PURPOSE: This rule establishes the methodology where a MO HealthNet maximum allowable fee for service is determined on an annual basis by the MO HealthNet Division.

1. (1) MO HealthNet reimbursement for covered home health services provided to eligible individuals shall be made at the lower of—

   1. (A) The provider’s billed charge for the service; or
   2. (B) The MO HealthNet maximum allowable fee for service. The fee schedule is available at www.dss.mo.gov/mhd/providers/index.htm.

2. (2) MO HealthNet reimbursement for covered non-routine supplies is the lower of—

   1. (A) The provider’s billed charge for the non-routine supply; or
   2. (B) The home health non-routine supply cost. The home health non-routine supply cost is defined as the invoiced acquisition cost of the supply multiplied by two (2) to cover the cost for overhead (including taxes and shipping). Invoiced acquisition cost is defined as the amount shown on the invoice received for purchase of the supply which must include any reduction in cost the provider receives (i.e., discounts, allowances) and does not include shipping or sales tax.

AUTHORITY: sections 208.153 and 208.201, RSMo Supp. 2013, and section 208.152, RSMo Supp. 2014.* This rule was previously filed as 13 CSR 40-81.057. Original rule filed May 11, 1984, effective Aug. 11, 1984. Amended: Filed Dec. 18, 1991, effective Aug. 6, 1992. Amended: Filed Aug. 17, 2009, effective Feb. 28, 2010. Amended: Filed May 1, 2015, effective Nov. 30, 2015.

*Original authority: 207.020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986, 1993; 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.