed the six percent (6%) of TANF collections). Level A
				and B counties will receive six percent (6%) of their counties' TANF
				collections plus six percent (6%) of non-TANF collections (up to one hundred
				fifteen percent (115%) of their counties' TANF collections). The incentives are
				subject to availability of federal funding and shall only be paid from federal
				incentive funds.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 110 - Fees › Section 13 CSR 40-110.030 - Annual Thirty-Five Dollar ($35) Fee

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment will bring the Department of
				  Social Services into compliance with the Bipartisan Budget Act of 2018,
				  Pub. L.
				  115-123 that requires updating the amount of the
				  annual fee assessed in a IV-D, never-assistance case in which the division has
				  disbursed to the obligee or payee at least five hundred fifty dollars ($550) of
				  support in the federal fiscal year from twenty-five dollars ($25) to
				  thirty-five dollars ($35). The act also requires updating the amount the state
				  must collect and disburse to the family before assessing the annual fee from
				  five hundred dollars ($500) to five hundred fifty dollars ($550). The Family
				  Support Division (FSD) is also amending this regulation to collect seventeen
				  dollars and fifty cents ($17.50) of the fee from obligee or payee and seventeen
				  dollars and fifty cents ($17.50) of the fee from obligors.
PURPOSE: This rule defines how the Family Support
				  Division will assess and collect an annual thirty-five dollar ($35) fee as
				  required by section 454(6)(B)(ii) of Title IV-D of the Social Security Act as
				  amended by the Bipartisan Budget Act of 2018,
				  Pub. L.
				  115-123.
(1) Definitions.
(A) "Case" means an official record comprised
				of an obligee or payee and dependent child(ren), associated with a particular
				obligor.
(B) "Obligee or Payee"
				means an individual to whom a duty of support is owed.
(C) "Division" means the Family Support
				Division.
(D) "Federal fiscal year"
				means the period from October 1 to September 30.
(E) "IV-D" means part IV-D of the Social
				Security Act.
(F) "IV-D,
				Never-Assistance Case" means a case in which the obligee or payee is receiving
				services pursuant to section
				454.400,
				RSMo, but has never received Aid to Families with Dependent Children or
				Temporary Assistance for Needy Families benefits on behalf of the child(ren)
				associated with the case.
(G)
				"Obligor" means a person who owes a duty of support as determined by a court or
				administrative agency of competent jurisdiction.
(H) "Support" means any financial support
				collected for the support or maintenance of a child or the obligee or payee of
				a child or a spouse or ex-spouse based upon a judicial or administrative
				order.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 110 - Fees › Section 13 CSR 40-110.040 - Annual Fee

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates terminology, and
				  defines two (2) new terms "obligor" and "obligee." It also moves the rule from
				  Title 13 Division 30-Child Support Enforcement to Title 13, Division 40-Family
				  Support Division.
PURPOSE: The purpose of this rule is to define how
				  the Family Support Division will collect an annual processing fee from an
				  obligee on a non-IV-D case who receives support payments that are processed by
				  the Family Support Payment Center.
(1) Definitions. For the purposes of this
				rule, the following definitions are applicable:
(A) "Division" means the Family Support
				Division;
(B) "Payment Center"
				means the Family Support Payment Center;
(C) "Support" means any financial support due
				for the support or maintenance of a child, or the custodian of a child, or a
				spouse or ex-spouse based upon a judicial or administrative order;
(D) "Case" means a family, as used in section
				454.425,
				RSMo, associated with a particular support order(s). A case includes a
				collection of people, generally, a obligee, and dependent(s) associated with an
				obligor;
(E) "Obligor" means a
				person who owes a duty of support as determined by a court or administrative
				agency of competent jurisdiction;
(F) "Obligee" means a person to whom a duty
				of support is owed as determined by a court or administrative agency of
				competent jurisdiction; and
(G)
				"Non-IV-D case" is a case as defined above which is not currently receiving
				child support services pursuant to section
				454.400,
				RSMo.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 112 - Child Support Program, Medical Support › Section 13 CSR 40-112.010 - Establishing or Modifying to Include Medical Support Obligations

