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 70-3.310 - Chiropractic Services

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: The purpose of this rule is to establish the
				  Department of Social Services' MO HealthNet Division guidelines regarding
				  coverage and reimbursement for chiropractic services as mandated in House Bill
				  1516, 99th General Assembly, section
				  208.152
				  RSMo.
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. Therefore, the material which is so incorporated is on file with
				  the agency who filed this rule, and with the Office of the Secretary of State.
				  Any interested person may view this material at either agency's headquarters or
				  the same will be made available at the Office of the Secretary of State at a
				  cost not to exceed actual cost of copy reproduction. The entire text of the
				  rule is printed here. This note refers only to the incorporated by reference
				  material.
(1) Administration.
				The Chiropractic Program shall be administered by the MO HealthNet Division,
				Department of Social Services. The chiropractic 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 Physician Provider Manual,
				which is incorporated by reference and made 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/manuals/
,
				May 15, 2019. This rule does not incorporate any subsequent amendments or
				additions. Chiropractic services covered by the MO HealthNet program shall
				include only those which are clearly shown to be medically necessary. The MO
				HealthNet Division considers medically necessary when all of the following
				criteria are met: The member has a neuromusculoskeletal disorder; and the
				medical necessity for treatment is clearly documented; and improvement is
				documented within the initial two (2) weeks of chiropractic care. If no
				improvement is documented within the initial two (2) weeks, additional
				chiropractic treatment is considered not medically necessary unless the
				chiropractic treatment is modified. If no improvement is documented within
				thirty (30) days despite modification of chiropractic treatment, continued
				chiropractic treatment is considered not medically necessary. The division
				reserves the right to effect changes in services, limitations, and fees with
				proper notification to MO HealthNet chiropractic providers.
(2) Provider Participation. To be eligible
				for participation in the MO HealthNet Chiropractic Program, a provider must be
				licensed to practice chiropractic by complying with the provisions of Chapter
				331, RSMo and shall have signed a participation agreement to provide
				chiropractic services under the MO HealthNet program.
(3) Participant Eligibility. Any person who
				is eligible for Title XIX benefits from the Family Support Division and who is
				found to be in need of chiropractic services in accordance with the procedures
				described in this rule shall be deemed eligible to receive these
				services.
(4) Chiropractic
				Services. Up to twenty (20) visits per year are covered for services limited to
				examinations, diagnoses, adjustments, manipulations and treatments of
				malpositioned articulations, and structures of the body provided by licensed
				chiropractic physicians practicing within their scope of practice.
(5) Records Retention. Providers who provide
				chiropractic services must follow section
				13 CSR
				70-3.030.