Missouri Statute | Act | Code |Public Health And Welfare| US Code - US Statute | Chapter 208 Old Age Assistance, Aid To Dependent Children And General Relief

1. In determining the eligibility of a claimant for public
assistance pursuant to this law, it shall be the duty of the division of
family services to consider and take into account all facts and
circumstances surrounding the claimant, including his or her living
conditions, earning capacity, income and resources, from whatever source
received, and if from all the facts and circumstances the claimant is not
found to be in need, assistance shall be denied. In determining the need
of a claimant, the costs of providing medical treatment which may be
furnished pursuant to sections 208.151 to 208.158 and 208.162 shall be
disregarded. The amount of benefits, when added to all other income,
resources, support, and maintenance shall provide such persons with
reasonable subsistence compatible with decency and health in accordance
with the standards developed by the division of family services;
provided, when a husband and wife are living together, the combined
income and resources of both shall be considered in determining the
eligibility of either or both. "Living together" for the purpose of this
chapter is defined as including a husband and wife separated for the
purpose of obtaining medical care or nursing home care, except that the
income of a husband or wife separated for such purpose shall be
considered in determining the eligibility of his or her spouse, only to
the extent that such income exceeds the amount necessary to meet the
needs (as defined by rule or regulation of the division) of such husband
or wife living separately. In determining the need of a claimant in
federally aided programs there shall be disregarded such amounts per
month of earned income in making such determination as shall be required
for federal participation by the provisions of the federal Social
Security Act (42 U.S.C.A. 301 et seq.), or any amendments thereto. When
federal law or regulations require the exemption of other income or
resources, the division of family services may provide by rule or
regulation the amount of income or resources to be disregarded.

2. Benefits shall not be payable to any claimant who:

(1) Has or whose spouse with whom he or she is living has, prior to July
1, 1989, given away or sold a resource within the time and in the manner
specified in this subdivision. In determining the resources of an
individual, unless prohibited by federal statutes or regulations, there
shall be included (but subject to the exclusions pursuant to subdivisions
(4) and (5) of this subsection, and subsection 5 of this section) any
resource or interest therein owned by such individual or spouse within
the twenty-four months preceding the initial investigation, or at any
time during which benefits are being drawn, if such individual or spouse
gave away or sold such resource or interest within such period of time at
less than fair market value of such resource or interest for the purpose
of establishing eligibility for benefits, including but not limited to
benefits based on December, 1973, eligibility requirements, as follows:

(a) Any transaction described in this subdivision shall be presumed to
have been for the purpose of establishing eligibility for benefits or
assistance pursuant to this chapter unless such individual furnishes
convincing evidence to establish that the transaction was exclusively for
some other purpose;

(b) The resource shall be considered in determining eligibility from the
date of the transfer for the number of months the uncompensated value of
the disposed of resource is divisible by the average monthly grant paid
or average Medicaid payment in the state at the time of the investigation
to an individual or on his or her behalf under the program for which
benefits are claimed, provided that:

a. When the uncompensated value is twelve thousand dollars or less, the
resource shall not be used in determining eligibility for more than
twenty-four months; or

b. When the uncompensated value exceeds twelve thousand dollars, the
resource shall not be used in determining eligibility for more than sixty
months;

(2) The provisions of subdivision (1) of this subsection shall not apply
to a transfer, other than a transfer to claimant's spouse, made prior to
March 26, 1981, when the claimant furnishes convincing evidence that the
uncompensated value of the disposed of resource or any part thereof is no
longer possessed or owned by the person to whom the resource was
transferred;

(3) Has received, or whose spouse with whom he or she is living has
received, benefits to which he or she was not entitled through
misrepresentation or nondisclosure of material facts or failure to report
any change in status or correct information with respect to property or
income as required by section 208.210. A claimant ineligible pursuant to
this subsection shall be ineligible for such period of time from the date
of discovery as the division of family services may deem proper; or in
the case of overpayment of benefits, future benefits may be decreased,
suspended or entirely withdrawn for such period of time as the division
may deem proper;

(4) Owns or possesses resources in the sum of one thousand dollars or
more; provided, however, that if such person is married and living with
spouse, he or she, or they, individually or jointly, may own resources
not to exceed two thousand dollars; and provided further, that in the
case of a temporary assistance for needy families claimant, the provision
of this subsection shall not apply;

(5) Prior to October 1, 1989, owns or possesses property of any kind or
character, excluding amounts placed in an irrevocable prearranged funeral
or burial contract pursuant to subsection 2 of section 436.035, RSMo, and
subdivision (5) of subsection 1 of section 436.053, RSMo, or has an
interest in property, of which he or she is the record or beneficial
owner, the value of such property, as determined by the division of
family services, less encumbrances of record, exceeds twenty-nine
thousand dollars, or if married and actually living together with husband
or wife, if the value of his or her property, or the value of his or her
interest in property, together with that of such husband and wife,
exceeds such amount;

(6) In the case of temporary assistance for needy families, if the
parent, stepparent, and child or children in the home owns or possesses
property of any kind or character, or has an interest in property for
which he or she is a record or beneficial owner, the value of such
property, as determined by the division of family services and as allowed
by federal law or regulation, less encumbrances of record, exceeds one
thousand dollars, excluding the home occupied by the claimant, amounts
placed in an irrevocable prearranged funeral or burial contract pursuant
to subsection 2 of section 436.035, RSMo, and subdivision (5) of
subsection 1 of section 436.053, RSMo, one automobile which shall not
exceed a value set forth by federal law or regulation and for a period
not to exceed six months, such other real property which the family is
making a good-faith effort to sell, if the family agrees in writing with
the division of family services to sell such property and from the net
proceeds of the sale repay the amount of assistance received during such
period. If the property has not been sold within six months, or if
eligibility terminates for any other reason, the entire amount of
assistance paid during such period shall be a debt due the state;

(7) Is an inmate of a public institution, except as a patient in a public
medical institution.

3. In determining eligibility and the amount of benefits to be granted
pursuant to federally aided programs, the income and resources of a
relative or other person living in the home shall be taken into account
to the extent the income, resources, support and maintenance are allowed
by federal law or regulation to be considered.

4. In determining eligibility and the amount of benefits to be granted
pursuant to federally aided programs, the value of burial lots or any
amounts placed in an irrevocable prearranged funeral or burial contract
pursuant to subsection 2 of section 436.035, RSMo, and subdivision (5) of
subsection 1 of section 436.053, RSMo, shall not be taken into account or
considered an asset of the burial lot owner or the beneficiary of an
irrevocable prearranged funeral or funeral contract. For purposes of this
section, "burial lots" means any burial space as defined in section
214.270, RSMo, and any memorial, monument, marker, tombstone or letter
marking a burial space. If the beneficiary, as defined in chapter 436,
RSMo, of an irrevocable prearranged funeral or burial contract receives
any public assistance benefits pursuant to this chapter and if the
purchaser of such contract or his or her successors in interest cancel or
amend the contract so that any person will be entitled to a refund, such
refund shall be paid to the state of Missouri up to the amount of public
assistance benefits provided pursuant to this chapter with any remainder
to be paid to those persons designated in chapter 436, RSMo.

5. In determining the total property owned pursuant to subdivision (5) of
subsection 2 of this section, or resources, of any person claiming or for
whom public assistance is claimed, there shall be disregarded any life
insurance policy, or prearranged funeral or burial contract, or any two
or more policies or contracts, or any combination of policies and
contracts, which provides for the payment of one thousand five hundred
dollars or less upon the death of any of the following:

(1) A claimant or person for whom benefits are claimed; or

(2) The spouse of a claimant or person for whom benefits are claimed with
whom he or she is living.

If the value of such policies exceeds one thousand five hundred dollars,
then the total value of such policies may be considered in determining
resources; except that, in the case of temporary assistance for needy
families, there shall be disregarded any prearranged funeral or burial
contract, or any two or more contracts, which provides for the payment of
one thousand five hundred dollars or less per family member.

6. Beginning September 30, 1989, when determining the eligibility of
institutionalized spouses, as defined in 42 U.S.C. Section 1396r-5, for
medical assistance benefits as provided for in section 208.151 and 42
U.S.C. Sections 1396a et seq., the division of family services shall
comply with the provisions of the federal statutes and regulations. As
necessary, the division shall by rule or regulation implement the federal
law and regulations which shall include but not be limited to the
establishment of income and resource standards and limitations. The
division shall require:

(1) That at the beginning of a period of continuous institutionalization
that is expected to last for thirty days or more, the institutionalized
spouse, or the community spouse, may request an assessment by the
division of family services of total countable resources owned by either
or both spouses;

(2) That the assessed resources of the institutionalized spouse and the
community spouse may be allocated so that each receives an equal share;

(3) That upon an initial eligibility determination, if the community
spouse's share does not equal at least twelve thousand dollars, the
institutionalized spouse may transfer to the community spouse a resource
allowance to increase the community spouse's share to twelve thousand
dollars;

(4) That in the determination of initial eligibility of the
institutionalized spouse, no resources attributed to the community spouse
shall be used in determining the eligibility of the institutionalized
spouse, except to the extent that the resources attributed to the
community spouse do exceed the community spouse's resource allowance as
defined in 42 U.S.C. Section 1396r-5;

(5) That beginning in January, 1990, the amount specified in subdivision
(3) of this subsection shall be increased by the percentage increase in
the Consumer Price Index for All Urban Consumers between September, 1988,
and the September before the calendar year involved; and

(6) That beginning the month after initial eligibility for the
institutionalized spouse is determined, the resources of the community
spouse shall not be considered available to the institutionalized spouse
during that continuous period of institutionalization.

7. Beginning July 1, 1989, institutionalized individuals shall be
ineligible for the periods required and for the reasons specified in 42
U.S.C. Section 1396p.

8. The hearings required by 42 U.S.C. Section 1396r-5 shall be conducted
pursuant to the provisions of section 208.080.

9. Beginning October 1, 1989, when determining eligibility for assistance
pursuant to this chapter there shall be disregarded unless otherwise
provided by federal or state statutes, the home of the applicant or
recipient when the home is providing shelter to the applicant or
recipient, or his or her spouse or dependent child. The division of
family services shall establish by rule or regulation in conformance with
applicable federal statutes and regulations a definition of the home and
when the home shall be considered a resource that shall be considered in
determining eligibility.

10. Reimbursement for services provided by an enrolled Medicaid provider
to a recipient who is duly entitled to Title XIX Medicaid and Title XVIII
Medicare Part B, Supplementary Medical Insurance (SMI) shall include
payment in full of deductible and coinsurance amounts as determined due
pursuant to the applicable provisions of federal regulations pertaining
to Title XVIII Medicare Part B, except the applicable Title XIX cost
sharing.

11. A "community spouse" is defined as being the noninstitutionalized
spouse.

12. An institutionalized spouse applying for Medicaid and having a spouse
living in the community shall be required, to the maximum extent
permitted by law, to divert income to such community spouse to raise the
community spouse's income to the level of the minimum monthly needs
allowance, as described in 42 U.S.C. Section 1396r-5. Such diversion of
income shall occur before the community spouse is allowed to retain
assets in excess of the community spouse protected amount described in 42
U.S.C. Section 1396r-5*. (RSMo 1939 § 9406, A.L. 1943 p. 950, A.L. 1949
p. 597, A.L. 1953 p. 644, A.L. 1955 p. 688, A.L. 1957 p. 694, A.L. 1959
H.B. 131, A.L. 1963 p. 377, A.L. 1965 1st Ex. Sess. p. 807, A.L. 1967 pp.
321, 323, A.L. 1969 H.B. 804, A.L. 1973 S.B. 325, A.L. 1974 S.B. 577,
A.L. 1978 S.B. 596, A.L. 1981 H.B. 894, H.B. 901, A.L. 1982 H.B. 1462,
A.L. 1985 H.B. 803, A.L. 1986 S.B. 463 & 629 merged with S.B. 555 & 570,
A.L. 1988 S.B. 494 & 556, A.L. 1989 S.B. 203 & 270, A.L. 1998 S.B. 701,
A.L. 2005 S.B. 539)

*Original rolls contain "1396-r", a typographical error.

CROSS REFERENCE:

Spousal impoverishment or premature placement in institutional care,
protection against by compliance with section 208.010, RSMo, in
determination of Medicaid eligibility, RSMo 660.690

(1960) On application of individual for old age assistance where it was
admitted that the applicant had turned over to his daughters certain
amounts of money, the burden was upon him to show that he was indebted to
such daughters and his failure to show it by convincing evidence was
sufficient to authorize the denial of his application for benefits.
Carlisle v. State Department of Public Health and Welfare (A.), 341
S.W.2d 617

(1962) Director of welfare acted arbitrarily in determining eligibility
of claimant and failed to grant fair hearing by refusing to consider
evidence as to equitable ownership of property. Claimant was not required
to establish by court action that beneficial ownership of property was in
another. Powers v. State Department of Public Health and Welfare (A.),
359 S.W.2d 33.

(1962) Claimant's execution of a deed of trust against his property to
secure a loan for $2,000 of which $1,000 went to his daughter-in-law and
balance was used to pay off claimant's prior indebtedness secured by the
property and the interest payments were paid by daughter-in-law, did not
render claimant ineligible for benefits. Dysart v. State Dept. of Public
Health & Welfare (A.), 361 S.W.2d 347.

(1962) Director's decision that claimants were ineligible for old age
assistance in that they had sold real estate in which they had one-half
interest without receiving anything of value therefor was not supported
where uncontradicted evidence was that claimants had been made joint
tenants with their daughter to prevent daughter's divorced husband
acquiring an interest therein and there was no evidence that claimants
had paid anything on purchase price. Velghe v. State Dept. of Public
Health and Welfare (A.), 362 S.W.2d 747.

(1964) Finding of director that applicant for old age assistance had
transferred $1500 to daughter without receiving fair and valuable
consideration was based upon substantial evidence and decision denying
compensation was not unreasonable or arbitrary. Dunnegan v. Gallop (A.),
374 S.W.2d 407.

(1972) Finding by director of public health and welfare that transfer of
life estate of 68 year old claimant in business building which was in
state of disrepair and disuse and encumbered by $1,500 in back taxes for
payment of $50 for each month of her life with a minimum total payment of
$1,000 was made without fair and valuable consideration was arbitrary and
unreasonable. Davis v. State Dept. of Public Health and Welfare (A.),
S.W.2d 775.

(1973) Held, verbal promise to pay for land conveyed by deed is within
statutory definition of "fair and valuable consideration." Hill v. State
Dept. of Public Health & Welfare (Mo. Banc), 503 S.W.2d 6.

(1975) Evidence held not to sustain a finding that property was
transferred without fair and valuable consideration. Value of undivided
interest of a cotenant out of possession is not necessarily one-half of
market value. Brumit v. State Department of Public Health and Welfare
(Mo.), 521 S.W.2d 445.

(1985) In determining entitlement to medical assistance to pay for the
cost of residential care, the director may not consider the value of the
assets of a spendthrift trust where the settlor intended that the
payments from the trust to his retarded son were to supplement rather
than supplant benefits to which the son would otherwise be entitled.
Tidrow v. Director of Mo. State Division of Family Services (Mo. App.),
688 S.W.2d 9.

Payments made from the Agent Orange Settlement Fund or any other
fund established pursuant to the settlement in the In Re Agent Orange
product liability litigation, M.D.L. No. 381 (E.D.N.Y.) shall not be
considered income or resources in determining eligibility for or the
amount of benefits under any state or state-assisted program. (L. 1990
H.B. 1849 § 1)

Effective 5-25-90

1. The following amounts received by an individual or returns
and payments to an individual shall not be considered income, resources
or assets when determining the amount of, or eligibility for, any public
assistance, benefit, entitlement or tax relief to such individual
pursuant to any state or state-assisted program:

(1) Amounts received as reparations or restitution for the loss of
liberty or life or damage to health by the victims of National Socialist
(Nazi) persecution;

(2) Returns of tangible or intangible property seized, misappropriated or
lost as a result of National Socialist (Nazi) actions or policies and any
cash values in replacement of such property;

(3) Payments of insurance policies purchased prior to December 31, 1945,
by the victims of National Socialist (Nazi) persecution; and

(4) Any accumulated or accrued interest on such amounts, returns or
payments.

2. The nonconsideration of the amounts, returns or payments as income,
resources or assets of an individual shall only apply if such individual
was a victim of National Socialist (Nazi) persecution, actions or
policies or is the spouse or descendant of a victim of National Socialist
(Nazi) persecution, actions or policies and such family member is the
first recipient of such amounts, returns or payments.

3. As used in this section, "National Socialist (Nazi) persecution,
actions and policies" means persecution, actions or policies taken by
Germany and other countries, or by organizations, institutions and
companies within those countries, against the victims of the Nazi
Holocaust. (L. 2000 H.B. 1452 § 208.750)

1. There is hereby established the "Medicaid Reform Commission".
The commission shall have as its purpose the study and review of
recommendations for reforms of the state Medicaid system. The commission
shall consist of ten members:

(1) Five members of the house of representatives appointed by the
speaker; and

(2) Five members of the senate appointed by the pro tem.

No more than three members from each house shall be of the same political
party. The directors of the department of social services, the department
of health and senior services, and the department of mental health or the
directors' designees shall serve as ex officio members of the commission.

2. Members of the commission shall be reimbursed for the actual and
necessary expenses incurred in the discharge of the member's official
duties.

3. A chair of the commission shall be selected by the members of the
commission.

4. The commission shall meet as necessary.

5. The commission is authorized to contract with a consultant. The
compensation of the consultant and other personnel shall be paid from the
joint contingent fund or jointly from the senate and house contingent
funds until an appropriation is made therefor.

6. The commission shall make recommendations in a report to the general
assembly by January 1, 2006, on reforming, redesigning, and restructuring
a new, innovative state Medicaid healthcare delivery system under Title
XIX, Public Law 89-97, 1965, amendments to the federal Social Security
Act (42 U.S.C. Section 30 et. seq.) as amended, to replace the current
state Medicaid system under Title XIX, Public Law 89-97, 1965, amendments
to the federal Social Security Act (42 U.S.C. Section 30, et seq.), which
shall sunset on June 30, 2008. (L. 2005 S.B. 539)

1. The division of family services shall grant general relief
benefits to those persons determined to be eligible under this chapter
and the applicable rules of the division. The director may adopt such
additional requirements for eligibility for general relief, not
inconsistent with this chapter, which he deems appropriate.

2. General relief shall not be granted to any person:

(1) Who has been approved for federal supplemental security income and
was not on the general relief rolls in December, 1973; or

(2) Who is a recipient of:

(a) Aid to families with dependent children benefits;

(b) Aid to the blind benefits;

(c) Blind pension benefits; or

(d) Supplemental aid to the blind benefits.

3. A person shall not be considered unemployable, under this section, if
unemployability is due to school attendance.

4. Persons receiving general relief in December, 1973, and who qualify
for supplemental security income shall continue to receive a general
relief grant if necessary to prevent a reduction in the total cash income
received by such person in December, 1973, which general relief grant
shall not exceed the amount of general relief provided by law.

5. In providing benefits to persons applying for or receiving general
relief, benefits shall not be provided to any member of a household if
the claimant is employable as defined by rule of the division of family
services; or if certain specified relatives living in the household of
the claimant are employed and have income sufficient to support
themselves and their legal dependents and to meet the needs of the
claimant as defined by rule of the division. "Specified relatives" shall
be defined as the spouse, mother, father, sister, brother, son, daughter,
and grandparents of the claimant, as well as the spouses of these
relatives, if living in the home.

6. General relief paid to an unemployable person shall not exceed one
hundred dollars a month. (L. 1973 S.B. 325, A.L. 1981 H.B. 901)

Effective 6-16-81

1. Any proceeds from involuntary conversion of real property
into personal property (such as forced transfer under condemnation,
eminent domain, and fire, flood or other act of God) received by a
recipient while eligible to receive public assistance benefits under
existing laws shall be considered real property and excluded from
resources for a period of one year from the time of their receipt.

2. For the purposes of this section the word "receipt" means actual
receipt of the proceeds or the payment into court of the proceeds, except
that in condemnation cases when the initial exception to the
commissioner's award is filed by the condemning authority, the word
"receipt" means receipt of an award under a final judgment. (L. 1949 p.
599 § 1, A.L. 1955 p. 688, A.L. 1965 p. 354, A.L. 1982 H.B. 1462)

Effective 2-16-82

1. The division of family services shall make monthly payments
to each person who was a recipient of old age assistance, aid to the
permanently and totally disabled, and aid to the blind and who:

(1) Received such assistance payments from the state of Missouri for the
month of December, 1973, to which they were legally entitled; and

(2) Is a resident of Missouri.

2. The amount of supplemental payment made to persons who meet the
eligibility requirements for and receive federal supplemental security
income payments shall be in an amount, as established by rule and
regulation of the division of family services, sufficient to, when added
to all other income, equal the amount of cash income received in
December, 1973; except, in establishing the amount of the supplemental
payments, there shall be disregarded cost-of-living increases provided
for in Titles II and XVI of the federal Social Security Act and any
benefits or income required to be disregarded by an act of Congress of
the United States or any regulation duly promulgated thereunder. As long
as the recipient continues to receive a supplemental security income
payment, the supplemental payment shall not be reduced. The minimum
supplemental payment for those persons who continue to meet the December,
1973, eligibility standards for aid to the blind shall be in an amount
which, when added to the federal supplemental security income payment,
equals the amount of the blind pension grant as provided for in chapter
209, RSMo.

3. The amount of supplemental payment made to persons who do not meet the
eligibility requirements for federal supplemental security income
benefits, but who do meet the December, 1973, eligibility standards for
old age assistance, permanent and total disability and aid to the blind
or less restrictive requirements as established by rule or regulation of
the division of family services, shall be in an amount established by
rule and regulation of the division of family services sufficient to,
when added to all other income, equal the amount of cash income received
in December, 1973; except, in establishing the amount of the supplemental
payment, there shall be disregarded cost-of-living increases provided for
in Titles II and XVI of the federal Social Security Act and any other
benefits or income required to be disregarded by an act of Congress of
the United States or any regulation duly promulgated thereunder. The
minimum supplemental payments for those persons who continue to meet the
December, 1973, eligibility standards for aid to the blind shall be a
blind pension payment as prescribed in chapter 209, RSMo.

4. The division of family services shall make monthly payments to persons
meeting the eligibility standards for the aid to the blind program in
effect December 31, 1973, who are bona fide residents of the state of
Missouri. The payment shall be in the amount prescribed in subsection 1
of section 209.040, RSMo, less any federal supplemental security income
payment.

5. The division of family services shall make monthly payments to persons
age twenty-one or over who meet the eligibility requirements in effect on
December 31, 1973, or less restrictive requirements as established by
rule or regulation of the division of family services, who were receiving
old age assistance, permanent and total disability assistance, general
relief assistance, or aid to the blind assistance lawfully, who are not
eligible for nursing home care under the Title XIX program, and who
reside in a licensed residential care facility I, a licensed residential
care facility II, a licensed intermediate care facility or a licensed
skilled nursing facility in Missouri and whose total cash income is not
sufficient to pay the amount charged by the facility; and to all
applicants age twenty-one or over who are not eligible for nursing home
care under the Title XIX program who are residing in a licensed
residential care facility I, a licensed residential care facility II, a
licensed intermediate care facility or a licensed skilled nursing
facility in Missouri, who make application after December 31, 1973,
provided they meet the eligibility standards for old age assistance,
permanent and total disability assistance, general relief assistance, or
aid to the blind assistance in effect on December 31, 1973, or less
restrictive requirements as established by rule or regulation of the
division of family services, who are bona fide residents of the state of
Missouri, and whose total cash income is not sufficient to pay the amount
charged by the facility. Until July 1, 1983, the amount of the total
state payment for home care in licensed residential care facilities I
shall not exceed one hundred twenty dollars monthly, for care in licensed
intermediate care facilities or licensed skilled nursing facilities shall
not exceed three hundred dollars monthly, and for care in licensed
residential care facilities II shall not exceed two hundred twenty-five
dollars monthly. Beginning July 1, 1983, for fiscal year 1983-1984 and
each year thereafter, the amount of the total state payment for home care
in licensed residential care facilities I shall not exceed one hundred
fifty-six dollars monthly, for care in licensed intermediate care
facilities or licensed skilled nursing facilities shall not exceed three
hundred ninety dollars monthly, and for care in licensed residential care
facilities II shall not exceed two hundred ninety-two dollars and fifty
cents monthly. No intermediate care or skilled nursing payment shall be
made to a person residing in a licensed intermediate care facility or in
a licensed skilled nursing facility unless such person has been
determined, by his own physician or doctor, to medically need such
services subject to review and approval by the department. Residential
care payments may be made to persons residing in licensed intermediate
care facilities or licensed skilled nursing facilities. Any person
eligible to receive a monthly payment pursuant to this subsection shall
receive an additional monthly payment of not more than twenty-five
dollars. The exact amount of the additional payment shall be determined
by rule of the department. This additional payment shall not be used to
pay for any supplies or services, or for any other items that would have
been paid for by the division of family services if that person would
have been receiving medical assistance benefits under Title XIX of the
federal Social Security Act for nursing home services pursuant to the
provisions of section 208.159. Notwithstanding the previous part of this
subsection, the person eligible shall not receive this additional payment
if such eligible person is receiving funds for personal expenses from
some other state or federal program. (RSMo 1939 § 9407, A. 1949 S.B.
1063, A.L. 1973 S.B. 325, A.L. 1974 H.B. 1563, A.L. 1975 H.B. 197, S.B.
99, A.L. 1978 S.B. 492, A.L. 1979 S.B. 328, et al., A.L. 1980 H.B. 1613,
A.L. 1981 H.B. 901, A.L. 1982 H.B. 1086, A.L. 1984 S.B. 451, A.L. 1985
H.B. 39, A.L. 1988 H.B. 960)

Effective 4-7-88

1. Temporary assistance benefits shall be granted on behalf of a
dependent child or children and may be granted to the parents or other
needy eligible relative caring for a dependent child or children who:

(1) Is under the age of eighteen years; or is under the age of nineteen
years and a full-time student in a secondary school (or at the equivalent
level of vocational or technical training), if before the child attains
the age of nineteen the child may reasonably be expected to complete the
program of the secondary school (or vocational or technical training);

(2) Has been deprived of parental support or care by reason of the death,
continued absence from the home, or physical or mental incapacity of a
parent, and who is living with father, mother, grandfather, grandmother,
brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle,
aunt, first cousin, nephew or niece, in a place of residence maintained
by one or more of such relatives as the child's own home, and financial
aid for such child is necessary to save the child from neglect and to
secure for the child proper care in such home. Physical or mental
incapacity shall be certified to by competent medical or other
appropriate authority designated by the division of family services, and
such certificate is hereby declared to be competent evidence in any
proceedings concerning the eligibility of such claimant to receive aid to
families with dependent children benefits. Benefits may be granted and
continued for this reason only while it is the judgment of the division
of family services that a physical or mental defect, illness or
disability exists which prevents the parent from performing any gainful
work;

(3) Is not receiving supplemental aid to the blind, blind pension,
supplemental payments, or aid or public relief as an unemployable person;

(4) Is a resident of the state of Missouri.

2. The division of family services shall require as additional conditions
of eligibility for benefits that each applicant for or recipient of aid:

(1) Shall furnish to the division the applicant or recipient's Social
Security number or numbers, if the applicant or recipient has more than
one such number;

(2) Shall assign to the division of family services in behalf of the
state any rights to support from any other person such applicant may have
in the applicant's own behalf or in behalf of any other family member for
whom the applicant is applying for or receiving aid. An application for
benefits made under this section shall constitute an assignment of
support rights which shall take effect, by operation of law, upon a
determination that the applicant is eligible for assistance under this
section. The assignment is effective as to both current and accrued
support obligations and authorizes the division of child support
enforcement of the department of social services to bring any
administrative or judicial action to establish or enforce a current
support obligation, to collect support arrearages accrued under an
existing order for support, or to seek reimbursement of support provided
by the division;

(3) Shall cooperate with the divisions of family services and of child
support enforcement unless the division of family services determines in
accordance with federally prescribed standards that such cooperation is
contrary to the best interests of the child on whose behalf aid is
claimed or to the caretaker of such child, in establishing the paternity
of a child born out of wedlock with respect to whom aid is claimed, and
in obtaining support payments for such applicant and for a child with
respect to whom such aid is claimed, or in obtaining any other payments
or property due such applicant or such child. The divisions of family
services and of child support enforcement shall impose all penalties
allowed pursuant to federal participation requirements;

(4) Shall cooperate with the department of social services in identifying
and providing information to assist the state in pursuing any third party
who may be liable to pay for care and services available under the
state's plan for medical assistance as provided in section 208.152,
unless such individual has good cause for refusing to cooperate as
determined by the department of social services in accordance with
federally prescribed standards; and

(5) Shall participate in any program designed to reduce the recipient's
dependence on welfare, if requested to do so by the department of social
services.

3. The division shall require as a condition of eligibility for temporary
assistance benefits that a minor child under the age of eighteen who has
never married and who has a dependent child in his or her care, or who is
pregnant and otherwise eligible for temporary assistance benefits, shall
reside in a place of residence maintained by a parent, legal guardian, or
other adult relative or in some other adult-supervised supportive living
arrangement, as required by Section 403 of P.L. 100-485. Exceptions to
the requirements of this subsection shall be allowed in accordance with
requirements of the federal Family Support Act of 1988 in any of the
following circumstances:

(1) The individual has no parent or legal guardian who is living or the
whereabouts of the individual's parent or legal guardian is unknown; or

(2) The division of family services determines that the physical health
or safety of the individual or the child of the individual would be
jeopardized; or

(3) The individual has lived apart from any parent or legal guardian for
a period of at least one year prior to the birth of the child or applying
for benefits; or

(4) The individual claims to be or to have been the victim of abuse while
residing in the home where she would be required to reside and the case
has been referred to the child abuse hotline and a "reason to suspect
finding" has been made. Households where the individual resides with a
parent, legal guardian or other adult relative or in some other
adult-supervised supportive living arrangement shall, subject to federal
waiver to retain full federal financial participation and appropriation,
have earned income disregarded from eligibility determinations up to one
hundred percent of the federal poverty level.

4. If the relative with whom a child is living is found to be ineligible
because of refusal to cooperate as required in subdivision (3) of
subsection 2 of this section, any aid for which such child is eligible
will be paid in the manner provided in subsection 2 of section 208.180,
without regard to subsections 1 and 2 of this section.

5. The department of social services may implement policies designed to
reduce a family's dependence on welfare. The department of social
services is authorized to implement these policies by rule promulgated
pursuant to section 660.017, RSMo, and chapter 536, RSMo, including the
following:

(1) The department shall increase the earned income and resource
disregards allowed recipients to help families achieve a gradual
transition to self-sufficiency, including implementing policies to
simplify employment-related eligibility standards by increasing the
earned income disregard to two-thirds by October 1, 1999. The expanded
earned income disregard shall apply only to recipients of cash assistance
who obtain employment but not to new applicants for cash assistance who
are already working. Once the individual has received the two-thirds
disregard for twelve months, the individual would not be eligible for the
two-thirds disregard until the individual has not received temporary
assistance benefits for twelve consecutive months. The department shall
promulgate rules pursuant to chapter 536, RSMo, to implement the expanded
earned income disregard provisions;

(2) The department shall permit a recipient's enrollment in educational
programs beyond secondary education to qualify as a work activity for
purposes of receipt of temporary assistance for needy families. Such
education beyond secondary education shall qualify as a work activity if
such recipient is attending and according to the standards of the
institution and the division of family services, making satisfactory
progress towards completion of a postsecondary or vocational program.
Weekly classroom time and allowable study time shall be applied toward
the recipient's weekly work requirement. Such recipient shall be subject
to the sixty-month lifetime limit for receipt of temporary assistance for
needy families unless otherwise excluded by rule of the division of
family services;

(3) Beginning January 1, 2002, and every two years thereafter, the
department of social services shall make a detailed report and a
presentation on the temporary assistance for needy families program to
the house appropriations for social services committee and the house
social services, Medicaid and the elderly committee, and the senate
aging, families and mental health committee, or comparable committees;

(4) Other policies designed to reduce a family's dependence on welfare
may include supplementing wages for recipients for the lesser of
forty-eight months or the length of the recipient's employment by
diverting the temporary assistance grant.

The provisions of this subsection shall be subject to compliance by the
department with all applicable federal laws and rules regarding temporary
assistance for needy families.

6. The work history requirements and definition of "unemployed" shall not
apply to any parents in order for these parents to be eligible for
assistance pursuant to section 208.041.

7. The department shall continue to apply uniform standards of
eligibility and benefits, excepting pilot projects, in all political
subdivisions of the state.

