PURPOSE: This rule establishes a payment plan for state-operated providers of services required by the Code of Federal Regulations. The plan describes principles to be followed by Title XIX intermediate care facility/mentally retarded providers in making financial reports and presents the necessary procedures for setting rates, making adjustments and auditing the cost reports.

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. The forms mentioned in this rule follow 13 CSR 70-10.010. (1) Objectives. The retrospective rate plan described in this rule shall apply to state-operated intermediate care facility/ mentally retarded (ICF/MR) facilities for dates of service on and after March 1, 1990, and the objective of this plan is to provide reimbursement of allowable cost. (2) General Principles. The Missouri Medical Assistance program shall reimburse qualified providers of ICF/MR services based solely on the individual MO HealthNet participant’s days of care (within benefit limitations) multiplied by the facility’s Title XIX per diem rate less any payments made by participants as described in sections (4) and (5). (3) Definitions. (A) Allowable cost areas. Those cost areas which are allowable for allocation to the MO HealthNet program based upon the principles established in this plan. The allowability of cost areas not specifically addressed in this plan will be based upon criteria of the Medicare Provider Reimbursement Manual (HIM- 15) and section (7) of this rule. (B) Cost report. The cost report shall detail the cost of rendering covered services for the fiscal reporting period. Providers must file the cost report on forms provided by and in accordance with the procedures of the department. (C) Department. The department, unless otherwise specified, refers to the Missouri Department of Social Services. (D) Director. The director, unless otherwise specified, refers to the director, Missouri Department of Social Services. (E) Division. The division, unless otherwise specified, refers to the MO HealthNet Division. (F) Effective date. The plan effective date shall be for services furnished on and after March 1, 1990. (G) ICF/MR. State-operated facilities certified to provide intermediate care for the mentally retarded under the Title XIX program. (H) Medicare rate. This is the allowable cost of care permitted by Medicare standards and principles of reimbursement (42 CFR part 405). (I) New construction. Newly built facilities or parts for which an approved Certificate of Need (CON) or applicable waivers were obtained and which were newly completed and operational on or after March 1, 1990. (J) Patient days. Patient day of care is that period of service rendered a patient between the census-taking hours on two (2) consecutive days, including the twelve (12) temporary leave of absence days per any period of six (6) consecutive months as specifically covered under section (6) of this rule, the day of discharge being counted only when the patient was admitted the same day. A census log shall be maintained in the facility for documentation purposes. Census shall be taken daily at midnight. A day of care includes those overnight periods when a participant is away from the facility on a facility-sponsored group trip and remains under the supervision and care of facility personnel. (K) Providers. A provider under the Retrospective Reimbursement Plan is a state-operated ICF/MR facility with a valid participation agreement in effect on or after February 28, 1990, with the Missouri Department of Social Services for the purpose of providing long-term care (LTC) services to Title XIX-eligible participants. (L) Reasonable and adequate reimbursement. Reimbursement levels which meet the needs of an efficiently and economically operated facility.

1. (4) Interim Rate.

