Missouri HB 842: Requires MO HealthNet and health benefit plans providing for maternity benefits to cover a home blood pressure monitoring device for pregnant and postpartum women

Bill Text

FIRST REGULAR SESSION
HOUSE BILL NO. 842
103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE PETERS.
1868H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
To repeal section 208.152, RSMo, and to enact in lieu thereof two new sections relating to
payments for home blood pressure monitoring.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 208.152, RSMo, is repealed and two new sections enacted in lieu
2 thereof, to be known as sections 208.152 and 376.1960, to read as follows:
208.152. 1. MO HealthNet payments shall be made on behalf of those eligible needy
2 persons as described in section 208.151 who are unable to provide for it in whole or in part,
3 with any payments to be made on the basis of the reasonable cost of the care or reasonable
4 charge for the services as defined and determined by the MO HealthNet division, unless
5 otherwise hereinafter provided, for the following:
6 (1) Inpatient hospital services, except to persons in an institution for mental diseases
7 who are under the age of sixty-five years and over the age of twenty-one years; provided that
8 theMOHealthNet divisionshallprovidethroughruleandregulationanexception processfor
9 coverage of inpatient costs in those cases requiring treatment beyond the seventy-fifth
10 percentile professional activities study (PAS) or the MO HealthNet children's diagnosis
11 length-of-stay schedule; and provided further that the MO HealthNet division shall take into
12 account through its payment system for hospital services the situation of hospitals which
13 serve a disproportionate number of low-income patients;
14 (2) All outpatient hospital services, payments therefor to be in amounts which
15 represent no more than eighty percent of the lesser of reasonable costs or customary charges
16 for such services, determined in accordance with the principles set forth in Title XVIII A and
17 B,Public Law 89-97, 1965 amendments to the federal Social Security Act (42U.S.C. Section
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language.

18 301, et seq.), but the MO HealthNet division may evaluate outpatient hospital services
19 rendered under this section and deny payment for services which are determined by the MO
20 HealthNet division not to be medically necessary, in accordance with federal law and
21 regulations;
22 (3) Laboratory and X-ray services;
23 (4) Nursing home services for participants, except to persons with more than five
24 hundred thousand dollars equity in their home or except for persons in an institution for
25 mentaldiseaseswhoareundertheageofsixty-fiveyears,whenresidinginahospitallicensed
26 by the department of health and senior services or a nursing home licensed by the department
27 of health and senior services or appropriate licensing authority of other states or government-
28 owned and -operated institutions which are determined to conform to standards equivalent to
29 licensingrequirementsinTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section301,
30 et seq.), as amended, for nursing facilities. The MO HealthNet division may recognize
31 through its payment methodology for nursing facilities those nursing facilities which serve a
32 high volume of MO HealthNet patients. The MO HealthNet division when determining the
33 amount of the benefit payments to be made on behalf of persons under the age of twenty-one
34 inanursingfacilitymayconsidernursingfacilitiesfurnishingcaretopersonsundertheageof
35 twenty-one as a classification separate from other nursing facilities;
36 (5) Nursing home costs for participants receiving benefit payments under subdivision
37 (4) of this subsection for those days, which shall not exceed twelve per any period of six
38 consecutivemonths, during which the participant ison a temporary leave of absence from the
39 hospital or nursing home, provided that no such participant shall be allowed a temporary
40 leave of absence unless it is specifically provided for in his plan of care. As used in this
41 subdivision, the term "temporary leave of absence" shall include all periods of time during
42 whichaparticipantisawayfromthehospitalornursinghomeovernightbecauseheisvisiting
43 a friend or relative;
44 (6) Physicians' services, whether furnished in the office, home, hospital, nursing
45 home, or elsewhere, provided, that no funds shall be expended to any abortion facility, as
46 defined in section 188.015, or to any affiliate, as defined in section 188.015, of such abortion
47 facility;
48 (7) Subject to appropriation, up to twenty visits per year for services limited to
49 examinations, diagnoses, adjustments, and manipulations and treatments of malpositioned
50 articulations and structures of the body provided by licensed chiropractic physicians
51 practicing within their scope of practice. Nothing in this subdivision shall be in