Mo. Code Regs. tit. 13 § 70-90.020

Current through Register Vol. 49, No. 9, May 1, 2024

Section 13 CSR 70-90.020 - Home Health-Care Services Reimbursement

PURPOSE: The purpose of this amendment is to remove outdated information from section (1) and to add section (2) which contains requirements regarding non-routine supply reimbursement.

(1) MO HealthNet reimbursement for covered home health services provided to eligible individuals shall be made at the lower of-

(A) The provider's billed charge for the service; or

(B) The MO HealthNet maximum allowable fee for service. The fee schedule is available at www.dss.mo.gov/mhd/providers/index.htm.

(2) MO HealthNet reimbursement for covered non-routine supplies is the lower of-

(A) The provider's billed charge for the non-routine supply; or

(B) The home health non-routine supply cost. The home health non-routine supply cost is defined as the invoiced acquisition cost of the supply multiplied by two (2) to cover the cost for overhead (including taxes and shipping). Invoiced acquisition cost is defined as the amount shown on the invoice received for purchase of the supply which must include any reduction in cost the provider receives (i.e., discounts, allowances) and does not include shipping or sales tax.

13 CSR 70-90.020

AUTHORITY: section 207.020, RSMo 2000 and sections 208.152, 208.153, and 208.201, RSMo Supp. 2008.* This rule was previously filed as 13 CSR 40-81.057. Original rule filed May 11 , 1984, effective Aug. 11 , 1984. Amended: Filed Dec. 18, 1991, effective Aug. 6, 1992. Amended: Filed Aug. 17, 2009, effective Feb. 28, 2010 .

Amended by Missouri Register October 1, 2015/Volume 40, Number 19, effective 11/30/2015

*Original authority: 207.020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986, 1993; 208.152, RSMo 1967, amended 1969, 1971, 1972, 1973, 1975, 1977, 1978, 1978, 1981, 1986, 1988, 1990, 1992, 1993, 2004, 2005, 2007; 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991, 2007; and 208.201, RSMo 1987, amended 2007.