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth the Family Support
				  Division's procedures for establishing medical support obligations or modifying
				  existing orders to include medical support obligations in accordance with
				  sections
				  454.600 and
				  454.603,
				  RSMo Supp. 2019.
(1) For
				purposes of this rule, the following terms will be defined as:
(A) "Gross Income" means the amount of money
				earned prior to tax deductions and other mandatory or voluntary
				deductions.
(B) "Parent Seeking
				Support" means the person or state agency that will be entitled to receive
				support after the entry of a support order.
(C) "Parent Not Seeking Support" means the
				person who will be obligated to pay support after the entry of a support
				order.
(D) "Private Health Benefit
				Plan" means any benefit plan or combination of plans, other than public
				assistance programs, providing medical or dental care or benefits through
				insurance or otherwise, including, but not limited to, health service
				corporations, as defined in section
				354.010; prepaid
				dental plans, as defined in section
				354.700; health
				maintenance organization plans, as defined in section
				354.400; and
				self-insurance plans, to the extent allowed by federal law.
(E) "Public Health Benefit Plan" means any
				benefit plan or combination of plans, providing medical or dental care that is
				funded under Title XIX or Title XXI of the Social Security Act.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 65 - Missouri Medicaid Audit and Compliance › Chapter 2 - Medicaid › Section 13 CSR 65-2.010 - Definitions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment combines and clarifies
				  definitions found in this regulation and definitions formerly found in
				  13 CSR
				  70-3.020, which is being rescinded, making it easier
				  for providers to locate and understand the definitions. Additionally, this
				  regulation now mirrors federal Medicaid program integrity regulatory
				  requirements that Missouri must follow as a condition of its federal Medicaid
				  funding.
(1) Affiliates means
				persons having an overt, covert, or conspiratorial relationship so that any one
				(1) of them directly or indirectly controls or has the power to control
				another.
(2) Agent means any person
				who has been delegated the authority to obligate or act on behalf of a
				provider.
(3) Application shall
				include:
(A) Enrollment application to become
				a MO HealthNet Program provider;
(B) Revalidation application to remain a MO
				HealthNet Program provider;
(C) New
				practice location application;
(D)
				Provider direct deposit application;
(E) Change of ownership
				application;
(F) Hardship waiver
				request; or
(G) Other information
				Missouri Medicaid Audit and Compliance (MMAC) needs, under applicable federal
				or state laws and regulations as they pertain to the Medicaid program, in order
				to enroll a MO HealthNet Program provider.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 65 - Missouri Medicaid Audit and Compliance › Chapter 2 - Medicaid › Section 13 CSR 65-2.020 - Provider Enrollment and Application

