Effective - 28 Aug 2007
208.950. Plans required — participant enrollment — survey to assess health and wellness outcomes — health risk assessments required. — 1. The department of social services shall, with the advice and approval of the Mo HealthNet oversight committee established under section 208.955, create health improvement plans for all participants in Mo HealthNet. Such health improvement plans shall include but not be limited to, risk-bearing coordinated care plans, administrative services organizations, and coordinated fee-for-service plans. Development of the plans and enrollment into such plans shall begin July 1, 2008, and shall be completed by July 1, 2011, and shall take into account the appropriateness of enrolling particular participants into the specific plans and the time line for enrollment. For risk-bearing care coordination plans and administrative services organization plans, the contract shall require that the contracted per diem be reduced or other financial penalty occur if the quality targets specified by the department are not met. For purposes of this section, "quality targets specified by the department" shall include, but not be limited to, rates at which participants whose care is being managed by such plans seek to use hospital emergency department services for nonemergency medical conditions.
2. Every participant shall be enrolled in a health improvement plan and be provided a health care home. All health improvement plans are required to help participants remain in the least restrictive level of care possible, use domestic-based call centers and nurse help lines, and report on participant and provider satisfaction information annually. All health improvement plans shall use best practices that are evidence-based. The department of social services shall evaluate and compare all health improvement plans on the basis of cost, quality, health improvement, health outcomes, social and behavioral outcomes, health status, customer satisfaction, use of evidence-based medicine, and use of best practices and shall report such findings to the oversight committee.
3. When creating a health improvement plan for participants, the department shall ensure that the rules and policies are promulgated consistent with the principles of transparency, personal responsibility, prevention and wellness, performance-based assessments, and achievement of improved health outcomes, increasing access, and cost-effective delivery through the use of technology and coordination of care.
4. No provisions of any state law shall be construed as to require any aged, blind, or disabled person to enroll in a risk-bearing coordination plan.
5. The department of social services shall, by July 1, 2008, commission an independent survey to assess health and wellness outcomes of MO HealthNet participants by examining key health care delivery system indicators, including but not limited to disease-specific outcome measures, provider network demographic statistics including but not limited to the number of providers per unit population broken down by specialty, subspecialty, and multidisciplinary providers by geographic areas of the state in comparison side-by-side with like indicators of providers available to the state-wide population, and participant and provider program satisfaction surveys. In counting the number of providers available, the study design shall use a definition of provider availability such that a provider that limits the number of MO HealthNet recipients seen in a unit of time is counted as a partial provider in the determination of availability. The department may contract with another organization in order to complete the survey, and shall give preference to Missouri-based organizations. The results of the study shall be completed within six months and be submitted to the general assembly, the governor, and the oversight committee.
6. The department of social services shall engage in a public process for the design, development, and implementation of the health improvement plans and other aspects of MO HealthNet. Such public process shall allow for but not be limited to input from consumers, health advocates, disability advocates, providers, and other stakeholders.
7. By July 1, 2008, all health improvement plans shall conduct a health risk assessment for enrolled participants and develop a plan of care for each enrolled participant with health status goals achievable through healthy lifestyles, and appropriate for the individual based on the participant's age and the results of the participant's health risk assessment.
8. For any necessary contracts related to the purchase of products or services required to administer the MO HealthNet program, there shall be competitive requests for proposals consistent with state procurement policies of chapter 34 or through other existing state procurement processes specified in chapter 630.
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(L. 2007 S.B. 577)
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.