8. Consistent with federal law, the department shall establish income and
resource eligibility requirements that are no more restrictive than its
July 16, 1996, income and resource eligibility requirements in
determining eligibility for temporary assistance benefits. (RSMo 1939 §
9408, A.L. 1941 p. 645, A.L. 1949 p. 589, A.L. 1951 p. 755, A.L. 1953 p.
642, A.L. 1955 p. 691, A.L. 1957 p. 696, A.L. 1973 S.B. 303, A.L. 1977
H.B. 601, A.L. 1982 S.B. 468 merged with H.B. 1462, A.L. 1983 H.B. 713
Revision, A.L. 1984 H.B. 1275, A.L. 1987 H.B. 518, A.L. 1994 H.B. 1547 &
961, A.L. 1999 S.B. 387, et al., A.L. 2001 S.B. 236)

1. Notwithstanding the provisions of subdivision (2) of section
208.050, the provisions of section 208.040 shall also apply to a needy
child who has been deprived of parental support or care by reason of the
unemployment of a parent as such term "unemployment" is defined and
determined by the division of family services pursuant to applicable
federal law and regulations. The unemployed parent, for whose child or
children benefits may be received, is eligible for payments and under
this section must:

(1) Be physically present in Missouri, living in the home with the child
or children, actively seeking employment, and complying with requirements
made by the division of family services pursuant to applicable state and
federal requirements for registration with the United States Secretary of
Labor or his representative regarding employment, training, work
incentive and special work projects;

(2) Have been unemployed for at least thirty days prior to receiving
benefits under this section and must apply for and receive any
unemployment benefits to which he or she is entitled, such benefits to be
considered as unearned income in determining eligibility for aid to
families with dependent children;

(3) Not have refused without good cause, within such thirty-day period
prior to the receipt of such aid, any bona fide offer of employment which
he or she is physically able to perform and otherwise qualified to engage
in;

(4) Not have refused, without good cause, vocational rehabilitation,
education, training, work incentive or special work projects offered;

(5) (a) Have six or more quarters of work within any
thirteen-calendar-quarter period ending within one year prior to the
application for such aid or have received or have been qualified to
receive unemployment compensation within such one-year period;

(b) A "quarter of work" with respect to any individual shall mean a
period of three consecutive calendar months ending on March thirty-first,
June thirtieth, September thirtieth, or December thirty-first in which he
or she received earned income of not less than fifty dollars or in which
he or she participated in a community work and training program or the
work incentive program;

(c) An individual shall be deemed "qualified" for unemployment
compensation under the state's unemployment compensation law if he or she
would have been eligible to receive such benefits upon filing
application, or he or she performed work not covered by such law which,
if it has been covered, would, together with any covered work he or she
performed, have made him or her eligible to receive such benefits upon
filing application; and

(6) Be the natural or adoptive parent of the child or children or legally
responsible for the support of the child or children.

2. The division of family services shall enter into a cooperative
agreement with the state department of elementary and secondary education
and the coordinating board for higher education for use of public
vocational rehabilitation and education services and facilities in
respect to the unemployed parent to the end that those capable of
assimilating and utilizing the same may be trained or retrained.

3. The division of family services shall enter into an agreement with the
division of employment security for registration and reregistration of
unemployed parents, and shall refer them to the United States Secretary
of Labor or his representative, within thirty days of receiving
assistance, for the purpose of providing employment, training, work
incentive and special work projects for all eligible unemployed parents
as provided in section 208.042.

4. Payments shall be prorated within the limits of the appropriations,
and shall not exceed the amount of the appropriations made therefor.

5. This section shall not become effective until June 16, 1983. (L. 1973
S.B. 155, A.L. 1975 S.B. 308, A.L. 1980 H.B. 1378, A.L. 1981 H.B. 901)

Effective 6-16-83

1. In households containing recipients of aid to families with
dependent children benefits, each appropriate child, relative or other
eligible individual sixteen years of age or over shall be referred by the
division of family services to the United States Secretary of Labor or
his representative for participation in employment, training, work
incentive or special work projects when established and operated by the
secretary, to afford such individuals opportunities to work in the
regular economy and to attain independence through gainful employment.

2. The division of family services, pursuant to applicable federal law
and regulations, shall determine the standards and procedures for the
referral of individuals for employment, training, work incentive and
special work projects, which shall not be refused by such individuals
without good cause; but no recipient or other eligible individual in the
household shall be required to participate in such work programs if the
person is

(1) Ill, incapacitated, or of advanced age;

(2) So remote from the location of any work or training project or
program that he cannot effectively participate;

(3) A child attending school full time;

(4) A person whose presence in the household on a substantially
continuous basis is required because of illness or incapacity of another
member of the household.

3. The division of family services shall pay to the United States
Secretary of Labor or his representative up to twenty percent of the
total cost, in cash or in kind, of the work incentive programs operated
for the benefit of the eligible persons referred by the division of
family services; and the division of family services shall pay an amount
to the secretary for eligible persons referred to and participating in
special work projects not to exceed the maximum monthly payments
authorized under sections 208.041 and 208.150 for recipients of public
assistance benefits. An allowance in addition to the maximum fixed by
section 208.150 may also be made by the division of family services for
the reasonable expenses of any needy child or needy eligible relative
which are attributable to his participating in a work training or work
incentive program.

4. If an eligible child or relative refuses without good cause to
participate in any work training or work incentive program to which he
has been referred, payment to or on behalf of the child or relative may
be continued for not more than sixty days thereafter, but in such cases
payments shall be made pursuant to subsection 2 of section 208.180. If a
relative has refused to so participate, payments on behalf of the
eligible children cared for by the relative shall be made pursuant to
subsection 2 of section 208.180.

5. The division of family services is authorized to expend funds to
provide child day care services, when appropriate, for the care of
children required by the absence of adult persons from the household due
to referral and participation in employment, training, work incentive
programs or special work projects. (L. 1967 1st Ex. Sess. p. 900, A.L.
1969 H.B. 678, H.B. 804, A.L. 1973 S.B. 325, A.L. 1981 H.B. 901)

Effective 6-16-81

1. Notwithstanding the provisions of section 208.040, aid to
dependent children benefits shall be granted on behalf of a needy child
and may be granted to a needy eligible legal guardian caring for a needy
dependent child who:

(1) Has been deprived of parental support or care by reason of the death,
continued absence from the home, or physical or mental incapacity of a
parent;

(2) Is living with a legal guardian;

(3) Is under the age of eighteen; and

(4) Is not eligible for aid to dependent children benefits under section
208.040 because the child is not living with a specified relative.

2. The amount of the monthly public assistance benefit payable hereunder
shall be determined by the standards set forth in section 208.150. (L.
1973 S.B. 159)

1. The division of family services shall provide child day care
services to any person who meets the qualifications set forth at sections
301 and 302 of the Family Support Act of 1988 (P.L. 100-485).

2. The division of family services shall purchase the child day care
services required by this section by making payments directly to any
providers of day care services licensed pursuant to chapter 210, RSMo, or
to providers of day care services who are not required by chapter 210,
RSMo, to be licensed because they are providing care to relative children
or no more than four children.

3. When a person who has been eligible and receiving day care services
under this section becomes ineligible due to the end of the twelve-month
period of transitional day care, as defined in section 208.400, such
person may receive day care services from the division of family services
if otherwise eligible for such services. Until October 1, 1992,
participants eligible for income eligible day care services, as defined
by the division of family services, will continue to receive such
services in the same proportion as that provided in fiscal year 1989,
subject to appropriation. (L. 1989 1st Ex. Sess. H.B. 2)

Effective 7-27-89

1. Notwithstanding the provisions of section 208.040, aid to
dependent children benefits may be granted to a dependent child:

(1) Who would meet the requirements of section 208.040, except for his
removal from the home of a relative as a result of a judicial
determination to the effect that continuation therein would be contrary
to the welfare of such child;

(2) For whose placement and care the division of family services is
responsible;

(3) Who has been placed in a foster family home or nonprofit private
child-care institution as a result of such determination; and

(4) Who (a) received aid to dependent children benefits in and for the
month in which court proceedings leading to such determination were
initiated; or (b) would have received aid in or for that month if
application had been made therefor; or (c) in the case of a child who had
been living with a relative specified in section 208.040 within six
months prior to the month in which such proceedings were initiated, would
have received aid in and for such month, if in such month he had been
living with, and removed from the home of, such a relative and
application had been made therefor.

2. Monthly aid to dependent children benefits on behalf of a child placed
in a foster family home or nonprofit private child-care institution shall
not exceed one hundred dollars for each child and in the event that
federal aid to states for dependent children placed in a nonprofit
private child-care institution is withdrawn, benefit payments under this
section shall be terminated on behalf of a dependent child in a nonprofit
private child-care institution. (L. 1963 p. 379 § 208.041, A.L. 1965 p.
355, A.L. 1969 H.B. 804)

Effective 7-15-69

1. A dependent child eighteen years of age shall, in order to
retain eligibility for aid to families with dependent children, be
enrolled as a full-time student in a public or private secondary school,
or an equivalent level of vocational or technical school in lieu of
secondary school, and reasonably expected to complete the program of the
secondary school, or equivalent vocational or technical training.

2. The department of social services shall promulgate rules and
regulations to carry out the provisions of this section pursuant to
section 660.017, RSMo, and chapter 536, RSMo. (L. 1994 H.B. 1547 & 961)

Aid to families with dependent children benefits shall not be
granted or continued:

(1) Unless the benefits granted are used to meet the needs of the child
and the needy eligible relative caring for a dependent child;

(2) To any person when benefits are claimed by reason of his physical or
mental incapacity, and such person refuses to accept vocational
rehabilitation services or training or medical or other legal healing
treatment necessary to improve or restore his capacity to support himself
and his dependents, and it is certified by competent medical authority
designated by the division of family services that such physical or
mental incapacity can be removed, corrected or substantially improved;
provided, however, the division of family services may in its discretion
waive this requirement, taking into consideration the age of the
individual, nature and extent of training and treatment, or whether he
endangers the health of others in his refusal, whether the training or
treatment is such that a reasonably prudent person would accept it, and
all other facts and circumstances in the individual case;

(3) To a household that receives in any month an amount of income which
together with all other income for that month, not excluded or
disregarded by the division, exceeds the standard of need applicable to
the family:

(a) Such amount of income shall be considered income to the individual in
the month received, and the household of which such person is a member
shall be ineligible for the whole number of months that equals the sum of
such amount and all other income received in such month, not excluded or
disregarded by the division, divided by the standard of need applicable
to the family;

(b) Any income remaining shall be treated as income received in the first
month following the period of ineligibility specified in paragraph (a);

(c) For the purposes of this subdivision, where consistent with federal
law or regulation, "income" shall not include the proceeds of any life
insurance policy, or prearranged funeral or burial contract, provided
that such proceeds are actually used to pay for the funeral or burial
expenses of the deceased family member. (L. 1949 p. 589 § 9408a, A.L.
1955 p. 691, A.L. 1969 H.B. 804, A.L. 1982 H.B. 1462, A.L. 1985 H.B. 803)

(1985) In determining whether income received exceeds standard of need
applicable to family, neither personal injury award, nor life insurance
award used to replace resources destroyed in connection with same event
causing deaths of those insured may be considered. Payne v. Toan, 626
F.Supp. 553 (W.D.Mo.)

1. A person who has applied for or is receiving public
assistance under programs funded under Part A of Title IV, the work first
program or Title XIX of the federal Social Security Act shall:

(1) Cooperate in good faith in establishing the paternity of, or in
establishing, modifying, or enforcing a support order for any child of
such person by providing the division of child support enforcement with
the name of the noncustodial parent of the child and such other
information as the division may require with respect to such parent,
subject to good cause and other exceptions to be applied in each case as
defined by the division of child support enforcement; and

(2) A person who has applied for or is receiving assistance under
programs funded under Part A of Title IV of the federal Social Security
Act and the work first program shall assign to the state any rights to
support from any other person such applicant may have in the applicant's
own behalf or on behalf of any other family member for whom the applicant
is applying for or receiving public assistance. An application for public
assistance shall constitute an assignment of support rights and shall
take effect by operation of law upon a determination that the applicant
is eligible for public assistance. The assignment is effective for both
current and accrued support obligations, unless otherwise prohibited by
the federal Social Security Act, and authorizes the division of child
support enforcement to bring any administrative or judicial action to
establish, modify or enforce a current support obligation, to collect
support arrearages accrued under an existing order for support, or to
seek reimbursement of public assistance provided by the state pursuant to
Part IV of the federal Social Security Act.

2. For purposes of this section, "public assistance" means any income
support benefit, including, but not limited to, money, institutional
care, or shelter, except temporary shelter. Public assistance includes
programs under the federal Social Security Act including, but not limited
to, Part IV-A, as amended by the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996. Public assistance shall not
include:

(1) A noncash benefit; or

(2) A short term benefit. (L. 1997 S.B. 361)

Effective 7-1-97

Application for any benefits under any law of this state
administered by the division of family services acting as a state agency
shall be filed in the county office. Application for aid to dependent
children shall be made by the person with whom the child will live while
receiving aid. All applications shall be in writing, or reduced to
writing, upon blank forms furnished by the division of family services,
and shall contain such information as may be required by the division of
family services or by any federal authority under the Social Security law
and amendments thereto. The term "benefits" as used herein or in this law
shall be construed to mean:

(1) Aid to dependent children;

(2) Aid or public relief to individuals in cases of public calamity;

(3) Money or services available for child welfare services;

(4) Any other grant, aid, pension or assistance administered by the
division of family services. (RSMo 1939 § 9409, A.L. 1973 S.B. 325)

Effective 1-1-74

1. The department shall permit any individual who wants to apply
for assistance pursuant to the temporary assistance or any other public
assistance program administered or supervised by the department to so
apply. Such public assistance shall be furnished with reasonable
promptness in accordance with statute and rules of the department.

2. A request for assistance may be made at a county office of the
division of family services in person, by telephone or by mail.

3. Whenever the division receives a request for assistance an
investigation and record shall be promptly made of the circumstances of
the applicant by the division in order to ascertain the facts supporting
the application. Upon the completion of such investigation the director
of the division of family services, or someone designated by the
director, shall decide whether the applicant is eligible for benefits and
if entitled to benefits determine the amount thereof and the date on
which such benefits shall begin. The division shall notify the applicant
of the decision.

4. During the investigation of any application or recertification of
assistance, the division shall:

(1) At the time of each application, provide each applicant household
with a clear written statement explaining what acts the member of the
household shall perform to cooperate in verifying and otherwise
completing the application process;

(2) Assist each applicant household in obtaining appropriate verification
and completing the application process;

(3) Not require any household to submit additional proof of a matter on
which the division already has current verification, unless the division
has reason to believe that such information is inaccurate, incomplete or
insufficient; and

(4) Not deny any application for assistance solely because of the failure
of a person outside the household to cooperate in providing information.

5. The division shall complete the investigation within the time allowed
by federal law or state statute. If no time limit is otherwise specified
by federal law or state statute, benefits shall be provided not later
than forty-five days following the filing of an application.

6. The division shall explain to the applicant the nature of all
categories of public assistance, benefits and services for which the
applicant household may be eligible and may be given, and the
consequences of accepting temporary assistance benefits, including, but
not limited to, lifetime limits and work requirements. If the applicant
chooses not to receive temporary assistance benefits, the division shall
evaluate the applicant's eligibility for medical assistance, food stamps
and any other public assistance benefits which the applicant or the
applicant's dependents may be eligible. (RSMo 1939 § 9410, A.L. 1999 S.B.
387, et al.)

1. The department shall make an individualized assessment of the
skills, prior work experience, and employability of each recipient of
assistance under the program who:

(1) Has attained eighteen years of age; or

(2) Has not completed high school or obtained a certificate of high
school equivalency, and is not attending secondary school.

2. No participant may be assigned to any education, training or
employment component of the state's welfare-to-work programs prior to an
individualized assessment. The assessment shall be consistent with the
criteria listed in section 208.325.

3. The division may promulgate rules and regulations that are reasonable
and necessary to accomplish the limited duties specifically provided by
this section. No rule or portion of a rule promulgated pursuant to the
authority of this section shall become effective unless it has been
promulgated pursuant to the provisions of chapter 536, RSMo. (L. 1999
S.B. 387, et al.)

1. A completed application for medical assistance for services
described in section 208.152 shall be approved or denied within thirty
days from submission to the division of family services or its successor.

2. The division of medical services shall remit to a licensed nursing
home operator the Medicaid payment for a newly admitted Medicaid resident
in a licensed long-term care facility within forty-five days of the
resident's date of admission. (L. 2001 H.B. 328 & 88 § 1)

1. When an application is made for aid to dependent children or
aid to the permanently and totally disabled benefits because of the
physical or mental condition of a person the division of family services
shall require the person to be examined by competent medical or other
appropriate authority designated by the division of family services. If
benefits are paid because of the physical or mental condition of a person
the division of family services may, as often as it deems necessary,
require such person to be reexamined by competent medical or other
appropriate authority designated by the division of family services.
Written reports of examinations and reexaminations shall be required and
evaluated by the division of family services in determining eligibility
to receive benefits or to continue to receive benefits.

2. In any appeal hearing as provided for by section 208.080 and the
question at issue involves the physical or mental incapacity of a person,
regardless of whether assistance has been denied or a recipient has been
removed from the assistance rolls, the written reports of the examination
or reexamination made by competent medical or other appropriate authority
designated by the division of family services, and any written medical
reports by other physicians or clinics submitted by claimant, are hereby
declared to be competent evidence and admissible as such at the appeal
hearing to be considered by the director with any other evidence
submitted. Any written medical report purporting to be executed and
signed by the medical or other appropriate authority, its agents, or
employees shall be prima facie evidence of it being properly executed and
signed without further proof of identification. (L. 1963 p. 380 § 208.052)

1. Any applicant for or recipient of benefits or services
provided by law by the division of family services may appeal to the
director of the division of family services from a decision of a county
office of the division of family services in any of the following cases:

(1) If his right to make application for any such benefits or services is
denied; or

(2) If his application is disallowed in whole or in part, or is not acted
upon within a reasonable time after it is filed; or

(3) If it is proposed to cancel or modify benefits or services; or

(4) If he is adversely affected by any determination of a county office
of the division of family services in its administration of the programs
administered by it; or

(5) If a determination is made pursuant to subsection 2 of section
208.180 that payment of benefits on behalf of a dependent child shall not
be made to the relative with whom he lives.

2. If the division proposes to terminate or modify the payment of
benefits or the providing of services to the recipient or the division
has terminated or modified the payment of benefits or providing of
services to the recipient and the recipient appeals, the decision of the
director as to the eligibility of the recipient at the time such action
was proposed or taken shall be based on the facts shown by the evidence
presented at the hearing of the appeal to have existed at the time such
action to terminate or modify was proposed or was taken.

3. In the case of a proposed action by the county office of the division
of family services to reduce, modify, or discontinue benefits or services
to a recipient, the recipient of such benefits or services shall have ten
days from the date of the mailing of notice of the proposed action to
reduce, modify, or discontinue benefits or services within which to
request an appeal to the director of the division of family services. In
the notice to the recipient of such proposed action, the county office of
the division of family services shall notify the recipient of all his
rights of appeal under this section. Proper blank forms for appeal to the
director of the division of family services shall be furnished by the
county office to any aggrieved recipient. Every such appeal to the
director of the division of family services shall be transmitted by the
county office to the director of the division of family services
immediately upon the same being filed with the county office. If an
appeal is requested, benefits or services shall continue undiminished or
unchanged until such appeal is heard and a decision has been rendered
thereon, except that in an aid to families with dependent children case
the recipient may request that benefits or services not be continued
undiminished or unchanged during the appeal.

4. When a case has been closed or modified and no appeal was requested
prior to closing or modification, the recipient shall have ninety days
from the date of closing or modification to request an appeal to the
director of the division of family services. Each recipient who has not
requested an appeal prior to the closing or modification of his case
shall be notified at the time of such closing or modification of his
right to request an appeal during this ninety-day period. Proper blank
forms for requesting an appeal to the director of the division of family
services shall be furnished by the county office to any aggrieved
applicant. Every such request made in any manner for an appeal to the
director of the division of family services shall be transmitted by the
county office to the director of the division of family services
immediately upon the same being filed with the county office. If an
appeal is requested in the ninety-day period subsequent to the closing or
modification, benefits or services shall not be continued at their prior
level during the pendency of the appeal.

5. In the case of a rejection of an application for benefits or services,
the aggrieved applicant shall have ninety days from the date of the
notice of the action in which to request an appeal to the director of the
division of family services. In the rejection notice the applicant for
benefits or services shall be notified of all of his rights of appeal
under this section. Proper blank forms for requesting an appeal to the
director of the division of family services shall be furnished by the
county office to any aggrieved applicant. Any such request made in any
manner for an appeal shall be transmitted by the county office to the
director of the division of family services, immediately upon the same
being filed with the county office.

6. If the division has rejected an application for benefits or services
and the applicant appeals, the decision of the director as to the
eligibility of the applicant at the time such rejection was made shall be
based upon the facts shown by the evidence presented at the hearing of
the appeal to have existed at the time the rejection was made.

7. The director of the division of family services shall give the
applicant for benefits or services or the recipient of benefits or
services reasonable notice of, and an opportunity for, a fair hearing in
the county of his residence at the time the adverse action was taken. The
hearing shall be conducted by the director of the division of family
services or his designee. Every applicant or recipient, on appeal to the
director of the division of family services, shall be entitled to be
present at the hearing, in person and by attorney or representative, and
shall be entitled to introduce into the record of such hearing any and
all evidence, by witnesses or otherwise, pertinent to such applicant's or
recipient's eligibility between the time he applied for benefits or
services and the time the application was denied or the benefits or
services were terminated or modified, and all such evidence shall be
taken down, preserved, and shall become a part of the applicant's or
recipient's appeal record. Upon the record so made, the director of the
division of family services shall determine all questions presented by
the appeal, and shall make such decision as to the granting of benefits
or services as in his opinion is justified and is in conformity with the
provisions of the law. The director shall clearly state the reasons for
his decision and shall include a statement of findings of fact and
conclusions of law pertinent to the questions in issue.

8. All appeal requests may initially be made orally or in any written
form, but all such requests shall be transcribed on forms furnished by
the division of family services and signed by the aggrieved applicant or
recipient or his representative prior to the commencement of the hearing.
(RSMo 1939 § 9411, A. 1949 S.B. 1063, A.L. 1951 p. 772, A.L. 1969 H.B.
804, A.L. 1981 S.B. 73, A.L. 1987 H.B. 518)

CROSS REFERENCE: Administrative hearings procedure, RSMo 536.060 to
536.090.

If an application has been denied or if a recipient's benefits
or services have been terminated or modified and the applicant or the
recipient is found by the director upon the hearing of his appeal to be
or to have been eligible, payment of benefits and providing of services
shall be made only for those months during which the applicant or
recipient was actually eligible and, if currently eligible, the applicant
or recipient shall be placed on the rolls, reinstated on the rolls, or
restored to the level of benefits and services for which he is eligible.
(RSMo 1939 § 9411, A. 1949 S.B. 1063, A.L. 1951 p. 772, A.L. 1969 H.B.
804, A.L. 1981 S.B. 73)

1. Any claimant aggrieved by the decision of the director of the
division of family services made under section 208.080 may appeal to the
circuit court of the county in which such claimant resides within ninety
days from the date of the action and decision appealed from.

2. The division shall furnish the claimant, upon request, with proper
form of affidavit for appeal from the director of the division of family
services to the circuit court.

3. Upon the affidavit for appeal, duly executed by the claimant before an
officer authorized to administer oaths, being filed with the division
within ninety days from the date of the decision of the director of the
division of family services the entire record preserved in the case at
the time of the claimant's hearing, together with the hearing decision
and the affidavit for appeal, shall be certified by the director of the
division of family services to the circuit court and the case shall be
docketed as other civil cases except that neither party shall be required
to give bond or deposit any money for docket fee on appeal to the circuit
court.

4. Such appeal shall be tried in the circuit court upon the record of the
proceedings had before and certified by the director of the division of
family services, which shall in such case be certified and included in
the return of said director to the court.

5. Upon the record so certified by the director of the division of family
services, the circuit court shall review the action and decision of the
director in accordance with the provisions of section 536.140, RSMo; and
the court shall render judgment affirming, reversing, or modifying the
director's decision, and may order the reconsideration of the case in the
light of the court's opinion and judgment, and may order the director to
take such further action as it may be proper to require. (RSMo 1939 §
9411, A. 1949 S.B. 1063, A.L. 1981 S.B. 73)

Appeals may be had by either party from the circuit court upon
the record in the same manner as provided herein for appeals from the
director to the circuit court, and all appeals to the circuit and
appellate courts shall be advanced on the docket of the courts for
immediate hearing and determination. (RSMo 1939 § 9411, A. 1949 S.B. 1063)

(1961) Finding that recipient of old age assistance had conveyed property
to her children without receiving in return a value equal to the property
conveyed held not supported by substantial evidence. Weidmaier v. State
Department of Public Health and Welfare (A.), 343 S.W.2d 93.

(1962) Where referee, in the course of a hearing on an application for
aid to dependent children based on the ground that the father of the
child was unable to work, stated that the father appeared to be able to
work and also that he appeared to be a normal person, the applicant for
benefits did not receive a fair hearing and the decision of the division
would be reversed. Jones v. State Department of Public Health and Welfare
(A.), 354 S.W.2d 37.

(1962) It was error, on appeal from decision of director of welfare, for
trial court to permit judgment of circuit court setting aside deed to be
introduced in evidence at hearing and made a part of the transcript on
appeal. Powers v. State Department of Public Health and Welfare (A.), 359
S.W.2d 23.

(1971) Appeals taken pursuant to § 208.110 are subject to the Rules of
Civil Procedure including the requirement that the Department of Public
Health and Welfare shall cause a transcript on appeal to be prepared,
filed, served and approved in the form and manner specified by Civil Rule
82.14. Stacy v. Department of Public Health and Welfare (A.), 468 S.W.2d
651.

(1972) Adding of affidavit is a permissible amendment to the original
notice of appeal and relates back to the filing of the original notice.
Fraher v. Department of Public Health and Welfare (A.), 484 S.W.2d 663.

1. For the protection of applicants and recipients, all officers
and employees of the state of Missouri are prohibited, except as
hereinafter provided, from disclosing any information obtained by them in
the discharge of their official duties relative to the identity of
applicants for or recipients of benefits or the contents of any records,
files, papers, and communications, except in proceedings or
investigations where the eligibility of an applicant to receive benefits,
or the amount received or to be received by any recipient, is called into
question, or for the purposes directly connected with the administration
of public assistance. In any judicial proceedings, except such
proceedings as are directly concerned with the administration of these
programs, such information obtained in the discharge of official duties
relative to the identity of applicants for or recipients of benefits, and
records, files, papers, communications and their contents shall be
confidential and not admissible in evidence.

2. The division of family services shall in each county welfare office
maintain monthly a report showing the name and address of all recipients
certified by such county welfare office to receive public assistance
benefits, together with the amount paid to each recipient during the
preceding month, and each such report and information contained therein
shall be open to public inspection at all times during the regular office
hours of the county welfare office; provided, however, that all
information regarding applicants or recipients other than names,
addresses and amounts of grants shall be considered as confidential.

3. It shall be unlawful for any person, association, firm, corporation or
other agency to solicit, disclose, receive, make use of or authorize,
knowingly permit, participate in or acquiesce in the use of any name or
lists of names for commercial or political purposes of any nature; or for
any name or list of names of recipients secured from such report in the
county welfare office to be published in any manner. Anyone willfully or
knowingly violating any provisions of this section shall be guilty of a
misdemeanor. If the violation is by other than an individual, the penalty
may be adjudged against any officer, agent, employee, servant or other
person of the association, firm, corporation or other agency who
committed or participated in such violation and is found guilty thereof.
(L. 1941 p. 646 § 9414a, A.L. 1951 p. 754, A.L. 1953 p. 636, A.L. 1973
S.B. 325)

Effective 1-1-74

(2000) Confidentiality provision does not preclude introduction of
Department of Social Services records in probate proceeding to recover
Medicaid expenditures from decedent's estate. Estate of West v. Moffatt,
32 S.W.3d 648 (Mo.App.W.D.).

The director of the division of family services is authorized to
destroy all applications and records compiled by the division of family
services in connection with the investigation and payment of public
assistance or blind pensions after five years have elapsed since the
closing of a case or the rejection of an application. (L. 1951 p. 755)

All benefits granted may be reconsidered by the director of
family services as frequently as he may deem necessary. After such
further investigation the amount of a benefit may be changed or entirely
withdrawn. (RSMo 1939 § 9412)

Every grant, aid, pension or assistance under the provisions of
this law shall be deemed to be granted and shall be held subject to the
provisions of any amendment or repealing law that may hereafter be
passed, and no recipient under this law shall have any claim for
compensation or otherwise by reason of his assistance being changed,
affected, or discontinued by such amending or repealing law or laws.
(RSMo 1939 § 9418)

The department of social services shall recognize the Part C
early intervention system established under sections 160.900 to 160.925,
RSMo, as an eligible program and shall pay all claims for reimbursement
for Medicaid-eligible children to the Part C early intervention system.
For those eligible children having other private insurance, the
department of social services shall seek reimbursement as appropriate
from the lead agency for payments made to the Part C early intervention
system for covered benefits provided by health benefit plans under
section 376.1218, RSMo. (L. 2005 S.B. 500)

CROSS REFERENCE: Sunset provision, RSMo 160.930

For the purposes of the application of section 208.151,
individuals shall be deemed to be recipients of aid to families with
dependent children and individuals shall be deemed eligible for such
assistance if:

(1) The individual meets eligibility requirements which are no more
restrictive than the July 16, 1996, eligibility requirements for aid to
families with dependent children, as established by the division of
family services; or

(2) Each dependent child, and each relative with whom such a child is
living including the spouse of such relative as described in 42 U.S.C.
606(b), as in effect on July 16, 1996, who ceases to meet the eligibility
criteria set forth in subdivision (1) of this section as a result of the
collection or increased collection of child or spousal support under part
IV-D of the Social Security Act, 42 U.S.C. 651 et seq., and who has
received such aid in at least three of the six months immediately
preceding the month in which ineligibility begins, shall be deemed
eligible for an additional four calendar months beginning with the month
in which such ineligibility begins. (L. 1998 S.B. 941)

1. The family support division shall conduct an annual income
and eligibility verification review of each recipient of medical
assistance. Such review shall be completed not later than twelve months
after the recipient's last eligibility determination.

2. The annual eligibility review requirement may be satisfied by the
completion of a periodic food stamp redetermination for the household.

3. The family support division shall annually send a reverification
eligibility form letter to the recipient requiring the recipient to
respond within ten days of receiving the letter and to provide income
verification documentation described in subsection 4 of this section. If
the division does not receive the recipient's response and documentation
within the ten days, the division shall send a letter notifying the
recipient that he or she has ten days to file an appeal or the case will
be closed.

