Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 7 - Family Healthcare › Section 13 CSR 40-7.050 - Presumptive Eligibility

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This proposed amendment allows qualified
				  hospitals to make Medicaid presumptive eligibility determinations for the Adult
				  Expansion Group (AEG), per Article IV Section 36(c) of the Missouri
				  Constitution. The state is legislatively mandated to implement these changes by
				  July 1, 2021. Applicable federal regulations require state Medicaid agencies to
				  offer qualified hospitals the opportunity to make presumptive eligibility
				  determinations for this Medicaid population.
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. This material as incorporated by reference in this rule shall be
				  maintained by the agency at its headquarters and shall be made available to the
				  public for inspection and copying at no more than the actual cost of
				  reproduction. This note applies only to the reference material. The entire text
				  of the rule is printed here.
(1) The department shall provide MO HealthNet
				benefits to individuals during a period of presumptive eligibility for
				individuals who have been determined eligible for MO HealthNet benefits on the
				basis of preliminary information by a presumptive eligibility qualified entity
				in accordance with this rule, and pursuant to sections 435.1100, 435.1101,
				435.1102, 435.1103, and 435.1110 of Title 42, Code of Federal Regulations,
				which is incorporated by reference and made part of this rule as published by
				the Office of the Federal Register, 800 North Capitol St. NW, Suite 700,
				Washington, DC 20408, and available at its website
(https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-435?toc=1
),
				October 20, 2021. This rule does not incorporate any subsequent amendments or
				additions.
(2) For the purposes of
				this rule-
(A) "Presumptive eligibility" means
				temporary MO HealthNet benefits for children under the age of nineteen (19)
				(pursuant to
				42 U.S.C. sections
				1396a(47) and
				1396r-1a
				and
				42 CFR sections
				435.1102 and
				435.1110
				), parents and other caretaker relatives (pursuant to
				42 CFR sections
				435.1103 and
				435.1110
				), former foster care children (pursuant to
				42 CFR sections
				435.1103 and
				435.1110
				), pregnant women (pursuant to
				42 U.S.C. sections
				1396a(47) and
				1396r-1
				and
				42 CFR sections
				435.1103 and
				435.1110
				), individuals with breast cancer or cervical cancer (pursuant to
				42 U.S.C. sections
				1396a(47) and
				1396r-1b
				and
				42 CFR sections
				435.1103 and
				435.1110
				), and adults between ages nineteen (19) and sixty-four (64) (pursuant to
				42 CFR
				435.1110 ), allowing them to receive MO
				HealthNet benefits before they have applied for MO HealthNet benefits through
				the division;
(B) "Qualifying
				hospital" has the same meaning as in
				42 CFR
				435.1110(b);
(C) "Federally qualified health center" has
				the same meaning as in
				42 U.S.C. section
				1396(l)(2)(B);
(D) "Rural health clinic" has the same
				meaning as in
				42
				U.S.C. section
				1395x(aa)(2);
(E) "Presumptive eligibility qualified
				entity" means a MO HealthNet provider organization responsible for screening
				individu-als/families regarding presumptive eligibility for MO HealthNet
				benefits.
1. For presumptive eligibility
				determinations for children under the age of nineteen (19), "presumptive
				eligibility qualified entity" means a federally qualified health center, rural
				health clinic, or qualifying hospital that meets the requirements for a
				"qualified entity" in
				42 U.S.C. section
				1396r-1a(b)(3)(A).
2. For presumptive eligibility determinations
				for pregnant women, "presumptive eligibility qualified entity" means a county
				health department, federally qualified health center, rural health clinic, or
				qualifying hospital that meets the requirements for a "qualified provider" in
				42 U.S.C. section
				1396r-1(b)(2).
3. For presumptive eligibility determinations
				for parents and caretaker relatives, "presumptive eligibility qualified entity"
				means a qualifying hospital as provided in section
				42 CFR
				435.1110.
4. For presumptive eligibility determinations
				for breast and cervical cancer treatment, "presumptive eligibility qualified
				entity" means a Show-Me Healthy Women provider which has a participation
				agreement with the Missouri Department of Health and Senior Services that meets
				the requirements for a "qualified entity" in
				42
				U.S.C. section
				1396r-1b(b)(2).
5. For presumptive eligibility determinations
				for former foster care children, "presumptive eligibility qualified entity"
				means a qualifying hospital.
6. For
				presumptive eligibility determinations for adults between ages nineteen (19)
				and sixty-four (64), "presumptive eligibility qualified entity" means a
				qualifying hospital.