   1. (A) For service dates beginning March 1, 1990 through and including June 30, 1991, each provider shall be assigned an interim per diem rate for reimbursement under the Missouri Medicaid program. The interim per diem rate will be based on the provider’s fiscal year FY-89 desk-reviewed allowable costs inflated forward on the basis of the historical rate of change. This rate of change shall be thirty-five percent (35%) of the following amount: the percentage increase between the FY- 87 weighted mean allowable cost per patient day for all stateoperated facilities (WMACPPDSOF) and the FY-89 WMACPPDSOF annualized by dividing by two (2). Example FY-87 WMACPPDSOF $128.06 FY-89 WMACPPDSOF $161.47 Percent of Change ($161.47 - $128.06) ÷ $128.06 = 26.09% Annualized Percent of Change (26.09% ÷ 2) = 13.04% 35% of Annualized Percent of Change (13.04% × 35%) = 4.57% Facility FY-89 Allowable Cost $24,220,500 Facility FY-89 Patient Days 150,000 Inflated Cost ($24,220,500 × 104.57%) = $25,327,376 Interim Rate ($25,327,376 ÷ 150,000) = $168.85
   2. (B) For service dates beginning July 1, 1991 and annually after that, each provider shall be assigned an interim per-diem rate based on the provider’s second prior year desk-reviewed allowable costs inflated forward on the basis of the historical rate of change. This rate of change shall be fifty percent (50%) of the following amount: the percentage increase between the fourth prior year WMACPPDSOF and the second prior year WMACPPDSOF annualized by dividing by two (2). For example with the July 1, 1991 interim rate, the fourth prior year is the facility fiscal year ending June 30, 1988, and the second prior year is the facility fiscal year ending June 30, 1990. Example FY-88 WMACPPDSOF $160 FY-90 WMACPPDSOF $180 Percent of Change ($180 - $160) ÷ $160 =12.50% Annualized Percent of Change ($12.50 ÷ 2) = 6.25% 50% of Annualized Percent of Change (6.25% × 50%) = 3.13% Facility FY-90 Allowable Cost $27,000,000 Facility FY-90 Patient Days 150,000 Inflated Cost ($27,000,000 × 103.13%) = $27,845,100 Interim Rate ($27,845,100 ÷ 150,000) = $185.63
   3. (C) In the case of newly constructed state-operated ICF/ MR facilities or existing facilities not previously certified to participate in the Title XIX Program entering the MO HealthNet Program after February 28, 1990, the facilities shall have an interim rate based on one hundred twenty-five percent (125%) of the weighted mean rate of all providers for the month prior to entering the MO HealthNet program until the time a second prior year cost report is available, at which time the provisions of subsection (4)(B) will apply. Example Weighted Mean Rate of All Providers (7/01/91) $160

   ($160 × 125%) = $200 (D) When information contained in a facility’s cost report

is found to be fraudulent, misrepresented or inaccurate, the facility’s interim rate at the discretion of the division may be both retroactively and prospectively adjusted if the fraudulent, misrepresented or inaccurate information as originally reported resulted in establishment of a different interim rate than the facility would have received in the absence of that information.

1. (5) Retroactive Adjustments.

   1. (A) The division shall desk review the MO HealthNet cost reports for each facility and shall determine the facility’s allowable cost per patient day. This shall be the final per diem rate for the service dates covered by the cost report. A payment adjustment will be made equal to the difference between the final per diem rate and the interim per diem rate multiplied by the MO HealthNet days corresponding to the service dates covered by the interim per diem rate. For the period March 1, 1990 through June 30, 1990, the full facility Fiscal Year 1990 Medicaid cost report will be used to establish the final per diem rate for payment adjustment purposes.
   2. (B) When information contained in a facility’s cost report is found to be fraudulent, misrepresented or inaccurate, the facility’s final rate at the discretion of the division may be both retroactively and prospectively adjusted if the fraudulent, misrepresented or inaccurate information as originally reported resulted in establishment of a different final rate than the facility would have received in the absence of that information.

2. (6) Covered Services and Supplies. ICF/MR services and supplies covered by the per diem reimbursement rate under this rule, and which must be provided, are found in 42 CFR 442.100– 442.516 and include, among other services, the regular room, dietary and nursing services or any other services that are required for standards of participation or certification, also included are minor medical and surgical supplies and the use of equipment and facilities. These items include, but are not limited to, the following:

