PURPOSE: This regulation interprets section 197.240, RSMo to permit health service corporations to vary benefit amounts payable to ambulatory surgical centers. This regulation is adopted pursuant to section 354.120, RSMo 1986 and to implement sections 197.240, 354.085 and 354.090, RSMo 1986.

1. (1) Ambulatory Surgical Centers.

   1. (A) No membership contract will be approved by the director which does not provide coverage for all health services performed at an ambulatory surgical center licensed under section 197.215, RSMo 1986 which are covered as a hospital inpatient benefit under that contract and are within the scope of the license of the ambulatory surgical center.
   2. (B) In keeping with the essential purpose of ambulatory surgical centers, this regulation in no way shall be construed to require the same level or dollar amount of benefits to be paid for health services performed in an ambulatory surgical center as is paid to a hospital or on account of inpatient hospital treatment.
   3. (C) Any contract not in compliance with this regulation after April 30, 1976 shall be deemed to provide equal benefits in scope and amount for ambulatory surgical centers services as for inpatient hospital care until amended or replaced by an approved contract form.

AUTHORITY: sections 197.240, 354.085, 354.090 and 354.120,* RSMo 1986. This rule was previously filed as 4 CSR 190- 15.030. Original rule filed Dec. 30, 1975, effective Jan. 15, 1976. *Original authority: 197.240, RSMo 1975; 354.085, RSMo 1973; 354.090, RSMo 1973; and 354.120, RSMo 1973.