Effective - 28 Aug 2018, 3 histories
208.217. Department may obtain medical insurance information — failure to provide information, attorney general to bring action, penalty — confidential information, penalty for disclosure — applicability to department of mental health. — 1. As used in this section, the following terms mean:
(1) "Data match", a method of comparing the department's information with that of another entity and identifying those records which appear in both files. This process is accomplished by a computerized comparison by which both the department and the entity utilize a computer readable electronic media format;
(2) "Department", the Missouri department of social services;
(3) "Entity":
(a) Any insurance company as defined in chapter 375 or any public organization or agency transacting or doing the business of insurance; or
(b) Any health service corporation or health maintenance organization as defined in chapter 354 or any other provider of health services as defined in chapter 354;
(c) Any self-insured organization or business providing health services as defined in chapter 354; or
(d) Any third-party administrator (TPA), administrative services organization (ASO), or pharmacy benefit manager (PBM) transacting or doing business in Missouri or administering or processing claims or benefits, or both, for residents of Missouri;
(4) "Individual", any applicant or present or former participant receiving public assistance benefits under sections 208.151 to 208.159 or a person receiving department of mental health services for the purposes of subsection 9 of this section;
(5) "Insurance", any agreement, contract, policy plan or writing entered into voluntarily or by court or administrative order providing for the payment of medical services or for the provision of medical care to or on behalf of an individual;
(6) "Request", any inquiry by the MO HealthNet division for the purpose of determining the existence of insurance where the department may have expended MO HealthNet benefits.
2. The department may enter into a contract with any entity, and the entity shall, upon request of the department of social services, inform the department of any records or information pertaining to the insurance of any individual.
3. The information which is required to be provided by the entity regarding an individual is limited to those insurance benefits that could have been claimed and paid by an insurance policy agreement or plan with respect to medical services or items which are otherwise covered under the MO HealthNet program.
4. A request for a data match made by the department pursuant to this section shall include sufficient information to identify each person named in the request in a form that is compatible with the recordkeeping methods of the entity. Requests for information shall pertain to any individual or the person legally responsible for such individual and may be requested at a minimum of twice a year.
5. The department shall reimburse the entity which is requested to supply information as provided by this section for actual direct costs, based upon industry standards, incurred in furnishing the requested information and as set out in the contract. The department shall specify the time and manner in which information is to be delivered by the entity to the department. No reimbursement will be provided for information requested by the department other than by means of a data match.
6. Any entity which has received a request from the department pursuant to this section shall provide the requested information in compliance with HIPAA required transactions within sixty days of receipt of the request. Willful failure of an entity to provide the requested information within such period shall result in liability to the state for civil penalties of up to ten dollars for each day thereafter. The attorney general shall, upon request of the department, bring an action in a circuit court of competent jurisdiction to recover the civil penalty. The court shall determine the amount of the civil penalty to be assessed. A health insurance carrier, including instances where it acts in the capacity of an administrator of an ASO account, and a TPA acting in the capacity of an administrator for a fully insured or self-funded employer, is required to accept and respond to the HIPAA ANSI standard transaction for the purpose of validating eligibility.
7. The director of the department shall establish guidelines to assure that the information furnished to any entity or obtained from any entity does not violate the laws pertaining to the confidentiality and privacy of an applicant or participant receiving MO HealthNet benefits. Any person disclosing confidential information for purposes other than set forth in this section shall be guilty of a class A misdemeanor.
8. The application for or the receipt of benefits under sections 208.151 to 208.159 shall be deemed consent by the individual to allow the department to request information from any entity regarding insurance coverage of said person.
9. The provisions of this section that apply to the department of social services shall also apply to the department of mental health when contracting with any entity to supply information as provided for in this section regarding an individual receiving department of mental health services.
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(L. 1987 H.B. 518 § 208.224, A.L. 2007 S.B. 577, A.L. 2014 H.B. 1299 Revision, A.L. 2018 S.B. 660 merged with S.B. 951)
Structure Missouri Revised Statutes
Title XII - Public Health and Welfare
Chapter 208 - Old Age Assistance, Aid to Dependent Children and General Relief
Section 208.001 - Citation of law — MO HealthNet created — division created — rulemaking authority.