   1. (A) All general nursing services including, but not limited to, administration of oxygen and related medications, handfeeding, incontinency care, tray service and enemas;
   2. (B) Items which are furnished routinely and relatively uniformly to all participants, for example, gowns, water pitchers, soap, basins and bed pans;
   3. (C) Items such as alcohol, applicators, cotton balls, bandaids and tongue depressors;
   4. (D) All nonlegend antacids, nonlegend laxatives, nonlegend stool softeners and nonlegend vitamins. All nonlegend drugs in one (1) of these four (4) categories must be provided to residents as needed and no additional charge may be made to any party for any of these drugs. Facilities may not elect which nonlegend drugs in any of the four (4) categories to supply; all must be provided as needed within the existing per-diem rate;
   5. (E) Items which are utilized by individual participants but which are reusable and expected to be available such as ice bags, bed rails, canes, crutches, walkers, wheelchairs, traction equipment and other durable, nondepreciable medical equipment;
   6. (F) Additional items as specified in the appendix to this plan when required by the patient;
   7. (G) Special dietary supplements used for tube feeding or oral feeding such as elemental high nitrogen diet, including dietary supplements written as a prescription item by a physician;
   8. (H) All laundry services including personal laundry;
   9. (I) All general personal care services which are furnished routinely and relatively uniformly to all participants for their personal cleanliness and appearance shall be covered services; for example, necessary clipping and cleaning of fingernails and toenails, basic hair care, shampoos and shaves to the extent necessary for reasonable personal hygiene. The provider shall not bill the patient or his/her responsible party for this type of personal service;
   10. (J) All consultative services as required by state or federal law or rule or for proper operation by the provider. Contracts for the purchase of these services must accompany the provider cost report. Failure to do so will result in the penalties specified in section (9) of this rule;
   11. (K) Semiprivate room and board and private room and board when necessary to isolate a participant due to a medical or social condition, such as contagious infection, irrational loud speech and the like. Unless a private room is necessary due to a medical or social condition, a private room is a noncovered service and a MO HealthNet participant or responsible party may pay the difference between a facility’s semiprivate charge and its charge for a private room. MO HealthNet participants may not be placed in private rooms and charged any additional amount above the facility’s MO HealthNet per diem unless the participant or responsible party specifically requests in writing a private room prior to placement in a private room and acknowledges that an additional amount not payable by MO HealthNet will be charged for a private room;
   12. (L) Twelve (12) days per any period of six (6) consecutive months during which a participant is on a temporary leave of absence from the facility. These temporary leave of absence days specifically must be provided for in the participant’s plan of care. Periods of time during which a participant is away from the facility because s/he is visiting a friend or relative are considered temporary leaves of absence; and
   13. (M) Days when participants are away from the facility overnight on facility-sponsored group trips under the continuing supervision and care of facility personnel.

3. (7) Allowable Cost Areas.

   1. (A) Covered Services and Supplies as Defined in Section (6) of This Plan.

   2. (B) Depreciation.

      1. 1. An appropriate allowance for depreciation on buildings,

furnishings and equipment which are part of the operation and sound conduct of the provider’s business is an allowable cost item. Finder’s fees are not an allowable cost item.

1. 2. The depreciation must be identifiable and recorded in

the provider’s accounting records, based on the basis of the asset and prorated over the estimated useful life of the asset using the straight-line method of depreciation from the date initially put into service.

1. 3. The basis of assets shall be the lower of the book value of

the provider, fair market value at the time of acquisition or the recognized Internal Revenue Service (IRS) tax basis. Donated assets will be allowed basis to the extent of recognition of income resulting from the donation of the asset. Should a dispute arise between a provider and the Department of Social Services as to the fair market value at the time of acquisition of a depreciable asset and an appraisal by a third party is required, the appraisal cost will be shared proportionately by the MO HealthNet program and the facility in ratio to MO HealthNet participant reimbursable patient days to total patient days.

1. 4. Allowable methods of depreciation shall be limited to

the straight-line method. The depreciation method used for an asset under the MO HealthNet program need not correspond to the method used by a provider for non-MO HealthNet purposes; however, useful life shall be in accordance with the American Hospital Association’s Guidelines. Component part depreciation is optional and allowable under this rule.

1. 5. Historical cost is the cost incurred by the provider in

acquiring the asset and preparing it for use except as provided in this rule. Usually, historical cost includes costs that would be capitalized under generally accepted accounting principles. For example, in addition to the purchase price, historical cost would include architectural fees and related legal fees. Where a provider has elected to expense certain items such as interest and taxes during construction, the historical cost basis for MO HealthNet depreciation purposes may include the amount of these expensed items. However, where a provider did not capitalize these costs and has written off the costs in the year they were incurred, the provider cannot retroactively capitalize any part of these costs under the program. For Title XIX purposes and this rule, any asset costing less than five hundred dollars ($500) or having a useful life of one (1) year or less may be expensed and not capitalized at the option of the provider.

1. 6. When an asset is acquired by trading in an existing

asset, the cost basis of the new asset shall be the sum of undepreciated cost basis of the traded asset plus the cash paid.

1. 7. Capital expenditures for building construction or for

renovation costs which are in excess of one hundred fifty thousand dollars ($150,000) and which cause an increase in a provider’s bed capacity shall not be allowed in the program or depreciation base if the capital expenditures have not received approved CON or waiver.

1. 8. Amortization of leasehold rights and related interest

and finance costs shall not be allowable costs under this plan.

1. (C) Interest and Finance Costs.

