13 CSR 70-15.015 - [Effective until 2/23/2023] Direct Medicaid Payments

PURPOSE: This emergency amendment provides for the calculation of the Outpatient Direct Medicaid payments made on or after July 1, 2022. The division is removing the calculation of the Inpatient Direct Medicaid Payment.

EMERGENCY STATEMENT: This emergency amendment removes the Inpatient Direct Medicaid Payment from the hospital program. The Department of Social Services, MO HealthNet Division (MHD) finds that this emergency rule is necessary to preserve a compelling governmental interest as it allows the State Medicaid Agency to implement a new reimbursement model under 13 CSR 70-15.010, and to eliminate the old reimbursement model. The new reimbursement model is effective July 1, 2022. As a result, the MHD finds it necessary to preserve its compelling governmental interest in eliminating the Inpatient Direct Medicaid Payment by July 1, 2022, which requires an early effective date. A proposed amendment, which covers the same material, is published in this issue of the Missouri Register. The scope of this emergency amendment is limited to the circumstances creating the emergency and complies with the protections extended by the Missouri and United States Constitutions. The MHD believes this emergency amendment to be fair to all interested parties under the circumstances. This emergency amendment was filed June 14, 2022, becomes effective July 1, 2022, and expires February 23, 2023.

(1) Outpatient Direct Medicaid Payments. Outpatient Direct Medicaid payments will be made to hospitals for the following allowable MO HealthNet costs:
(A) The increased MO HealthNet costs resulting from the Federal Reimbursement Allowance (FRA) assessment becoming an allowable cost on January 1, 1999;
(B) The MO HealthNet Division will calculate the Outpatient Direct Medicaid payment as follows:
1. The Medicaid share of the outpatient FRA assessment will be calculated by dividing the hospital's outpatient Medicaid charges by the total outpatient hospital charges from the base year cost report to arrive at the Medicaid utilization percentage. This percentage is then multiplied by the outpatient FRA assessment for the current SFY to arrive at the increased allowable Medicaid cost for the outpatient FRA assessment.
A. Effective for payments made on or after July 1, 2022, only the Fee-for-Service (FFS) components of the Medicaid share of the outpatient FRA assessment will be included in the Outpatient Direct Medicaid Payment.


13 CSR 70-15.015
Amended by Missouri Register July 15, 2022/Volume 47, Number 14, effective 7/1/2022

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