4. The family support division shall require recipients to provide
documentation for income verification for purposes of eligibility review
described in subsection 1 of this section. Such documentation may
include, but not be limited to:

(1) Current wage stubs;

(2) A current W-2 form;

(3) Statements from the recipient's employer;

(4) A wage match with the division of employment security; and

(5) Bank statements. (L. 2005 S.B. 539)

The maximum amount of monthly public assistance money payment
benefits payable to or on behalf of a needy person shall not exceed the
following:

(1) Aid to families with a dependent child, or children, and needy
eligible relatives caring for a dependent child, or children, in an
amount to be computed as follows:

(a) Beginning July 1, 1993, and at least every three years thereafter,
the division of family services shall determine by regulation the average
need for each such eligible person, which shall include the cost of basic
needs required to maintain a child or children in the home at a
reasonable and decent low-income standard of living, and shall pay, on a
uniform basis, the highest percent of such need as shall be possible
within the limits of funds appropriated for that purpose, less available
income;

(b) "Available income" means the total income, before taxes or other
deductions, of each person residing within the same household, except, to
the extent allowed by federal law, the earnings of a student under
nineteen years of age enrolled in a secondary school or at the equivalent
level of vocational or technical training, plus or minus such credits or
deductions as may be prescribed by the division of family services by
regulations for the sole purpose of complying with federal laws or
regulations relating to this state's eligibility to receive federal funds
for aid to families with dependent children payments, and such credits or
deductions as may otherwise be prescribed by law;

(c) The available income shall be subtracted from the total amount which
otherwise would be paid;

(d) If the determined need under this subdivision is of an amount less
than ten dollars, no cash payment will be made;

(2) Aid or public relief to an unemployable person not to exceed one
hundred dollars. (RSMo 1939 § 9413, A.L. 1945 p. 1743, A.L. 1951 p. 760,
A.L. 1959 H.B. 1, A.L. 1963 pp. 381, 382, A.L. 1965 1st Ex. Sess. p. 807,
A.L. 1965 2d Ex. Sess. p. 898, A.L. 1967 p. 325, A.L. 1967 1st Ex. Sess.
p. 902, A.L. 1969 pp. 337, 345, A.L. 1973 S.B. 325, H.B. 514, A.L. 1973
1st Ex. Sess. S.B. 3, A.L. 1975 H.B. 25, A.L. 1977 H.B. 601, A.L. 1980
H.B. 1290, A.L. 1982 H.B. 1462, A.L. 1985 H.B. 803, A.L. 1990 S.B. 556,
A.L. 1994 H.B. 1547 & 961)

1. For the purpose of paying medical assistance on behalf of
needy persons and to comply with Title XIX, Public Law 89-97, 1965
amendments to the federal Social Security Act (42 U.S.C. Section 301 et
seq.) as amended, the following needy persons shall be eligible to
receive medical assistance to the extent and in the manner hereinafter
provided:

(1) All recipients of state supplemental payments for the aged, blind and
disabled;

(2) All recipients of aid to families with dependent children benefits,
including all persons under nineteen years of age who would be classified
as dependent children except for the requirements of subdivision (1) of
subsection 1 of section 208.040;

(3) All recipients of blind pension benefits;

(4) All persons who would be determined to be eligible for old age
assistance benefits, permanent and total disability benefits, or aid to
the blind benefits under the eligibility standards in effect December 31,
1973, or less restrictive standards as established by rule of the family
support division, who are sixty-five years of age or over and are
patients in state institutions for mental diseases or tuberculosis;

(5) All persons under the age of twenty-one years who would be eligible
for aid to families with dependent children except for the requirements
of subdivision (2) of subsection 1 of section 208.040, and who are
residing in an intermediate care facility, or receiving active treatment
as inpatients in psychiatric facilities or programs, as defined in 42
U.S.C. 1396d, as amended;

(6) All persons under the age of twenty-one years who would be eligible
for aid to families with dependent children benefits except for the
requirement of deprivation of parental support as provided for in
subdivision (2) of subsection 1 of section 208.040;

(7) All persons eligible to receive nursing care benefits;

(8) All recipients of family foster home or nonprofit private child-care
institution care, subsidized adoption benefits and parental school care
wherein state funds are used as partial or full payment for such care;

(9) All persons who were recipients of old age assistance benefits, aid
to the permanently and totally disabled, or aid to the blind benefits on
December 31, 1973, and who continue to meet the eligibility requirements,
except income, for these assistance categories, but who are no longer
receiving such benefits because of the implementation of Title XVI of the
federal Social Security Act, as amended;

(10) Pregnant women who meet the requirements for aid to families with
dependent children, except for the existence of a dependent child in the
home;

(11) Pregnant women who meet the requirements for aid to families with
dependent children, except for the existence of a dependent child who is
deprived of parental support as provided for in subdivision (2) of
subsection 1 of section 208.040;

(12) Pregnant women or infants under one year of age, or both, whose
family income does not exceed an income eligibility standard equal to one
hundred eighty-five percent of the federal poverty level as established
and amended by the federal Department of Health and Human Services, or
its successor agency;

(13) Children who have attained one year of age but have not attained six
years of age who are eligible for medical assistance under 6401 of P.L.
101-239 (Omnibus Budget Reconciliation Act of 1989). The family support
division shall use an income eligibility standard equal to one hundred
thirty-three percent of the federal poverty level established by the
Department of Health and Human Services, or its successor agency;

(14) Children who have attained six years of age but have not attained
nineteen years of age. For children who have attained six years of age
but have not attained nineteen years of age, the family support division
shall use an income assessment methodology which provides for eligibility
when family income is equal to or less than equal to one hundred percent
of the federal poverty level established by the Department of Health and
Human Services, or its successor agency. As necessary to provide Medicaid
coverage under this subdivision, the department of social services may
revise the state Medicaid plan to extend coverage under 42 U.S.C. 1396a
(a)(10)(A)(i)(III) to children who have attained six years of age but
have not attained nineteen years of age as permitted by paragraph (2) of
subsection (n) of 42 U.S.C. 1396d using a more liberal income assessment
methodology as authorized by paragraph (2) of subsection (r) of 42 U.S.C.
1396a;

(15) The family support division shall not establish a resource
eligibility standard in assessing eligibility for persons under
subdivision (12), (13) or (14) of this subsection. The division of
medical services shall define the amount and scope of benefits which are
available to individuals eligible under each of the subdivisions (12),
(13), and (14) of this subsection, in accordance with the requirements of
federal law and regulations promulgated thereunder;

(16) Notwithstanding any other provisions of law to the contrary,
ambulatory prenatal care shall be made available to pregnant women during
a period of presumptive eligibility pursuant to 42 U.S.C. Section
1396r-1, as amended;

(17) A child born to a woman eligible for and receiving medical
assistance under this section on the date of the child's birth shall be
deemed to have applied for medical assistance and to have been found
eligible for such assistance under such plan on the date of such birth
and to remain eligible for such assistance for a period of time
determined in accordance with applicable federal and state law and
regulations so long as the child is a member of the woman's household and
either the woman remains eligible for such assistance or for children
born on or after January 1, 1991, the woman would remain eligible for
such assistance if she were still pregnant. Upon notification of such
child's birth, the family support division shall assign a medical
assistance eligibility identification number to the child so that claims
may be submitted and paid under such child's identification number;

(18) Pregnant women and children eligible for medical assistance pursuant
to subdivision (12), (13) or (14) of this subsection shall not as a
condition of eligibility for medical assistance benefits be required to
apply for aid to families with dependent children. The family support
division shall utilize an application for eligibility for such persons
which eliminates information requirements other than those necessary to
apply for medical assistance. The division shall provide such application
forms to applicants whose preliminary income information indicates that
they are ineligible for aid to families with dependent children.
Applicants for medical assistance benefits under subdivision (12), (13)
or (14) shall be informed of the aid to families with dependent children
program and that they are entitled to apply for such benefits. Any forms
utilized by the family support division for assessing eligibility under
this chapter shall be as simple as practicable;

(19) Subject to appropriations necessary to recruit and train such staff,
the family support division shall provide one or more full-time,
permanent case workers to process applications for medical assistance at
the site of a health care provider, if the health care provider requests
the placement of such case workers and reimburses the division for the
expenses including but not limited to salaries, benefits, travel,
training, telephone, supplies, and equipment, of such case workers. The
division may provide a health care provider with a part-time or temporary
case worker at the site of a health care provider if the health care
provider requests the placement of such a case worker and reimburses the
division for the expenses, including but not limited to the salary,
benefits, travel, training, telephone, supplies, and equipment, of such a
case worker. The division may seek to employ such case workers who are
otherwise qualified for such positions and who are current or former
welfare recipients. The division may consider training such current or
former welfare recipients as case workers for this program;

(20) Pregnant women who are eligible for, have applied for and have
received medical assistance under subdivision (2), (10), (11) or (12) of
this subsection shall continue to be considered eligible for all
pregnancy-related and postpartum medical assistance provided under
section 208.152 until the end of the sixty-day period beginning on the
last day of their pregnancy;

(21) Case management services for pregnant women and young children at
risk shall be a covered service. To the greatest extent possible, and in
compliance with federal law and regulations, the department of health and
senior services shall provide case management services to pregnant women
by contract or agreement with the department of social services through
local health departments organized under the provisions of chapter 192,
RSMo, or chapter 205, RSMo, or a city health department operated under a
city charter or a combined city-county health department or other
department of health and senior services designees. To the greatest
extent possible the department of social services and the department of
health and senior services shall mutually coordinate all services for
pregnant women and children with the crippled children's program, the
prevention of mental retardation program and the prenatal care program
administered by the department of health and senior services. The
department of social services shall by regulation establish the
methodology for reimbursement for case management services provided by
the department of health and senior services. For purposes of this
section, the term "case management" shall mean those activities of local
public health personnel to identify prospective Medicaid-eligible
high-risk mothers and enroll them in the state's Medicaid program, refer
them to local physicians or local health departments who provide prenatal
care under physician protocol and who participate in the Medicaid program
for prenatal care and to ensure that said high-risk mothers receive
support from all private and public programs for which they are eligible
and shall not include involvement in any Medicaid prepaid, case-managed
programs;

(22) By January 1, 1988, the department of social services and the
department of health and senior services shall study all significant
aspects of presumptive eligibility for pregnant women and submit a joint
report on the subject, including projected costs and the time needed for
implementation, to the general assembly. The department of social
services, at the direction of the general assembly, may implement
presumptive eligibility by regulation promulgated pursuant to chapter
207, RSMo;

(23) All recipients who would be eligible for aid to families with
dependent children benefits except for the requirements of paragraph (d)
of subdivision (1) of section 208.150;

(24) (a) All persons who would be determined to be eligible for old age
assistance benefits under the eligibility standards in effect December
31, 1973, as authorized by 42 U.S.C. Section 1396a(f), or less
restrictive methodologies as contained in the Medicaid state plan as of
January 1, 2005; except that, on or after July 1, 2005, less restrictive
income methodologies, as authorized in 42 U.S.C. Section 1396a(r)(2), may
be used to change the income limit if authorized by annual appropriation;

(b) All persons who would be determined to be eligible for aid to the
blind benefits under the eligibility standards in effect December 31,
1973, as authorized by 42 U.S.C. Section 1396a(f), or less restrictive
methodologies as contained in the Medicaid state plan as of January 1,
2005, except that less restrictive income methodologies, as authorized in
42 U.S.C. Section 1396a(r)(2), shall be used to raise the income limit to
one hundred percent of the federal poverty level;

(c) All persons who would be determined to be eligible for permanent and
total disability benefits under the eligibility standards in effect
December 31, 1973, as authorized by 42 U.S.C. 1396a(f); or less
restrictive methodologies as contained in the Medicaid state plan as* of
January 1, 2005; except that, on or after July 1, 2005, less restrictive
income methodologies, as authorized in 42 U.S.C. Section 1396a(r)(2), may
be used to change the income limit if authorized by annual
appropriations. Eligibility standards for permanent and total disability
benefits shall not be limited by age;

(25) Persons who have been diagnosed with breast or cervical cancer and
who are eligible for coverage pursuant to 42 U.S.C. 1396a
(a)(10)(A)(ii)(XVIII). Such persons shall be eligible during a period of
presumptive eligibility in accordance with 42 U.S.C. 1396r-1.

2. Rules and regulations to implement this section shall be promulgated
in accordance with section 431.064, RSMo, and chapter 536, RSMo. Any rule
or portion of a rule, as that term is defined in section 536.010, RSMo,
that is created under the authority delegated in this section shall
become effective only if it complies with and is subject to all of the
provisions of chapter 536, RSMo, and, if applicable, section 536.028,
RSMo. This section and chapter 536, RSMo, are nonseverable and if any of
the powers vested with the general assembly pursuant to chapter 536,
RSMo, to review, to delay the effective date or to disapprove and annul a
rule are subsequently held unconstitutional, then the grant of rulemaking
authority and any rule proposed or adopted after August 28, 2002, shall
be invalid and void.

3. After December 31, 1973, and before April 1, 1990, any family eligible
for assistance pursuant to 42 U.S.C. 601 et seq., as amended, in at least
three of the last six months immediately preceding the month in which
such family became ineligible for such assistance because of increased
income from employment shall, while a member of such family is employed,
remain eligible for medical assistance for four calendar months following
the month in which such family would otherwise be determined to be
ineligible for such assistance because of income and resource limitation.
After April 1, 1990, any family receiving aid pursuant to 42 U.S.C. 601
et seq., as amended, in at least three of the six months immediately
preceding the month in which such family becomes ineligible for such aid,
because of hours of employment or income from employment of the caretaker
relative, shall remain eligible for medical assistance for six calendar
months following the month of such ineligibility as long as such family
includes a child as provided in 42 U.S.C. 1396r-6. Each family which has
received such medical assistance during the entire six-month period
described in this section and which meets reporting requirements and
income tests established by the division and continues to include a child
as provided in 42 U.S.C. 1396r-6 shall receive medical assistance without
fee for an additional six months. The division of medical services may
provide by rule and as authorized by annual appropriation the scope of
medical assistance coverage to be granted to such families.

4. When any individual has been determined to be eligible for medical
assistance, such medical assistance will be made available to him or her
for care and services furnished in or after the third month before the
month in which he made application for such assistance if such individual
was, or upon application would have been, eligible for such assistance at
the time such care and services were furnished; provided, further, that
such medical expenses remain unpaid.

5. The department of social services may apply to the federal Department
of Health and Human Services for a Medicaid waiver amendment to the
Section 1115 demonstration waiver or for any additional Medicaid waivers
necessary not to exceed one million dollars in additional costs to the
state. A request for such a waiver so submitted shall only become
effective by executive order not sooner than ninety days after the final
adjournment of the session of the general assembly to which it is
submitted, unless it is disapproved within sixty days of its submission
to a regular session by a senate or house resolution adopted by a
majority vote of the respective elected members thereof.

6. Notwithstanding any other provision of law to the contrary, in any
given fiscal year, any persons made eligible for medical assistance
benefits under subdivisions (1) to (22) of subsection 1 of this section
shall only be eligible if annual appropriations are made for such
eligibility. This subsection shall not apply to classes of individuals
listed in 42 U.S.C. Section 1396a(a)(10)(A)(i). (L. 1967 p. 325, A.L.
1973 S.B. 301, H.B. 48, A.L. 1981 H.B. 894, H.B. 901, A.L. 1982 H.B.
1462, A.L. 1987 H.B. 518, A.L. 1988 H.B. 1139, A.L. 1989 1st Ex. Sess.
H.B. 2, A.L. 1990 S.B. 765, A.L. 1991 H.B. 447, A.L. 1993 H.B. 564 merged
with S.B. 52, A.L. 1995 S.B. 3, A.L. 2001 H.B. 762, A.L. 2001 1st Ex.
Sess. H.B. 3 merged with S.B. 4, et al., A.L. 2005 S.B. 539)

*Word "as" does not appear in original rolls, a typographical error.

1. Benefit payments for medical assistance shall be made on
behalf of those eligible needy persons as defined in section 208.151 who
are unable to provide for it in whole or in part, with any payments to be
made on the basis of the reasonable cost of the care or reasonable charge
for the services as defined and determined by the division of medical
services, unless otherwise hereinafter provided, for the following:

(1) Inpatient hospital services, except to persons in an institution for
mental diseases who are under the age of sixty-five years and over the
age of twenty-one years; provided that the division of medical services
shall provide through rule and regulation an exception process for
coverage of inpatient costs in those cases requiring treatment beyond the
seventy-fifth percentile professional activities study (PAS) or the
Medicaid children's diagnosis length-of-stay schedule; and provided
further that the division of medical services shall take into account
through its payment system for hospital services the situation of
hospitals which serve a disproportionate number of low-income patients;

(2) All outpatient hospital services, payments therefor to be in amounts
which represent no more than eighty percent of the lesser of reasonable
costs or customary charges for such services, determined in accordance
with the principles set forth in Title XVIII A and B, Public Law 89-97,
1965 amendments to the federal Social Security Act (42 U.S.C. 301, et
seq.), but the division of medical services may evaluate outpatient
hospital services rendered under this section and deny payment for
services which are determined by the division of medical services not to
be medically necessary, in accordance with federal law and regulations;

(3) Laboratory and X-ray services;

(4) Nursing home services for recipients, except to persons in an
institution for mental diseases who are under the age of sixty-five
years, when residing in a hospital licensed by the department of health
and senior services or a nursing home licensed by the department of
health and senior services or appropriate licensing authority of other
states or government-owned and -operated institutions which are
determined to conform to standards equivalent to licensing requirements
in Title XIX of the federal Social Security Act (42 U.S.C. 301, et seq.),
as amended, for nursing facilities. The division of medical services may
recognize through its payment methodology for nursing facilities those
nursing facilities which serve a high volume of Medicaid patients. The
division of medical services when determining the amount of the benefit
payments to be made on behalf of persons under the age of twenty-one in a
nursing facility may consider nursing facilities furnishing care to
persons under the age of twenty-one as a classification separate from
other nursing facilities;

(5) Nursing home costs for recipients of benefit payments under
subdivision (4) of this subsection for those days, which shall not exceed
twelve per any period of six consecutive months, during which the
recipient is on a temporary leave of absence from the hospital or nursing
home, provided that no such recipient shall be allowed a temporary leave
of absence unless it is specifically provided for in his plan of care. As
used in this subdivision, the term "temporary leave of absence" shall
include all periods of time during which a recipient is away from the
hospital or nursing home overnight because he is visiting a friend or
relative;

(6) Physicians' services, whether furnished in the office, home,
hospital, nursing home, or elsewhere;

(7) Drugs and medicines when prescribed by a licensed physician, dentist,
or podiatrist; except that no payment for drugs and medicines prescribed
on and after January 1, 2006, by a licensed physician, dentist, or
podiatrist may be made on behalf of any person who qualifies for
prescription drug coverage under the provisions of P.L. 108-173;

(8) Emergency ambulance services and, effective January 1, 1990,
medically necessary transportation to scheduled, physician-prescribed
nonelective treatments;

(9) Early and periodic screening and diagnosis of individuals who are
under the age of twenty-one to ascertain their physical or mental
defects, and health care, treatment, and other measures to correct or
ameliorate defects and chronic conditions discovered thereby. Such
services shall be provided in accordance with the provisions of Section
6403 of P.L. 101-239 and federal regulations promulgated thereunder;

(10) Home health care services;

(11) Family planning as defined by federal rules and regulations;
provided, however, that such family planning services shall not include
abortions unless such abortions are certified in writing by a physician
to the Medicaid agency that, in his professional judgment, the life of
the mother would be endangered if the fetus were carried to term;

(12) Inpatient psychiatric hospital services for individuals under age
twenty-one as defined in Title XIX of the federal Social Security Act (42
U.S.C. 1396d, et seq.);

(13) Outpatient surgical procedures, including presurgical diagnostic
services performed in ambulatory surgical facilities which are licensed
by the department of health and senior services of the state of Missouri;
except, that such outpatient surgical services shall not include persons
who are eligible for coverage under Part B of Title XVIII, Public Law
89-97, 1965 amendments to the federal Social Security Act, as amended, if
exclusion of such persons is permitted under Title XIX, Public Law 89-97,
1965 amendments to the federal Social Security Act, as amended;

(14) Personal care services which are medically oriented tasks having to
do with a person's physical requirements, as opposed to housekeeping
requirements, which enable a person to be treated by his physician on an
outpatient, rather than on an inpatient or residential basis in a
hospital, intermediate care facility, or skilled nursing facility.
Personal care services shall be rendered by an individual not a member of
the recipient's family who is qualified to provide such services where
the services are prescribed by a physician in accordance with a plan of
treatment and are supervised by a licensed nurse. Persons eligible to
receive personal care services shall be those persons who would otherwise
require placement in a hospital, intermediate care facility, or skilled
nursing facility. Benefits payable for personal care services shall not
exceed for any one recipient one hundred percent of the average statewide
charge for care and treatment in an intermediate care facility for a
comparable period of time;

(15) Mental health services. The state plan for providing medical
assistance under Title XIX of the Social Security Act, 42 U.S.C. 301, as
amended, shall include the following mental health services when such
services are provided by community mental health facilities operated by
the department of mental health or designated by the department of mental
health as a community mental health facility or as an alcohol and drug
abuse facility or as a child-serving agency within the comprehensive
children's mental health service system established in section 630.097,
RSMo. The department of mental health shall establish by administrative
rule the definition and criteria for designation as a community mental
health facility and for designation as an alcohol and drug abuse
facility. Such mental health services shall include:

(a) Outpatient mental health services including preventive, diagnostic,
therapeutic, rehabilitative, and palliative interventions rendered to
individuals in an individual or group setting by a mental health
professional in accordance with a plan of treatment appropriately
established, implemented, monitored, and revised under the auspices of a
therapeutic team as a part of client services management;

(b) Clinic mental health services including preventive, diagnostic,
therapeutic, rehabilitative, and palliative interventions rendered to
individuals in an individual or group setting by a mental health
professional in accordance with a plan of treatment appropriately
established, implemented, monitored, and revised under the auspices of a
therapeutic team as a part of client services management;

(c) Rehabilitative mental health and alcohol and drug abuse services
including home and community-based preventive, diagnostic, therapeutic,
rehabilitative, and palliative interventions rendered to individuals in
an individual or group setting by a mental health or alcohol and drug
abuse professional in accordance with a plan of treatment appropriately
established, implemented, monitored, and revised under the auspices of a
therapeutic team as a part of client services management. As used in this
section, "mental health professional" and "alcohol and drug abuse
professional" shall be defined by the department of mental health
pursuant to duly promulgated rules.

With respect to services established by this subdivision, the department
of social services, division of medical services, shall enter into an
agreement with the department of mental health. Matching funds for
outpatient mental health services, clinic mental health services, and
rehabilitation services for mental health and alcohol and drug abuse
shall be certified by the department of mental health to the division of
medical services. The agreement shall establish a mechanism for the joint
implementation of the provisions of this subdivision. In addition, the
agreement shall establish a mechanism by which rates for services may be
jointly developed;

(16) Such additional services as defined by the division of medical
services to be furnished under waivers of federal statutory requirements
as provided for and authorized by the federal Social Security Act (42
U.S.C. 301, et seq.) subject to appropriation by the general assembly;

(17) Beginning July 1, 1990, the services of a certified pediatric or
family nursing practitioner to the extent that such services are provided
in accordance with chapter 335, RSMo, and regulations promulgated
thereunder, regardless of whether the nurse practitioner is supervised by
or in association with a physician or other health care provider;

(18) Nursing home costs for recipients of benefit payments under
subdivision (4) of this subsection to reserve a bed for the recipient in
the nursing home during the time that the recipient is absent due to
admission to a hospital for services which cannot be performed on an
outpatient basis, subject to the provisions of this subdivision:

(a) The provisions of this subdivision shall apply only if:

a. The occupancy rate of the nursing home is at or above ninety-seven
percent of Medicaid certified licensed beds, according to the most recent
quarterly census provided to the department of health and senior services
which was taken prior to when the recipient is admitted to the hospital;
and

b. The patient is admitted to a hospital for a medical condition with an
anticipated stay of three days or less;

(b) The payment to be made under this subdivision shall be provided for a
maximum of three days per hospital stay;

(c) For each day that nursing home costs are paid on behalf of a
recipient pursuant to this subdivision during any period of six
consecutive months such recipient shall, during the same period of six
consecutive months, be ineligible for payment of nursing home costs of
two otherwise available temporary leave of absence days provided under
subdivision (5) of this subsection; and

(d) The provisions of this subdivision shall not apply unless the nursing
home receives notice from the recipient or the recipient's responsible
party that the recipient intends to return to the nursing home following
the hospital stay. If the nursing home receives such notification and all
other provisions of this subsection have been satisfied, the nursing home
shall provide notice to the recipient or the recipient's responsible
party prior to release of the reserved bed.

2. Additional benefit payments for medical assistance shall be made on
behalf of those eligible needy children, pregnant women and blind persons
with any payments to be made on the basis of the reasonable cost of the
care or reasonable charge for the services as defined and determined by
the division of medical services, unless otherwise hereinafter provided,
for the following:

(1) Dental services;

(2) Services of podiatrists as defined in section 330.010, RSMo;

(3) Optometric services as defined in section 336.010, RSMo;

(4) Orthopedic devices or other prosthetics, including eye glasses,
dentures, hearing aids, and wheelchairs;

(5) Hospice care. As used in this subsection, the term "hospice care"
means a coordinated program of active professional medical attention
within a home, outpatient and inpatient care which treats the terminally
ill patient and family as a unit, employing a medically directed
interdisciplinary team. The program provides relief of severe pain or
other physical symptoms and supportive care to meet the special needs
arising out of physical, psychological, spiritual, social, and economic
stresses which are experienced during the final stages of illness, and
during dying and bereavement and meets the Medicare requirements for
participation as a hospice as are provided in 42 CFR Part 418. The rate
of reimbursement paid by the division of medical services to the hospice
provider for room and board furnished by a nursing home to an eligible
hospice patient shall not be less than ninety-five percent of the rate of
reimbursement which would have been paid for facility services in that
nursing home facility for that patient, in accordance with subsection (c)
of Section 6408 of P.L. 101-239 (Omnibus Budget Reconciliation Act of
1989);

(6) Comprehensive day rehabilitation services beginning early posttrauma
as part of a coordinated system of care for individuals with disabling
impairments. Rehabilitation services must be based on an individualized,
goal-oriented, comprehensive and coordinated treatment plan developed,
implemented, and monitored through an interdisciplinary assessment
designed to restore an individual to optimal level of physical,
cognitive, and behavioral function. The division of medical services
shall establish by administrative rule the definition and criteria for
designation of a comprehensive day rehabilitation service facility,
benefit limitations and payment mechanism. Any rule or portion of a rule,
as that term is defined in section 536.010, RSMo, that is created under
the authority delegated in this subdivision shall become effective only
if it complies with and is subject to all of the provisions of chapter
536, RSMo, and, if applicable, section 536.028, RSMo. This section and
chapter 536, RSMo, are nonseverable and if any of the powers vested with
the general assembly pursuant to chapter 536, RSMo, to review, to delay
the effective date, or to disapprove and annul a rule are subsequently
held unconstitutional, then the grant of rulemaking authority and any
rule proposed or adopted after August 28, 2005, shall be invalid and void.

3. Benefit payments for medical assistance for surgery as defined by rule
duly promulgated by the division of medical services, and any costs
related directly thereto, shall be made only when a second medical
opinion by a licensed physician as to the need for the surgery is
obtained prior to the surgery being performed.

4. The division of medical services may require any recipient of medical
assistance to pay part of the charge or cost, as defined by rule duly
promulgated by the division of medical services, for all covered services
except for those services covered under subdivisions (14) and (15) of
subsection 1 of this section and sections 208.631 to 208.657 to the
extent and in the manner authorized by Title XIX of the federal Social
Security Act (42 U.S.C. 1396, et seq.) and regulations thereunder. When
substitution of a generic drug is permitted by the prescriber according
to section 338.056, RSMo, and a generic drug is substituted for a name
brand drug, the division of medical services may not lower or delete the
requirement to make a co-payment pursuant to regulations of Title XIX of
the federal Social Security Act. A provider of goods or services
described under this section must collect from all recipients the partial
payment that may be required by the division of medical services under
authority granted herein, if the division exercises that authority, to
remain eligible as a provider. Any payments made by recipients under this
section shall be reduced from any payments made by the state for goods or
services described herein except the recipient portion of the pharmacy
professional dispensing fee shall be in addition to and not in lieu of
payments to pharmacists. A provider may collect the co-payment at the
time a service is provided or at a later date. A provider shall not
refuse to provide a service if a recipient is unable to pay a required
cost sharing. If it is the routine business practice of a provider to
terminate future services to an individual with an unclaimed debt, the
provider may include uncollected co-payments under this practice.
Providers who elect not to undertake the provision of services based on a
history of bad debt shall give recipients advance notice and a reasonable
opportunity for payment. A provider, representative, employee,
independent contractor, or agent of a pharmaceutical manufacturer shall
not make co-payment for a recipient. This subsection shall not apply to
other qualified children, pregnant women, or blind persons. If the
Centers for Medicare and Medicaid Services does not approve the Missouri
Medicaid state plan amendment submitted by the department of social
services that would allow a provider to deny future services to an
individual with uncollected co-payments, the denial of services shall not
be allowed. The department of social services shall inform providers
regarding the acceptability of denying services as the result of unpaid
co-payments.

5. The division of medical services shall have the right to collect
medication samples from recipients in order to maintain program integrity.

6. Reimbursement for obstetrical and pediatric services under subdivision
(6) of subsection 1 of this section shall be timely and sufficient to
enlist enough health care providers so that care and services are
available under the state plan for medical assistance at least to the
extent that such care and services are available to the general
population in the geographic area, as required under subparagraph
(a)(30)(A) of 42 U.S.C. 1396a and federal regulations promulgated
thereunder.

7. Beginning July 1, 1990, reimbursement for services rendered in
federally funded health centers shall be in accordance with the
provisions of subsection 6402(c) and Section 6404 of P.L. 101-239
(Omnibus Budget Reconciliation Act of 1989) and federal regulations
promulgated thereunder.

8. Beginning July 1, 1990, the department of social services shall
provide notification and referral of children below age five, and
pregnant, breast-feeding, or postpartum women who are determined to be
eligible for medical assistance under section 208.151 to the special
supplemental food programs for women, infants and children administered
by the department of health and senior services. Such notification and
referral shall conform to the requirements of Section 6406 of P.L.
101-239 and regulations promulgated thereunder.

9. Providers of long-term care services shall be reimbursed for their
costs in accordance with the provisions of Section 1902 (a)(13)(A) of the
Social Security Act, 42 U.S.C. 1396a, as amended, and regulations
promulgated thereunder.

10. Reimbursement rates to long-term care providers with respect to a
total change in ownership, at arm's length, for any facility previously
licensed and certified for participation in the Medicaid program shall
not increase payments in excess of the increase that would result from
the application of Section 1902 (a)(13)(C) of the Social Security Act, 42
U.S.C. 1396a (a)(13)(C).

11. The department of social services, division of medical services, may
enroll qualified residential care facilities, as defined in chapter 198,
RSMo, as Medicaid personal care providers. (L. 1967 p. 325, A.L. 1969 p.
337, A.L. 1971 H.B. 17, A.L. 1972 H.B. 673, H.B. 1254, A.L. 1973 S.B.
302, A.L. 1975 H.B. 974, A.L. 1977 S.B. 334, A.L. 1978 S.B. 492, S.B.
671, A.L. 1978 S.B. 505 §§ 1, 2, 3, A.L. 1981 S.B. 63, H.B. 901, A.L.
1986 S.B. 463 & 629, A.L. 1988 H.B. 1139, A.L. 1990 S.B. 524 merged with
S.B. 765, A.L. 1992 H.B. 899 merged with S.B. 573 & 634 merged with S.B.
721, A.L. 1993 H.B. 564, A.L. 2004 S.B. 1003, A.L. 2005 S.B. 539)

1. Pursuant to and not inconsistent with the provisions of
sections 208.151 and 208.152, the division of medical services shall by
rule and regulation define the reasonable costs, manner, extent,
quantity, quality, charges and fees of medical assistance herein
provided. 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, and all
persons shall be required to apply for and utilize all benefits available
to them and to pursue all causes of action to which they are entitled.
Any person entitled to medical assistance may obtain it from any provider
of services with which an agreement is in effect under this section and
which undertakes to provide the services, as authorized by the division
of medical services. At the discretion of the director of medical
services and with the approval of the governor, the division of medical
services is authorized to provide medical benefits for recipients of
public assistance by expending funds for the payment of federal medical
insurance premiums, coinsurance and deductibles pursuant to the
provisions of Title XVIII B and XIX, Public Law 89-97, 1965 amendments to
the federal Social Security Act (42 U.S.C. 301 et seq.), as amended.

2. Medical assistance shall include benefit payments on behalf of
qualified Medicare beneficiaries as defined in 42 U.S.C. section
1396d(p). The division of family services shall by rule and regulation
establish which qualified Medicare beneficiaries are eligible. The
division of medical services shall define the premiums, deductible and
coinsurance provided for in 42 U.S.C. section 1396d(p) to be provided on
behalf of the qualified Medicare beneficiaries.

3. Beginning July 1, 1990, medical assistance shall include benefit
payments for Medicare Part A cost sharing as defined in clause
(p)(3)(A)(i) of 42 U.S.C. 1396d on behalf of qualified disabled and
working individuals as defined in subsection (s) of section 42 U.S.C.
1396d as required by subsection (d) of section 6408 of P.L. 101-239
(Omnibus Budget Reconciliation Act of 1989). The division of medical
services may impose a premium for such benefit payments as authorized by
paragraph (d)(3) of section 6408 of P.L. 101-239.

4. Medical assistance shall include benefit payments for Medicare Part B
cost-sharing described in 42 U.S.C. section 1396(d)(p)(3)(A)(ii) for
individuals described in subsection 2 of this section, but for the fact
that their income exceeds the income level established by the state under
42 U.S.C. section 1396(d)(p)(2) but is less than one hundred and ten
percent beginning January 1, 1993, and less than one hundred and twenty
percent beginning January 1, 1995, of the official poverty line for a
family of the size involved.