   1. 1. Necessary and proper interest on both current and

capital indebtedness shall be an allowable cost item excluding finder’s fees.

1. 2. Interest is the cost incurred for the use of borrowed

funds. Interest on current indebtedness is the cost incurred for funds borrowed for a relatively short-term. This is usually for purposes as working capital for normal operating expenses. Interest on capital indebtedness is the cost incurred for funds borrowed for capital purposes such as acquisition of facilities and capital improvements and this indebtedness must be amortized over the life of the loan.

1. 3. Interest may be included in finance charges imposed

by some lending institutions or it may be a prepaid cost or discount in transactions with those lenders who collect the full interest charges when funds are borrowed.

1. 4. To be an allowable cost item, interest (including finance

charges, prepaid costs and discounts) must be supported by evidence of an agreement that funds were borrowed and that payment of interest and repayment of the funds are required, identifiable in the provider’s accounting records, relating to the reporting period in which the costs are claims and necessary and proper for the operation, maintenance or acquisition of the provider’s facilities.

1. 5. Necessary means that the interest be incurred for a

loan made to satisfy a financial need of the provider and for a purpose related to participant care. Loans which result in excess funds or investments are not considered necessary.

1. 6. Proper means that the interest be incurred at a rate not

in excess of what a prudent borrower would have had to pay in the money market existing at the time the loan was made and provided further the department shall not reimburse for interest and finance charges any amount in excess of the prime rate current at the time the loan was obtained.

1. 7. Income from a provider’s qualified retirement fund shall

be excluded in consideration of the per diem rate.

1. 8. A provider shall amortize finance charges, prepaid

interest and discount over the period of the loan ratably or by means of the constant rate of interest method on the unpaid balance.

1. 9. Usual and customary costs excluding finder’s fees

incurred to obtain loans shall be treated as interest expense and shall be allowable costs over the loan period ratably or by means of the constant interest applied method.

1. 10. Usual and customary costs shall be limited to the

lender’s title and recording fees, appraisal fees, legal fees, escrow fees and closing costs.

1. 11. Interest expense resulting from capital expenditures

for building construction or for renovation costs which are in excess of one hundred fifty thousand dollars ($150,000) and which cause an increase in a bed capacity by the provider shall not be an allowable cost item if the expenditure fails to comply with other federal or state requirements that promulgate a limitation on reimbursement for capital expenditures, such as CON.

1. (D) Rental and Leases.

   1. 1. Rental and leases of land, buildings, furnishings and

equipment are allowable cost areas; provided, that the rented items are necessary and not in essence a purchase of those assets. Finder’s fees are not an allowable cost item.

1. 2. Necessary rental and lease items are those which are

pertinent to the economical operation of the provider.

1. 3. In the case of related parties, rental and lease amounts

cannot exceed the lesser of those which are actually paid or the costs to the related party.

1. 4. Determination of reasonable and adequate reimburse-

ment for rental and lease amounts, except in the case of related parties which is subject to other provisions of this plan, may require affidavits of competent, impartial experts who are familiar with the current rentals and leases.

1. 5. The test of necessary costs shall take into account the

agreement between the owner and the tenant regarding the payment of related property costs.

1. 6. Leases subject to CON approval must have that approval

before a rate is determined.

1. (E) Taxes. Taxes levied on or incurred by providers shall be allowable cost areas with the exceptions of the following items:

   1. 1. Federal, state or local income and excess profit taxes

including any interest and penalties paid;

1. 2. Taxes in connection with financing, refinancing or

refunding operations such as taxes on the issuance of bond, property transfer, issuance or transfer of stocks;

1. 3. Taxes for which exemptions are available to the provider;
2. 4. Special assessments on land which represent capital

improvements. These costs shall be capitalized and depreciated over the period during which the assessment is scheduled to be paid;

1. 5. Taxes on property which is not a part of the operation of

the provider; and

1. 6. Taxes which are levied against a resident and collected

and remitted by the provider.

1. (F) Value of Services of Employees.

   1. 1. Except as provided for in this rule, the value of services

performed by employees in the facility shall be included as an allowable cost area to the extent actually compensated, either to the employee or to the supplying organization.

