PURPOSE: The purpose of this rule is to establish, via regulation, the Department of Social Services’ Division of Medical Services’ guidelines regarding Medicaid coverage and reimbursement for services provided by nurse-midwives as mandated in Title 42 CFR 440.220(1).

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.

1. (1) Administration. The Nurse-Midwife Program shall be administered by the Department of Social Services, Division of Medical Services. 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, Division of Medical Services.
2. (2) Persons Eligible. Any person who is eligible for Medical Assistance Program benefits from the Department of Social Services and is in need of medical services in accordance with the procedures described in this regulation.

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

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

      1. 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. 13 CSR 70-55

1. 2. A nurse-midwife who provides ser-

vices, in whole or in part, to Missouri Medicaid recipients 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

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

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

   1. (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 post-delivery/postpartum period not to exceed six (6) weeks; and
   2. (B) Routine post-delivery care of the neonate, including physical examination of the baby and conference with parents.

2. (5) Nurse-midwives may be reimbursed by Medicaid for services performed in the following locations:

   1. (A) Inpatient hospital;
   2. (B) Outpatient hospital;
   3. (C) Office; and
   4. (D) Home.
3. (6) Reimbursement. Medicaid reimbursement for service(s) rendered will be the lower of the provider’s usual and customary charge to the general public or the Medicaid maximum allowable amount.
4. (7) General Regulations. This rule shall not encompass all of the general regulations of the Medicaid Program. These regulations, however, shall be in effect for nurse-midwife services.

AUTHORITY: sections 207.020 and 208.153, RSMo 1986.* 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. *Original authority: 207,020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986 and 208.153, RSMo 1967, amended 1967, 1973.