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment combines and clarifies the
				  procedures found in this regulation and the procedure formerly found at
				  13 CSR
				  70-3.020, which is being rescinded. MO HealthNet
				  providers will no longer have to look in two (2) locations to find Medicaid
				  provider enrollment requirements. The amendment clarifies the circumstances
				  under which the department may deny a provider's enrollment application or
				  terminate the participation of an enrolled provider. Additionally, the
				  regulation now mirrors federal Medicaid program integrity regulatory
				  requirements that Missouri must follow as a condition of its federal Medicaid
				  funding.
(1) Enrollment.
(A) All persons are required to enroll with
				MMAC as a billing or performing provider in the MO HealthNet Program if the
				services or items they provide will be billed to the MO HealthNet
				Program.
(B) For any person to
				receive payment from the MO HealthNet Program for items or services other than
				out-of-state emergency services, the billing providers and the performing
				providers of such items or services must be enrolled providers in the MO
				HealthNet Program on the date the items or services are provided unless
				applicable rules or manuals permit enrollment as of an earlier date, up to a
				maximum of three hundred sixty-five (365) days prior to the actual enrollment
				date.
(C) All claims for payment for
				items and services that were ordered, prescribed, or referred must contain the
				National Provider Identifier (NPI) of the provider who ordered, prescribed, or
				referred such items or services.
(D) All persons enrolled as MO HealthNet
				providers shall abide by the policies and procedures set forth in the MO
				HealthNet provider manual(s) applicable to the provider's provider type(s). The
				MO HealthNet provider manuals 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 and available at
				http://manuals.momed.com/manu-als/, August 20, 2021. This rule does not
				incorporate any subsequent amendments or additions. A MO HealthNet provider's
				breach of any MO HealthNet provider manual may result in imposition of
				sanctions, including but not limited to termination.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 65 - Missouri Medicaid Audit and Compliance › Chapter 3 - Providers and Participants-General Provider and Participant Policies › Section 13 CSR 65-3.010 - Participant Lock-In Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes a process to safeguard
				  against unnecessary or inappropriate utilization of care and services by MO
				  HealthNet participants by identifying excessive use patterns in order to
				  rectify overutilization practices of participants.
(1) Definitions applicable to the
				administration of this program are as follows:
(A) "Lock-In" means limiting or restricting a
				participant's ability to access services to a single physician and/or a single
				pharmacy to reduce excessive MO HealthNet benefits usage;
(B) "Medically necessary" means health care
				services or supplies that are needed to diagnose or treat an illness, injury,
				condition, disease, or its symptoms and that meet accepted standards of
				medicine;
(C) "Misutilization" or
				"misuse" means overusing, underusing, or using MO HealthNet services in a way
				that is harmful, wasteful, and uncoordinated or using services provided under
				the MO HealthNet program in an improper or incorrect manner, whether that use
				is intentional or unintentional;
(D) "Overlap" means at least one (1) day of
				overlapping dispensing of prescriptions written by two (2) or more different
				prescribers; and
(E) "Therapeutic
				class" means a class of medications that are used to treat similar medical
				conditions.
(F) MMAC approved
				pharmacy" means a licensed pharmacy that is currently enrolled with MO
				HealthNet and is not currently sanc- tioned or under investigation by any
				federal or state authority.
(G)
				MMAC approved physician" means a licensed physician that is currently enrolled
				with MO HealthNet and is not currently sanc- tioned or under investigation by
				any federal or state authority.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 65 - Missouri Medicaid Audit and Compliance › Chapter 3 - Providers and Participants-General Provider and Participant Policies › Section 13 CSR 65-3.050 - Electronic Signatures for Mo HealthNet Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the basis on which
				  Health Care Providers and participants under Missouri Medicaid Title XIX
				  Programs may utilize electronic signatures when validating services rendered
				  and received.
(1) As used in
				this rule, the following terms shall mean:
(A)
				"Electronic Medical Record" means a record from which symptoms, conditions,
				diagnosis, treatments, prognosis, and the identity of the patient to which
				these things relate can be readily discerned and verified with reasonable
				certainty. Electronic Medical Records may be referred to as "Electronic Health
				Records;"
(B) "Electronic Record"
				means an electronic record of health-related information on an individual, from
				which services rendered and the amount of reimbursement received by a provider
				can be readily discerned and verified with reasonable certainty;
(C) "Electronic Signature" means a computer
				data compilation of any symbol or series of symbols executed, adopted, or
				authorized by an individual with the intent to be the legally binding
				equivalent of the individual's handwritten signature. The use of biometrics
				does not constitute an electronic signature; however, biometrics may be used as
				part of electronic signature verification. A signature stamp does not
				constitute an electronic signature;
(D) "Participant" means any individual who is
				a participant in the Missouri Medicaid Title XIX or Title XXI programs;
(E) "Provider" means any health
				care provider that participates or provides services under Title XIX and under
				Title XXI of the federal Social Security Act.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 65 - Missouri Medicaid Audit and Compliance › Chapter 3 - Providers and Participants-General Provider and Participant Policies › Section 13 CSR 65-3.060 - Computation of Provider Overpayment by Statistical Sampling

