Missouri Statute | Act | Code |Public Health And Welfare| US Code - US Statute | Chapter 189 Aid To Local Governmental Health Facilities

1. As used in sections 189.010 to 189.085, unless the context
clearly indicates otherwise, the following terms mean:

(1) "Approved provider", hospitals, clinics, laboratories, or other
health personnel or facilities meeting standards to be established under
the provisions of sections 189.010 to 189.085;

(2) "Department", the department of social services of the state of
Missouri;

(3) "Director", the director of the department of social services of the
state of Missouri or his duly authorized representative;

(4) "High risk patient", a woman of childbearing age who has any
condition, or is at risk of developing some condition, medically or
otherwise known to predispose to premature birth or to produce mental
retardation; or any infant or child who has any condition, or is at risk
of developing some condition, medically known to predispose to mental
retardation;

(5) "Person", any individual, firm, partnership, association,
corporation, company, group of individuals acting together for a common
purpose or organization of any kind, including any governmental agency
other than the United States or the state of Missouri;

(6) "Region", contiguous geographic areas of the state larger than single
counties where health programs including special services for high risk
patients can be developed efficiently and economically;

(7) "Service", any medical, surgical, corrective, diagnostic procedure,
or hospitalization, and related activity to correct high risk conditions
including all things reasonably incident and necessary to make the
service available to the high risk patient;

(8) "Special services", diagnostic and treatment services which may not
be efficiently or economically developed as a regular component of a
hospital or clinic either because of high cost or infrequent demand but
which may be required for high risk patients; such services would
include, but not be limited to, intensive care units for the care of
premature infants and intra-uterine fetal monitoring.

2. Expenditures for the operation of a hospital include, but are not
limited to, amounts paid in connection with inpatient care in the
hospital; ambulatory or emergency care provided by the hospital;
ambulance services used in the transportation of patients to the hospital
or among hospitals; administration of the hospital; maintenance and
repairs of the hospital; depreciation of hospital capital assets; food,
drugs, equipment and other supplies used by the hospital; and
recruitment, selection and training of physician, nursing, allied health
and other hospital personnel.

3. Funds approved under the provisions of sections 189.010 to 189.085 are
not restricted for paying certain operating costs, or groups of costs,
but are intended to supplement the appropriations from the local
governmental agency for poor patients. Patients eligible for Medicare,
Medicaid and other third party insurance are not eligible under this
chapter. (L. 1974 H.B. 1686 § 1, A.L. 1980 S.B. 847)

The chief fiscal officer of:

(1) Each city and county operating a hospital, clinic operated by a
social welfare board of a county of the second class, or hospital
district in the state of Missouri; and

(2) Each not-for-profit corporation operating a hospital under contract
with a city or county shall submit to the director and the state board of
health, a report, setting forth the local public hospital tax effort for
its last fiscal year, which shall equal:

(a) The total gross expenditures made by such city, county, corporation
or hospital district during a fiscal year for the operation of a hospital
in the city, county or district, less

(b) The total amounts received during that fiscal year by such city,
county, corporation, or district in payment for hospital services or in
support of hospital operations. The report shall be made to the director
not later than September first of each year. (L. 1974 H.B. 1686 § 2, A.L.
1980 S.B. 847)

Upon receipt of the above information, the director may:

(1) Request further information concerning receipts and expenditures of
the city, county, corporation, or district; and may

(2) Examine the books and records of the city, county, corporation or
district; or may

(3) Request from the fiscal officer an audit by a certified public
accountant of any hospital covered by sections 189.010 to 189.085, and
accept the same in lieu of requesting further information or an examining
of the books and records of the city, county, corporation, or district.
(L. 1974 H.B. 1686 § 3, A.L. 1980 S.B. 847)

The director shall promptly propose such allocations in the
statements which he shall determine to be reasonably necessary to conform
to the provisions of sections 189.010 to 189.085 and which are within the
limits of the budget recommendations. He shall, thereupon, determine the
local public hospital tax effort for patient care for the fiscal year. He
shall report this amount to the state board of health and the chief
fiscal officers of the city, county, corporation, or district,
accompanied by the proposed allocations. (L. 1974 H.B. 1686 § 4, A.L.
1980 S.B. 847)

Upon receipt of the information from the director, the state
board of health shall within forty-five days examine the proposed
allocated appropriations to ensure that such funds are allocated
proportionately to qualifying hospitals in a ratio based upon available
funds as compared to the maximum entitlement of each qualifying hospital
and either approve them within the limit of the budget recommendation, or
shall disapprove proposed allocated appropriations or parts thereof which
it does not find to be reasonable for the improvement of care to poor
patients in the hospital or hospitals. If any appropriation or part
thereof is disapproved by the board of health, the director may continue
to submit revised proposals to the state board of health within the
limits of the budget recommendation therefor until the state board of
health approves the appropriation within the limits of the budget
recommendation. The board shall send a letter on the proposed
appropriations allocation approved by it to the director and to the chief
fiscal officer of the city, county, corporation, or district. Thereafter
by June fifteenth of each year the state board of health shall revise the
allocations within the appropriation therefor. (L. 1974 H.B. 1686 § 5,
A.L. 1980 S.B. 847, A.L. 1988 H.B. 1134)