5. Beginning July 1, 1991, for an individual eligible for medical
assistance under Title XIX of the Social Security Act, medical assistance
shall include payment of enrollee premiums in a group health plan and all
deductibles, coinsurance and other cost-sharing for items and services
otherwise covered under the state Title XIX plan under section 1906 of
the federal Social Security Act and regulations established under the
authority of section 1906, as may be amended. Enrollment in a group
health plan must be cost effective, as established by the Secretary of
Health and Human Services, before enrollment in the group health plan is
required. If all members of a family are not eligible for medical
assistance under Title XIX and enrollment of the Title XIX eligible
members in a group health plan is not possible unless all family members
are enrolled, all premiums for noneligible members shall be treated as
payment for medical assistance of eligible family members. Payment for
noneligible family members must be cost effective, taking into account
payment of all such premiums. Non-Title XIX eligible family members shall
pay all deductible, coinsurance and other cost-sharing obligations. Each
individual as a condition of eligibility for medical assistance shall
apply for enrollment in the group health plan. (L. 1967 p. 325, A.L. 1967
1st Ex. Sess. p. 903, A.L. 1973 S.B. 325, A.L. 1989 S.B. 203 & 207, A.L.
1990 S.B. 765, A.L. 1991 H.B. 447)

Effective 7-1-91

If the funds at the disposal or which may be obtained by the
division of family services for the payment of public assistance money
payment benefits or to or on behalf of any person for medical assistance
benefits shall at any time become insufficient to pay the full amount
thereof, the amount of any type of payment to or on behalf of each of
such persons shall be reduced pro rata in proportion to such deficiency
in the total amount available or to become available for such purpose.
(L. 1967 p. 325)

All information concerning applicants and recipients of medical
assistance shall be confidential, and any disclosure of such information
shall be restricted to purposes directly connected with the
administration of the medical assistance program. (L. 1967 p. 325)

(2000) Confidentiality provision does not preclude introduction of
Department of Social Services records in probate proceeding to recover
Medicaid expenditures from decedent's estate. Estate of West v. Moffatt,
32 S.W.3d 648 (Mo.App.W.D.).

1. The division of family services shall provide for granting an
opportunity for a fair hearing under section 208.080 to any applicant or
recipient whose claim for medical assistance is denied or is not acted
upon with reasonable promptness.

2. Any person authorized under section 208.153 to provide services for
which benefit payments are authorized under section 208.152 whose claim
for reimbursement for such services is denied or is not acted upon with
reasonable promptness shall be entitled to a hearing before the
administrative hearing commission pursuant to the provisions of chapter
621, RSMo.

3. Any person authorized under section 208.153 to provide services for
which benefit payments are authorized under section 208.152 who is denied
participation in any program or programs established under the provisions
of chapter 208 shall be entitled to a hearing before the administrative
hearing commission pursuant to the provisions of chapter 621, RSMo.

4. Any person authorized under section 208.153 to provide services for
which benefit payments are authorized under section 208.152 who is
aggrieved by any rule or regulation promulgated by the department of
social services or any division therein shall be entitled to a hearing
before the administrative hearing commission pursuant to the provisions
of chapter 621, RSMo.

5. Any person authorized under section 208.153 to provide services for
which benefit payments are authorized under section 208.152 who is
aggrieved by any rule or regulation, contractual agreement, or decision,
as provided for in section 208.166, by the department of social services
or any division therein shall be entitled to a hearing before the
administrative hearing commission pursuant to the provisions of chapter
621, RSMo.

6. No provider of service may file a petition for a hearing before the
administrative hearing commission unless the amount for which he seeks
reimbursement exceeds five hundred dollars.

7. One or more providers of service as will fairly insure adequate
representation of others having similar claims against the department of
social services or any division therein may institute the hearing on
behalf of all in the class if there is a common question of law or fact
affecting the several rights and a common relief is sought.

8. Any person authorized under section 208.153 to provide services for
which benefit payments are authorized under section 208.152 and who is
entitled to a hearing as provided for in the preceding sections shall
have thirty days from the date of mailing or delivery of a decision of
the department of social services or its designated division in which to
file his* petition for review with the administrative hearing commission
except that claims of less than five hundred dollars may be accumulated
until they total that sum and at which time the provider shall have
ninety days to file his** petition.

9. When a person entitled to a hearing as provided for in this section
applies to the administrative hearing commission for a stay order staying
the actions of the department of social services or its divisions, the
administrative hearing commission shall not grant such stay order until
after a full hearing on such application. The application shall be
advanced on the docket for immediate hearing and determination. The
person applying for such stay order shall not be granted such stay order
unless that person shall show that immediate and irreparable injury,
loss, or damage will result if such stay order is denied, or that such
person has a reasonable likelihood of success upon the merits of his**
claim; and provided further that no stay order shall be issued without
the person seeking such order posting a bond in such sum as the
administrative hearing commission finds sufficient to protect and
preserve the interest of the department of social services or its
divisions. In no event may the administrative hearing commission grant
such stay order where the claim arises under a program or programs funded
by federal funds or by any combination of state and federal funds, unless
it is specified in writing by the financial section of the appropriate
federal agency that federal financial participation will be continued
under the stay order.

10. The other provisions of this section notwithstanding, a person
receiving or providing benefits shall have the right to bring an action
in appealing from the administrative hearing commission in the circuit
court of Cole County, Missouri, or the county of his residence pursuant
to section 536.050, RSMo. (L. 1967 p. 325, A.L. 1979 H.B. 88, A.L. 1981
S.B. 73, A.L. 1982 H.B. 1086)

*Word "its" appears in original rolls.

**Word "their" appears in original rolls.

(1993) Where action is based on specific facts involving named entities
and is a challenge to an agency decision, jurisdiction to challenge
decision is vested in the administrative hearing commission under this
section. Because action challenged an agency decision and not an agency
rule, section 536.050, RSMo, does not allow a declaratory judgment action
to be brought in the circuit court. Missouri Health Care Association, EBG
III, Inc. v. Missouri Department of Social Services, 851 S.W.2d 567 (Mo.
App. W.D.).

The division of family services shall comply with the provisions
of Title VI, Public Law 88-352, The Civil Rights Act of 1964, and shall
not in any manner deny any aid, care, services or other benefits to nor
discriminate against any person on the ground of race, color or national
origin; and no payment shall be made on behalf of any eligible needy
person to any provider of medical assistance, care or services who
refuses to comply with the Act, or who engages in any practices contrary
thereto. (L. 1967 p. 325)

Payments of medical assistance in federally aided programs shall
be made only during such times as grants-in-aid are provided or made
available to the state on the basis of the state plan approved by the
federal government for medical assistance pursuant to provisions of the
Federal Social Security Act, as amended. (L. 1967 p. 325)

Notwithstanding the provisions of sections 207.010, RSMo,
208.152, and 208.153, the department of social services shall administer
payments for nursing home services authorized in sections 208.151, et
seq., which govern medical assistance under Title XIX, Public Law 89-97,
1965 amendments to the Federal Social Security Act (42 U.S.C. 301 et
seq.), as amended, and shall administer vendor payments for the aged and
direct adult services for the aged under Title XX, Public Law 93-647,
1974 amendments to the Federal Social Security Act (42 U.S.C. 1397 et
seq.), as amended. The department shall, pursuant to chapter 536, RSMo,
promulgate rules and regulations for the purpose of administering such
payments, including rules to define the reasonable costs, manner, extent,
quality, charges and fees or* payments for nursing home services. (L.
1979 S.B. 328, et al.)

*Word "of" appears in original rolls.

The department of social services or its divisions shall prepare
separate rolls of persons entitled to benefits or compensation for:

(1) Supplemental payments;

(2) Aid to dependent children;

(3) Aid or public relief;

(4) Administrative personnel services and expenses;

(5) Any other grant, aid, pension, assistance or welfare services
administered by the department of social services or its divisions. From
the rolls, the department of social services or its divisions shall
prepare warrants in the form required by section 33.160, RSMo, which
shall be certified by the commissioner of administration to the state
treasurer for certification as required by section 30.180, RSMo. As
authorized by section 30.205, RSMo, or sections 105.273 to 105.278, RSMo,
the commissioner or the state treasurer may authorize the department of
social services to place their signature on the warrant to create a
negotiable check or draft or may authorize the electronic transfer of
funds in place of a check or draft. (RSMo 1939 § 9414, A.L. 1949 p. 600,
A.L. 1973 S.B. 325, A.L. 1993 H.B. 732)

1. In addition to benefit payments for medical assistance which
may be made on behalf of those eligible needy persons under this chapter,
benefit payments may be made for inpatient psychiatric hospital services
for individuals under age twenty-one, as defined in Title XIX of the
Federal Social Security Act (42 U.S.C.A. section 1396d) as amended, to
the extent and in the manner provided for other types of medical
assistance under this chapter.

2. Notwithstanding any other provision of this chapter for benefit
payments for medical assistance which may be made for nursing home
services to recipients eighteen years of age or older, benefit payments
for medical assistance may be made for nursing home services for
recipients of any age except as otherwise provided in Title XIX of the
Federal Social Security Act (42 U.S.C.A. section 1396d) as amended. (L.
1981 H.B. 894)

Effective 3-26-81

The state treasurer, in making benefit payments for medical
assistance on behalf of eligible needy persons as authorized in section
208.151, may, at the request of the hospital, nursing home, or other
provider of services authorized to receive such payments, disregard the
provisions in section 30.180, RSMo, and section 208.160 requiring the
treasurer to convert the warrant requesting payment into a check or
draft, and may wire transfer the amount directly to the hospital, nursing
home, or other provider of services authorized to receive such payment.
(L. 1980 H.B. 1840)

1. As used in this section, unless the context clearly requires
otherwise, the following terms mean:

(1) "Abuse", a documented pattern of inducing, furnishing, or otherwise
causing a recipient to receive services or merchandise not otherwise
required or requested by the recipient, attending physician or
appropriate utilization review team; a documented pattern of performing
and billing tests, examinations, patient visits, surgeries, drugs or
merchandise that exceed limits or frequencies determined by the
department for like practitioners for which there is no demonstrable
need, or for which the provider has created the need through ineffective
services or merchandise previously rendered. The decision to impose any
of the sanctions authorized in this section shall be made by the director
of the department, following a determination of demonstrable need or
accepted medical practice made in consultation with medical or other
health care professionals, or qualified peer review teams;

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

(3) "Excessive use", the act, by a person eligible for services under a
contract or provider agreement between the department of social services
or its divisions and a provider, of seeking and/or obtaining medical
assistance benefits from a number of like providers and in quantities
which exceed the levels that are considered medically necessary by
current medical practices and standards for the eligible person's needs;

(4) "Fraud", a known false representation, including the concealment of a
material fact that provider knew or should have known through the usual
conduct of his profession or occupation, upon which the provider claims
reimbursement under the terms and conditions of a contract or provider
agreement and the policies pertaining to such contract or provider
agreement of the department or its divisions in carrying out the
providing of services, or under any approved state plan authorized by the
federal Social Security Act;

(5) "Health plan", a group of services provided to recipients of medical
assistance benefits by providers under a contract with the department;

(6) "Medical assistance benefits", those benefits authorized to be
provided by sections 208.152 and 208.162;

(7) "Prior authorization", approval to a provider to perform a service or
services for an eligible person required by the department or its
divisions in advance of the actual service being provided or approved for
a recipient to receive a service or services from a provider, required by
the department or its designated division in advance of the actual
service or services being received;

(8) "Provider", any person, partnership, corporation, not-for-profit
corporation, professional corporation, or other business entity that
enters into a contract or provider agreement with the department or its
divisions for the purpose of providing services to eligible persons, and
obtaining from the department or its divisions reimbursement therefor;

(9) "Recipient", a person who is eligible to receive medical assistance
benefits allocated through the department;

(10) "Service", the specific function, act, successive acts, benefits,
continuing benefits, requested by an eligible person or provided by the
provider under contract with the department or its divisions.

2. The department or its divisions shall have the authority to suspend,
revoke, or cancel any contract or provider agreement or refuse to enter
into a new contract or provider agreement with any provider where it is
determined the provider has committed or allowed its agents, servants, or
employees to commit acts defined as abuse or fraud in this section.

3. The department or its divisions shall have the authority to impose
prior authorization as defined in this section:

(1) When it has reasonable cause to believe a provider or recipient has
knowingly followed a course of conduct which is defined as abuse or fraud
or excessive use by this section; or

(2) When it determines by rule that prior authorization is reasonable for
a specified service or procedure.

4. If a provider or recipient reports to the department or its divisions
the name or names of providers or recipients who, based upon their
personal knowledge has reasonable cause to believe an act or acts are
being committed which are defined as abuse, fraud or excessive use by
this section, such report shall be confidential and the reporter's name
shall not be divulged to anyone by the department or any of its
divisions, except at a judicial proceeding upon a proper protective order
being entered by the court.

5. Payments for services under any contract or provider agreement between
the department or its divisions and a provider may be withheld by the
department or its divisions from the provider for acts or omissions
defined as abuse or fraud by this section, until such time as an
agreement between the parties is reached or the dispute is adjudicated
under the laws of this state.

6. The department or its designated division shall have the authority to
review all cases and claim records for any recipient of public assistance
benefits and to determine from these records if the recipient has, as
defined in this section, committed excessive use of such services by
seeking or obtaining services from a number of like providers of services
and in quantities which exceed the levels considered necessary by current
medical or health care professional practice standards and policies of
the program.

7. The department or its designated division shall have the authority
with respect to recipients of medical assistance benefits who have
committed excessive use to limit or restrict the use of the recipient's
Medicaid identification card to designated providers and for designated
services; the actual method by which such restrictions are imposed shall
be at the discretion of the department of social services or its
designated division.

8. The department or its designated division shall have the authority
with respect to any recipient of medical assistance benefits whose use
has been restricted under subsection 7 of this section and who obtains or
seeks to obtain medical assistance benefits from a provider other than
one of the providers for designated services to terminate medical
assistance benefits as defined by this chapter, where allowed by the
provisions of the federal Social Security Act.

9. The department or its designated division shall have the authority
with respect to any provider who knowingly allows a recipient to violate
subsection 7 of this section or who fails to report a known violation of
subsection 7 of this section to the department of social services or its
designated division to terminate or otherwise sanction such provider's
status as a participant in the medical assistance program. Any person
making such a report shall not be civilly liable when the report is made
in good faith. (L. 1982 H.B. 1086 § 1, A.L. 1995 S.B. 3)

CROSS REFERENCE: Health care assistance payments fraud and abuse, RSMo
191.900 to 191.910

The department or its designated division shall have authority
after forty-five days written notice to the affected provider to withhold
from any payments that may be or become due to a provider of service
under the medical assistance program such amounts as the department or
its designated division may determine are due to the state as a result of
overpayments, cost settlements, disallowances, duplicate payments, fraud
or abuse; provided that should a judicial tribunal, including the
administrative hearing commission, finally determine that all or part of
such withholding is due to the provider of services, the judicial
tribunal may, in its discretion, allow a reasonable rate of interest on
such amount from the time of the withholding. (L. 1982 H.B. 1086 § 2)

1. As used in this section, the following terms mean:

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

(2) "Prepaid capitated", a mode of payment by which the department
periodically reimburse a contracted health provider plan or primary care
physician sponsor for delivering health care services for the duration of
a contract to a maximum specified number of members based on a fixed rate
per member, notwithstanding:

(a) The actual number of members who receive care from the provider; or

(b) The amount of health care services provided to any members;

(3) "Primary care case-management", a mode of payment by which the
department reimburses a contracted primary care physician sponsor on a
fee-for-service schedule plus a monthly fee to manage each recipient's
case;

(4) "Primary care physician sponsor", a physician licensed pursuant to
chapter 334, RSMo, who is a family practitioner, general practitioner,
pediatrician, general internist or an obstetrician or gynecologist;

(5) "Specialty physician services arrangement", an arrangement where the
department may restrict recipients of specialty services to designated
providers of such services, even in the absence of a primary care
case-management system.

2. The department or its designated division shall maximize the use of
prepaid health plans, where appropriate, and other alternative service
delivery and reimbursement methodologies, including, but not limited to,
individual primary care physician sponsors or specialty physician
services arrangements, designed to facilitate the cost-effective purchase
of comprehensive health care.

3. In order to provide comprehensive health care, the department or its
designated division shall have authority to:

(1) Purchase medical services for recipients of public assistance from
prepaid health plans, health maintenance organizations, health insuring
organizations, preferred provider organizations, individual practice
associations, local health units, community health centers, or primary
care physician sponsors;

(2) Reimburse those health care plans or primary care physicians'
sponsors who enter into direct contract with the department on a prepaid
capitated or primary care case-management basis on the following
conditions:

(a) That the department or its designated division shall ensure, whenever
possible and consistent with quality of care and cost factors, that
publicly supported neighborhood and community-supported health clinics
shall be utilized as providers;

(b) That the department or its designated division shall ensure
reasonable access to medical services in geographic areas where managed
or coordinated care programs are initiated; and

(c) That the department shall ensure full freedom of choice for
prescription drugs at any Medicaid participating pharmacy;

(3) Limit providers of medical assistance benefits to those who
demonstrate efficient and economic service delivery for the level of
service they deliver, and provided that such limitation shall not limit
recipients from reasonable access to such levels of service;

(4) Provide recipients of public assistance with alternative services as
provided for in state law, subject to appropriation by the general
assembly;

(5) Designate providers of medical assistance benefits to assure
specifically defined medical assistance benefits at a reduced cost to the
state, to assure reasonable access to all levels of health services and
to assure maximization of federal financial participation in the delivery
of health related services to Missouri citizens; provided, all qualified
providers that deliver such specifically defined services shall be
afforded an opportunity to compete to meet reasonable state criteria and
to be so designated;

(6) Upon mutual agreement with any entity of local government, to elect
to use local government funds as the matching share for Title XIX
payments, as allowed by federal law or regulation;

(7) To elect not to offset local government contributions from the
allowable costs under the Title XIX program, unless prohibited by federal
law and regulation.

4. Nothing in this section shall be construed to authorize the department
or its designated division to limit the recipient's freedom of selection
among health care plans or primary care physician sponsors, as authorized
in this section, who have entered into contract with the department or
its designated division to provide a comprehensive range of health care
services on a prepaid capitated or primary care case-management basis,
except in those instances of overutilization of Medicaid services by the
recipient. (L. 1982 H.B. 1086 § 3, A.L. 1990 S.B. 765, A.L. 1992 H.B. 899)

Payment for nursing home services made pursuant to section
208.152 to a provider of services shall not exceed the provider's per
diem, as set by the department of social services, times eighty-five
percent of the provider's licensed bed capacity; or the provider's actual
count of certified bed capacity, whichever is less, except that payments
shall continue to be made on behalf of any qualified recipient occupying
a bed, on August 13, 1982. The department or its designated division
shall waive this restriction for providers in areas where the department
determines that there is an inadequate number of Medicaid-certified beds
available and shall waive the restriction in geographic areas where
eligible medical assistance benefits recipients are disproportionately
higher than those not eligible for medical assistance benefits; may waive
the restriction for public institutions; and may waive the restriction in
other special circumstances approved by the director, upon review of an
appeal from an individual provider. (L. 1982 H.B. 1086 § 4)

1. Beginning July 1, 1983, in addition to those benefit payments
for medical assistance for eligible needy persons authorized under the
provisions of section 208.152, benefit payments for medical assistance
may be made on behalf of those eligible needy persons who are unable to
provide for it in whole or in part for adult day care and treatment to
those persons who would require placement in an intermediate care
facility or skilled nursing home as the latter two terms are defined by
section 198.006, RSMo.

2. Payments under this section shall be made on the basis of the
reasonable cost of the care as reasonable cost of the services is defined
and determined by the division of family services. (L. 1982 H.B. 1086 § 5)

1. Notwithstanding other provisions of this chapter, including
but not limited to sections 208.152, 208.153, 208.159 and 208.162:

*(1) There shall be no revisions to a facility's reimbursement rate for
providing nursing care services under this chapter upon a change in
ownership, management control, operation, stock, leasehold interests by
whatever form for any facility previously licensed or certified for
participation in the Medicaid program. Increased costs for the successor
owner, management or leaseholder that result from such a change shall not
be recognized for purposes of reimbursement;

*(2) In the case of a newly built facility or part thereof which is less
than two years of age and enters the Title XIX program under this chapter
after July 1, 1983, a reimbursement rate shall be assigned based on the
lesser of projected estimated operating costs or one hundred ten percent
of the median rate for the facility's class to include urban and rural
categories for each level of care including ICF only and SNF/ICF. The
rates set under this provision shall be effective for a period of twelve
months from the effective date of the provider agreement at which time
the rate for the future year shall be set in accordance with reported
costs of the facility recognized under the reimbursement plan and as
provided in subdivisions (3) and (4) of this subsection. Rates set under
this section may in no case exceed the maximum ceiling amounts in effect
under the reimbursement regulation;

*(3) Reimbursement for capital related expenses for newly built
facilities entering the Title XIX program after March 18, 1983, shall be
calculated as the building and building equipment rate, movable equipment
rate, land rate, and working capital rate.

(a) The building and building equipment rate will be the lower of:

a. Actual acquisition costs, which is the original cost to construct or
acquire the building, not to exceed the costs as determined in section
197.357, RSMo; or

b. Reasonable construction or acquisition cost computed by applying the
regional Dodge Construction Index for 1981 with a trend factor, if
necessary, or another current construction cost measure multiplied by one
hundred eight percent as an allowance for fees authorized as
architectural or legal not included in the Dodge Index Value, multiplied
by the square footage of the facility not to exceed three hundred
twenty-five square feet per bed, multiplied by the ratio of forty minus
the actual years of the age of the facility divided by forty; and
multiplied by a return rate of twelve percent; and divided by
ninety-three percent of the facility's total available beds times three
hundred sixty-five days.

(b) The maximum movable equipment rate will be fifty-three cents per bed
day.

(c) The maximum allowable land area is defined as five acres for a
facility with one hundred or less beds and one additional acre for each
additional one hundred beds or fraction thereof for a facility with one
hundred one or more beds.

(d) The land rate will be calculated as:

a. For facilities with land areas at or below the maximum allowable land
area, multiply the acquisition cost of the land by the return rate of
twelve percent, divide by ninety-three percent of the facility's total
available beds times three hundred sixty-five days.

b. For facilities with land areas greater than the maximum allowable land
area, divide the acquisition cost of the land by the total acres,
multiply by the maximum allowable land area, multiply by the return rate
of twelve percent, divide by ninety-three percent of the facility's total
available beds times three hundred sixty-five days.

(e) The maximum working capital rate will be twenty cents per day;

*(4) If a provider does not provide the actual acquisition cost to
determine a reimbursement rate under subparagraph a. of paragraph (a) of
subdivision (3) of subsection 1 of this section, the sum of the building
and building equipment rate, movable equipment rate, land rate, and
working capital rate shall be set at a reimbursement rate of six dollars;

(5) For each state fiscal year a negotiated trend factor shall be applied
to each facility's Title XIX per diem reimbursement rate. The trend
factor shall be determined through negotiations between the department
and the affected providers and is intended to hold the providers harmless
against increase in cost. In no circumstances shall the negotiated trend
factor to be applied to state funds exceed the health care finance
administration market basket price index for that year. The provisions of
this subdivision shall apply to fiscal year 1996 and thereafter.

2. The provisions of subdivisions (1), (2), (3), and (4) of subsection 1
of this section shall remain in effect until July 1, 1989, unless
otherwise provided by law. (L. 1983 H.B. 825, A.L. 1986 S.B. 463 & 629,
A.L. 1987 S.B. 277, A.L. 1995 S.B. 366, A.L. 1996 H.B. 1081)

*Subdivisions (1), (2), (3), & (4) of subsection 1 expired 7-1-89.

1. The state treasurer shall be treasurer and custodian of all
funds and moneys of the department and shall issue checks upon such funds
or moneys in accordance with such rules and regulations as the department
shall prescribe.

2. There is hereby established as a special fund, separate and apart from
the public moneys of this state, the following:

(1) Supplemental payment fund;

(2) Aid to families with dependent children fund;

(3) Relief fund;

(4) Child welfare service fund;

(5) Administration fund;

(6) Title XIX fund;

(7) Child support enforcement fund.

3. The supplemental payment fund shall consist of moneys appropriated by
the state, and such moneys as may be received from the federal government
or other sources for the payment of supplemental payments. All checks
payable to recipients of supplemental payments shall be drawn on and paid
from this fund.

4. The aid to families with dependent children fund shall consist of
moneys appropriated by the state, and such moneys as may be received from
the federal government or other sources for the payment of aid to
families with dependent children. All checks payable for aid to families
with dependent children shall be drawn on and paid from this fund.

5. The relief fund shall consist of moneys appropriated by the state, and
such moneys as may be received from the federal government or other
sources for aid or relief in cases of public calamity. All expenditures
for aid or relief in cases of public calamity shall be paid from this
fund.

6. The child welfare service fund shall consist of moneys appropriated by
the state, and such moneys as may be received from the federal government
or other sources for child welfare services, and this fund or any portion
of it may be transferred to the administration fund.

7. The administration fund shall consist of moneys appropriated by the
state, and moneys received from the federal government to pay the
administrative costs of the department in administering the provisions of
the law. All checks payable for employees and personal services of
representatives of the department shall be drawn on and paid from the
administration fund.

8. The Title XIX fund shall consist of moneys appropriated by the state
and such moneys as may be received from the federal government or other
sources for the payment of medical assistance rendered to eligible
recipients pursuant to the Title XIX state plan, and all checks payable
on behalf of recipients shall be drawn on and paid from this fund.

9. The child support enforcement fund shall consist of moneys
appropriated by the state, and such moneys as may be received from the
federal government or other sources including moneys representing
assigned support obligations collected on behalf of recipients of public
assistance and nonrecipients of public assistance, any fees collected by
the department and any incentive payments received from other states.
From this fund shall be paid any moneys collected which represent
assigned support obligations required by state law or federal law to be
returned to the obligee on whose behalf the obligation was collected,
incentive payments to political subdivisions of this state or to other
states, any reimbursement to the federal government for its respective
share of payments for aid to families with dependent children and
administrative costs incurred by the department in the administration of
the child support enforcement program including purchase of child support
enforcement services pursuant to the terms of cooperative agreements
entered into with political subdivisions of this state, appropriate
courts, law enforcement officials or others. Nothing herein shall
prohibit the appropriation of federal funds to defer all administrative
costs incurred by the department pursuant to chapter 454, RSMo, in the
event that federal financial participation is extended to include all
costs. (RSMo 1939 § 9415, A.L. 1973 S.B. 325, A.L. 1977 H.B. 601, A.L.
1989 S.B. 203 & 270)

Effective 7-27-89

Sections 1, 207.010, 207.060, 208.010, 208.015, 208.030,
208.042, 208.060, 208.120, 208.150, 208.160, 208.170, and 209.040 of this
act shall become effective January 1, 1974, or upon the operational date
of Title XVI of Public Law 92-603, establishing the federal program of
supplemental security income for the aged, blind and disabled, whichever
occurs later. (L. 1973 S.B. 325 § A)

Effective 1-1-74

Increases in assessed valuations of property pursuant to
sections 137.010 to 137.960 shall not be the sole basis for a reduction
in or denial of benefits under this chapter. (L. 1985 S.B. 152)

Effective 12-31-85

The department of social services shall establish a "Medicaid
Drug Prior Authorization Committee". (L. 1992 H.B. 899)

1. Within thirty days of August 28, 1992, the director of the
department of social services shall apply to the United States Secretary
of Health and Human Services for an amendment of the waiver of
comparability of services for persons under section 42 U.S.C. 1396a
(a)(10)(A)(ii)(VI) to include medical assistance benefits for persons who
are defined in 42 U.S.C. 1396 r-5.

2. Upon receipt of an amended waiver received pursuant to subsection 1 of
this section, the director of the department of social services shall,
subject to appropriations made for such purpose, promulgate rules and
regulations to extend eligibility for medical assistance benefits by
applying institutional status to individuals who are at risk of placement
in an intermediate care facility or skilled nursing facility licensed
pursuant to chapter 198, RSMo, but who, with the provision of home and
community based services, may be cared for at home.

3. 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. (L. 1992 H.B. 899 § 17, A.L.
1993 S.B. 52, A.L. 1995 S.B. 3)

1. The "Drug Utilization Review Board" is hereby established
within the division of medical services and shall be composed of the
following health care professionals who shall be appointed by the
governor not later than October 1, 1992, and whose appointment shall be
subject to the advice and consent of the senate:

(1) Six physicians who shall include:

(a) Three physicians who hold the doctor of medicine degree and are
active in medical practice;

(b) Two physicians who hold the doctor of osteopathy degree and are
active in medical practice; and

(c) One physician who holds the doctor of medicine or the doctor of
osteopathy degree and is active in the practice of psychiatry;

(2) Six actively practicing pharmacists who shall include:

(a) Three pharmacists who hold bachelor of science degrees in pharmacy
and are active as retail or patient care pharmacists;

(b) Two pharmacists who hold advanced clinical degrees in pharmacy and
are active in the practice of pharmaceutical therapy and clinical
pharmaceutical management; and

(c) One pharmacist who holds either a bachelor of science degree in
pharmacy or an advanced clinical degree in pharmacy and is employed by a
pharmaceutical manufacturer of Medicaid-approved formulary drugs; and

(3) One certified medical quality assurance registered nurse with an
advanced degree.

2. The membership of the drug utilization review board shall include
health care professionals who have recognized knowledge and expertise in
one or more of the following:

(1) The clinically appropriate prescribing of covered outpatient drugs;

(2) The clinically appropriate dispensing and monitoring of covered
outpatient drugs;

(3) Drug use review, evaluation and intervention;

(4) Medical quality assurance.

3. A chairperson shall be elected by the board members at their first
meeting, which shall take place not later than November 1, 1992. The
board shall meet at least once every ninety days. A quorum of eight
members, including no fewer than three physicians and three pharmacists,
shall be required for the board to act in its official capacity.

4. Members appointed pursuant to subsection 1 of this section shall serve
four-year terms, except that of the original members, four shall be
appointed for a term of two years, four shall be appointed for a term of
three years and five shall be appointed for a term of four years. Members
may be reappointed.

5. The members of the drug utilization review board or any regional
advisory committee shall receive no compensation for their services other
than reasonable expenses actually incurred in the performance of their
official duties.

6. The drug utilization review board shall, either directly or through
contracts between the division of medical services and accredited health
care educational institutions, state medical societies or state
pharmacist associations or societies or other appropriate organizations,
provide for educational outreach programs to educate practitioners on
common drug therapy problems with the aim of improving prescribing and
dispensing practices.

7. The drug utilization review board shall monitor drug usage and
prescribing practices in the Medicaid program. The board shall conduct
its activities in accordance with the requirements of subsection (g) of
section 4401 of the Omnibus Budget Reconciliation Act of 1990 (P.L.
101-508). The board shall publish an educational newsletter to Missouri
Medicaid providers as to its considered opinion of the proper usage of
the Medicaid formulary. It shall advise providers of inappropriate drug
utilization when it deems it appropriate to do so.

8. Office space and support personnel shall be provided by the division
of medical services.

9. Subject to appropriations made specifically for that purpose, up to
six regional advisory committees to the drug utilization review board may
be appointed. Members of the regional advisory committees shall be
physicians and pharmacists appointed by the drug utilization review
board. Each such member of a regional advisory committee shall have
recognized knowledge and expertise in one or more of the following:

(1) The clinically appropriate prescribing of covered outpatient drugs;

(2) The clinically appropriate dispensing and monitoring of covered
outpatient drugs;

(3) Drug use review, evaluation, and intervention; or

(4) Medical quality assurance. (L. 1992 S.B. 721 § 3, A.L. 1993 H.B. 765)

By December 1, 1992, the division of medical services shall,
either directly or through contract with a private organization, provide
for a prospective review of drug therapy. The review shall include
screening for potential drug therapy problems, duplication,
contraindications, interactions, incorrect drug dosage, drug allergy,
duration of therapy and clinical abuse or misuse. (L. 1992 S.B. 721 § 4)

Appropriations made to the department of health and senior
services for medical services for children who were ineligible for
Medicaid prior to August 28, 1993, but become eligible because of changes
made in section 208.151 shall, if unused for their intended purposes, be
retained by the department of health and senior services and upon
subsequent appropriation be transferred to the department of social
services for the purpose of funding Medicaid expansion. (L. 1993 H.B. 564
§ 10)

1. On or after July 1, 1995, the department of social services
may make available for purchase a policy of health insurance coverage
through the Medicaid program. Premiums for such a policy shall be charged
based upon actuarially sound principles to pay the full cost of insuring
persons under the provisions of this section. The full cost shall include
both administrative costs and payments for services. Coverage under a
policy or policies made available for purchase by the department of
social services shall include coverage of all or some of the services
listed in section 208.152, RSMo, as determined by the director of the
department of social services. Such a policy may be sold to a person who
is otherwise uninsured and who is:

(1) A surviving spouse eligible for coverage under sections 376.891 to
376.894, RSMo, who is determined under rules and regulations of the
department of social services to be unable to afford continuation of
coverage under that section;

(2) An adult over twenty-one years of age who is not pregnant and who
resides in a household with an income which does not exceed one hundred
eighty-five percent of the federal poverty level for the applicable
family size. Net taxable income shall be used to determine that portion
of income of a self-employed person; or

(3) A dependent of an insured person who resides in a household with an
income which does not exceed one hundred eighty-five percent of the
federal poverty level for the applicable family size.