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes a statistical methodology
				  where the billing forms or claims for payment submitted by Medicaid providers
				  may be examined to determine compliance with Title XIX (Medicaid) Program
				  requirements and proper payment, and this rule also sets forth the manner in
				  which providers may challenge the results.
(1) The following definitions will be used in
				administering this rule:
(A) "Claim for
				payment" or "claim" means the Internal Control Number (ICN) and the associated
				data submitted to the Medicaid agency for the purpose of obtaining payment by
				the Title XIX Medicaid Program;
(B)
				"Disproportionate Stratified Random Sampling Technique" means a sampling method
				in which the size of the sample drawn from a particular stratum is not
				proportional to the relative size of that stratum;
(C) "Medicaid agency" or "the agency" means
				the single state agency administering or supervising the administration of the
				state Medicaid plan;
(D)
				"Overpayment" means an amount of money paid to a provider by the Medicaid
				agency to which the provider was not entitled by reason of improper billing,
				error, fraud, abuse, lack of verification, or insufficient medical
				necessity;
(E) "Provider" means any
				person, partnership, corporation, not-for-profit corporation, professional
				corporation, or other business entity that enters into a contract or provider
				agreement with the Medicaid agency for the purpose of providing services to
				Medicaid-eligible persons and obtaining from the Medicaid agency reimbursement
				for services;
(F) "Sampling Unit"
				means one (1) of the units into which an aggregate (e.g. total paid on claims)
				is divided for the purpose of sampling. For example a sampling unit may be
				ICNs, a specific procedure code or codes, or participant DCNs (Document Control
				Numbers);
(G) "Stratum" refers to a
				sampling method in which the universe is divided into non-overlapping
				subgroups. Each of the subgroups is called a stratum, and two (2) or more
				subgroups are called strata; and
(H) "Universe" means all claims for payment
				or all claims relating to a specific service or a specific item or merchandise
				submitted by a provider between two (2) certain dates.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 1 - Organization › Section 13 CSR 70-1.010 - Organization and Description

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment corrects outdated language
				  and updates the function and general organization of the MO HealthNet Division
				  to comply with the requirements of section
				  536.023,
				  RSMo.
PURPOSE: This rule states the function and general
				  organization of the MO HealthNet Division to comply with the requirements of
				  section
				  536.023,
				  RSMo.
(1) General Authority
				and Purpose.
(A) The MO HealthNet Division
				(MHD) was created within the Department of Social Services by executive order
				of the governor on February 27, 1985. The Missouri General Assembly granted
				statutory authority to the division by adding section
				208.201,
				RSMo, effective September 28, 1987. MHD operates under the provisions of
				Chapter 208, RSMo, and Title XIX of the federal Social Security Act.
(B) MHD is responsible for the administration
				of the medical assistance program in Missouri except for the determination of
				participant eligibility for the program, which shall be the responsibility of
				the Family Support Division.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 1 - Organization › Section 13 CSR 70-1.020 - Standards for Privacy of Individually Identifiable Health Information

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: The state of Missouri, Department of Social
				  Services, MO HealthNet Division, is committed to protecting the confidentiality
				  of protected health information of applicants and participants of the Medical
				  Assistance MO HealthNet Program. This rule describes how health care
				  information about MO HealthNet applicants and participants may be used and
				  disclosed and how MO HealthNet participants can get access to their personal
				  health information.
(1)
				General Authority. There are many state and federal laws and regulations that
				safe guard applicants' and participants' protected health information.
(A) Section 1902(a)(7) of the federal Social
				Security Act requires that a state plan for medical assistance must provide
				safeguards which restrict the use or disclosure of information concerning
				applicants and participants to purposes directly connected with the
				administration of the plan.
(B) The
				Health Insurance Portability and Accountability Act (HIPAA) represents the
				first comprehensive federal protection of patient privacy (45 Code of Federal
				Regulations, parts 160-164). Passed by the United States Congress in 1996,
				HIPAA sets national standards to protect personal health information, reduces
				health care fraud, and makes health coverage more portable. The entire health
				care industry must implement HIPAA, including state governments.
(C) The Health Information Technology for
				Economic and Clinical Health (HITECH) Act, enacted as part of the American
				Recovery and Reinvestment Act of 2009, was signed into law on February 17,
				2009, to promote the adoption and meaningful use of health information
				technology. Subtitle D of the HITECH Act, Sections 13400-13424 of
				Public
				Law 111-5, codified at
				42 U.S.C.
				300 jj et seq.; 17901 et seq., addresses the
				privacy and security concerns associated with the electronic transmission of
				health information, in part, through several provisions that strengthen the
				civil and criminal enforcement of the HIPAA rules. The U.S. Department of
				Health and Human Services (HHS) Office of Civil Rights (OCR) issued a final
				rule that implements a number of provisions of the HITECH Act, to strengthen
				the privacy and security protections for health information established under
				the HIPAA for individual's health information maintained in electronic health
				records and other formats at 45 CFR Parts 160 and 164, Vol. 78, No.
				17.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 2 - General Scope of Medical Service Coverage › Section 13 CSR 70-2.020 - Scope of Medical Services for General Relief Recipients

