Mo. Code Regs. tit. 13 § 70-55.010

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

Section 13 CSR 70-55.010 - MO HealthNet Program Benefits for Nurse-Midwife Services

PURPOSE: This amendment updates the purpose statement and adds the most recent publication information for the MO HealthNet Nurse-Midwife Manual.

PURPOSE: This rule establishes the MO HealthNet payment policy for the Nurse-Midwife Services Program. The goal of the Nurse-Midwife Services Program is to provide care of a pregnant woman and her unborn/newborn infant throughout the maternity cycle.

(1) Administration. The Nurse-Midwife Program shall be administered by the Department of Social Services, MO HealthNet Division. The medical services covered and not covered, the program limitations, and the maximum allowable fees for all covered services shall be determined by the Department of Social Services, MO HealthNet Division, and shall be included in the Nurse-Midwife Program 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, at its website at http://manuals.momed.com/collections/collection_nmw/print.pdf, November 25, 2020. This rule does not incorporate any subsequent amendments or additions.

(2) Persons Eligible. Any person who is eligible for MO HealthNet benefits from the Department of Social Services and is in need of medical services in accordance with the procedures described in this regulation.

(3) Provider Participation. To be eligible for participation in the MO HealthNet Nurse-Midwife Program, a provider must meet the following criteria:

(A) Be currently licensed and maintain an active license as a registered nurse.

1. A nurse-midwife who resides in or outside Missouri and who practices in whole or in part in Missouri must be a currently licensed registered nurse (RN) in Missouri.

2. A nurse-midwife who provides services, in whole or in part, to MO HealthNet participants in a state other than Missouri must be a currently licensed registered nurse (RN) in that state and be legally authorized under that state's law to practice as a nurse-midwife; and

(B) Be currently certified and maintain active certification by the American College of Nurse-Midwives.

(4) MO HealthNet reimbursement for nurse-midwives will be limited to the following types of care in accordance with federal and state laws. The MO HealthNet Nurse-Midwife Provider Manual will contain a listing of covered and noncovered services:

(A) Complete care, management and monitoring of a woman in the absence of medical complications and her unborn/newborn infant throughout the course of the normal cycle of gestation including pregnancy, labor and delivery, and the initial postdelivery/postpartum period not to exceed six (6) weeks; and

(B) Routine post-delivery care of the neonate, including physical examination of the baby and conference with parents.

(5) Nurse-midwives may be reimbursed by MO HealthNet for services performed in the following locations:

(A) Inpatient hospital;

(B) Outpatient hospital;

(C) Office; and

(D) Home.

(6) Reimbursement. MO HealthNet reimbursement for service(s) rendered will be the lower of the provider's usual and customary charge to the general public or the MO HealthNet maximum allowable amount.

(7) General Regulations. This rule shall not encompass all of the general regulations of the MO HealthNet Program. These regulations, however, shall be in effect for nurse-midwife services.

13 CSR 70-55.010

AUTHORITY: sections 208.152, 208.153, and 208.201, RSMo Supp. 2008.* This rule was previously filed as 13 CSR 40-81.045. Original rule filed Sept. 1, 1987, effective Dec. 1, 1987. Emergency amendment filed Nov. 18, 1987, effective Dec. 1, 1987, expired March 30, 1988. Amended: Filed Nov. 19, 1987, effective March 11, 1988. Amended: Filed May 14, 2009, effective Nov. 30, 2009.

Amended by Missouri Register January 3, 2022/Volume 47, Number 1, effective 2/28/2022

*Original authority: 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.