Effective 5-4-88

Upon receipt of the revised proposal under section 189.030 from
the state board of health, the commissioner of administration shall issue
warrants on the state treasurer for an amount equal to the lesser of (a)
ten percent of the local public hospital tax effort of the city, county,
corporation, or district, as determined by him under section 189.025, or
(b) the total proposed appropriations approved by the board of health.
(L. 1974 H.B. 1686 § 6, A.L. 1980 S.B. 847)

The state treasurer shall pay the warrants to the treasurer of
the city, county, corporation or district, who shall deposit the same to
be used to supplement the appropriations from the local governmental
agency for poor patients. (L. 1974 H.B. 1686 § 7, A.L. 1980 S.B. 847)

Other than for the year for which the chief fiscal officer first
renders a report hereunder, and notwithstanding the provisions of
sections 189.030 and 189.035, no payment shall be made to any city,
county, corporation, or district for any fiscal year in which its total
gross expenditures for operation of a hospital or hospitals were less
than the total of:

(1) The gross amount of that city's, county's, corporation's, or
district's gross expenditures for operation of a hospital or hospitals,
according to the first request rendered hereunder by that city, county,
corporation, or district as finally accepted by the commissioner of
administration, plus

(2) The amount paid to that city, county, corporation, or district by the
state of Missouri. (L. 1974 H.B. 1686 § 8, A.L. 1980 S.B. 847)

1. Notwithstanding any provision of law to the contrary, no
hospital in this state receiving state assistance under the provisions of
sections 189.010 to 189.085 shall deny any services and care described in
section 189.010 to a prospective patient who is a resident of this state,
solely for the reason that the prospective patient* does not reside in
the city, county, or hospital district in which the hospital is located.

2. Any hospital which violates the provisions of subsection 1 shall not
be entitled to any funds under the provisions of sections 189.010 to
189.085. (L. 1974 H.B. 1686 § 9)

*Word "patients" appears in original rolls.

The department is hereby designated as administrator of sections
189.010 to 189.085 and:

(1) Shall formulate and carry on a program to achieve the purposes of
sections 189.010 to 189.085. Such program shall be developed in
consultation with the advisory committees established by sections 189.010
to 189.085 and in accord with the rules and regulations relating to this
program;

(2) Shall, to the greatest degree possible, provide for local or regional
management and is authorized to enter into contracts with public and
private institutions, agencies and persons for the administration of the
provisions of sections 189.010 to 189.085;

(3) In addition to state appropriations, the department shall receive and
expend all funds made available by the federal government, by the state
or its political subdivision, or from any other sources for such
purposes; and it shall cooperate with the federal government in
developing, improving, and extending the services and in the
administration of any state plan;

(4) Shall cooperate with other state departments and agencies of this
state and with medical, health, nursing, and welfare groups and
organizations, private or public, and endeavor to coordinate the efforts
of all persons and agencies interested in the discovery, care, and
rehabilitation of high risk women and children; and it is entitled to
receive aid and assistance from other departments and agencies of this
state in carrying out the plans adopted by the department*;

(5) May receive title to property, real or personal, in all cases of
gifts, devises, or bequests to the service and may act as trustee and as
such receive title to property, real or personal, where given in trust
for the benefit of the service;

(6) Shall develop a program to find and identify high risk patients. Such
program shall be developed in consultation with the advisory committees
established by sections 189.010 to 189.085, with any other federal, state
or local governmental agencies presently involved or likely to be
involved in the future with such programs and with any person presently
involved or likely to be involved in the future with such programs;

(7) Shall develop a program to evaluate at least annually all programs
offered by any persons approved by the department or a party to any
contract, agreement or cooperative endeavor with the department relative
to standards and regulations promulgated pursuant to sections 189.010 to
189.085. A copy of such evaluation shall be provided the governor and the
members of the general assembly in the form of a report submitted over
the signature of the director. (L. 1974 H.B. 1686 § 10)

*Word "division" appears in original rolls.

1. Within six months from August 13, 1974, the director shall
promulgate rules and regulations required by sections 189.010 to 189.085
pursuant to this section and chapter 536, RSMo. No rule or portion of a
rule promulgated under the authority of this chapter shall become
effective unless it has been promulgated pursuant to the provisions of
section 536.024, RSMo.

2. The director of the department of mental health shall designate an
employee of the department of mental health to provide liaison with
services provided by that department which relate to the program required
by sections 189.010 to 189.085.