Section 208.022 - TANF electronic benefit cards to include photograph of recipient.
Section 208.044 - Child day care services to be provided certain persons — eligible providers.
Section 208.048 - Aid to families with dependent child — school attendance required — rules.
Section 208.050 - Aid to dependent children denied, when.
Section 208.060 - Applications for benefits, how and where filed.
Section 208.065 - Verification of eligibility for public assistance, contract for.
Section 208.067 - TANF set-aside minimums for certain programs.
Section 208.071 - Individualized assessment of applicant — rulemaking authority.
Section 208.080 - Appeal to director of the respective division, when — procedure.
Section 208.090 - Reinstatement and payment of benefits to applicant.
Section 208.100 - Appeal to circuit court — procedure.
Section 208.110 - Appeals from circuit court.
Section 208.120 - Records, when evidence, restrictions on disclosure — penalty.
Section 208.125 - Records may be destroyed, when.
Section 208.130 - Benefits granted may be reconsidered.
Section 208.140 - Grants subject to any change of law.
Section 208.145 - Medical assistance benefits, eligibility based on receipt of AFDC benefits, when.
Section 208.146 - Ticket-to-work health assurance program — eligibility — expiration date.
Section 208.150 - Monthly benefits, how determined.
Section 208.154 - Insufficient funds, benefits to be paid pro rata.
Section 208.155 - Records concerning applicants and recipients of medical assistance confidential.
Section 208.158 - Payments to be made only when federal grants-in-aid are provided.
Section 208.159 - Payments for nursing home services, how administered — rules.
Section 208.160 - Payment rolls, how prepared — checks and warrants, how issued.
Section 208.163 - Direct payment on request by authorized providers of services.
Section 208.170 - Duties of state treasurer — special funds created.
Section 208.171 - Effective date of certain sections.
Section 208.172 - Reduction or denial of benefits, basis for, restrictions on.
Section 208.173 - Committee established.
Section 208.175 - Drug utilization review board established, members, terms, compensation, duties.
Section 208.176 - Division to provide for prospective review of drug therapy.
Section 208.180 - Payment of benefits, to whom — disposition of benefit check of deceased person.
Section 208.181 - Expedited eligibility process, pregnant women.
Section 208.190 - Division to comply with acts of congress relating to Social Security benefits.
Section 208.198 - Same or similar services, equal reimbursement rate required.
Section 208.210 - Undeclared income or property — benefits may be recovered by division, when.
Section 208.212 - Annuities, affect on Medicaid eligibility — rulemaking authority.
Section 208.213 - Personal care contracts, effect on eligibility.
Section 208.221 - Jurisdiction, administrative hearing commission, procedure.
Section 208.223 - Reimbursement for ambulance service to be based on mileage.
Section 208.225 - Medicaid per diem rate recalculation for nursing homes, amount.
Section 208.229 - Rebates on outpatient drugs — definitions.
Section 208.230 - Public assistance beneficiary employer disclosure act — report, content.
Section 208.238 - Eligibility, automated process to check applicants and recipients.
Section 208.240 - Statewide dental delivery system authorized.
Section 208.247 - Food stamp eligibility, felony conviction not to make ineligible, when.
Section 208.250 - Definitions.
Section 208.265 - Rules and procedures, developed by whom, published, where.
Section 208.341 - School programs — postponing sexual involvement — QUEST — rites of passage.
Section 208.342 - Earned income tax credit program, AFDC recipients.
Section 208.345 - Protocols for referral of public assistance recipients to federal programs.
Section 208.400 - Definitions.
Section 208.405 - JOBS program established, duties of department.
Section 208.420 - Department to apply for and accept federal funds.
Section 208.425 - Welfare reform coordinating committee established.
Section 208.431 - Medicaid managed care organization reimbursement allowance, amount.
Section 208.432 - Record keeping required, submission to department.
Section 208.434 - Amount final, when — protest, procedure.
