Mo. Code Regs. tit. 13 § 70-98.015

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

Section 13 CSR 70-98.015 - Behavioral Health Services Program

PURPOSE: This amendment will eliminate separate and more restrictive documentation requirements for behavioral health services. Behavioral health services will remain subject to the adequate documentation requirements in 13 CSR 70-3.030 that apply to all MO HealthNet services.

PURPOSE: This rule establishes the regulatory basis for the program requirements of the MO HealthNet behavioral health services program.

(1) Administration. The MO HealthNet behavioral health services program shall be administered by the Department of Social Services, MO HealthNet Division (MHD). The services covered and not covered and the limitations under which services are covered shall be determined by MHD and shall be included in the MO HealthNet Behavioral Health Services Provider Manual and the Physician's Provider Manual, which are 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/, October 1, 2018. This rule does not incorporate any subsequent amendments or additions. Behavioral health services shall include only those which are clearly shown to be medically necessary.

(2) Persons Eligible. The MO HealthNet Program pays for approved MO HealthNet behavioral health services when furnished within the provider's scope of practice. The participant must be eligible on the date the service is furnished. Participants may have specific limitations for behavioral health 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 their type of assistance as outlined in the provider program manual. The provider shall ascertain the patient's MO HealthNet and managed care or other lock-in status before any service is performed. The participant's eligibility shall be verified in accordance with methodology outlined in the provider program manual.

(3) Provider Participation. To be eligible to participate as a MO HealthNet provider of behavioral health services, a provider must meet the qualifications specified by the state agency for his or her profession and be an enrolled MO HealthNet provider.

(A) The enrolled MO HealthNet provider shall comply with the following requirements:

1. Maintain adequate documentation and adequate records in accordance with 13 CSR 70-3.030(2)(A); and

2. On request furnish to the MO HealthNet agency, the Medicaid Audit and Compliance Unit, or State Medicaid Fraud Control Unit any information regarding payments claimed by the provider for furnishing services under the plan.

13 CSR 70-98.015

AUTHORITY: sections 208.152, 208.153, and 208.201, RSMo Supp. 2013.* Original rule filed Nov. 14, 2003, effective June 30, 2004. Amended: Filed Oct. 30, 2007, effective April 30, 2008. Amended: Filed June 2, 2008, effective Nov. 30, 2008. Amended: Filed Oct. 31, 2008, effective May 30, 2009. Amended: Filed Sept. 26, 2013, effective March 30, 2014.

Amended by Missouri Register April 1, 2019/Volume 44, Number 7, effective 5/31/2019

*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.