1. 2. Services rendered by volunteers, such as those affiliated

with the American Red Cross, hospital guilds, auxiliaries, private individuals and similar organizations, shall not be included as an allowable cost area, as the services traditionally have been rendered on a purely volunteer basis without expectation of any form of reimbursement by the organization through which the service is rendered or by the person rendering the service.

1. 3. Services by priests, ministers, rabbis and similar type

professionals shall be an allowable cost area, provided that the services are not of a religious nature. An example of an allowable cost area under this section would be a necessary administrative function performed by a clergyman. The state will not recognize building costs on space set aside primarily for professionals providing any religious function. Costs for wardrobe and similar items likewise are considered nonallowable.

1. (G) Fringe Benefits.

   1. 1. Life insurance.
   2. 2. Retirement plans. Contributions to qualified retirement

plans, as determined by the United States IRS, for the benefit of employees of the provider shall be allowable cost area.

1. (H) Education and Training Expenses.

   1. 1. The cost of training which directly benefits the quality of

health care or administration at the facility shall be allowable.

1. 2. Cost of education and training shall include travel costs

incidental to training but will not include leaves of absence or sabbaticals.

1. (I) Advertising Costs. Advertising costs which are reasonable, appropriate and helpful in developing, maintaining and furnishing services shall be an allowable cost area. The costs must be common and accepted occurrence in the field of the activity of the provider.
2. (J) Central Office and State Central Service Costs. Costs which are appropriately distributed to the provider as direct costs, properly allocated to the provider, or allocated in accordance with approved cost allocation plans when plans are required, shall be allowable.
3. (K) Utilization Review. Incurred cost for the performance of required utilization review for ICF/MR is an allowable cost area. The expenditures must be for the purpose of providing utilization review on behalf of Title XIX participants. Utilization review costs incurred for Title XVIII and XIX must be apportioned on the basis of reimbursable participant days recorded for each program during the reporting period.
4. (L) Minimum Utilization. In the event the occupancy utilization of a provider is below ninety percent (90%) of its certified bed capacity, appropriate adjustments shall be made to the allowable cost areas of the provider. Fixed costs will be calculated as if the provider experienced ninety percent (90%) utilization. The fixed costs are laundry, housekeeping, general and administrative and plant operation costs. Variable costs will be calculated at actual utilization. The variable costs are nursing, dietary and ancillary costs. In no case may costs disallowed under this provision be carried forward to succeeding periods.

5. (M) Nonreimbursable Costs.

   1. 1. Bad debts, charity and courtesy allowances are deductions

from revenue and are not to be included as allowable costs.

1. 2. Those services that are specifically provided by Medicare

and MO HealthNet must be billed to those agencies.

1. 3. Any costs incurred that are related to fund drives are not

reimbursable.

1. 4. Costs incurred for research purposes shall not be

included as allowable costs.

1. 5. The cost of services provided under the Title XX

program, by contract or subcontract, is specifically excluded as an allowable item.

1. (N) Other Revenues. Other revenues, including those listed that follow, will be deducted from the total allowable cost, and must be shown separately in the cost report by use of a separate schedule if included in the gross revenue: income from telephone services; sale of employee and guest meals; sale of medical abstracts; sale of scrap and waste food or materials; rental income; cash, trade, quantity time and other discounts; purchase rebates and refunds; parking lot revenues; vending machine commission or profit; sales from drugs to other than participants; Medicare Part B revenues; and room reservation charges for temporary leave of absence days which are not covered services under section (6) of this rule. Failure to separately account for any of the revenues specifically set out previously in this rule in a readily ascertainable manner shall result in termination from the program.
2. (O) Apportionment of Costs to MO HealthNet Participant Residents. Provider’s allowable cost areas shall be apportioned between the certified ICF/MR portion and the noncertified portion so that the share borne by the MO HealthNet program is based upon actual services received by program participants.

1. (8) Reporting Requirements.

   1. (A) Annual Cost Report.

      1. 1. Each provider shall establish a twelve (12)-month period

which is to be designated as the provider’s fiscal year. An annual cost report for the fiscal year shall be submitted by the provider to the department on forms to be furnished for that purpose. The completed forms shall be submitted by each provider within ninety (90) days following the close of its fiscal year.

1. 2. Unless adequate and current documentation in the

following areas have previously been filed with the department, authenticated copies of the following documents must be submitted with the cost reports: authenticated copies of all leases related to the activities of the facility, all management contracts and all contracts with consultants.

