Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 65 - Rehabilitation Center Program › Section 13 CSR 70-65.010 - Rehabilitation Center Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment changes the record retention
				  time from five (5) years to six (6) years.
(1) Administration. The MO HealthNet
				rehabilitation center program shall be administered by the Department of Social
				Services, MO HealthNet Division. The rehabilitation center 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 rehabilitation center 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, and at its website at
http://manuals.momed.com/collections/collection_reh/print.pdf
,
				November 24, 2020. This rule does not incorporate any subsequent amendments or
				additions. Rehabilitation center services shall include only those that are
				clearly shown to be medically necessary as determined by the treating
				physician. The division reserves the right to effect changes in services,
				limitations, and fees with notification to rehabilitation center providers by
				amending this rule.
(2) Persons
				Eligible. The MO HealthNet Rehabilitation Program pays for the adaptive
				training of MO HealthNet participants who receive a prosthetic/orthotic device.
				In addition, rehabilitation centers may provide physical, occupational, and
				speech therapy to children under the age of twenty-one (21) when medically
				necessary as determined by the treating physician. The Omnibus Reconciliation
				Act of 1989 (OBRA-89) mandated that MO HealthNet covered services be provided
				based on medical necessity as determined by the treating physician in a healthy
				children and youth screening. The participant must be eligible on the date
				service is furnished. Participants may have specific limitations to
				rehabilitation center 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 his or her type
				of assistance as outlined in the rehabilitation center provider manual. The
				provider shall ascertain the patient's MO HealthNet/MO HealthNet Managed Care
				status before any service is performed. The participant's eligibility shall be
				verified in accordance with methodology outlined in the rehabilitation center
				provider manual.
(3) Provider
				Participation.
(A) To be eligible for
				participation in the MO HealthNet rehabilitation center program, a provider
				must meet the criteria specified for his or her profession as outlined in the
				rehabilitation center provider manual and be an enrolled MO HealthNet
				provider.
(B) The enrolled MO
				HealthNet 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.