3. Any hearing before the director shall be governed by the provisions of
chapter 563, RSMo. The director may promulgate regulations and standards
to further the standards to further the accomplishment of the purpose of
this law in management of high risk patients and in the interest of
public health, safety and welfare. The members of the committees shall
receive actual and necessary expenses incurred for attendance at
meetings. (L. 1974 H.B. 1686 § 11, A.L. 1993 S.B. 52, A.L. 1995 H.B. 574
merged with S.B. 3)

The department is authorized and directed to work with public
and private institutions and agencies or persons to insure that special
services will be available in all regions of the state, both rural and
metropolitan. Whenever services or special services required for the
purposes of sections 189.010 to 189.085 are not available, the department
is authorized to use up to ten percent of the funds appropriated for the
purposes of sections 189.010 to 189.085 to assist in establishing the
facilities and professional staff required. For the purposes of
implementing this section, the department and the advisory committees
shall give special consideration to those areas of the state or
population groups which demonstrate the highest incidence of mental
retardation or where accessibility to services or special services may be
limited because of distance. (L. 1974 H.B. 1686 § 12)

Prior to its acceptance as an approved provider, the director
shall cause an inspection to be made of its facilities to determine that
the facility is in compliance with the standards prescribed in section
189.020 and with the regulations promulgated under such section.
Subsequent to the acceptance of an approved provider, the director shall
cause periodic inspections to be made of its facilities whenever he deems
such inspections to be necessary, but at least annually. The periodic
inspections hereunder shall be in addition to other inspections required
to be made under general law or ordinance and shall not excuse compliance
with the requirements of any other applicable general law or ordinance.
(L. 1974 H.B. 1686 § 13)

Funds appropriated under sections 189.010 to 189.085 shall be
paid only to providers meeting standards promulgated under sections
189.010 to 189.085. Reimbursement for facilities and equipment approved
by the department shall be on the basis of actual cost. Reimbursement for
services rendered by providers shall be on the basis of their fair and
reasonable charges, not to exceed the customary and usual charges in that
community for those services. (L. 1974 H.B. 1686 § 14, A.L. 1995 H.B. 574)

Any high risk patient residing in the state of Missouri who is
in need of services because of his* condition, who has been certified by
a licensed physician as having a high risk condition and who, as a
person, can probably benefit from such services and who is otherwise
financially unable to pay for such services shall be entitled to health
services without charge to the limit of the appropriations provided for
in** sections 189.010 to 189.085. Any high risk patient who, or whose
parents, guardian, or other person legally chargeable with the support of
the patient, is able to pay a portion but not all of the expenses for the
required services for the patient, shall be entitled to the services if
the patient or parent, guardian, or other person legally charged with the
support of the patient shall pay such portion of the expenses to the
hospital and physician as the patient or parent, guardian, or other
person legally charged with the support of the patient is reasonably able
to pay. Provided, however, that where the patient is eligible, payments
will be made for such services through Medicaid, or other insurance
benefits available to the patient will be utilized to the fullest extent.
The benefits available under these sections shall not replace those
provided under other federal or state law or under other contractual or
legal entitlements of the persons receiving them. Persons entitled to
health services may obtain these from any available provider of services
with which an agreement is in effect under this section. The funds made
available for the purposes of sections 189.010 to 189.085 shall be
disbursed so as to insure full payment for the financially eligible for
those conditions of highest risk in accord with priorities to be
recommended by the coordinating committee and adopted by the director.
(L. 1974 H.B. 1686 § 15)

*Word "their" appears in original rolls.

**Word "in" does not appear in original rolls.

The department shall develop and maintain appropriate records of
services and financial transactions relating to sections 189.010 to
189.085. Disclosure of such information shall be restricted to purposes
directly connected with the administration of this health services
program. The center for health statistics of the department and the
providers shall coordinate record systems and related programs to insure
that information needed by the department for the purposes of this
program shall be efficiently and economically provided. Records
concerning applicants and recipients of health services shall be kept
confidential, provided, however, that nothing shall prohibit the
department from providing the department of elementary and secondary
education access to all records maintained pursuant to this section. The
department and the department of elementary and secondary education shall
coordinate record systems and related programs to insure that information
needed by the department for the purpose of evaluation of this program
will be available. The department shall assist the department of
elementary and secondary education by providing information required by
the department of elementary and secondary education to discharge
responsibility for the developmentally disabled and other handicapped
children as provided for in subsection 2 of section 162.700, RSMo. The
department shall have access to all records or information obtained
pursuant to subsection 2 of section 162.700, RSMo. (L. 1974 H.B. 1686 §
16, A.L. 2005 H.B. 258)

1. Hospitals eligible for payments pursuant to the provisions of
sections 189.015 to 189.050, which also qualify as hospitals serving a
disproportionate number of low income patients pursuant to subdivision
(1) of section 208.152, RSMo, and regulations issued thereunder, shall,
because of such qualification, become ineligible to receive payments
under sections 189.015 to 189.050 during the period of such qualification.

2. Moneys which, but for the provisions of this section, would have been
paid to hospitals made ineligible by the provisions of this section shall
be paid over to the division of medical services of the department of
social services and used, upon appropriation, by the division of medical
services for payments to hospitals.

3. Notwithstanding the provisions of this section, any hospital
determined to be ineligible for payments pursuant to the provisions of
sections 189.015 to 189.050, solely because of its qualification pursuant
to subdivision (1) of section 208.152, RSMo, may elect to reject such
qualification by July fifteenth of any year and accept its eligibility
pursuant to sections 189.015 to 189.050.

4. The division of medical services of the department of social services
may issue rules and regulations necessary to carry out the provisions of
this section. (L. 1988 H.B. 1134 § 1)

Effective 5-4-88

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