1. 3. Adequate documentation for all line items on the

uniform cost reports must be maintained by the facility and must be submitted to the department upon request.

1. 4. Following the ninety (90)-day period, payments will be

withheld from the facility until the cost report is submitted. Upon receipt of a cost report prepared in accordance with these rules, the payments that were withheld will be released.

1. 5. If requested in writing, a thirty (30)-day extension of the

filing date may be granted for good cause shown.

1. 6. The termination of or by a provider of participation in

the program requires that the provider submit a cost report for the period ending with the date of termination. The cost report is due within forty-five (45) days of the date of termination. Cost reports under this paragraph shall conform to the principles of section (7). The final payment due providers shall be withheld until their cost report is filed.

1. 7. Cost reports shall be based upon the provider’s financial

and statistical records which must be capable of verification by audit.

1. 8. The annual cost report for the fiscal year of the provider

may be subject to audit by the Department of Social Services or its contracted agents.

1. 9. The department shall retain the annual cost report and

any working papers relating to the audits of the cost reports for a period of not less than seven (7) full years from the date of submission of the report or completion of the audit.

1. (B) Certification of Cost Reports.

   1. 1. The accuracy and validity of any cost report must

be certified. Certification must be made by one (1) of the following persons (who must be authorized by the governing body of the facility to make the certification and will furnish proof of authorization): an incorporated entity, an officer of the corporation; for a partnership, a partner; for a sole proprietorship or sole owner, the owner; or for a public facility, the chief administrative officer of the facility. The cost report also must be notarized by a licensed notary public.

1. 2. Certification statement. Form of Certification Misrepresentation or falsification of any information

contained in this report may be punishable by fine, imprisonment, or both, under state or federal law. Certification by officer or administrator of provider: I hereby certify that I have read the above statement and that I have examined the accompanying Cost Report and supporting schedules prepared by ____________________________________ ________________________________________________________ (Provider name(s) and number(s)) for the cost report period beginning ____________________, 19____ and ending ____________________, 19____ and that to the best of my knowledge and belief, it is a true, correct and complete statement prepared from the books and records of the provider in accordance with applicable instructions, except as noted. __________________________ ____________________ _________ (Signature) (Title) (Date)

1. (C) Adequacy of Records.

   1. 1. The provider must make available to the department

or its duly authorized agent, including federal agents from the Department of Health and Human Services (HHS), at all reasonable times, records as are necessary to permit review and audit of provider’s cost reports. Failure to do so may lead to sanctions stated in paragraph (8)(A)4. of this rule or other sanctions available in section (9).

1. 2. All records associated with the preparation and

documentation of the data associated with the cost report must be retained for seven (7) years from the cost report filing date.

1. (D) Accounting Basis.

   1. 1. The cost report submitted must be based on the accrual

basis of accounting.

1. 2. Governmental institutions that operate on a cash

or modified cash basis of accounting may continue to use those methods, provided appropriate treatment of capital expenditures is made.

1. (9) Sanctions and Overpayments.

   1. (A) Sanctions may be imposed against a provider in accordance with 13 CSR 70-3.030 and other federal or state statutes and regulations.
   2. (B) In the case of overpayments, the provider shall repay the overpayment in accordance with the provisions as set forth in 13 CSR 70-3.030.

2. (10) Payment Assurance.