Section 208.435 - Rulemaking authority.
Section 208.436 - Remittance to the department — deposit in dedicated fund.
Section 208.455 - Formula for federal reimbursement allowance established by rule — procedure.
Section 208.463 - Documents content and form prescribed by rule.
Section 208.469 - Tax exempt or nonprofit status granted by state not to be affected.
Section 208.471 - Medicaid reimbursement payments to hospitals, amount, how calculated.
Section 208.475 - Effective date of allowance.
Section 208.477 - Medicaid eligibility, criteria used, effect when more restrictive than FY2003.
Section 208.480 - Federal reimbursement allowance expiration date.
Section 208.530 - Definitions.
Section 208.533 - Commission established — members, qualifications — terms — expenses.
Section 208.535 - Commission, duties.
Section 208.600 - Citation of law, definitions.
Section 208.603 - Department of health and senior services to administer federal program.
Section 208.618 - Program to address mental health needs.
Section 208.621 - Program, at-risk elderly.
Section 208.624 - Invest in caring, model program — intergenerational care and training program.
Section 208.627 - Report, delivery of case management services, contents — delivery of report.
Section 208.631 - Program established, terminates, when — definitions.
Section 208.633 - Eligible children, income limits of parents or guardians.
Section 208.636 - Requirements of parents or guardians.
Section 208.640 - Co-payments required, when, amount, limitations.
Section 208.643 - Rules, compliance with federal law.
Section 208.646 - Waiting period required, when.
Section 208.647 - Special health care needs, waiver of waiting period for coverage.
Section 208.650 - Studies and reports required by department of social services.
Section 208.655 - Abortion counseling prohibited, exceptions.
Section 208.657 - Rules, effective when, invalid when.
Section 208.659 - Revision of eligibility requirements for uninsured women's health program.
Section 208.670 - Practice of telehealth, definitions — reimbursement of providers.
Section 208.677 - School children, parental authorization required for telehealth.
Section 208.690 - Citation of law — definitions.
Section 208.692 - Program established, purpose — asset disregard — departments duties — rules.
Section 208.694 - Eligibility — discontinuance of program, effect of — reciprocal agreements.
Section 208.696 - Director's duties — rules.
Section 208.698 - Reports required.
Section 208.750 - Title — definitions.
Section 208.760 - Eligibility — withdrawal of moneys, when.
Section 208.765 - Forfeiture of account moneys, when — death of account holder, effect of.
Section 208.770 - Tax exemption, credit, when.
Section 208.775 - Independent evaluation — report.
Section 208.780 - Definitions.
Section 208.782 - Missouri Rx plan established, purpose — rulemaking authority.
Section 208.786 - Authority of department in providing benefits — start of program benefits, when.
Section 208.788 - Program not an entitlement — payer of last resort requirements.
Section 208.794 - Fund created.
Section 208.798 - Termination date.
Section 208.853 - Findings and purpose.
Section 208.856 - Council created, expenses, members, terms, removal.
Section 208.859 - Powers and duties of the council.
Section 208.862 - Consumer rights and employment relations.
Section 208.865 - Definitions.
Section 208.868 - Federal approval and funding.
Section 208.871 - Severability clause.
Section 208.900 - Definitions.
Section 208.903 - Financial assistance for personal care, eligibility requirements.
Section 208.909 - Responsibilities of recipients and vendors.
Section 208.918 - Vendor requirements, philosophy and services.
Section 208.921 - Denial of eligibility, applicant entitled to hearing.
Section 208.924 - Discontinuation of services, when.
Section 208.927 - Rulemaking authority.
Section 208.935 - Assessment tool, home and community-based services.
Section 208.951 - Request for proposals.
Section 208.952 - Committee established, members, duties.
Section 208.955 - Committee established, members, duties — issuance of findings.
Section 208.990 - MO HealthNet eligibility requirements.
Section 208.991 - Definitions — persons eligible for MO HealthNet — rulemaking authority.
Section 208.1050 - Fund created, use of moneys.
Section 208.1060 - Food banks, state plan to be submitted for federal project.