2. Any policy of health insurance sold pursuant to the provisions of this
section shall conform to requirements governing group health insurance
under chapters 375, 376, and 379, RSMo.

3. The department of social services shall establish policies governing
the issuance of health insurance policies pursuant to the provisions of
this section by rules and regulations developed in consultation with the
department of insurance. (L. 1993 H.B. 564 § 15)

1. Subject to appropriations made for that purpose, a pilot
project shall be created by the director of the division of medical
services to provide up to one thousand residents of this state who become
unemployed and receive unemployment compensation benefits pursuant to
chapter 288, RSMo, with medical assistance during the period of time they
continue to receive such unemployment compensation benefits.

2. The director of the division of medical services shall determine the
amount and scope of benefits which are available under this section. The
director may also establish utilization and cost limits for care
delivered to the participants. Recipients qualifying for medical
assistance under the provisions of this section shall be subject to
cost-sharing requirements as determined by the director of the department
of social services. Such cost-sharing requirements may include the
payment of premiums, premium payment assistance, deductibles or
coinsurance. The director shall specify these requirements in regulations.

3. The director of the division of medical services may elect to pay
premiums for such eligible residents under continuation of benefit
arrangements which may be available to such eligible residents through
their former employer.

4. The director of the division of medical services shall promulgate such
rules and regulations as may be necessary to implement the provisions of
this section. No rule or portion of a rule promulgated under the
authority of this section shall become effective unless it has been
promulgated pursuant to the provisions of section 536.024, RSMo. (L. 1993
H.B. 564 § 20, A.L. 1995 S.B. 3)

1. Payment of benefits hereunder shall be made monthly in
advance, at such regular intervals as shall be determined by the division
of family services, directly to the recipient, or in the event of his
incapacity or disability, to his legally appointed conservator, and
except as provided in subsection 2, in the case of a dependent child to
the relative with whom he lives; provided, that payments for the cost of
authorized inpatient hospital or nursing home care in behalf of an
individual may be made after the care is received either during his
lifetime or after his death to the person, firm, corporation,
association, institution, or agency furnishing such care, and shall be
considered as the equivalent of payment to the individual to whom such
care was rendered. All incapacity or disability proceedings of persons
applying for or receiving benefits under this law shall be carried out
without fee or other expense when in the opinion of the probate division
of the circuit court the person is unable to assume such expense. At the
discretion of the court such a guardian or conservator may serve without
bond.

2. Payment of benefits with respect to a dependent child may be made,
pursuant to regulations of the division of family services, to an
individual, other than the relative with whom he lives, who is interested
in or concerned with the welfare of the child, or who is furnishing food,
living accommodations or other goods, services or items to or for the
dependent child, in the following cases:

(1) Where the relative with whom the child lives has demonstrated an
inability to manage funds to the extent that payments to him have not
been or are not being used in the best interest of the child; or

(2) Where the relative has refused to participate in a work or training
program to which he has been referred under section 208.042.

3. Whenever any recipient shall have died after the issuance of a benefit
check to him, or on or after the date upon which a benefit check was due
and payable to him, and before the same is endorsed or presented for
payment by the recipient, the probate division of the circuit court of
the county in which the recipient resided at the time of his death shall,
on the filing of an affidavit by one of the next of kin, or creditor of
the deceased recipient, and upon the court being satisfied as to the
correctness of such affidavit, make an order authorizing and directing
such next of kin, or creditor, to endorse and collect the check, which
shall be paid upon presentation with a certified copy of the order
attached to the check and the proceeds of which shall be applied upon the
funeral expenses and the debts of the decedent, duly approved by the
probate division of the circuit court, and it shall not be necessary that
an administrator be appointed for the estate of the decedent in order to
collect the benefit check. No cost shall be charged in such proceedings.
Such affidavit filed by one of the next of kin, or creditor, shall state
the name of the deceased recipient, the date of his death, the amount and
number of such benefit check, the funeral expenses and debts owed by the
decedent, and whether the decedent had any estate other than the unpaid
benefit check and, in the event the decedent had an estate that requires
administration, the provisions of this section shall not apply and the
estate of the decedent shall be administered upon in the same manner as
estates of other deceased persons. (RSMo 1939 § 9417, A.L. 1941 p. 647,
A.L. 1959 H.B. 1, A.L. 1969 H.B. 804, A.L. 1978 H.B. 1634, A.L. 1983 S.B.
44 & 45)

The department of social services shall develop an expedited
eligibility process for pregnant women for medical assistance benefits.
The expedited process shall be in place no later than January 1, 1994.
(L. 1993 H.B. 564 § 26)

1. The division of family services shall establish pilot
projects in St. Louis City and in any county with a population of six
hundred thousand or more, which shall provide for a system of electronic
transfer of benefits to public assistance recipients. Such system shall
allow recipients to obtain cash from automated teller machines or point
of sale terminals. If less than the total amount of benefits is
withdrawn, the recipient shall be given a receipt showing the current
status of his account.

2. The disclosure of any information provided to a financial institution,
business or vendor by the division of family services pursuant to this
section is prohibited. Such financial institution, business or vendor may
not use or sell such information and may not divulge the information
without a court order. Violation of this subsection is a class A
misdemeanor.

3. Subject to appropriations and subject to receipt of waivers from the
federal government to prevent the loss of any federal funds, the
department of social services shall require the use of photographic
identification on electronic benefit transfer cards issued to recipients
in this system. Such photographic identification electronic benefit
transfer card shall be in a form approved by the department of social
services.

4. The division of family services shall promulgate rules and regulations
necessary to implement the provisions of this section pursuant to section
660.017, RSMo, and chapter 536, RSMo.

5. The delivery of electronic benefits and the electronic eligibility
verification, including, but not limited to, aid to families with
dependent children (AFDC), women, infants and children (WIC), early
periodic screening diagnosis and treatment (EPSDT), food stamps,
supplemental security income (SSI), including Medicaid, child support,
and other programs, shall reside in one card that may be enabled by
function from time to time in a convenient manner. (L. 1992 H.B. 899,
A.L. 1993 S.B. 52, A.L. 1994 H.B. 1547 & 961)

The division of family services is hereby directed to comply
with the provisions of any act of congress providing for the distribution
and expenditure of funds of the United States appropriated by congress
for Social Security benefits, and to comply with any and all rules and
regulations attached to or made a part of such appropriation act and not
inconsistent with the constitution and laws of Missouri. (RSMo 1939 §
9416)

The director of the division of family services shall appoint an
advisory committee to provide professional and technical consultation in
respect to the medical care aspects for public assistance recipients as
set out in this chapter. The committee shall consist of twenty members,
including the chairman of the senate committee of public health and
welfare and chairman of the house of representatives committee of Social
Security, and a minority member of each committee and at least three
physicians licensed to practice in this state. The others shall be
persons interested in hospital administration, nursing home
administration, nursing, dentistry, optometry and pharmaceutics. The
members of the advisory committee shall receive no compensation for their
services other than expenses actually incurred in the performance of
their official duties. (L. 1959 H.B. 1 § 208.150, A.L. 1963 p. 383, A.L.
1967 p. 328)

1. The "Division of Medical Services" is hereby established
within the department of social services. The director of the division
shall be appointed by the director of the department.

2. The division of medical services is an integral part of the department
of social services and shall have and exercise all the powers and duties
necessary to carry out fully and effectively the purposes assigned to it
by law and shall be the state agency to administer payments to providers
under the medical assistance program and to carry out such other
functions, duties, and responsibilities as the division of medical
services may be transferred by law, or by a departmental reorganizational
plan pursuant to law.

3. All powers, duties and functions of the division of family services
relative to the development, administration and enforcement of the
medical assistance programs of this state are transferred by type I
transfer as defined in the Omnibus State Reorganization Act of 1974 to
the division of medical services. The division of family services shall
retain the authority to determine and regulate the eligibility of needy
persons for participation in the medical assistance program.

4. The director of the division of medical services shall exercise the
powers and duties of an appointing authority under chapter 36, RSMo, to
employ such administrative, technical, and other personnel as may be
necessary, and may designate subdivisions as needed for the performance
of the duties and responsibilities of the division.

5. In addition to the powers, duties and functions vested in the division
of medical services by other provisions of this chapter or by other laws
of this state, the division of medical services shall have the power:

(1) To sue and be sued;

(2) To adopt, amend and rescind such rules and regulations necessary or
desirable to perform its duties under state law and not inconsistent with
the constitution or laws of this state;

(3) To make and enter into contracts and carry out the duties imposed
upon it by this or any other law;

(4) To administer, disburse, accept, dispose of and account for funds,
equipment, supplies or services, and any kind of property given, granted,
loaned, advanced to or appropriated by the state of Missouri or the
federal government for any lawful purpose;

(5) To cooperate with the United States government in matters of mutual
concern pertaining to any duties of the division of medical services or
the department of social services, including the adoption of such methods
of administration as are found by the United States government to be
necessary for the efficient operation of state medical assistance plans
required by federal law, and the modification or amendment of a state
medical assistance plan where required by federal law;

(6) To make reports in such form and containing such information as the
United States government may, from time to time, require and comply with
such provisions as the United States government may, from time to time,
find necessary to assure the correctness and verification of such reports;

(7) To create and appoint, when and if it may deem necessary, advisory
committees not otherwise provided in any other provision of the law to
provide professional or technical consultation with respect to medical
assistance program administration. Each advisory committee shall consult
with and advise the division of medical services with respect to policies
incident to the administration of the particular function germane to
their respective field of competence;

(8) To define, establish and implement the policies and procedures
necessary to administer payments to providers under the medical
assistance program;

(9) To conduct utilization reviews to determine the appropriateness of
services and reimbursement amounts to providers participating in the
medical assistance program;

(10) To establish or cooperate in research or demonstration projects
relative to the medical assistance programs, including those projects
which will aid in effective coordination or planning between private and
public medical assistance programs and providers, or which will help
improve the administration and effectiveness of medical assistance
programs. (L. 1987 H.B. 579)

1. The division of medical services may administer the funds
appropriated to the department of social services or any division of the
department for payment of medical care provided to children in the legal
custody of the department of social services or any division of the
department.

2. Through judicial review or family support team meetings, the
children's division shall determine which cases involve children in the
system due exclusively to a need for mental health services, and identify
the cases where no instance of abuse, neglect, or abandonment exists.

3. Within sixty days of a child being identified pursuant to subsection 2
of this section, an individualized service plan shall be developed by the
applicable state agencies responsible for providing or paying for any and
all appropriate and necessary services. The individualized service plan
shall specifically identify which agencies are going to pay for, subject
to appropriations, and provide such services, and such plan shall be
submitted to the court for approval. Services shall be provided in the
least restrictive, most appropriate environment that meets the needs of
the child including home, community-based treatment, and supports. The
child's family shall actively participate in designing the individualized
service plan for the child. The department of social services shall
notify the appropriate judge of the child and shall submit the
individualized service plan developed for approval by the judge. The
child may be returned by the judge to the custody of the child's family.

4. When the children are returned to their family's custody and become
the service responsibility of the department of mental health, the
appropriate moneys to provide for the care of each child in each
particular situation shall be billed to the department of social services
by the department of mental health pursuant to a comprehensive financing
plan jointly developed by the two departments. (L. 1988 H.B. 1139, A.L.
2004 S.B. 1003)

1. If at any time during the continuance of public assistance to
any person, the recipient thereof, or the husband or wife of the
recipient with whom he is living, is possessed or becomes possessed of
any property or income in excess of the amount declared at the time of
application or reinvestigation of his case and in such amount as would
affect his needs or right to receive benefits, it shall be the duty of
the recipient, or the husband or the wife of the recipient, to notify the
county welfare office of the receipt or possession of such property or
income, and the division of family services may, after investigation,
either cancel the benefits or alter the amount thereof in accordance with
the circumstances.

2. Any benefits paid when the recipient or his spouse is in possession of
such undeclared property or income shall be recoverable by the division
of family services as a debt due to the state. If during the life, or
upon the death, of any person who is receiving or has received benefits,
it is found that the recipient or his spouse was possessed of any
property or income in excess of the amount reported that would affect his
needs or right to receive benefits, or if it be shown such benefits were
obtained through misrepresentation, nondisclosure of material facts, or
through mistake of fact, the amount of benefits, without interest, may be
recovered from him or his estate by the division of family services as a
debt due the state.

3. The possession of undeclared property by a recipient or his spouse
with whom he is living shall be prima facie evidence of its ownership
during the time benefits were granted, and the burden to prove otherwise
shall be upon the recipient or his legal representative.

4. The federal government shall be entitled to share in any amount
collected under the provisions of this section, however, not to exceed
the amount contributed by the federal government in each case. The amount
due the United States shall be promptly paid or credited upon collection
to the designated agency of the federal government by the division of
family services. (L. 1951 p. 771 § 208.201)

1. For purposes of Medicaid eligibility, investment in annuities
shall be limited to those annuities that:

(1) Are actuarially sound as measured against the Social Security
Administration Life Expectancy Tables, as amended;

(2) Provide equal or nearly equal payments for the duration of the device
and which exclude balloon-style final payments; and

(3) Provide the state of Missouri secondary or contingent beneficiary
status ensuring payment if the individual predeceases the duration of the
annuity, in an amount equal to the Medicaid expenditure made by the state
on the individual's behalf.

2. The department shall establish a sixty month look-back period to
review any investment in an annuity by an applicant for Medicaid
benefits. If an investment in an annuity is determined by the department
to have been made in anticipation of obtaining or with an intent to
obtain eligibility for Medicaid benefits, the department shall have
available all remedies and sanctions permitted under federal and state
law regarding such investment. The fact that an investment in an annuity
which occurred prior to August 28, 2005, does not meet the criteria
established in subsection 1 of this section shall not automatically
result in a disallowance of such investment.

3. The department of social services shall promulgate rules to administer
the provisions of this section. Any rule or portion of a rule, as that
term is defined in section 536.010, RSMo, that is created under the
authority delegated in this section shall become effective only if it
complies with and is subject to all of the provisions of chapter 536,
RSMo, and, if applicable, section 536.028, RSMo. This section and chapter
536, RSMo, are nonseverable and if any of the powers vested with the
general assembly pursuant to chapter 536, RSMo, to review, to delay the
effective date, or to disapprove and annul a rule are subsequently held
unconstitutional, then the grant of rulemaking authority and any rule
proposed or adopted after August 28, 2005, shall be invalid and void. (L.
2005 S.B. 539)

1. Medicaid is payer of last resort unless otherwise specified
by law. When any person, corporation, institution, public agency or
private agency is liable, either pursuant to contract or otherwise, to a
recipient of public assistance on account of personal injury to or
disability or disease or benefits arising from a health insurance plan to
which the recipient may be entitled, payments made by the department of
social services shall be a debt due the state and recoverable from the
liable party or recipient for all payments made in behalf of the
recipient and the debt due the state shall not exceed the payments made
from medical assistance provided under sections 208.151 to 208.158 and
section 208.162 and section 208.204 on behalf of the recipient, minor or
estate for payments on account of the injury, disease, or disability or
benefits arising from a health insurance program to which the recipient
may be entitled.

2. The department of social services may maintain an appropriate action
to recover funds due under this section in the name of the state of
Missouri against the person, corporation, institution, public agency, or
private agency liable to the recipient, minor or estate.

3. Any recipient, minor, guardian, conservator, personal representative,
estate, including persons entitled under section 537.080, RSMo, to bring
an action for wrongful death who pursues legal rights against a person,
corporation, institution, public agency, or private agency liable to that
recipient or minor for injuries, disease or disability or benefits
arising from a health insurance plan to which the recipient may be
entitled as outlined in subsection 1 of this section shall upon actual
knowledge that the department of social services has paid medical
assistance benefits as defined by this chapter, promptly notify the
department as to the pursuit of such legal rights.

4. Every applicant or recipient by application assigns his right to the
department of any funds recovered or expected to be recovered to the
extent provided for in this section. All applicants and recipients,
including a person authorized by the probate code, shall cooperate with
the department of social services in identifying and providing
information to assist the state in pursuing any third party who may be
liable to pay for care and services available under the state's plan for
medical assistance as provided in sections 208.151 to 208.159 and
sections 208.162 and 208.204. All applicants and recipients shall
cooperate with the agency in obtaining third-party resources due to the
applicant, recipient, or child for whom assistance is claimed. Failure to
cooperate without good cause as determined by the department of social
services in accordance with federally prescribed standards shall render
the applicant or recipient ineligible for medical assistance under
sections 208.151 to 208.159 and sections 208.162 and 208.204.

5. Every person, corporation or partnership who acts for or on behalf of
a person who is or was eligible for medical assistance under sections
208.151 to 208.159 and sections 208.162 and 208.204 for purposes of
pursuing the applicant's or recipient's claim which accrued as a result
of a nonoccupational or nonwork-related incident or occurrence resulting
in the payment of medical assistance benefits shall notify the department
upon agreeing to assist such person and further shall notify the
department of any institution of a proceeding, settlement or the results
of the pursuit of the claim and give thirty days' notice before any
judgment, award, or settlement may be satisfied in any action or any
claim by the applicant or recipient to recover damages for such injuries,
disease, or disability, or benefits arising from a health insurance
program to which the recipient may be entitled.

6. Every recipient, minor, guardian, conservator, personal
representative, estate, including persons entitled under section 537.080,
RSMo, to bring an action for wrongful death, or his attorney or legal
representative shall promptly notify the department of any recovery from
a third party and shall immediately reimburse the department from the
proceeds of any settlement, judgment, or other recovery in any action or
claim initiated against any such third party.

7. The department director shall have a right to recover the amount of
payments made to a provider under this chapter because of an injury,
disease, or disability, or benefits arising from a health insurance plan
to which the recipient may be entitled for which a third party is or may
be liable in contract, tort or otherwise under law or equity.

8. The department of social services shall have a lien upon any moneys to
be paid by any insurance company or similar business enterprise, person,
corporation, institution, public agency or private agency in settlement
or satisfaction of a judgment on any claim for injuries or disability or
disease benefits arising from a health insurance program to which the
recipient may be entitled which resulted in medical expenses for which
the department made payment. This lien shall also be applicable to any
moneys which may come into the possession of any attorney who is handling
the claim for injuries, or disability or disease or benefits arising from
a health insurance plan to which the recipient may be entitled which
resulted in payments made by the department. In each case, a lien notice
shall be served by certified mail or registered mail, upon the party or
parties against whom the applicant or recipient has a claim, demand or
cause of action. The lien shall claim the charge and describe the
interest the department has in the claim, demand or cause of action. The
lien shall attach to any verdict or judgment entered and to any money or
property which may be recovered on account of such claim, demand, cause
of action or suit from and after the time of the service of the notice.

9. On petition filed by the department, or by the recipient, or by the
defendant, the court, on written notice of all interested parties, may
adjudicate the rights of the parties and enforce the charge. The court
may approve the settlement of any claim, demand or cause of action either
before or after a verdict, and nothing in this section shall be construed
as requiring the actual trial or final adjudication of any claim, demand
or cause of action upon which the department has charge. The court may
determine what portion of the recovery shall be paid to the department
against the recovery. In making this determination the court shall
conduct an evidentiary hearing and shall consider competent evidence
pertaining to the following matters:

(1) The amount of the charge sought to be enforced against the recovery
when expressed as a percentage of the gross amount of the recovery; the
amount of the charge sought to be enforced against the recovery when
expressed as a percentage of the amount obtained by subtracting from the
gross amount of the recovery the total attorney's fees and other costs
incurred by the recipient incident to the recovery; and whether the
department should, as a matter of fairness and equity, bear its
proportionate share of the fees and costs incurred to generate the
recovery from which the charge is sought to be satisfied;

(2) The amount, if any, of the attorney's fees and other costs incurred
by the recipient incident to the recovery and paid by the recipient up to
the time of recovery, and the amount of such fees and costs remaining
unpaid at the time of recovery;

(3) The total hospital, doctor and other medical expenses incurred for
care and treatment of the injury to the date of recovery therefor, the
portion of such expenses theretofore paid by the recipient, by insurance
provided by the recipient, and by the department, and the amount of such
previously incurred expenses which remain unpaid at the time of recovery
and by whom such incurred, unpaid expenses are to be paid;

(4) Whether the recovery represents less than substantially full
recompense for the injury and the hospital, doctor and other medical
expenses incurred to the date of recovery for the care and treatment of
the injury, so that reduction of the charge sought to be enforced against
the recovery would not likely result in a double recovery or unjust
enrichment to the recipient;

(5) The age of the recipient and of persons dependent for support upon
the recipient, the nature and permanency of the recipient's injuries as
they affect not only the future employability and education of the
recipient but also the reasonably necessary and foreseeable future
material, maintenance, medical rehabilitative and training needs of the
recipient, the cost of such reasonably necessary and foreseeable future
needs, and the resources available to meet such needs and pay such costs;

(6) The realistic ability of the recipient to repay in whole or in part
the charge sought to be enforced against the recovery when judged in
light of the factors enumerated above.

10. The burden of producing evidence sufficient to support the exercise
by the court of its discretion to reduce the amount of a proven charge
sought to be enforced against the recovery shall rest with the party
seeking such reduction.

11. The court may reduce and apportion the department's lien
proportionate to the recovery of the claimant. The court may consider the
nature and extent of the injury, economic and noneconomic loss,
settlement offers, comparative negligence as it applies to the case at
hand, hospital costs, physician costs, and all other appropriate costs.
The department shall pay its pro rata share of the attorney's fees based
on the department's lien as it compares to the total settlement agreed
upon. This section shall not affect the priority of an attorney's lien
under section 484.140, RSMo. The charges of the department described in
this section, however, shall take priority over all other liens and
charges existing under the laws of the state of Missouri with the
exception of the attorney's lien under such statute.

12. Whenever the department of social services has a statutory charge
under this section against a recovery for damages incurred by a recipient
because of its advancement of any assistance, such charge shall not be
satisfied out of any recovery until the attorney's claim for fees is
satisfied, irrespective of whether or not an action based on recipient's
claim has been filed in court. Nothing herein shall prohibit the director
from entering into a compromise agreement with any recipient, after
consideration of the factors in subsections 9 to 13 of this section.

13. This section shall be inapplicable to any claim, demand or cause of
action arising under the workers' compensation act, chapter 287, RSMo.
From funds recovered pursuant to this section the federal government
shall be paid a portion thereof equal to the proportionate part
originally provided by the federal government to pay for medical
assistance to the recipient or minor involved. The department shall
enforce TEFRA liens, 42 U.S.C. 1396p, as authorized by federal law and
regulation on permanently institutionalized individuals. The department
shall have the right to enforce TEFRA liens, 42 U.S.C. 1396p, as
authorized by federal law and regulation on all other institutionalized
individuals. For the purposes of this subsection, "permanently
institutionalized individuals" includes those people who the department
determines cannot reasonably be expected to be discharged and return
home, and "property" includes the homestead and all other personal and
real property in which the recipient has sole legal interest or a legal
interest based upon co-ownership of the property which is the result of a
transfer of property for less than the fair market value within thirty
months prior to the recipient's entering the nursing facility. The
following provisions shall apply to such liens:

(1) The lien shall be for the debt due the state for medical assistance
paid or to be paid on behalf of a recipient. The amount of the lien shall
be for the full amount due the state at the time the lien is enforced;

(2) The director of the department or the director's designee shall file
for record, with the recorder of deeds of the county in which any real
property of the recipient is situated, a written notice of the lien. The
notice of lien shall contain the name of the recipient and a description
of the real estate. The recorder shall note the time of receiving such
notice, and shall record and index the notice of lien in the same manner
as deeds of real estate are required to be recorded and indexed. The
director or the director's designee may release or discharge all or part
of the lien and notice of the release shall also be filed with the
recorder;

(3) No such lien may be imposed against the property of any individual
prior to his death on account of medical assistance paid except:

(a) In the case of the real property of an individual:

a. Who is an inpatient in a nursing facility, intermediate care facility
for the mentally retarded, or other medical institution, if such
individual is required, as a condition of receiving services in such
institution, to spend for costs of medical care all but a minimal amount
of his income required for personal needs; and

b. With respect to whom the director of the department of social services
or the director's designee determines, after notice and opportunity for
hearing, that he cannot reasonably be expected to be discharged from the
medical institution and to return home. The hearing, if requested, shall
proceed under the provisions of chapter 536, RSMo, before a hearing
officer designated by the director of the department of social services;
or

(b) Pursuant to the judgment of a court on account of benefits
incorrectly paid on behalf of such individual;

(4) No lien may be imposed under paragraph (b) of subdivision (3) of this
subsection on such individual's home if one or more of the following
persons is lawfully residing in such home:

(a) The spouse of such individual;

(b) Such individual's child who is under twenty-one years of age, or is
blind or permanently and totally disabled; or

(c) A sibling of such individual who has an equity interest in such home
and who was residing in such individual's home for a period of at least
one year immediately before the date of the individual's admission to the
medical institution;

(5) Any lien imposed with respect to an individual pursuant to
subparagraph b of paragraph (a) of subdivision (3) of this subsection
shall dissolve upon that individual's discharge from the medical
institution and return home.

14. The debt due the state provided by this section is subordinate to the
lien provided by section 484.130, RSMo, or section 484.140, RSMo,
relating to an attorney's lien and to the recipient's expenses of the
claim against the third party.

15. Application for and acceptance of medical assistance under this
chapter shall constitute an assignment to the department of social
services of any rights to support for the purpose of medical care as
determined by a court or administrative order and of any other rights to
payment for medical care.

16. All recipients of benefits as defined in this chapter shall cooperate
with the state by reporting to the division of family services or the
division of medical services, within thirty days, any occurrences where
an injury to their persons or to a member of a household who receives
medical assistance is sustained, on such form or forms as provided by the
division of family services or the division of medical services.

17. If a person fails to comply with the provision of any judicial or
administrative decree or temporary order requiring that person to
maintain medical insurance on or be responsible for medical expenses for
a dependent child, spouse, or ex-spouse, in addition to other remedies
available, that person shall be liable to the state for the entire cost
of the medical care provided pursuant to eligibility under any public
assistance program on behalf of that dependent child, spouse, or
ex-spouse during the period for which the required medical care was
provided. Where a duty of support exists and no judicial or
administrative decree or temporary order for support has been entered,
the person owing the duty of support shall be liable to the state for the
entire cost of the medical care provided on behalf of the dependent child
or spouse to whom the duty of support is owed.

18. The department director or his designee may compromise, settle or
waive any such claim in whole or in part in the interest of the medical
assistance program. (L. 1981 H.B. 901 § 1, A.L. 1982 H.B. 1086, A.L. 1987
H.B. 518, A.L. 1990 S.B. 765, A.L. 1993 H.B. 564, A.L. 1996 S.B. 869,
A.L. 2005 S.B. 539)

CROSS REFERENCE: Division of medical services has right to payment from
insurers or other obligated parties for health care services, RSMo 376.819

(1998) The amended statute is remedial and may be applied retroactively
and is more specific than section 473.398 where it conflicts. Pierce v.
State, Department of Social Services, 969 S.W.2d 814 (W.D.Mo.).

1. The department of social services shall make disbursements to
any attorney who represented a recipient of general relief under this
chapter in an appeal of any claim for federal supplemental security
income benefits before an administrative law judge which is decided in
favor of such recipient. The amount of such disbursement shall not exceed
twenty-five percent of the maximum federal supplemental security income
grant payable to an individual for a period of one year. No such
disbursement shall be made unless a petition and a copy of the favorable
decision is submitted by such attorney to the department of social
services within sixty days of the date of such decision. The disbursement
shall be made within thirty days after the petition is received.

2. The department of social services shall promulgate rules and
regulations necessary to implement the provisions of this section,
pursuant to the provisions of section 208.151 and chapter 536, RSMo. (L.
1990 S.B. 765 § 11, A.L. 1993 S.B. 52)

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 or any
division thereof;

(3) "Entity":

(a) Any insurance company as defined in chapter 375, RSMo, 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, RSMo, or any other provider of health services as
defined in chapter 354, RSMo; or

(c) Any self-insured organization or business providing health services
as defined in chapter 354, RSMo;

(4) "Individual", any applicant or present or former recipient of public
assistance benefits under sections 208.151 to 208.159 and section 208.162;

(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 division of medical services for the
purpose of determining the existence of insurance where the department
may have expended medical assistance 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 Missouri Medicaid 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 record-keeping
methods of the entity. Requests for information shall pertain to any
individual or the person legally responsible for such individual.

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 writing 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.

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 recipient of Medicaid. 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 and section 208.162 shall be deemed consent by the individual
to allow the department to request information from any entity regarding
insurance coverage of said person. (L. 1987 H.B. 518 § 208.224)

The commissioner of administration may deduct from any state
employee's compensation amounts determined to be owed by such employee
pursuant to the procedures contained in section 208.080 for any debt
related to the overpayment of public assistance benefits, including food
stamps, aid to families with dependent children, medical assistance,
general relief, and similar assistance administered by the department of
social services or other state department; provided that involuntary
deductions based on such a debt determination may be made only if the
determination is final. (L. 1996 S.B. 869)

For reimbursement or recoupment cases filed pursuant to
subsection 3 of section 208.156, jurisdiction is as outlined therein. The
administrative hearing commission shall render a decision within three
hundred days of filing the appeal. For each day the proceeding is
continued or delayed by appellant, the time frame for rendering a
decision is extended by one day. If the commission does not render a
decision within three hundred days of filing, or as extended, the
appellant may seek the same appeal in the circuit court of Cole County or
in the circuit court where the facility is located. The circuit court
performing review in lieu of the administrative hearing commission herein
shall perform its review under the same guidelines and restrictions as
the administrative hearing commission, except that the circuit court
shall retain authority to render final decisions of law. (L. 1999 S.B.
326 § 14)

1. To implement fully the provisions of section 208.152, the
division of medical services shall calculate the Medicaid per diem
reimbursement rates of each nursing home participating in the Medicaid
program as a provider of nursing home services based on its costs
reported in the Title XIX cost report filed with the division of medical
services for its fiscal year as provided in subsection 2 of this section.

2. The recalculation of Medicaid rates to all Missouri facilities will be
performed as follows: effective July 1, 2004, the department of social
services shall use the Medicaid cost report containing adjusted costs for
the facility fiscal year ending in 2001 and redetermine the allowable
per-patient day costs for each facility. The department shall recalculate
the class ceilings in the patient care, one hundred twenty percent of the
median; ancillary, one hundred twenty percent of the median; and
administration, one hundred ten percent of the median cost centers. Each
facility shall receive as a rate increase one-third of the amount that is
unpaid based on the recalculated cost determination. (L. 2004 S.B. 1123,
A.L. 2005 S.B. 539)

The following words shall have the following meanings unless a
different meaning clearly appears from the context:

(1) "Corporation" means a domestic not-for-profit corporation organized
under the provisions of chapter 355, RSMo;

(2) "Department" means the Missouri department of transportation;

(3) "Director" means the director of the Missouri department of
transportation. (L. 1976 S.B. 875 § 1, A.L. 1981 S.B. 410)

There is hereby created the "Missouri Elderly and Handicapped
Transportation Assistance Program". The purpose of this program is to
provide state financial assistance to defray operating costs incurred by
corporations providing transportation services to the elderly and
handicapped at below cost rates as long as matching federal funds or
local or private funds, or both, are available and received. (L. 1976
S.B. 875 § 2, A.L. 1981 S.B. 410)

Funds appropriated for this program shall be appropriated to and
administered by the department of transportation. The distribution of
funds to corporations shall be determined on the basis of ridership, cost
and alternative transportation means available. (L. 1976 S.B. 875 § 3,
A.L. 1981 S.B. 410)

The director shall develop specific procedures and rules for the
program for inclusion in the Missouri Register. These rules shall be
subject to all state laws regarding the development of such rules. (L.
1976 S.B. 875 § 4)

1. As used in this section, unless the context otherwise
indicates, the following terms mean:

(1) "Elderly", any person who is sixty years of age or older;

(2) "Handicapped", any person having a physical or mental condition,
either permanent or temporary, which would substantially impair ability
to operate or utilize available transportation.

