Mo. Code Regs. tit. 13 § 70-4.060

Current through Register Vol. 49, No. 23, December 2, 2024

Section 13 CSR 70-4.060 - Required Reporting of Injuries Received by MO HealthNet Participants

PURPOSE: This amendment replaces outdated language throughout the regulation.

PURPOSE: Section 208.215.16, RSMo requires participants receiving benefits as defined in Chapter 208, RSMo report injuries to the Family Support Division or MO HealthNet Division.

(1) All participants receiving benefits provided for in Chapter 208, RSMo, within thirty (30) days of the date of benefit receipt, shall provide the Family Support Division or MO HealthNet Division with detailed information concerning any occurrences, other than an illness, routine medical service, or other medical treatment not related to a casualty, where medical treatment is given as a result of a casualty.

(2) "Casualty" as used in this regulation means an accident, event due to sudden unusual occurrence, misfortune, or mishap.

(3) "Participant" is defined as any person for whom medical benefits are provided for in Chapter 208, RSMo.

(4) Failure to supply the information to the MO HealthNet Division within thirty (30) days of the occurrence, as determined by the Family Support Division, may be held as constituting participant failure to cooperate and result in loss of benefits.

(5) Loss of benefits resulting from a determination of a participant's failure to cooperate in accordance with the provisions of this rule shall not penalize nor deny reimbursement to a MO HealthNet provider who provided covered services to a participant presenting valid evidence of MO HealthNet eligibility as of the date service is provided, where the provider has advised the Family Support Division that the covered services rendered may have resulted from circumstances defined in this rule by completing the accident portion of the claim form or other written notice.

13 CSR 70-4.060

AUTHORITY: sections 207.020, 208.153 and 208.159, RSMo 1986.* This rule was previously filed as 13 CSR 40-81.092. Original rule filed Aug. 13, 1982, effective Nov. 11, 1982.

Amended by Missouri Register October 15, 2021/Volume 46, Number 20, effective 11/30/2021

*Original authority: 207.020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986; 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991; and 208.159, RSMo 1979.