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded December 30, 2005)
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 2 - General Scope of Medical Service Coverage › Section 13 CSR 70-2.200 - MO HealthNet Program Benefits for Human Organ and Bone Marrow/Stem Cell Transplants and Related Medical Services

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes, via regulation, the
				  Department of Social Services'/MO HealthNet Division's guidelines regarding MO
				  HealthNet coverage and reimbursement for human organ or bone marrow/stem cell
				  transplants and related medical services. These policies will be administered
				  by the MO HealthNet Division with the assistance and guidance of its medical
				  consultant and/or transplant consultants.
(1) Administration. Through its MO HealthNet
				program, the Department of Social Services (DSS)/MO HealthNet Division (MHD)
				will provide limited coverage and reimbursement for the transplantation of
				human organs or bone marrow/stem cell and the related medical services,
				including, but not necessarily limited to, treatment and necessary
				pre-transplant and post-operative care for the specific procedures defined here
				and as further defined by the DSS/[DMS]MHD and included in the provider program
				manuals.
(A) The participant must be MO
				HealthNet-eligible on each date on which services are rendered.
(B) MO HealthNet shall be the payor of last
				resort and all other appropriate funding sources must be exhausted prior to
				obtaining MO HealthNet reimbursement.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.020

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 208.153, RSMo 1967, amended 1967,
					 1973, 1989, 1990, 1991, 2007; 208.159, RSMo 1979; 208.164, RSMo 1982, amended
					 1995; 208.201, RSMo 1987, amended 2007; and 210.924, RSMo
					 1999.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.030 - Administrative Actions for Improperly Paid, False, or Fraudulent Claims for MO HealthNet Services

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This proposed amendment updates, clarifies,
				  and simplifies language in this rule. The language changes reflect the reality
				  that some actions taken under this rule are not due to fraud, but rather to
				  mistakes on the part of the provider or the agency. Claims in these
				  circumstances must still be recouped, but are not necessarily considered
				  "sanctions." Also, the language regarding which practitioners can bill for
				  certain services needs to be updated. Section (3) (Program Violations) has 44
				  distinct paragraphs/violations, some of which are not clear or are redundant,
				  and the language updates rectify these issues.
PURPOSE: This rule establishes the basis on which
				  certain claims for MO HealthNet services or merchandise will be determined to
				  be improperly paid, false, or fraudulent and lists the administrative actions
				  that may be imposed and the method of imposing those actions.
(1) Administration.
(A) The MO HealthNet program shall be
				administered by the Department of Social Services, MO HealthNet Division. The
				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 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 dss.mo.gov/mhd, July
				20, 2022. This rule does not incorporate any subsequent amendments or
				additions.
(B) When a rule
				published in the Missouri Code of State Regulations relating to a specific
				provider type or service incorporates by reference a MO HealthNet provider
				manual which contains a later date of incorporation than
				13
				CSR 70-3.030, the manual incorporated into the more
				specific rule shall be applied in place of the manual incorporated into
				13
				CSR 70-3.030.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.035 - Violations Attested to by the Department of Health and Senior Services

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule adds violations determined by the
				  Department of Health and Senior Services as independent grounds for provider
				  sanctions.
Violations of
				  13 CSR
				  70-3.030(3) identified by the
				  Department of Health and Senior Services (DHSS) or its designee during the
				  course of an investigation shall be considered for purposes of sanctions
				  without the need for further investigation by the Missouri Medicaid Audit and
				  Compliance Unit (MMAC). The DHSS shall report any such violations by sworn
				  affidavit to MMAC. Prior violations of
				  13 CSR
				  70-3.030(3) or other program
				  violations, including, but not limited to, program violations as determined by
				  and attested to by affidavit by the DHSS, shall be considered in their totality
				  to determine if there is an ongoing pattern of violations. Such pattern of
				  violations shall weigh heavily to support invoking severe
				  sanctions.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.040

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 208.153, RSMo 1967, amended 1967,
					 1973, 1989, 1990, 1991.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.050

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 207.020, RSMo 1945, amended 1961,
					 1965, 1977, 1981, 1982, 1986, 1993.
Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.060 - Medicaid Program Payment of Claims for Medicare Part B Services

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded August 11, 1988)