2. There is hereby created the "Coordinating Council on Special
Transportation" within the Missouri department of transportation. The
members of the council shall be: two members of the senate appointed by
the president pro tem, who shall be from different political parties; two
members of the house of representatives appointed by the speaker, who
shall be from different political parties; the assistant for
transportation of the Missouri department of transportation, or his
designee; the assistant commissioner of the department of elementary and
secondary education, responsible for special transportation, or his
designee; the director of the division of aging of the department of
social services, or his designee; the deputy director for mental
retardation/developmental disabilities and the deputy director for
administration of the department of mental health, or their designees;
the executive secretary of the governor's committee on the employment of
the handicapped; and seven consumer representatives appointed by the
governor by and with the advice and consent of the senate, four of the
consumer representatives shall represent the elderly and three shall
represent the handicapped. Two of such three members representing
handicapped persons shall represent those with physical handicaps.
Consumer representatives appointed by the governor shall serve for terms
of three years or until a successor is appointed and qualified. Of the
members first selected, two shall be selected for a term of three years,
two shall be selected for a term of two years, and three shall be
selected for a term of one year. In the event of the death or resignation
of any member, his successor shall be appointed to serve for the
unexpired period of the term for which such member had been appointed.

3. State agency personnel shall serve on the council without additional
appropriations or compensation. The consumer representatives shall serve
without compensation except for receiving reimbursement for the
reasonable and necessary expenses incurred in the performance of their
duties on the council from funds appropriated to the department of
transportation. Legislative members shall be reimbursed by their
respective appointing bodies out of the contingency fund for such body
for necessary expenses incurred in the performance of their duties.

4. Staff for the council shall be provided by the Missouri department of
transportation. The department shall designate a special transportation
coordinator who shall have had experience in the area of special
transportation, as well as such other staff as needed to enable the
council to perform its duties.

5. The council shall meet at least quarterly each year and shall elect
from its members a chairman and a vice chairman.

6. The coordinating council on special transportation shall:

(1) Recommend and periodically review policies for the coordinated
planning and delivery of special transportation when appropriate;

(2) Identify special transportation needs and recommend agency funding
allocations and resources to meet these needs when appropriate;

(3) Identify legal and administrative barriers to effective service
delivery;

(4) Review agency methods for distributing funds within the state and
make recommendations when appropriate;

(5) Review agency funding criteria and make recommendations when
appropriate;

(6) Review area transportation plans and make recommendations for plan
format and content;

(7) Establish measurable objectives for the delivery of transportation
services;

(8) Review annual performance data and make recommendations for improved
service delivery, operating procedures or funding when appropriate;

(9) Review local disputes and conflicts on special transportation and
recommend solutions. (L. 1985 S.B. 53 §§ 1 to 4, A.L. 1988 S.B. 676)

The division of aging of the department of social services may
establish a program under which elderly persons who are sixty years of
age or older and others who have designated an elderly person as a
beneficiary may volunteer their time and services to an in-home service
or voluntary agency serving the elderly or to a not-for-profit
organization or agency which provides services that benefit the elderly
which is approved by the division and receive credit for providing
volunteer respite service, which credit may then be drawn upon by such
elderly persons or designated elderly beneficiaries when they themselves
or their families need such respite services. The division shall
establish a registry of names of such volunteers and shall, monthly or as
often as it deems necessary for efficient management of the program,
credit each of such volunteers with the number of hours of service each
has performed for organizations and agencies approved by the division. No
person serving as a volunteer pursuant to any program established by the
division under the provisions of this section shall be credited for more
than ten hours of volunteer service under this program per week. (L. 1984
H.B. 959 § 1, A.L. 1987 S.B. 277, A.L. 1992 H.B. 1687)

At such time as an elderly person who has done volunteer work
under the program established under section 208.300, or the designated
beneficiary, shall need assistance himself, he shall so notify the
division and, if the division shall determine that such person is in fact
in need of such assistance, which need shall not be based on financial
need but on the social and medical condition of the person in question,
such person shall receive the assistance of a volunteer. If no volunteer
is available to assist a person entitled to assistance under this section
because of his participation as a volunteer in the program established
under section 208.300, and such unavailability has been verified by the
division, the division, or an agency approved by the division, may obtain
paid assistance for such person. Such paid assistance shall be at a rate
which is no higher than the prevailing reimbursable rate established by
the state for a unit of in-home services. The cost of such paid
assistance shall be paid by the state if the person in question is not
eligible for Medicaid from in-home service funds appropriated to the
division. (L. 1984 H.B. 959 § 2, A.L. 1987 S.B. 277)

The division of aging shall submit a report to the general
assembly on January 1, 1987, indicating the number of volunteers
recruited through the program established under section 208.300 and the
number of credited hours of service. (L. 1984 H.B. 959 § 3)

1. Sections 208.309 to 208.315 shall be known as the "Elders
Volunteer for Elders Project (EVE) Act". Subject to appropriations, the
department of social services, division of aging, shall review
applications and award grants to at least three community provider
organizations for the provisions of services which shall establish a
three- year demonstration project designed to prevent the premature or
unnecessary institutionalization of Missouri's low-income elderly
citizens in specifically defined neighborhoods located in a city not
within a county, a city with a population of more than three hundred
fifty thousand inhabitants which is located in more than one county and
in region 2 of the Missouri area agencies on aging.

2. As used in sections 208.309 to 208.315, the following terms mean:

(1) "Community provider organizations", any:

(a) Charitable organization as defined in section 407.453, RSMo;

(b) Not-for-profit corporation established pursuant to chapter 355, RSMo;
or

(c) An organization that has obtained an exemption from the payment of
federal income taxes as provided in section 501(c)(3), 501(c)(7) or
501(c)(8) of Title 26, U.S.C., as amended;

(2) "Division", division of aging of the department of social services;

(3) "Elderly low-income person", a Missouri citizen who is sixty years of
age or older and whose income is at or below one hundred fifty percent of
the federal poverty level;

(4) "Project", a demonstration project directed at Missouri's low- income
elderly who are at risk of involuntary and unnecessary
institutionalization;

(5) "Recipient", any elderly low-income person who is in need of
assistance with at least one of the activities of daily life or
assistance with instrumental activities of daily living. The highest
priority will be given to those at risk of incapacity adjudication. (L.
1996 S.B. 884 & 841)

The purpose of the EVE projects shall be:

(1) To help low-income elderly, adjudicated incapacitated or not, who
live within a project's geographical location to obtain access to
services to retain their independence and postpone consignment to nursing
homes and to improve their quality of life;

(2) To advocate for low-income elderly during an incapacity adjudication
hearing;

(3) To help those low-income elderly who become institutionalized and who
can be restored sufficiently to return home, to do so; and

(4) To train and support mostly senior volunteers and to add volunteer
work opportunities for healthy senior citizens. (L. 1996 S.B. 884 & 841)

1. The division shall review applications and make grant awards
to three community provider organizations who meet the criteria and
requirements set forth in subsection 2 of this section. One of the
community provider organizations shall be located in a city not within a
county and the second shall be located in a city with a population of
more than three hundred fifty thousand inhabitants which is located in
more than one county and the third shall be located in region 2 of the
Missouri area agencies on aging.

2. In order to be considered for selection as a demonstration project
site a community provider organization shall file an application with the
division and present the following information:

(1) A proposed program, including the approximate number of elderly
citizens that the project is designed to reach in a specifically defined
neighborhood;

(2) A proposed budget;

(3) A proposed program to recruit, train and retain volunteers as case
managers and advocates for the low-income elderly of the defined
neighborhood;

(4) A proposed client eligibility and screening process; and

(5) A proposed format to file an annual external audit and annual
comprehensive evaluation of the services provided to the low-income
elderly to the division of aging for consideration of potential statewide
implementation. (L. 1996 S.B. 884 & 841)

The division of aging may continue or expand such programs
within appropriations. (L. 1996 S.B. 884 & 841)

1. Beginning October 1, 1994, the department of social services
shall enroll AFDC recipients in the self-sufficiency program established
by this section. The department may target AFDC households which meet at
least one of the following criteria:

(1) Received AFDC benefits in at least eighteen out of the last
thirty-six months; or

(2) Are parents under twenty-four years of age without a high school
diploma or a high school equivalency certificate and have a limited work
history; or

(3) Whose youngest child is sixteen years of age, or older; or

(4) Are currently eligible to receive benefits pursuant to section
208.041, an assistance program for unemployed married parents.

2. The department shall, subject to appropriation, enroll in
self-sufficiency pacts by July 1, 1996, the following AFDC households:

(1) Not fewer than fifteen percent of AFDC households who are required to
participate in the FUTURES program under sections 208.405 and 208.410,
and who are currently participating in the FUTURES program;

(2) Not fewer than five percent of AFDC households who are required to
participate in the FUTURES program under sections 208.405 and 208.410,
but who are currently not participating in the FUTURES program; and

(3) By October 1, 1997, not fewer than twenty-five percent of aid to
families with dependent children recipients, excluding recipients who
meet the following criteria and are exempt from mandatory participation
in the family self-sufficiency program:

(a) Disabled individuals who meet the criteria for coverage under the
federal Americans with Disabilities Act, P.L. 101-336, and are assessed
as lacking the capacity to engage in full-time or part-time subsidized
employment;

(b) Parents who are exclusively responsible for the full-time care of
disabled children; and

(c) Other families excluded from mandatory participation in FUTURES by
federal guidelines.

3. Upon enrollment in the family self-sufficiency program, a household
shall receive an initial assessment of the family's educational, child
care, employment, medical and other supportive needs. There shall also be
assessment of the recipient's skills, education and work experience and a
review of other relevant circumstances. Each assessment shall be
completed in consultation with the recipient and, if appropriate, each
child whose needs are being assessed.

4. Family assessments shall be used to complete a family self-sufficiency
pact in negotiation with the family. The family self-sufficiency pact
shall identify a specific point in time, no longer than twenty-four
months after the family enrolls in the self-sufficiency pact, when the
family's primary self-sufficiency pact shall conclude. The
self-sufficiency pact is subject to reassessment and may be extended for
up to an additional twenty-four months, but the maximum term of any
self-sufficiency pact shall not exceed a total of forty-eight months.
Family self-sufficiency pacts should be completed and entered into within
three months of the initial assessment.

5. The division of family services shall complete family self-sufficiency
pact assessments and/or may contract with other agencies for this
purpose, subject to appropriation.

6. Family self-sufficiency assessments shall be used to develop a family
self-sufficiency pact after a meeting. The meeting participants shall
include:

(1) A representative of the division of family services, who may be a
case manager or other specially designated, trained and qualified person
authorized to negotiate the family self-sufficiency pact and follow-up
with the family and responsible state agencies to ensure that the
self-sufficiency pact is reviewed at least annually and, if necessary,
revised as further assessments, experience, circumstances and resources
require;

(2) The recipient and, if appropriate, another family member, assessment
personnel or an individual interested in the family's welfare.

7. The family self-sufficiency pact shall:

(1) Be in writing and establish mutual state and family member
obligations as part of a plan containing goals, objectives and timelines
tailored to the needs of the family and leading to self-sufficiency;

(2) Identify available support services such as subsidized child care,
medical services and transportation benefits during a transition period,
to help ensure that the family will be less likely to return to public
assistance.

8. The family self-sufficiency pact shall include a parent and child
development plan to develop the skills and knowledge of adults in their
role as parents to their children and partners of their spouses. Such
plan shall include school participation records. The department of social
services shall, in cooperation with the department of health and senior
services, the department of mental health, and the "Parents as Teachers"
program in the department of elementary and secondary education, develop
or make available existing programs to be presented to persons enrolled
in a family self-sufficiency pact.

9. A family enrolled in a family self-sufficiency pact may own or possess
property as described in subdivision (6) of subsection 2 of section
208.010 with a value of five thousand dollars instead of the one thousand
dollars as set forth in subdivision (6) of subsection 2 of section
208.010.

10. A family receiving AFDC may own one automobile, which shall not be
subject to property value limitations provided in section 208.010.

11. Subject to appropriations and necessary waivers, the department of
social services may disregard from one-half to two-thirds of a
recipient's gross earned income for job-related and other expenses
necessary for a family to make the transition to self-sufficiency.

12. A recipient may request a review by the director of the division of
family services, or his designee, of the family self-sufficiency pact or
any of its provisions that the recipient objects to because it is
inappropriate. After receiving an informal review, a recipient who is
still aggrieved may appeal the results of that review under the
procedures in section 208.080.

13. The term of the family self-sufficiency pact may only be extended due
to circumstances creating barriers to self-sufficiency and the family
self-sufficiency pact may be updated and adjusted to identify and address
the removal of these barriers to self-sufficiency.

14. Where the capacity of services does not meet the demand for the
services, limited services may be substituted and the pact completion
date extended until the necessary services become available for the
participant. The pact shall be modified appropriately if the services are
not delivered as a result of waiting lists or other delays.

15. The division of family services shall establish a training program
for self-sufficiency pact case managers which shall include but not be
limited to:

(1) Knowledge of public and private programs available to assist
recipients to achieve self-sufficiency;

(2) Skills in facilitating recipient access to public and private
programs; and

(3) Skills in motivating and in observing, listening and communicating.

16. The division of family services shall ensure that families enrolled
in the family self-sufficiency program make full use of the federal
earned income tax credit.

17. Failure to comply with any of the provisions of a self-sufficiency
pact developed pursuant to this section shall result in a recalculation
of the AFDC cash grant for the household without considering the needs of
the caretaker recipient.

18. If a suspension of caretaker benefits is imposed, the recipient shall
have the right to a review by the director of the division of family
services or his designee.

19. After completing the family self-sufficiency program, should a
recipient who has previously received thirty-six months of aid to
families with dependent children benefits again become eligible for aid
to families with dependent children benefits, the cash grant amount shall
be calculated without considering the needs of caretaker recipients. The
limitations of this subsection shall not apply to any applicant who
starts a self-sufficiency pact on or before July 1, 1997, or to any
applicant who has become disabled or is receiving or has received
unemployment benefits since completion of a self-sufficiency program.

20. There shall be conducted a comprehensive evaluation of the family
self-sufficiency program contained in the provisions of this act* and the
job opportunities and basic skills training program ("JOBS" or "FUTURES")
as authorized by the provisions of sections 208.400 to 208.425. The
evaluation shall be conducted by a competitively chosen independent and
impartial contractor selected by the commissioner of the office of
administration. The evaluation shall be based on specific, measurable
data relating to those who participate successfully and unsuccessfully in
these programs and a control group, factors which contributed to such
success or failures, the structure of such programs and other areas. The
evaluation shall include recommendations on whether such programs should
be continued and suggested improvements in such programs. The first such
evaluation shall be completed and reported to the governor and the
general assembly by September 1, 1997. Future evaluations shall be
completed every three years thereafter. In addition, in 1997, and every
three years thereafter, the oversight division of the committee on
legislative research shall complete an evaluation on general relief,
child care and development block grants and social services block grants.

21. The director of the department of social services may promulgate
rules and regulations, pursuant to section 660.017, RSMo, and chapter
536, RSMo, governing the use of family self-sufficiency pacts in this
program and in other programs, including programs for noncustodial
parents of children receiving assistance.

22. The director of the department of social services shall apply to the
United States Secretary of Health and Human Services for all waivers of
requirements under federal law necessary to implement the provisions of
this section with full federal participation. The provisions of this
section shall be implemented, subject to appropriation, as waivers
necessary to ensure continued federal participation are received. (L.
1994 H.B. 1547 & 961 § 1)

*"This act" (H.B. 1547 & 961, 1994) contained numerous sections. Consult
Disposition of Sections table for a definitive listing.

1. The general assembly is committed to community renewal and
revitalization, especially in high poverty areas. Community renewal
depends on fostering a sense of belonging and a sense of community.
Community renewal and revitalization are important for enhancing the
quality of life for community residents. To this end, the general
assembly supports the development and use of community-based systems of
support that include traditional and nontraditional mechanisms for
enhancing quality of life.

2. As used in this section, the following terms mean:

(1) "Community", an area of similar and like interests for developing an
infrastructure that supports a self-sufficiency pact, as established in
section 208.325, while reducing the need for welfare except as a
transitional benefit. A community can include a group of blocks or a
self-defined neighborhood in an area;

(2) "Systems of support", a program, service or other activity with the
goal of alleviating poverty or improving the quality of life.

3. The department of social services in collaboration with the department
of economic development, department of labor and industrial relations,
department of health and senior services, department of mental health and
other agencies shall develop a comprehensive methodology to focus a blend
of federal, state and local resources on communities to address issues of
poverty specific to the community. Part of this methodology shall be
specific strategies for the coordinated use of existing job training
programs at the local level, including federal and state job training
funds, and the private industry councils. The elimination of duplication
of services and the enhancing of access to existing agencies shall be the
primary goals of these strategies. The department of social services
shall also develop strategies for contracting at the community level with
public agencies and private not-for-profit organizations, community
action agencies, for the delivery of services to promote
self-sufficiency; such services may include the provision of child care,
transportation, employment-readiness, and job training. The methodology
of the department of social services should include, but need not be
limited to:

(1) An inventory of community strengths and weaknesses, including the
availability of community services, businesses and individual volunteers;

(2) Assessing the potential for local residents, given sufficient
training and financial support, to provide for improved community
services and businesses;

(3) Provision of staff resources needed to help identify and inform local
residents about the program, organize public meetings, develop local
leadership and gain the commitment of local residents for the success of
the project; and

(4) Giving preference to projects that would include small businesses
managed or owned by local residents. The director of the department of
social services shall establish pilot programs that promote local
authority and decision making. The department of social services shall
give local communities, to the maximum extent possible, authority to
direct assistance in conjunction with local resources to provide new and
innovative ways of assisting people living in poverty.

4. The department of social services shall accept applications and work
with other agencies, subject to appropriation, to establish a pilot
project in a city not within a county to develop and implement an
alternative neighborhood, community-based program for disadvantaged
youths known as the "Youth Build St. Louis" program.

5. Communities should submit a community revitalization plan to the
department of social services designed to strengthen local systems of
support and provide economic incentives for investment in the community.

6. Local resources shall be identified in the plan which shall be used to
expand the community's capacity to sustain residents' self-sufficiency.
The plan should be tailored to the community and should build on existing
initiatives and service delivery systems.

7. Community agencies which may include community action agencies as
defined in section 660.370, RSMo, shall be used to manage revitalization
programs and support system development.

8. Community revitalization plans should include, but not be limited to,
the following components:

(1) Community cooperatives which expand the capacity to meet basic needs
such as child care;

(2) Transportation strategies, which make better use of existing
transportation resources through multisystem use and coordination;

(3) Health care strategies which maximize available resources for the
health and safety of the individuals residing in the community;

(4) Community support and volunteer involvement, which maximize human
resources and provide residents the opportunity to reinvest in their
neighborhoods, volunteer service banks, mentoring and adolescent-specific
programs may be included;

(5) Service integration, which improves efficacy and facilitates a
needs-based approach to service delivery. Service integration should
include common intake and referral strategies;

(6) Economic revitalization, which creates an environment of opportunity
and growth. Neighborhood assistance programs and other economic
development tools, such as investment incentives should be identified;

(7) Private sector involvement and investment, which ensures the
viability of the community is self-sustaining and involves the total
community. Community representation and private sector commitments should
be specified;

(8) Prevention, which gives families in need of short-term assistance the
resources necessary to avoid long-term dependency.

9. Communities receiving assistance to implement a revitalization plan
should be provided with the following resources:

(1) Flexible funding, to facilitate the initial organization of community
resources and agencies for the purpose of plan implementation;

(2) Technical assistance, for the development of unified intake, referral
and service delivery strategies, and communication network systems;

(3) Expanded options, subject to waiver approval, such as wage
supplementation and resource and income disregards for welfare recipients
to increase the probability of economic independence;

(4) Evaluation of results, to monitor system effectiveness and program
impact.

10. The provisions of this section shall be implemented as waivers
necessary to ensure continued federal funding are received. (L. 1994 H.B.
1547 & 961 § 2)

1. The division may deposit funds into an account on behalf of
children whose custodial parent is a participant in the program
authorized pursuant to the provisions of sections 208.400 to 208.425, and
whose noncustodial parent is participating in a state job training and
adult educational program approved by the division of family services. If
agreed upon by the parties, funds may also be deposited for this purpose
when the noncustodial parent terminates participation in the job training
or educational program, until the custodial parent completes
participation in the program authorized pursuant to the provisions of
sections 208.400 to 208.425. The amount deposited for each child shall
not exceed the portion of current child support paid by the noncustodial
parent, to which the state of Missouri is entitled according to
applicable state and federal laws. Money so received shall be governed by
this section notwithstanding other state laws and regulations to the
contrary.

2. Any money deposited by the division on behalf of a child, as provided
in subsection 3 of this section, shall be accounted for in the name of
the child. Any money in the account of a child may be expended only for
care or services for the child as agreed upon by both parents. The
division shall, by rule adopted pursuant to section 454.400, RSMo, and
chapter 536, RSMo, establish procedures for the establishment of the
accounts, use, expenditure, and accounting of the money, and the
protection of the money against theft, loss or misappropriation.

3. The division shall deposit money appropriated for the purposes of this
section with the state treasurer. Any earnings attributable to the money
in the account of a child shall be credited to that child's account.

4. Each child for whose benefit funds have been received by the division,
and the parents of such child, shall be furnished annually by the
division of budget and finance of the department of social services with
a statement listing all transactions involving the funds which have been
deposited on the child's behalf, to include each receipt and
disbursement, if any.

5. (1) The director of the department of social services shall apply for
all waivers of requirements under federal law to implement the provisions
of this section.

(2) This program shall not be implemented until the waiver has been
obtained from the Secretary of the Department of Health and Human
Services by the director of the department of social services. (L. 1994
H.B. 1547 & 961 § 4)

The office of administration, division of personnel, shall
explore telecommuting employment options for aid to families with
dependent children recipients. (L. 1994 H.B. 1547 & 961 § 5)

1. The department of elementary and secondary education shall
offer, upon request, to all schools the "Postponing Sexual Involvement
Program".

2. The department of social services shall establish one additional
location for the program known as "QUEST". The department of social
services shall offer to schools, upon request, the "Rites of Passage
Program". (L. 1994 H.B. 1547 & 961 § 6)

The director of the department of social services shall, in
conjunction with the state treasurer's office, coordinate an earned
income tax credit program for qualifying AFDC recipients. (L. 1994 H.B.
1547 & 961 § 7)

1. By December 1, 2002, and annually thereafter, the division of
family services shall submit a report to the governor, the president pro
tempore of the senate, and the speaker of the house of representatives
regarding the progress of welfare reform in Missouri. The report shall
include, but not be limited to, current statistics and recommendations
regarding:

(1) Individuals who have successfully left welfare and employment of such
individuals;

(2) Individuals who remain on or have returned to welfare; and

(3) Benefits of welfare reform realized by families, employers, and the
state.

2. The provisions of this section shall expire on December 31, 2007. (L.
2002 S.B. 923, et al.)

Expires 12-31-07

The division of family services, with the cooperation of the
division of vocational rehabilitation, shall establish a protocol where
persons who qualify for public assistance, including aid to families with
dependent children, general relief and medical assistance, because of a
disability may be directed to an appropriate federal agency to apply for
other benefits. The division of family services shall also establish a
procedure to identify applicants and recipients who may be entitled to
supplement or supplant state benefits with other benefits through the
Social Security Disability, Railroad Retirement, Supplemental Security
Income, Veterans, Qualified Medicare Beneficiary and Specified Low Income
Medicare Beneficiary and other programs. (L. 1994 H.B. 1547 & 961 § 12)

As used in sections 208.400 to 208.425 and section 452.311,
RSMo, the following terms mean:

(1) "Case manager", an employee of the division having responsibility for
the assessment of the participant's educational and employment needs and
for assisting the participant in the development and execution of the
service plan;

(2) "Community work experience program", as defined under section 201 of
the Family Support Act of 1988 (P.L. 100-485), a program designed to
enhance the employability of participants not otherwise able to obtain
employment through providing training and an actual work experience;

(3) "Department", the department of social services;

(4) "Division", the division of family services of the department of
social services;

(5) "Educational component", that portion of the Missouri job
opportunities and basic skills training (JOBS) program which is intended
to provide educational opportunities for participants. This component
will include:

(a) "Adult basic education", any part-time or full-time program of
instruction emphasizing reading, writing and computation skills,
including day classes or night classes, which prepares a person to earn a
Missouri high school equivalency certificate pursuant to section 161.093,
RSMo;

(b) "High school education", instruction in two or more grades not lower
than the ninth nor higher than the twelfth grade which leads to the award
of a diploma provided by any school to a person, to the extent that such
instruction conforms to the requirements established pursuant to section
201 of P.L. 100-485 and federal regulations promulgated under said
section;

(c) "Postsecondary education", any part-time or full-time program of
instruction in a community junior college, college or university as
allowed by regulations of the Department of Health and Human Services; and

(d) "Vocational education", any part-time or full-time program of
instruction of less than baccalaureate grade, including day classes or
night classes, which prepares a person for gainful employment;

(6) "Employment component", that portion of the Missouri JOBS program
which is intended to provide employment counseling, training, and
referral and employment opportunities for participants;

(7) "JOBS", the job opportunities and basic skills training program for
AFDC recipients developed by the division of family services;

(8) "Participant", any recipient who is participating in the Missouri
JOBS program;

(9) "Recipient", any person receiving aid to families with dependent
children benefits under section 208.040 or 208.041;

(10) "Service plan", as defined in section 201 of the Family Support Act
of 1988 (P.L. 100-485), an employability plan designating the services to
be provided by the department and the activities in which the participant
will be involved; and

(11) "Transitional child care services", child day care services
provided, as defined in sections 301 and 302 of the Family Support Act of
1988 (P.L. 100-485), to participants who have become ineligible for such
services due to the increased wages of or hours of employment. (L. 1989
1st Ex. Sess. H.B. 2 § 1)

Effective 7-27-89

1. No later than October 1, 1990, the division of family
services shall establish and operate a job opportunities and basic skills
training (JOBS) program for AFDC recipients.

2. The division of family services, subject to appropriation, shall
administer the job opportunities and basic skills training (JOBS) program
as provided in Part F of Title IV of the Social Security Act.

3. Pursuant to Public Law 100-485, state funds expended for education,
training and employment activities, including supportive services, to
assist aid to families with dependent children recipients in becoming
self-sufficient shall be no less than the level expended for such
purposes in fiscal year 1986.

4. The department shall plan and coordinate all the JOBS program with the
Missouri Job Training Coordinating Council, educational training and
basic skills training and opportunities afforded under the provisions of
this act* with the department of elementary and secondary education, the
department of labor and industrial relations and the department of
economic development so as not to duplicate any existing program and
services now offered. The existing personnel in those departments
together with such added personnel as may be authorized by appropriations
shall be utilized in carrying out the provisions of this act*. (L. 1989
1st Ex. Sess. H.B. 2 § 2)

Effective 7-27-89

*"This act" (H.B. 2, 1989 1st Ex. Sess.) contained numerous sections.
Consult Disposition of Sections table for a definitive listing.

1. The division, in determining the priority of participation by
individuals, shall give priority to volunteers as described in section
201 of P.L. 100-485.

2. The state plan for the job opportunities and basic skills training
program shall include a publicity or recruitment program the goal of
which shall be to ensure that volunteers for participation in the job
opportunities and basic skills training program are served first and are
given preference for available education, training and support services.

3. Any recipient who has a child under three years of age living in the
home and is personally providing care for the child shall be exempt from
required participation in the JOBS program.

4. Prior to the termination of any benefits or supportive services of a
participant by the division as a sanction authorized pursuant to the
provisions of this section, the participant shall be afforded a
pretermination hearing, on the record, with an opportunity for the
participant to be heard.

5. No person shall without good cause, as such term is defined in Public
Law 100-485 and regulations defined thereunder, refuse services offered
by the division pursuant to this section. The division may, by rule and
regulation, provide sanctions against any person who violates the
provisions of this subsection. Sanctions shall be consistent with the
provisions of Title II, Section 201 of the Family Support Act of 1988.
(L. 1989 1st Ex. Sess. H.B. 2 § 3, A.L. 1994 H.B. 1547 & 961)

1. The division shall adopt rules and regulations pursuant to
chapter 536, RSMo, to administer such program. Such rules shall include
procedures for referral of individuals for education, employment, job
search, training including on-the-job training, and special work
projects. Such rules may implement any optional provision of the Family
Support Act of 1988.

2. An initial assessment of the educational, child care, and other
supportive services needs as well as the skills, prior work experience,
and employability of each participant in the program including a review
of the family circumstances shall be completed for all participants. This
assessment shall be completed in consultation with the participant.

3. On the basis of the assessment, the division, in consultation with the
participant, shall develop a service plan for the participant. The
service plan shall explain the services that will be provided by the
state agency and the activities in which the participant will take part
under the program, including child care and other supportive services,
shall set forth a service goal for the participant, and shall, to the
maximum extent possible and consistent with sections 208.400 to 208.425,
and section 452.311, RSMo, reflect the respective preferences of such
participant. The plan shall take into account the participant's
supportive services needs, available program resources, and local
employment opportunities. The plan shall include a description of the
rights, duties, and responsibilities of the participant and the division.

4. The division may operate a community work experience program in
accordance with section 201 of P.L. 100-485. The program shall be
voluntary for thirty-six months after July 27, 1989, after which time
those individuals who have received AFDC benefits for thirty-six of the
preceding sixty months may be required to participate in the community
work experience program. (L. 1989 1st Ex. Sess. H.B. 2 § 4)

Effective 7-27-89

The department of social services shall make application for and
accept such federal moneys as shall be awarded for the purpose of
carrying out demonstration projects authorized under Title V of the
Family Support Act of 1988. (L. 1989 1st Ex. Sess. H.B. 2 § 5)

Effective 7-27-89

There is hereby established in the department of social services
a "Welfare Reform Coordinating Committee" to assist in the development of
regional and state implementation plans for welfare reform. (L. 1989 1st
Ex. Sess. H.B. 2 § 6)

Effective 7-27-89

1. For purposes of sections 208.431 to 208.437, the following
terms mean:

(1) "Engaging in the business of providing health benefit services",
accepting payment for health benefit services;

(2) "Medicaid managed care organization", a health benefit plan, as
defined in section 376.1350, RSMo, with a contract under 42 U.S.C.
Section 1396b(m) to provide benefits to Missouri MC+ managed care program
eligibility groups.

2. Beginning July 1, 2005, each Medicaid managed care organization in
this state shall, in addition to all other fees and taxes now required or
paid, pay a Medicaid managed care organization reimbursement allowance
for the privilege of engaging in the business of providing health benefit
services in this state.

3. Each Medicaid managed care organization's reimbursement allowance
shall be based on a formula set forth in rules, including emergency rules
if necessary, promulgated by the department of social services. No
Medicaid managed care organization reimbursement allowance shall be
collected by the department of social services if the federal Center for
Medicare and Medicaid Services determines that such reimbursement
allowance is not authorized under Title XIX of the Social Security Act.
If such determination is made by the federal Center for Medicare and
Medicaid Services, any Medicaid managed care organization reimbursement
allowance collected prior to such determination shall be immediately
returned to the Medicaid managed care organizations which have paid such
allowance. (L. 2005 S.B. 189)

Effective 5-13-05

Expires 6-30-06

Each Medicaid managed care organization shall keep such records
as may be necessary to determine the amount of its reimbursement
allowance. Every Medicaid managed care organization shall submit to the
department of social services a statement that accurately reflects such
information as is necessary to determine that Medicaid managed care
organization's reimbursement allowance. (L. 2005 S.B. 189)

Effective 5-13-05

Expires 6-30-06

1. The director of the department of social services shall make
a determination as to the amount of Medicaid managed care organization's
reimbursement allowance due from each Medicaid managed care organization.

2. The director of the department of social services shall notify each
Medicaid managed care organization of the annual amount of its
reimbursement allowance. Such amount may be paid in monthly increments
over the balance of the reimbursement allowance period.

3. The department of social services may offset the managed care
organization reimbursement allowance owed by the Medicaid managed care
organization against any payment due that managed care organization only
if the managed care organization requests such an offset. The amounts to
be offset shall result, so far as practicable, in withholding from the
managed care organization an amount substantially equivalent to the
reimbursement allowance owed by the managed care organization. The office
of administration and state treasurer may make any fund transfers
necessary to execute the offset. (L. 2005 S.B. 189)

Effective 5-13-05

Expires 6-30-06

1. Each Medicaid managed care organization reimbursement
allowance determination shall be final after receipt of written notice
from the department of social services, unless the Medicaid managed care
organization files a protest with the director of the department of
social services setting forth the grounds on which the protest is based,
within thirty days from the date of receipt of written notice from the
department of social services to the managed care organization.