   1. (A) The state will pay each provider, which furnished the services in accordance with the requirements of the state plan, the amount determined for services furnished by the provider according to the standards and methods set forth in these rules.
   2. (B) Where third-party payment is involved, MO HealthNet will be the payor of last resort with the exception of state programs such as Vocational Rehabilitation and the Missouri Crippled Children’s Service. Procedures for remitting thirdparty payments are provided in the Missouri Medical Assistance (MO HealthNet) Program provider manuals.
3. (11) Provider Participation. Payments made in accordance with the standards and methods described in this rule are designed to enlist participation of a sufficient number of providers in the program so that eligible persons can receive medical care and services included in the state plan at least to the extent these services are available to the general public.
4. (12) Payment in Full. Participation in the program shall be limited to providers who accept as payment in full for covered services rendered to MO HealthNet participants, the amount paid in accordance with these rules and applicable copayments.
5. (13) Plan Evaluation. Documentation will be maintained to effectively monitor and evaluate experience during administration of this plan.
6. (14) Transition. Cost reports used for the determination of the rates and the historical rate of change shall be adjusted by the division in accordance with the cost principles provided in this plan. APPENDIX A Routine Covered Medical Supplies and Services ABD Pads A & D Ointment Adhesive Tape Aerosol Inhalators, Self-Contained Aerosol, Other Types Air Mattresses Air P.R. Mattresses Airway—Oral Alcohol Alcohol Plasters Alcohol Sponges Antacids, Nonlegend Applicators, Cotton-Tipped Applicators, Swab-Eez Aquamatic K Pads (water-heated pad) Arm Slings Asepto Syringes Baby Powder Bandages Bandages (elastic or cohesive) Bandaids Basins Bed Frame Equipment (for certain immobilized bed patients) Bed Rails Bedpan, Fracture Bedpan, Regular Bedside Tissues Benzoin Bibs Bottle, Specimen Canes Cannula—Nasal Catheter Indwelling Catheter Plugs Catheter Trays Catheter (any size) Colostomy Bags Composite Pads Cotton Balls Crutches Customized Crutches, Canes and Wheelchairs Decubitus Ulcer Pads Deodorants Disposable Underpads Donuts Douche Bags Drain Tubing Drainage Bags Drainage Sets Drainage Tubes Dressing Tray Dressings (all) Drugs, Stock (excluding Insulin) Enema Can Enema Soap Enema Supplies Enema Unit Enemas Equipment and Supplies for Diabetic Urine Testing Eye Pads Feeding Tubes Female Urinal Flotation Mattress or Biowave Mattress Flotation Pads, Turning Frames, or both Folding Foot Cradle Gastric Feeding Unit Gauze Sponges Gloves, Unsterile and Sterile Gowns, Hospital Green Soap Hand-Feeding Heat Cradle Heating Pads Heel Protector Hot Pack Machine Ice Bags Incontinency Care Incontinency Pads and Pants Infusion Arm Boards Inhalation Therapy Supplies Intermittent Positive Pressure Breathing Machine (IPPB) Invalid Ring Irrigation Bulbs Irrigation Trays I.V. Trays Jelly—Lubricating Laxatives, Nonlegend Lines, Extra Lotion, Soap and Oil Male Urinal Massages (by nurses) Medical Social Services Medicine Cups Medicine Dropper Merthiolate Aerosol Mouthwashes Nasal Cannula Nasal Catheter Nasal Catheter, Insertion and Tube Nasal Gastric Tubes Nasal Tube Feeding Nebulizer and Replacement Kit Needles (hypodermic, scalp, vein) Needles (various sizes) Nonallergic Tape Nursing Services (all) regardless of level, including the administration of oxygen and restorative nursing care Nursing Supplies and Dressing (other than items of personal comfort or cosmetic) Overhead Trapeze Equipment Oxygen Equipment (such as IPPB machines and oxygen tents) Oxygen Mask Pads Peroxide Pitcher Plastic Bib Pump (aspiration and suction) Restraints Room and Board (semiprivate or private if necessitated by a medical or social condition) Sand Bags Scalpel Sheepskin Special Diets Specimen Cups Sponges Steam Vaporizer Sterile Pads Stomach Tubes Stool Softeners, Nonlegend Suction Catheter Suction Machines Suction Tube Surgical Dressings (including sterile sponges) Surgical Pads Surgical Tape Suture Removal Kit Suture Trays Syringes (all sizes) Syringes, Disposable Tape (for laboratory tests) Tape (nonallergic or butterfly) Testing Sets and Refills (S & A) Tongue Depressors Tracheostomy Sponges Tray Service Tubing I.V. Trays, Blood Infusion Set, I.V. Tubing Underpads Urinary Drainage Tube Urinary Tube and Bottle Urological Solutions Vitamins, Nonlegend Walkers Water Pitchers Wheelchairs

AUTHORITY: sections 208.159, RSMo 2000 and 208.153 and 208.201, RSMo Supp. 2007.* Original rule filed March 5, 1990, effective June 11, 1990. Amended: Filed Dec. 14, 1992, effective June 7, 1993. Amended: Filed Aug. 15, 2007, effective March 30, 2008. *Original authority: 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991, 2007, 2012; 208.159, RSMo 1979; and 208.201, RSMo 1987, amended 2007.