PURPOSE: This rule establishes the methodology where a Medicaid maximum allowable fee for service is determined on an annual basis by the Division of Family Services.

1. (1) Reimbursement. Title XIX Medicaid 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;
   2. (B) The Title XVIII interim Medicare rate in effect as of the date of service for the billing provider as determined by the Medicare fiscal intermediary; or
   3. (C) The Medicaid maximum allowable fee for service.

AUTHORITY: sections 207.020, RSMo Supp. 1993, 208.152, RSMo Supp. 1992, 208.153, RSMo Supp. 1991 and 208.201, RSMo Supp. 1987.* 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.

*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, 1981, 1986, 1988, 1990, 1992; 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991; and 208.201, RSMo 1987.