2. If a timely protest is filed, the director of the department of social
services shall reconsider the determination and, if the Medicaid managed
care organization has so requested, the director or the director's
designee shall grant the managed care organization a hearing to be held
within forty-five days after the protest is filed, unless extended by
agreement between the managed care organization and the director. The
director shall issue a final decision within forty-five days of the
completion of the hearing. After reconsideration of the reimbursement
allowance determination and a final decision by the director of the
department of social services, a managed care organization's appeal of
the director's final decision shall be to the administrative hearing
commission in accordance with sections 208.156 and 621.055, RSMo. (L.
2005 S.B. 189)

Effective 5-13-05

Expires 6-30-06

1. The department of social services shall promulgate rules,
including emergency rules if necessary, to implement the provisions of
sections 208.431 to 208.437, including but not limited to:

(1) The form and content of any documents required to be filed under
sections 208.431 to 208.437;

(2) The dates for the filing of documents by Medicaid managed care
organizations and for notification by the department to each Medicaid
managed care organization of the annual amount of its reimbursement
allowance; and

(3) The formula for determining the amount of each managed care
organization's reimbursement allowance.

2. Any rule or portion of a rule, as that term is defined in section
536.010, RSMo, that is created under the authority delegated in sections
208.431 to 208.437 shall become effective only if it complies with and is
subject to all of the provisions of chapter 536, RSMo, and, if
applicable, section 536.028, RSMo. Sections 208.431 to 208.437 and
chapter 536, RSMo, are nonseverable and if any of the powers vested with
the general assembly pursuant to chapter 536, RSMo, to review, to delay
the effective date, or to disapprove and annul a rule are subsequently
held unconstitutional, then the grant of rulemaking authority and any
rule proposed or adopted after May 13, 2005, shall be invalid and void.
(L. 2005 S.B. 189)

Effective 5-13-05

Expires 6-30-06

1. (1) The Medicaid managed care organization reimbursement
allowance owed or, if an offset has been requested, the balance, if any,
after such offset, shall be remitted by the managed care organization to
the department of social services. The remittance shall be made payable
to the director of the department of revenue.

(2) The amount remitted shall be deposited in the state treasury to the
credit of the "Medicaid Managed Care Organization Reimbursement Allowance
Fund", which is hereby created for the sole purposes of providing payment
to Medicaid managed care organizations. All investment earnings of the
managed care organization reimbursement allowance fund shall be credited
to the Medicaid managed care organization reimbursement allowance fund.

(3) The unexpended balance in the Medicaid managed care organization
reimbursement allowance fund at the end of the biennium is exempt from
the provisions of section 33.080, RSMo. The unexpended balance shall not
revert to the general revenue fund, but shall accumulate in the Medicaid
managed care organization reimbursement allowance fund from year to year.

(4) The state treasurer shall maintain records that show the amount of
money in the Medicaid managed care organization reimbursement allowance
fund at any time and the amount of any investment earnings on that
amount. The department of social services shall disclose such information
to any interested party upon written request.

2. An offset as authorized by this section or a payment to the Medicaid
managed care organization reimbursement allowance fund shall be accepted
as payment of the Medicaid managed care organization's obligation imposed
by section 208.431. (L. 2005 S.B. 189)

Effective 5-13-05

Expires 6-30-06

1. A Medicaid managed care organization reimbursement allowance
period as provided in sections 208.431 to 208.437 shall be from the first
day of July to the thirtieth day of June. The department shall notify
each Medicaid managed care organization with a balance due on the
thirtieth day of June of each year the amount of such balance due. If any
managed care organization fails to pay its managed care organization
reimbursement allowance within thirty days of such notice, the
reimbursement allowance shall be delinquent. The reimbursement allowance
may remain unpaid during an appeal.

2. Except as otherwise provided in this section, if any reimbursement
allowance imposed under the provisions of sections 208.431 to 208.437 is
unpaid and delinquent, the department of social services may compel the
payment of such reimbursement allowance in the circuit court having
jurisdiction in the county where the main offices of the Medicaid managed
care organization is located. In addition, the director of the department
of social services or the director's designee may cancel or refuse to
issue, extend or reinstate a Medicaid contract agreement to any Medicaid
managed care organization which fails to pay such delinquent
reimbursement allowance required by sections 208.431 to 208.437 unless
under appeal.

3. Except as otherwise provided in this section, failure to pay a
delinquent reimbursement allowance imposed under sections 208.431 to
208.437 shall be grounds for denial, suspension or revocation of a
license granted by the department of insurance. The director of the
department of insurance may deny, suspend or revoke the license of a
Medicaid managed care organization with a contract under 42 U.S.C.
Section 1396b(m) which fails to pay a managed care organization's
delinquent reimbursement allowance unless under appeal.

4. Nothing in sections 208.431 to 208.437 shall be deemed to affect or in
any way limit the tax-exempt or nonprofit status of any Medicaid managed
care organization with a contract under 42 U.S.C. Section 1396b(m)
granted by state law.

5. Sections 208.431 to 208.437 shall expire on June 30, 2006. (L. 2005
S.B. 189)

Effective 5-13-05

Expires 6-30-06

Every hospital as defined by section 197.020, RSMo, except
public hospitals which are operated primarily for the care and treatment
of mental disorders and any hospital operated by the department of health
and senior services, shall, in addition to all other fees and taxes now
required or paid, pay a federal reimbursement allowance for the privilege
of engaging in the business of providing inpatient health care in this
state. For the purpose of this section, the phrase "engaging in the
business of providing inpatient health care in this state" shall mean
accepting payment for inpatient services rendered. The federal
reimbursement allowance to be paid by a hospital which has an unsponsored
care ratio that exceeds sixty-five percent or hospitals owned or operated
by the board of curators, as defined in chapter 172, RSMo, may be
eliminated by the director of the department of social services. The
unsponsored care ratio shall be calculated by the department of social
services. (L. 1992 H.B. 1744 § 208.405, A.L. 1994 H.B. 1362)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

1. Each hospital's federal reimbursement allowance shall be
based on a formula set forth in rules and regulations promulgated by the
department of social services. 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. Notwithstanding any other provision of law to the contrary, appeals
regarding this section shall be to the circuit court of Cole County or
the circuit court in the county in which the hospital is located. The
circuit court shall hear the matter as the court of original
jurisdiction. (L. 1992 H.B. 1744 § 208.410, A.L. 1993 S.B. 52, A.L. 1994
H.B. 1362, A.L. 1995 S.B. 3)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

Each hospital shall keep such records as may be necessary to
determine the amount of its federal reimbursement allowance. On or before
September 1, 1992 and the first day of January of each year thereafter
every hospital as defined by section 197.020, RSMo, shall submit to the
department of social services a statement that accurately reflects if the
hospital is publicly or privately owned, if the hospital is operated
primarily for the care and treatment of mental disorders, if the hospital
is operated by the department of health and senior services, or if the
hospital accepts payment for services rendered. Every hospital required
to pay the federal reimbursement allowance shall also submit a statement
that accurately reflects total Missouri Medicaid hospital days, total
unreimbursed care as determined from the hospital's third prior year
desk-reviewed cost report and all other information as may be necessary
to implement sections 208.450* to 208.480. If the hospital does not have
a third prior year desk-reviewed cost report, unreimbursed care shall be
based on estimates determined by the department of social services as
established by rule and regulation. (L. 1992 H.B. 1744 § 208.415)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

*Section 208.450 was repealed by L. 1994 H.B. 1362.

1. The director of the department of social services shall make
a determination as to the amount of federal reimbursement allowance due
from the various hospitals.

2. The director of the department of social services shall notify each
hospital of the annual amount of its federal reimbursement allowance.
Such amount may be paid in increments over the balance of the assessment
period.

3. The department of social services is authorized to offset the federal
reimbursement allowance owed by a hospital against any Missouri Medicaid
payment due that hospital, if the hospital requests such an offset. The
amounts to be offset shall result, so far as practicable, in withholding
from the hospital an amount substantially equivalent to the assessment to
be due from the hospital. The office of administration and state
treasurer are authorized to make any fund transfers necessary to execute
the offset. (L. 1992 H.B. 1744 § 208.420, A.L. 1994 H.B. 1362)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

1. Each federal reimbursement allowance assessment shall be
final, unless the hospital files a protest with the director of the
department of social services setting forth the grounds on which the
protest is based, within thirty days from the date of notice by the
department of social services to the hospital.

2. If a timely protest is filed, the director of the department of social
services shall reconsider the assessment and, if the hospital has so
requested, the director shall grant the hospital a hearing within ninety
days after the protest is filed, unless extended by agreement between the
hospital and the director. The director shall issue a final decision
within sixty days of completion of the hearing. After reconsideration of
the assessment and a final decision by the director of the department of
social services, a hospital's appeal of the director's final decision
shall be to the administrative hearing commission in accordance with
sections 208.156 and 621.055, RSMo. (L. 1992 H.B. 1744 § 208.425)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

The director of the department of social services shall
prescribe by rule the form and content of any document required to be
filed pursuant to the provisions of sections 208.450* to 208.480. (L.
1992 H.B. 1744 § 208.430)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

*Section 208.450 was repealed by L. 1994 H.B. 1362.

1. The federal reimbursement allowance owed or, if an offset has
been requested, the balance, if any, after such offset, shall be remitted
by the hospital to the department of social services. The remittance
shall be made payable to the director of the department of revenue. The
amount remitted shall be deposited in the state treasury to the credit of
the "Federal Reimbursement Allowance Fund", which is hereby created for
the purpose of providing payments to hospitals. All investment earnings
of the fund shall be credited to the fund.

2. An offset as authorized by section 208.459 or a payment to the federal
reimbursement allowance fund shall be accepted as payment of the
obligation of section 208.453.

3. The state treasurer shall maintain records that show the amount of
money in the fund at any time and the amount of any investment earnings
on that amount.

4. The unexpended balance in the federal reimbursement allowance fund at
the end of the biennium is exempt from the provisions of section 33.080,
RSMo. The unexpended balance shall not revert to the general revenue
fund, but shall accumulate from year to year. (L. 1992 H.B. 1744 §
208.435)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

1. A federal reimbursement allowance period shall be from the
first day of October until the thirtieth day of September of the
following year. The department shall notify each hospital with a balance
due on September thirtieth of each year the amount of such balance due.
If any hospital fails to pay its federal reimbursement allowance within
thirty days of such notice, the assessment shall be delinquent.

2. If any assessment imposed under the provisions of sections 208.453 to
208.480 for a previous assessment period is unpaid and delinquent, the
department of social services may proceed to enforce the state's lien
against the property of the hospital and to compel the payment of such
assessment in the circuit court having jurisdiction in the county where
the hospital is located. In addition, the director of the department of
social services or the director's designee may cancel or refuse to issue,
extend or reinstate a Medicaid provider agreement to any hospital which
fails to pay the allowance required by section 208.453.

3. Failure to pay an assessment imposed under sections 208.450* to
208.480 shall be grounds for denial, suspension or revocation of a
license granted under chapter 197, RSMo. The director of the department
of social services may request that the director of the department of
health and senior services deny, suspend or revoke the license of any
hospital which fails to pay its assessment. (L. 1992 H.B. 1744 § 208.440,
A.L. 1994 H.B. 1362)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

*Section 208.450 was repealed by L. 1994 H.B. 1362.

Nothing in sections 208.450* to 208.480 shall be deemed to
affect or in any way limit the tax exempt or nonprofit status of any
hospital granted by state law. (L. 1992 H.B. 1744 § 208.445)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

*Section 208.450 was repealed by L. 1994 H.B. 1362.

1. The department of social services shall make payments to
those hospitals which have a Medicaid provider agreement with the
department. Prior to June 30, 2002, the payment shall be in an annual,
aggregate statewide amount which is at least the same as that paid in
fiscal year 1991-1992 pursuant to rules in effect on August 30, 1991,
under the federally approved state plan amendments.

2. Beginning July 1, 2002, sections 208.453 to 208.480 shall expire one
hundred eighty days after the end of any state fiscal year in which the
aggregate federal reimbursement allowance (FRA) assessment on hospitals
is more than eighty-five percent of the sum of aggregate direct Medicaid
payments, uninsured add-on payments and enhanced graduate medical
education payments, unless during such one hundred eighty-day period,
such payments or assessments are adjusted prospectively by the director
of the department of social services to comply with the eighty-five
percent test imposed by this subsection. Enhanced graduate medical
education payments shall not be included in the calculation required by
this subsection if the general assembly appropriates the state's share of
such payments from a source other than the federal reimbursement
allowance. For purposes of this section, direct Medicaid payments,
uninsured add-on payments and enhanced graduate medical education
payments shall:

(1) Include direct Medicaid payments, uninsured add-on payments and
enhanced graduate medical education payments as defined in state
regulations as of July 1, 2000;

(2) Include payments that substantially replace or supplant the payments
described in subdivision (1) of this subsection;

(3) Include new payments that supplement the payments described in
subdivision (1) of this subsection; and

(4) Exclude payments and assessments of acute care hospitals with an
unsponsored care ratio of at least sixty-five percent that are licensed
to operate less than fifty inpatient beds in which the state's share of
such payments are made by certification.

3. The division of medical services may provide an alternative
reimbursement for outpatient services. Other provisions of law to the
contrary notwithstanding, the payment limits imposed by subdivision (2)
of subsection 1 of section 208.152 shall not apply to such alternative
reimbursement for outpatient services. Such alternative reimbursement may
include enhanced payments or grants to hospital-sponsored clinics serving
low income uninsured patients. (L. 1992 H.B. 1744 § 208.450, A.L. 2001
H.B. 955)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

The requirements of sections 208.450* to 208.480 shall apply
only as long as the revenues generated under section 208.453 are eligible
for federal financial participation and payments are made pursuant to the
provisions of section 208.471. For the purposes of this section, "federal
financial participation" is the federal government's share of Missouri's
expenditures under the Medicaid program. (L. 1992 H.B. 1744 § 208.455)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

*Section 208.450 was repealed by L. 1994 H.B. 1362.

The allowance imposed by sections 208.453 to 208.480 shall be
effective upon promulgation of rules and regulations issued by the
department of social services, but not later than October 1, 1992. (L.
1992 H.B. 1744 § 208.460)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

For each state fiscal year, if the criteria used to determine
eligibility for Medicaid coverage under a Section 1115 waiver are more
restrictive than those in place in state fiscal year 2003, the division
of medical services shall:

(1) Reduce the federal reimbursement allowance assessment for that fiscal
year. The reduction shall equal the amount of federal reimbursement
allowance appropriated to fund the Section 1115 waiver in state fiscal
year 2002 multiplied by the percentage decrease in Medicaid waiver
enrollment as a result of using the more restrictive waiver eligibility
standards; and

(2) Increase cost of the uninsured payments for that fiscal year. The
increased payments shall offset the higher uninsured costs resulting from
the use of more restrictive Medicaid waiver eligibility criteria, as
determined by the department of social services. (L. 2003 H.B. 286)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

1. For each state fiscal year beginning on or after July 1,
2003, the amount of appropriations made to fund Medicaid graduate medical
education and enhanced graduate medical education payments pursuant to
subsections (19) and (21) of 13 CSR 70-15.010 shall not be less than the
amount paid for such purposes for state fiscal year 2002.

2. Sections 208.453 to 208.480 shall expire one hundred eighty days after
the end of any state fiscal year in which the requirements of subsection
1 of this section were not met, unless during such one hundred eighty day
period, payments are adjusted prospectively by the director of the
department of social services to comply with the requirements of
subsection 1 of this section. (L. 2003 H.B. 286)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

No regulations implementing sections 208.450* to 208.475 may be
filed with the secretary of state without first being provided to
interested parties registered on a list of such parties to be maintained
by the director of social services. Regulations must be provided to
interested parties seventy-two hours prior to being filed with the
secretary of state. (L. 1992 H.B. 1744 § 208.465, A.L. 1994 H.B. 1362)

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

*Section 208.450 was repealed by H.B. 1362, 1994.

Notwithstanding the provisions of section 208.471 to the
contrary, sections 208.453 to 208.480 shall expire on September 30, 2006.
(L. 1992 H.B. 1744 § 208.470, A.L. 1994 H.B. 1362, A.L. 1997 H.B. 342,
A.L. 2000 S.B. 810, A.L. 2001 H.B. 955, A.L. 2003 H.B. 286, A.L. 2005
S.B. 189)

Effective 5-13-05

Expires 9-30-06 or upon reaching the contingency contained in § 208.478,
whichever first occurs.

1. Sections 208.500 to 208.507 shall be known as "Transitional
Benefits Demonstration Project". Subject to appropriations and receipt of
a federal waiver, the division of family services shall establish a
three-year demonstration project which shall provide transitional
benefits to families who lose their eligibility for assistance under aid
to families of dependent children because of an increase in earned income.

2. As used in sections 208.500 to 208.507, the following terms mean:

(1) "Child care", child care services provided by the division of family
services;

(2) "Division", division of family services of the department of social
services;

(3) "Medical services", those services provided for under section 208.152;

(4) "Participant", any recipient who is participating in the
demonstration project;

(5) "Project", a demonstration project directed at AFDC recipients who
become ineligible for benefits due to an increase in earned income, in
which such recipients can receive child care and medical services for an
indefinite period of time, not to exceed three years, to assist in the
transition from welfare to employment;

(6) "Recipient", any person receiving aid to families of dependent
children benefits under section 208.040 or 208.041. (L. 1993 H.B. 330 § 6)

1. The division shall select project participants from
applicants who meet the criteria and requirements set forth in subsection
3 of this section.

2. Subject to appropriations, the division shall provide child care and
medical services to no more than two hundred fifty head-of-household
participants. Such child care and medical services will continue until
the earned income of the participant is at least two times the minimum
wage. The division shall deliver the transitional child care assistance
through a vendor voucher payment or purchase of service system which
requires that as the recipient's earned income increases, the recipient
shall contribute to the cost of the assistance in accordance with a
sliding scale fee established by rule.

3. In order to be considered for selection as a prospective project
participant pursuant to sections 208.500 to 208.507:

(1) A person shall apply to the division to participate in the program;

(2) An applicant shall have been a recipient of AFDC benefits for at
least twelve of the last thirty-six months preceding application;

(3) The applicant shall have become ineligible for AFDC benefits due to
an increase in earned income, within the year preceding application, or
is currently receiving transitional child care services as defined in
section 208.400;

(4) The applicant shall be employed at the time of application and not
receiving employer paid child care or medical services;

(5) The applicant shall meet any other criteria as determined by the
division of family services. (L. 1993 H.B. 330 § 7)

The division of family services shall conduct research to
determine the relationship between continued employment of former
recipients and providing child care and medical services to participants
and shall make recommendations to the general assembly concerning the
continuation or modification of the project. (L. 1993 H.B. 330 § 8)

The division of family services shall make such application as
necessary to receive federal waiver(s) and shall promulgate rules and
regulations necessary to implement the provisions of sections 208.500 to
208.507. No rule or portion of a rule promulgated under the authority of
this section shall become effective unless it has been promulgated
pursuant to the provisions of section 536.024, RSMo. (L. 1993 H.B. 330 §
9, A.L. 1995 S.B. 3)

As used in sections 208.530 to 208.535, the following terms
shall mean:

(1) "Commission", the commission on the special health, psychological and
social needs of minority older individuals established in section 208.533;

(2) "Minority older individual", an individual who is sixty years of age
or older and a member of a racial minority group;

(3) "Racial minority group":

(a) Blacks or African Americans;

(b) Native Americans;

(c) Hispanics;

(d) Asian Americans; and

(e) Other similar racial minority groups. (L. 1994 S.B. 480, A.L. 1999
S.B. 7)

1. There is hereby established a twenty-member "Commission on
the Special Health, Psychological and Social Needs of Minority Older
Individuals" under the division of aging. The commission shall consist of
the following members:

(1) The directors of the departments of health and senior services,
mental health and social services or their designees;

(2) The directors of the office of minority health and the division of
aging who shall serve as cochairs of the commission;

(3) Two members of the Missouri house of representatives, one from each
major political party represented in the house of representatives,
appointed by the speaker of the house who shall serve in a nonvoting,
advisory capacity;

(4) Two members of the senate, one from each major political party
represented in the senate, appointed by the president pro tem of the
senate who shall serve in a nonvoting, advisory capacity;

(5) A representative of the office of the lieutenant governor who shall
serve in a nonvoting, advisory capacity; and

(6) Ten individuals appointed by the governor with the advice and consent
of the senate who are currently working in the field of minority elderly
health, psychological or social problems who have demonstrated expertise
in one or more of the following areas: treatment of cardiovascular,
cancer and diabetic conditions; nutrition; community-based health
services; legal services; elderly consumer advocacy; gerontology or
geriatrics; social work and other related services including housing. At
least two of the individuals appointed by the governor shall be minority
older individuals. The members appointed by the governor shall be
residents of Missouri. Any vacancy on the commission shall be filled in
the same manner as the original appointment.

2. Members appointed by the governor shall serve for three-year terms.
Other members, except legislative members, shall serve for as long as
they hold the position which made them eligible for appointment.
Legislative members shall serve during their current term of office but
may be reappointed.

3. Members of the commission shall not be compensated for their services,
but shall be reimbursed for actual and necessary expenses incurred in the
performance of their duties. The office of administration and the
departments of health and senior services, mental health and social
services shall provide such support as the commission requires to aid it
in the performance of its duties. (L. 1994 S.B. 480, A.L. 1995 H.B. 502,
A.L. 1999 S.B. 7)

The responsibilities of the commission shall include, but not be
limited to, the following:

(1) The commission shall annually prepare a report identifying the
special needs of the minority older population in Missouri as compared to
the older population at-large and make recommendations for meeting those
needs. The report shall be completed no later than October first of each
year, beginning in 1999, and copies transmitted to the governor, the
general assembly and appropriate state agencies. The report shall, at a
minimum:

(a) Contain an overview of the special health, psychological and social
needs of minority older Missourians with particular attention to
low-income minority older individuals;

(b) Identify specific diseases and health conditions for which minority
older individuals are at greater risk than the general population;

(c) Identify problems experienced by minority older individuals in
obtaining services from governmental agencies;

(d) Identify programs at the state and local level designed to
specifically meet the needs of minority older individuals; and

(e) Recommend program improvements and services at the state and local
level designed to address the special unmet needs of the minority older
population;

(2) In preparing the report required by this section, the commission
shall solicit and consider the input of individuals and organizations
representing the concerns of the minority older population, with
particular attention to the service needs of those with incomes below the
federal poverty level, concerning:

(a) Programs and services needed by minority older individuals;

(b) The extent to which existing programs do not meet the needs of
minority older individuals;

(c) The accessibility of existing programs to minority older individuals;

(d) The availability and adequacy of information regarding existing
services;

(e) Health problems that minority older individuals experience at a
higher rate than the nonminority older population; and

(f) Financial, social and other barriers experienced by minority older
individuals in obtaining needed services;

(3) Conduct an outreach program that provides information to minority
older Missourians about health, psychological and social problems
experienced by minority older individuals and available programs to
address those problems, as identified in the report prepared pursuant to
this section. (L. 1994 S.B. 480, A.L. 1999 S.B. 7)

The provisions of sections 208.550 to 208.571 shall be
reauthorized every four years. (L. 2001 1st Ex. Sess. H.B. 3 § C merged
with S.B. 4, et al. § C)

Effective 12-13-01

CROSS REFERENCE: Contingent termination date, RSMo 208.798

1. Sections 208.600 to 208.630 shall be known and may be cited
as the "Elderly Health and Nutrition Act of 1994".

2. As used in sections 208.600 to 208.630, the following terms mean:

(1) "Elderly hunger", the lack of sufficient food or nutrition, or food
and nutrition, to maintain health or morale that may be caused by a
variety of factors including poverty, isolation, medical, mental or
dental problems, lack of knowledge of helping programs, lack of
transportation, fear of crime or other causes;

(2) "Elderly person", a Missouri citizen who is sixty years of age or
older;

(3) "Food bank", a food collection and distribution agency, of which
there are at least six in Missouri, which is organized for the purpose of
distributing emergency food supplies to low-income people who would
otherwise not have access to food supplies;

(4) "Gatekeeper programs", programs designed to use nontraditional
referral sources, who through their regular business activities come in
contact with elderly persons, to systematically locate those isolated,
living alone or in need of some type of assistance in order to allow such
persons to maintain independence. (L. 1994 S.B. 426 § 1)

The department of health and senior services shall apply for and
administer the U. S. Department of Agriculture Commodity Supplemental
Food Program and, upon federal appropriations, the department of health
and senior services shall in turn distribute the commodity foods from
this program pursuant to federal regulation * to elderly persons through
qualified food banks and other qualified programs. (L. 1994 S.B. 426 § 2)

*Word "and" appears here in original rolls.

1. The department of social services through its division of
aging, in collaboration with other state agencies, shall devise and
implement a competent, thorough and ongoing public education program
aimed at at-risk elderly persons. The purpose of this public education
program is to identify regularly and inform fully elderly citizens of the
existence, eligibility criteria, means of access and location of existing
federal and state elderly service programs that would serve to alleviate
personal situations that would otherwise lead to hunger and deterioration
of health. Such programs would include, but are not limited to, the
Qualified Medicare Beneficiary Program, the USDA Food Stamp Program, the
Medical Assistance Spenddown Program, the availability of local food
pantries, the availability of caseworkers to take application in the home
for elderly service programs, and any other program that might become
available to assist elderly persons in the future.

2. This public education program shall devise action steps with
preference toward personal as opposed to mass media contacts. Among the
methods to be used may be:

(1) Offering grants to local nonprofit service agencies to carry out
public education programs;

(2) Producing brochures in easy-to-read language and formats using
enlarged lettering;

(3) Holding information sessions at senior nutrition sites and with
senior service agencies, such as the area agencies on aging, and with
other agencies or service providers who serve the elderly;

(4) Organizing volunteer gatekeeper programs in communities with a high
percentage of vulnerable elderly persons;

(5) Applying for a statewide Volunteers in Service to America or the
VISTA Program to assist the state in organizing volunteer public
education efforts. (L. 1994 S.B. 426 § 3)

1. The departments of social services, elementary and secondary
education, transportation, mental health, and health shall establish a
task force which shall devise plans to integrate and coordinate existing
transportation services such as school buses, OATS, Head Start, volunteer
and other programs to take full advantage of existing transportation
resources for the benefit of elderly and other needy populations.

2. The division of aging shall apply for a statewide Volunteers in
Service to America Program for the purpose of helping to organize
volunteer transportation systems in various communities with large
numbers of at-risk elderly persons.

3. The division of aging shall devise models and provide training for
senior housing facilities which seek to provide emergency food services
to residents and neighbors. (L. 1994 S.B. 426 § 4)

The departments of social services, mental health, and health
shall collaborate in addressing the problems of elderly hunger by
entering into collaborative agreements and protocols with each other,
private, public and federal agencies with the intent of creating one-stop
shopping for elderly citizens to apply for all programs for which they
are entitled. They shall devise one application form that will provide
entry to all available elderly services and programs. Any public elderly
service agency that commonly serves elderly persons shall make available
and provide information relating to the one-stop shopping concept. (L.
1994 S.B. 426 § 5)

The division of aging shall devise and implement an unmet needs
report which standardizes information expected from the various
senior-serving agencies, such as the area agencies on aging, and defines
the changing needs and problems of elderly citizens of the state, such as
hunger, isolation, mental illness, crime and other factors affecting the
health, safety and quality of life of elderly persons. Such a report
shall be issued annually to the governor, the speaker of the house of
representatives, the president pro tempore of the senate and the public.
(L. 1994 S.B. 426 § 6)

The department of mental health shall plan, develop and
implement a program that addresses the mental health needs of the elderly
population. Such plan and program shall address the issues of elderly
isolation, depression or other mental health problems. The department of
mental health shall devise materials to instruct physicians,
senior-serving agencies and others in the manifestations of senior mental
illness. Such plan shall be incorporated into the goals and budgets of
the department of mental health in suitable proportion, urgency and
priority with other programs that serve other populations. (L. 1994 S.B.
426 § 7)

The division of aging shall apply for a statewide Volunteers in
Service to America program to assist the division in organizing and
coordinating volunteer resources in areas with a substantial high-risk
elderly population, especially geared toward identifying at-risk elderly
persons, personally contacting them with important information and
friendly reassurance and to assist in volunteer transportation services.
(L. 1994 S.B. 426 § 8)

1. The department of elementary and secondary education shall
devise a model program entitled "Invest in Caring" that recruits, trains
and connects student volunteers with senior service programs and in turn
provides student volunteers with credit hours toward graduation or
college credit.

2. The department of elementary and secondary education shall devise and
implement a model apprenticeship program to enable high school students
who volunteer for certain elderly service tasks to achieve certification
as a certified nurse's aide, day care provider, or other skill that has
job potential upon graduation from high school or which provides credit
toward achieving certification in those skills in an ongoing education
program. Such a program shall be called an "Intergenerational Care and
Training Program". (L. 1994 S.B. 426 § 9)

1. The department of social services shall seek input from the
department of mental health and community-based social service agencies,
which provide case management services to the elderly, for the purpose of
developing a report outlining areas and strategies by which the
department can deliver case management services to the elderly by
collaboration and cooperation with community-based social service
agencies, employing licensed personnel. The report shall include, but not
be limited to, the identification of at-risk elderly, transportation
services, case management services, nutrition services, health services,
and socialization activities and programs. The goal of strategies
outlined should be to enhance the quality of life and welfare of
Missouri's elderly population, and specifically Missouri's at-risk
elderly.

2. The report required by subsection 1 of this section shall be delivered
to the governor, the president pro tem of the senate, and the speaker of
the house not later than January 1, 1995. The report shall identify
effective and efficient methods of delivering necessary services to
at-risk elderly. (L. 1994 S.B. 426 § 10)

The coordinating council on special transportation created in
section 208.275 shall, in cooperation with the department of social
services, coordinate existing transportation reports for Missouri's
elderly and persons with disabilities. Such reports shall be compiled as
one comprehensive plan to meet the special transportation needs of the
elderly and persons with disabilities. The plan shall contain a strategy
for implementation and recommendations for funding. The plan shall be
delivered to the governor, the president pro tem of the senate, and the
speaker of the house of representatives by September 1, 1995. (L. 1994
S.B. 426 § 11)

1. Notwithstanding any other provision of law to the contrary,
the department of social services shall establish a program to pay for
health care for uninsured children. Coverage pursuant to sections 208.631
to 208.660 is subject to appropriation. The provisions of sections
208.631 to 208.657 shall be void and of no effect after July 1, 2007.

2. For the purposes of sections 208.631 to 208.657, "children" are
persons up to nineteen years of age. "Uninsured children" are persons up
to nineteen years of age who are emancipated and do not have access to
affordable employer-subsidized health care insurance or other health care
coverage or persons whose parent or guardian have not had access to
affordable employer-subsidized health care insurance or other health care
coverage for their children for six months prior to application, are
residents of the state of Missouri, and have parents or guardians who
meet the requirements in section 208.636. A child who is eligible for
medical assistance as authorized in section 208.151 is not uninsured for
the purposes of sections 208.631 to 208.657. (L. 1998 S.B. 632 § 208.185
subsecs. 1, 2, A.L. 2002 H.B. 1926)

Effective 6-5-02

Expires 7-1-07

The department of social services is authorized to pay for
coverage of health care services for uninsured children whose parents or
guardians have an available income between zero percent and one hundred
eighty-five percent, between one hundred eighty-six percent and two
hundred twenty-five percent, between two hundred twenty-six percent and
two hundred fifty percent, between two hundred fifty-one percent and two
hundred seventy-five percent and between two hundred seventy-six percent
and three hundred percent of the federal poverty level, subject to
appropriation. (L. 1998 S.B. 632 § 208.185 subsec. 3)

Expires 7-1-07

Parents and guardians of uninsured children eligible for the
program established in sections 208.631 to 208.657 shall:

(1) Furnish to the department of social services the uninsured child's
Social Security number or numbers, if the uninsured child has more than
one such number;

(2) Cooperate with the department of social services in identifying and
providing information to assist the state in pursuing any third-party
insurance carrier who may be liable to pay for health care;

(3) Cooperate with the department of social services, division of child
support enforcement in establishing paternity and in obtaining support
payments, including medical support;

(4) Demonstrate upon request their child's participation in wellness
programs including immunizations and a periodic physical examination.
This subdivision shall not apply to any child whose parent or legal
guardian objects in writing to such wellness programs including
immunizations and an annual physical examination because of religious
beliefs or medical contraindications; and

(5) Demonstrate annually that their total net worth does not exceed two
hundred fifty thousand dollars in total value. (L. 1998 S.B. 632 §
208.185 subsec. 4)

Expires 7-1-07

Parents and guardians of uninsured children with incomes between
one hundred fifty-one and three hundred percent of the federal poverty
level who do not have access to affordable employer-sponsored health care
insurance or other affordable health care coverage may obtain coverage
pursuant to this section. For the purposes of sections 208.631 to
208.657, "affordable employer-sponsored health care insurance or other
affordable health care coverage" refers to health insurance requiring a
monthly premium less than or equal to one hundred thirty-three percent of
the monthly average premium required in the state's current Missouri
consolidated health care plan. The parents and guardians of eligible
uninsured children pursuant to this section are responsible for* a
monthly premium equal to the average premium required for the Missouri
consolidated health care plan; provided that the total aggregate cost
sharing for a family covered by these sections shall not exceed five
percent of such family's income for the years involved. No co-payments or
other cost sharing is permitted with respect to benefits for well-baby
and well-child care including age-appropriate immunizations. Cost-sharing
provisions pursuant to sections 208.631 to 208.657 shall not exceed the
limits established by 42 U.S.C. Section 1397cc(e). (L. 1998 S.B. 632 §
208.185 subsecs. 5, 6, A.L. 2005 S.B. 539)

Expires 7-1-07

*Word "for" was deleted in original rolls.

1. The department of social services shall implement policies
establishing a program to pay for health care for uninsured children by
rules promulgated pursuant to chapter 536, RSMo, either statewide or in
certain geographic areas, subject to obtaining necessary federal approval
and appropriation authority. The rules may provide for a health care
services package that includes all medical services covered by section
208.152, except nonemergency transportation.

2. Available income shall be determined by the department of social
services by rule, which shall comply with federal laws and regulations
relating to the state's eligibility to receive federal funds to implement
the insurance program established in sections 208.631 to 208.657. (L.
1998 S.B. 632 § 208.185 subsecs. 7, 8)

Expires 7-1-07

There shall be a thirty-day waiting period after enrollment for
uninsured children in families with an income of more than two hundred
twenty-five percent of the federal poverty level before the child becomes
eligible for insurance under the provisions of sections 208.631 to
208.660. If the parent or guardian with an income of more than two
hundred twenty-five percent of the federal poverty level fails to meet
the co-payment or premium requirements, the child shall not be eligible
for coverage under sections 208.631 to 208.660 for six months after the
department provides notice of such failure to the parent or guardian. (L.
1998 S.B. 632 § 208.185 subsec. 9)

Expires 7-1-07

Any child identified as having "special health care needs",
defined as a condition which left untreated would result in the death or
serious physical injury of a child, that does not have access to
affordable employer-subsidized health care insurance shall not be
required to be without health care coverage for six months in order to be
eligible for services under sections 208.631 to 208.657 and shall not be
subject to the waiting period required under section 208.646, as long as
the child meets all other qualifications for eligibility. (L. 2004 H.B.
1453)

Effective 7-1-04

1. The department of social services shall commission a study on
the impact of this program on providing a comprehensive array of
community-based wraparound services for seriously emotionally disturbed
children and children affected by substance abuse. The department shall
issue a report to the general assembly within forty-five days of the
twelve-month anniversary of the beginning of this program and yearly
thereafter. This report shall include recommendations to the department
on how to improve access to the provisions of community-based wraparound
services pursuant to sections 208.631 to 208.660.

2. The department of social services shall prepare an annual report to
the governor and the general assembly on the effect of this program. The
report shall include, but is not limited to:

(1) The number of children participating in the program in each income
category;

(2) The effect of the program on the number of children covered by
private insurers;

(3) The effect of the program on medical facilities, particularly
emergency rooms;

(4) The overall effect of the program on the health care of Missouri
residents;

(5) The overall cost of the program to the state of Missouri; and

(6) The methodology used to determine availability for the purpose of
enrollment, as established by rule.

3. The department of social services shall establish an identification
program to identify children not participating in the program though
eligible for extended medical coverage. The department's efforts to
identify these uninsured children shall include, but not be limited to:

(1) Working closely with hospitals and other medical facilities; and

(2) Establishing a statewide education and information program.

4. The department of social services shall commission a study on any
negative impact this program may have on the number of children covered
by private insurance as a result of expanding health care coverage to
children with a gross family income above one hundred eighty-five percent
of the federal poverty level. The department shall issue a report to the
general assembly within forty-five days of the twelve-month anniversary
of the beginning of this program and annually thereafter. If this study
demonstrates that a measurable negative impact on the number of privately
insured children is occurring, the department shall take one or more of
the following measures targeted at eliminating the negative impact:

(1) Implementing additional co-payments, sliding scale premiums or other
cost-sharing provisions;

(2) Adding an insurability test to preclude participation;

(3) Increasing the length of the required period of uninsured status
prior to application;

(4) Limiting enrollment to an annual open enrollment period for children
with gross family incomes above one hundred eighty-five percent of the
federal poverty level; and

(5) Any other measures designed to efficiently respond to the measurable
negative impact. (L. 1998 S.B. 632 § 208.185 subsecs. 10, 11, 12, 13)

Expires 7-1-07

No funds used to pay for insurance or for services pursuant to
sections 208.631 to 208.657 may be expended to encourage, counsel or
refer for abortion unless the abortion is done to save the life of the
mother or if the unborn child is the result of rape or incest. No funds
may be paid pursuant to sections 208.631 to 208.657 to any person or
organization that performs abortions or counsels or refers for abortion
unless the abortion is done to save the life of the mother or if the
unborn child is the result of rape or* incest. (L. 1998 S.B. 632 §
208.185 subsec. 14)

Expires 7-1-07

*Word "of" appears in original rolls.

Any rule or portion of a rule, as that term is defined in
section 536.010, RSMo, that is promulgated under the authority delegated
in this chapter shall become effective only if the agency has fully
complied with all of the requirements of chapter 536, RSMo, including but
not limited to, section 536.028, RSMo, if applicable, after August 28,
1998. All rulemaking authority delegated prior to August 28, 1998, is of
no force and effect and repealed as of August 28, 1998, however, nothing
in sections 208.631 to 208.657 shall be interpreted to repeal or affect
the validity of any rule adopted or promulgated prior to August 28, 1998.
If the provisions of section 536.028, RSMo, apply, the provisions of
sections 208.631 to 208.657 are nonseverable and if any of the powers
vested with the general assembly pursuant to section 536.028, RSMo, to
review, to delay the effective date, or to disapprove and annul a rule or
portion of a rule are held unconstitutional or invalid, the purported
grant of rulemaking authority and any rule so proposed and contained in
the order of rulemaking shall be invalid and void, except that nothing in
sections 208.631 to 208.660 shall affect the validity of any rule adopted
and promulgated prior to August 28, 1998. (L. 1998 S.B. 632 § 208.185
subsec. 15)

Expires 7-1-07

1. Sections 208.700 to 208.720 shall be known and may be cited
as the "Welfare to Work Protection Act".

2. For purposes of sections 208.700 to 208.720, the following terms shall
mean:

(1) "Department", the department of social services;

(2) "Direct placement program", any program in which an office of the
department has a prearranged agreement with a specific employer or
employers to supply such employer or employers with applicants;

(3) "Employer", an employer that operates the site where a public
assistance recipient is employed or placed, and shall not mean any
placement agency or temporary help service firm;

(4) "Supplemental wage assistance employment position", any position in
which the state of Missouri, through the department or any of its
divisions, reimburses the employer for a portion of the wages of such
position as an incentive to an employer for hiring designated individuals;

(5) "TANF benefits", temporary assistance for needy families benefits
provided pursuant to the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, as amended;

(6) "Work first program", a program in the department of social services
implementing the provisions of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996, as amended. The work first
program is not a relief or work training program for purposes of
subsection 9 of section 288.034, RSMo. (L. 1999 S.B. 387, et al. § 4)

Any adult receiving benefits through the work first program
employed by or assigned to a subsidized or unsubsidized work activity
with an employer shall be considered an employee of the employer to the
same extent as other employees of the employer for purposes of all state
and federal labor laws, including, but not limited to, laws pertaining to
collective bargaining, occupational safety and health, workplace
discrimination, unemployment insurance, workers' compensation and minimum
wage. Each participant employed by or assigned to a subsidized or
unsubsidized work activity with an employer shall receive paid sick,
holiday, vacation and all other leave time equivalent to, and on the same
basis as, the leave time paid to regular employees. For purposes of this
section, "employer" means the employer that operates the site where the
recipient is employed or placed, and does not include any placement
agency or temporary help service organization. (L. 1999 S.B. 387, et al.
§ 5)

1. A supplemental wage assistance employment position shall be a
new position within that place of employment.

2. Any individual or employee who believes that he or she has been
adversely affected by a violation of subsection 1 of this section or an
organization that is authorized to represent such individual or employee
shall be afforded an opportunity to grieve it. Such individual or
employee, or such individual's or employee's organization, shall first
attempt to remedy the alleged violation through a meeting with the
employer within thirty days of the request for a meeting. If the
complaint is not resolved to the satisfaction of the individual or
employee, such individual or employee may appeal to the department of
labor and industrial relations commission, and the hearing shall be
conducted in accordance with rules and notification requirements adopted
by the commission and a decision shall be rendered within forty-five days
of such hearing. If the individual or employee is aggrieved by the
decision of the commission, the individual or employee may, within thirty
days of the date of such decision, file a petition for review in the
circuit court for the county in which the individual or employee resides.
The commission shall not be a party in the action before the circuit
court. However, if there is an existing grievance procedure in a
collective bargaining agreement, such procedure shall be followed.
Remedies shall include reinstatement, and retroactive pay and benefits.

3. Nothing in this section shall preempt or supersede any provision of
state law which provides greater protection for employees from job
displacement. (L. 1999 S.B. 387, et al. § 6)

1. Direct placement programs are not required to sanction the
public assistance recipient who refuses employment or an offer of
employment for the following reasons and conditions:

(1) Three or fewer employers are direct placement program participants
and such employment or offer of employment requires travel to and from
the place of employment and the recipient's home which exceeds a total of
two hours in round-trip time, inclusive of the time necessary to
transport family members to a school or place providing child care, or
when walking is the only available means of transportation, the
round-trip is more than four miles; or

(2) The employment or offer of employment involves conditions that are in
violation of applicable health and safety standards.

2. Nothing in this section shall preempt or supersede any provision of
state law which provides greater protections for public assistance
recipients from sanctioning. (L. 1999 S.B. 387, et al. § 7)

The department of social services shall maintain lists of
employers used in supplemental wage assistance programs, direct placement
programs and community work experience programs. The lists shall include
the number of clients placed with such employers year to date. Reporting
of employer lists and client placement with such employers from service
delivery areas to the department shall be made quarterly. Such program
employer lists shall be made available to the public upon request. (L.
1999 S.B. 387, et al. § 8)

1. Sections 208.750 to 208.775 shall be known and may be cited
as the "Family Development Account Program".

2. For purposes of sections 208.750 to 208.775, the following terms mean:

(1) "Account holder", a person who is the owner of a family development
account;

(2) "Community-based organization", any religious or charitable
association formed pursuant to chapter 352, RSMo, that is approved by the
director of the department of economic development to implement the
family development account program;

(3) "Department", the department of economic development;

(4) "Director", the director of the department of economic development;

(5) "Family development account", a financial instrument established
pursuant to section 208.760;

(6) "Family development account reserve fund", the fund created by an
approved community-based organization for the purposes of funding the
costs incurred in the administration of the program and for providing
matching funds for moneys in family development accounts;

(7) "Federal poverty level", the most recent poverty income guidelines
published in the calendar year by the United States Department of Health
and Human Services;

(8) "Financial institution", any bank, trust company, savings bank,
credit union or savings and loan association as defined in chapter 362,
369 or 370, RSMo, and with an office in Missouri which is approved by the
director for participation in the program;

(9) "Program", the Missouri family development account program
established in sections 208.750 to 208.775;

(10) "Program contributor", a person or entity who makes a contribution
to a family development account reserve fund and is not the account
holder. (L. 1999 S.B. 387, et al. § 9)

1. There is hereby established within the department of economic
development a program to be known as the "Family Development Account
Program". The program shall provide eligible families and individuals
with an opportunity to establish special savings accounts for moneys
which may be used by such families and individuals for education, home
ownership or small business capitalization.

2. The department shall solicit proposals from community-based
organizations seeking to administer the accounts on a not-for-profit
basis. Community-based organization proposals shall include:

(1) A requirement that the individual account holder or the family of an
account holder match the contributions of a community-based organization
member by contributing cash;

(2) A process for including account holders in decision making regarding
the investment of funds in the accounts;

(3) Specifications of the population or populations targeted for priority
participation in the program;

(4) A requirement that the individual account holder or the family of an
account holder attend economic literacy seminars;

(5) A process for including economic literacy seminars in the family
development account program; and

(6) A process for regular evaluation and review of family development
accounts to ensure program compliance by account holders.

3. In reviewing the proposals of community-based organizations, the
department shall consider the following factors:

(1) The not-for-profit status of such organization;

(2) The fiscal accountability of the community-based organization;

(3) The ability of the community-based organization to provide or raise
moneys for matching contributions;

(4) The ability of the community-based organization to establish and
administer a reserve fund account which shall receive all contributions
from program contributors; and

(5) The significance and quality of proposed auxiliary services,
including economic literacy seminars, and their relationship to the goals
of the family development account program.

4. No more than twenty percent of all funds in the reserve fund account
may be used for administrative costs of the program in each of the first
two years of the program, and no more than fifteen percent of such funds
may be used for administrative costs for any subsequent year. Funds
deposited by account holders shall not be used for administrative costs.

5. The department shall promulgate rules and regulations to implement and
administer the provisions of sections 208.750 to 208.775. No rule or
portion of a rule promulgated pursuant to the authority of sections
208.750 to 208.775 shall become effective unless it has been promulgated
pursuant to the provisions of chapter 536, RSMo. (L. 1999 S.B. 387, et
al. § 10)

CROSS REFERENCE: Tax Credit Accountability Act of 2004, additional
requirements, RSMo 135.800 to 135.830

1. A family or individual whose household income is less than or
equal to two hundred percent of the federal poverty level may open a
family development account for the purpose of accumulating and
withdrawing moneys for specified expenditures. The account holder may
withdraw moneys from the account on the approval of the community-based
organization, without penalty, for any of the following expenditures:

(1) Educational costs for any family member at an accredited institution
of higher education;

(2) Job training costs for any family member eighteen years of age or
older, at an accredited or licensed training program;

(3) Purchase of a primary residence;

(4) Major repairs or improvements to a primary residence; or

(5) Start-up capitalization of a small business for any family member
eighteen years of age or older.

2. Financial institutions approved by the department shall be permitted
to establish family development accounts pursuant to sections 208.750 to
208.775. The financial institution shall certify to the department, on
forms prescribed by the department and accompanied by any documentation
required by the department, that such accounts have been established
pursuant to the provisions of sections 208.750 to 208.775 and that
deposits have been made on behalf of the account holder.

3. A financial institution establishing a family development account
shall:

(1) Keep the account in the name of the account holder;

(2) Permit deposits to be made in the account by the following, subject
to the indicated conditions:

(a) The account holder; or

(b) A community-based organization on behalf of the account holder. Such
a deposit may include moneys to match the account holder's deposits, up
to a three-to-one match rate;

(3) Require the account to earn at least the market rate of interest; and

(4) Permit the account holder to withdraw moneys from the account for any
of the purposes listed in subsection 1 of this section.

4. The total of all deposits by the account holder into a family
development account in a calendar year shall not exceed two thousand
dollars. The total balance in a family development account shall not
exceed fifty thousand dollars. (L. 1999 S.B. 387, et al. § 11)

1. Account holders who withdraw moneys from a family development
account not in accordance with subsection 1 of section 208.760 shall
forfeit all matching moneys in the account.

2. All moneys forfeited by an account holder pursuant to subsection 1 of
this section shall be returned to the family development account reserve
fund of the community-based organization.

3. In the event of an account holder's death, the account may be
transferred to the ownership of a contingent beneficiary. An account
holder shall name contingent beneficiaries at the time the account is
established and may change such beneficiaries at any time. If the named
beneficiary is deceased or otherwise cannot accept the transfer, the
moneys shall be transferred to the family development account reserve
fund of the community-based organization. (L. 1999 S.B. 387, et al. § 12)

1. Moneys deposited in or withdrawn pursuant to subsection 1 of
section 208.760 from a family development account by an account holder
are exempted from taxation pursuant to chapter 143, RSMo, excluding
withholding tax imposed by sections 143.191 to 143.265, RSMo, and chapter
147, 148 or 153, RSMo, provided, however, that any money withdrawn for an
unapproved use should be subject to tax as required by law.

2. Interest earned by a family development account is exempted from
taxation pursuant to chapter 143, RSMo.

3. Any funds in a family development account, including accrued interest,
shall be disregarded when determining eligibility to receive, or the
amount of, any public assistance or benefits.

4. A program contributor shall be allowed a credit against the tax
imposed by chapter 143, RSMo, excluding withholding tax imposed by
sections 143.191 to 143.265, RSMo, and chapter 147, 148 or 153, RSMo,
pursuant to sections 208.750 to 208.775. Contributions up to fifty
thousand dollars per program contributor are eligible for the tax credit
which shall not exceed fifty percent of the contribution amount.

5. The department of economic development shall verify all tax credit
claims by contributors. The administrator of the community-based
organization, with the cooperation of the participating financial
institutions, shall submit the names of contributors and the total amount
each contributor contributes to a family development account reserve fund
for the calendar year. The director shall determine the date by which
such information shall be submitted to the department by the local
administrator. The department shall submit verification of qualified tax
credits pursuant to sections 208.750 to 208.775 to the department of
revenue.

6. The total tax credits authorized pursuant to sections 208.750 to
208.775 shall not exceed four million dollars in any fiscal year. (L.
1999 S.B. 387, et al. § 13)

Subject to appropriations and to the provisions of chapter 34,
RSMo, the department shall annually award up to one hundred thousand
dollars for an independent evaluation of the program. Based on this
program evaluation, the department shall provide a comprehensive report
on the program to the speaker of the house and the president pro tem of
the senate by March first of each year, beginning in 2000. (L. 1999 S.B.
387, et al. § 14)

As used in sections 208.780 to 208.798, the following terms
shall mean:

(1) "Asset test", the asset limits as defined by the Medicare
Prescription Drug Improvement and Modernization Act, P.L. 108-173;

(2) "Contractor", the person, partnership, or corporate entity which has
an approved contract with the department to administer the pharmaceutical
assistance program established under sections 208.780 to 208.798 and this
chapter;

(3) "Department", the department of social services;

(4) "Division", the department of social services, division of medical
services;

(5) "Enrollee", a resident of this state who meets the conditions
specified in sections 208.780 to 208.798 and in department regulations
relating to eligibility for participation in the Missouri Rx plan and
whose application for enrollment in the Missouri Rx plan has been
approved by the department;

(6) "Federal poverty guidelines", the federal poverty guidelines updated
annually in the Federal Register by the United States Department of
Health and Human Services under the authority of 42 U.S.C. Section
9902(2);

(7) "Liquid assets", assets used in the eligibility determination process
as defined by the Medicare Modernization Act;

(8) "Medicaid dual eligible" or "dual eligible", a person who is eligible
for both Medicare and Medicaid as defined by the Medicare Modernization
Act;

(9) "Medicare Modernization Act" or "MMA", the Medicare Prescription
Drug, Improvement and Modernization Act of 2003, P.L. 108-173;

(10) "Medicare Part D prescription drug benefit", the prescription
benefit provided under the Medicare Modernization Act, as it may vary
from one prescription drug plan to another;

(11) "Missouri resident", a person who has or intends to have a fixed
place of residence in Missouri, with the present intent of maintaining a
permanent home in Missouri for the indefinite future;

(12) "Missouri Rx plan", the state pharmacy assistance program created in
section 208.782, or the combination of state and federal programs
providing services to the population described in section 208.784;

(13) "Participating pharmacy", a pharmacy that elects to participate as a
pharmaceutical provider and enters into a participating network agreement
with the department or contractor;

(14) "Prescription drug plan" or "PDP", nongovernmental drug plans under
contract with the Center for Medicare and Medicaid Services to provide
prescription benefits under the Medicare Modernization Act;

(15) "Prescription drugs", outpatient prescription drugs that have been
approved as safe and effective by the United States Food and Drug
Administration. Prescription drugs do not include experimental drugs or
over-the-counter pharmaceutical products;

(16) "Program", the Missouri Rx plan created under sections 208.780 to
208.798. (L. 2005 S.B. 539)

Sunset date 8-28-11, unless reauthorized.

1. There is hereby established a state pharmaceutical assistance
program within the meaning of federal law at 42 U.S.C. Section 1395
w-133(b), to be known as the "Missouri Rx Plan". The purpose of the
Missouri Rx plan, established within the department of social services,
is to provide certain pharmaceutical benefits to certain elderly and
disabled residents of this state, to facilitate coordination of benefits
between the Missouri Rx plan and the federal Medicare Part D drug benefit
program established by the Medicare Prescription Drug, Improvement and
Modernization Act of 2003, P.L. 108-173, and as well as to enroll such
individuals in said program.

2. The Missouri Rx plan shall assist eligible elderly and disabled
individuals, including individuals qualified as dual eligibles by virtue
of their eligibility for receipt of benefits under both the Medicaid and
Medicare programs, in defraying the cost of medically necessary
prescription drugs through coordination with the Medicare Part D drug
benefit program. The Missouri Rx plan may select one or more prescription
drug plans, as approved by the federal Centers for Medicare and Medicaid
Services, as the preferred plan for purposes of the coordination of
benefits between the Missouri Rx plan and the Medicare Part D drug. To
ensure Medicare eligible seniors receive a coordinated benefit, the
Missouri Rx plan may preliminarily enroll or reenroll beneficiaries of
the Missouri Rx plan into a preferred prescription drug plan or plans in
the absence of any action or application of the individual beneficiary
seeking such enrollment, provided that each individual so enrolled shall
be promptly informed of:

(1) The procedures by which the individual may disenroll from the
preferred PDP;

(2) The existence of an alternative PDP or PDPs authorized to provide
Medicare Part D benefits in the region in which the individual resides;

(3) The manner by which the individual may change his or her enrollment
to an alternative, nonpreferred PDP or obtain assistance in doing so; and

(4) * Enrollment in a nonpreferred PDP will not adversely affect either
the individual's eligibility for enrollment in the Missouri Rx plan or
the amount of benefits the individual may be eligible to receive from the
Missouri Rx plan. The enrollment authority under this section shall also
include the authority to withdraw individuals from nonpreferred plans in
order to maximize the benefit to the individual.

3. The department shall promulgate rules and regulations, including
benefit limits, as may be necessary to implement the Missouri Rx plan.
Any rule or portion of a rule, as that term is defined in section
536.010, RSMo, that is created under the authority delegated in this
section shall become effective only if it complies with and is subject to
all of the provisions of chapter 536, RSMo, and, if applicable, section
536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and
if any of the powers vested with the general assembly pursuant to chapter
536, RSMo, to review, to delay the effective date, or to disapprove and
annul a rule are subsequently held unconstitutional, then the grant of
rulemaking authority and any rule proposed or adopted after August 28,
2005, shall be invalid and void.

4. The department may delegate administrative responsibilities as
necessary to implement the Missouri Rx plan. The department may designate
or enter into contracts with other entities including but not limited to
other states, governmental purchasing pools, or for-profit or nonprofit
organizations to assist in the administration of the program.

5. When requested by the department, other state agencies shall provide
assistance or information necessary for the administration of the
program. (L. 2005 S.B. 539)

Sunset date 8-28-11, unless reauthorized.

*Word "That" appears in original rolls, a typographical error.

1. The program shall coordinate prescription drug coverage with
the Medicare Part D prescription drug benefit, including related supplies
as determined by the department, who:

(1) Is a resident of the state of Missouri and is either:

(a) Sixty-five years of age or older; or

(b) Is disabled and receiving a Social Security benefit and is enrolled
in the Medicare program;

(2) Is enrolled in a Medicare Part D drug plan;

(3) Is not a member of a Medicare Advantage Plan that provides a
prescription drug benefit;

(4) Is not a member of a retirement plan that is receiving a benefit
under the Medicare Prescription Drug, Improvement and Modernization Act
of 2003, P.L. 108-173.

2. The department shall give initial enrollment priority to the Medicaid
dual eligible population. A second enrollment priority will be afforded
to Medicare-eligible applicants with annual household incomes at or below
one hundred fifty percent of the federal poverty guidelines who also meet
the asset test. Medicaid dual eligible persons may be automatically
enrolled into the program, as long as they may opt out of the program if
they so choose. The department shall determine the procedures for
automatic enrollment in, and election out of, the Missouri Rx plan.
Applicants meeting the eligibility requirements set forth in this section
may begin enrolling in the program as determined by the department.

3. An individual or married couple who meet the eligibility requirements
in subsection 1 of this section and who are not Medicaid dual eligible
persons may apply for enrollment in the program by submitting an
application to the department, or the department's designee, that attests
to the age, residence, household income, and liquid assets of the
individual or couple. (L. 2005 S.B. 539)

Sunset date 8-28-11, unless reauthorized.

1. In providing program benefits, the department shall have the
authority to:

(1) Adopt, amend, and rescind such rules and regulations necessary to
perform its duties under this law to maximize the benefits;

(2) Enter into a contract with one or more prescription drug plans to
coordinate the prescription benefits of the Missouri Rx plan and the
Medicare Part D prescription benefit;

(3) Require that pharmaceutical manufacturers provide Medicaid level or
greater rebates for enrollees at or below two hundred percent of the
federal poverty level who also meet the asset test for Medicare Part D
prescription benefit in order for the manufacturer's products to be
available to the enrollees of the Missouri Rx plan. These rebates shall
be no less than those provided to Medicaid under Section 1927 of Title
XIX of the Social Security Act, 42 U.S.C. Section 1396r-8. If revenue is
generated for the program from sources other than appropriation, the
additional revenue shall be deposited in the Missouri Rx plan fund. This
additional revenue shall be used to fund program benefits and make
payments, as may be required, under the Medicare Prescription Drug,
Improvement and Modernization Act of 2003, P.L. 108-173;

(4) Preliminarily enroll beneficiaries into a preferred Medicare Part D
prescription drug plan, with an opt-out provision for the individual.
Individuals who opt out of the preferred PDP shall remain enrolled in the
Missouri Rx plan unless they choose to withdraw from the program;

(5) Prescribe the application and enrollment procedures for prospective
enrollees in the Missouri Rx plan;

(6) Select in accordance with applicable procurement laws, a contractor
to assist in the administration of the Missouri Rx plan or negotiate the
provision of administrative function for the Missouri Rx plan.

2. Program benefits shall begin January 1, 2006. For persons meeting the
eligibility requirements in section 208.784, the program may, subject to
appropriation and contingent upon available funds, pay all or some of the
deductibles, coinsurance payments, premiums, and co-payments required
under the Medicare Part D pharmacy benefit. (L. 2005 S.B. 539)

Sunset date 8-28-11, unless reauthorized.

1. The program created in sections 208.780 to 208.798 is not an
entitlement. The program created in or authorized under sections 208.780
to 208.798 is subject to the annual appropriation of funds by the general
assembly. Benefits are limited by moneys appropriated in the
appropriations bill and signed by the governor less actions by the
governor under article IV, sections 26 and 27 of the Missouri
Constitution and section 33.290, RSMo.

2. The program is the payor of last resort, and shall only cover costs
for participants that are not covered by the Medicare Part D prescription
benefit.

3. Except for dual eligibles during the transition period in which they
are being transferred from the Medicaid program to a prescription drug
plan, applicants who are qualified for coverage of payments for
prescription drugs under a public assistance program, other than MMA
benefits, are ineligible for the Missouri Rx plan as long as they are so
qualified.

4. Applicants who are qualified for full coverage of payments for
prescription drugs under another plan of assistance or insurance are
ineligible to receive benefits from the Missouri Rx plan as long as they
are eligible to receive prescription drug benefits from another plan.

5. Applicants who are qualified for partial payments for prescription
drugs under another insurance plan are eligible for the Missouri Rx plan,
but may receive reduced assistance from the Missouri Rx plan. (L. 2005
S.B. 539)

Sunset date 8-28-11, unless reauthorized.

1. The applicant shall have or intend to have a fixed place of
residence in Missouri, with the present intent of maintaining a permanent
home in Missouri for the indefinite future. The burden of establishing
proof of residence within this state is on the applicant. The requirement
also applies to persons residing in long-term care facilities located in
the state of Missouri.

2. The department shall promulgate rules outlining standards for
documenting proof of residence in Missouri. Documents used to show proof
of residence shall include the applicant's name and address in the state
of Missouri. (L. 2005 S.B. 539)

Sunset date 8-28-11, unless reauthorized.

1. There is hereby established the "Missouri Rx Plan Advisory
Commission" within the department of health and senior services, division
of senior services and regulation to provide advice on the benefit design
and operational policy of the Missouri Rx plan established in sections
208.782 to 208.798. The commission shall consist of the following fifteen
members:

(1) The lieutenant governor, in his or her capacity as advocate for the
elderly;

(2) Two members of the senate, with one member from the majority party
appointed by the president pro tem of the senate and one member of the
minority party appointed by the president pro tem of the senate with the
concurrence of the minority floor leader of the senate;

(3) Two members of the house of representatives, with one member from the
majority party appointed by the speaker of the house of representatives
and one member of the minority party appointed by the speaker of the
house of representatives with the concurrence of the minority floor
leader of the house of representatives;

(4) The director of the division of medical services in the department of
social services;

(5) The director of the division of senior services and regulation in the
department of health and senior services;

(6) The chairperson of the governor's commission on special health,
psychological and social needs of minority older individuals;

(7) The following four members appointed by the governor, with the advice
and consent of the senate:

(a) A licensed pharmacist;

(b) A licensed physician;

(c) A representative from a senior advocacy group; and

(d) A representative from an area agency on aging;

(8) A representative from the pharmaceutical manufacturers industry as a
nonvoting member appointed by the president pro tem of the senate and the
speaker of the house of representatives;

(9) One public member appointed by the president pro tem of the senate;
and

(10) One public member appointed by the speaker of the house of
representatives.

In making the initial appointment to the committee, the governor,
president pro tem, and speaker shall stagger the terms of the appointees
so that four members serve initial terms of two years, four members serve
initial terms of three years, four members serve initial terms of four
years, and one member serves an initial term of one year. All members
appointed thereafter shall serve three-year terms. All members shall be
eligible for reappointment. The commission shall elect a chair and may
employ an executive director and such professional, clerical, and
research personnel as may be necessary to assist in the performance of
the commission's duties.

2. Recognizing the unique medical needs of the senior African- American
population, the president pro tem of the senate, speaker of the house of
representatives, and governor will collaborate to ensure that there is
adequate minority representation among legislative members and other
members of the commission.

3. The commission:

(1) May provide advice on guidelines, policies, and procedures necessary
to establish the Missouri Rx plan;

(2) Shall educate Missouri residents on quality prescription drug
programs and cost-containment strategies in medication therapy;

(3) Shall assist Missouri residents in enrolling or accessing
prescription drug assistance programs for which they are eligible; and

(4) Shall hold quarterly meetings and other meetings as deemed necessary.

4. The members of the commission shall receive no compensation for their
service on the commission, but shall be reimbursed for ordinary and
necessary expenses incurred in the performance of their duties as a
member of the commission. (L. 2005 S.B. 539)

Sunset date 8-28-11, unless reauthorized.

1. There is hereby created in the state treasury the "Missouri
Rx Plan Fund", which shall consist of all moneys deposited in the fund
under sections 208.780 to 208.798, and all moneys which may be
appropriated to it by the general assembly from federal or other sources.

2. The state treasurer shall be custodian of the fund and shall approve
disbursements from the fund in accordance with sections 30.170 and
30.180, RSMo. Upon appropriation, money in the fund shall be used solely
for the administration of sections 208.780 to 208.798. Notwithstanding
the provisions of section 33.080, RSMo, to the contrary, any moneys
remaining in the fund at the end of the biennium shall not revert to the
credit of the general revenue fund. The state treasurer shall invest
moneys in the fund in the same manner as other funds are invested. Any
interest and moneys earned on such investments shall be credited to the
fund.

3. All funds collected by or due and payable to the Missouri Rx plan fund
shall remain in and accrue to said fund.

4. Notwithstanding the provisions of section 33.080, RSMo, to the
contrary, moneys in the fund shall not revert to the credit of the
general revenue fund at the end of the biennium. (L. 2005 S.B. 539)

Sunset date 8-28-11, unless reauthorized.

1. The provisions of sections 208.550 to 208.568* shall
terminate following notice to the revisor of statutes by the Missouri RX
plan advisory commission that the Medicare Prescription Drug, Improvement
and Modernization Act of 2003 has been fully implemented.

2. Pursuant to section 23.253, RSMo, of the Missouri sunset act, the
provisions of the new program authorized under sections 208.780 to
208.798 shall automatically sunset August 28, 2011, unless reauthorized
by an act of the general assembly. (L. 2005 S.B. 539)

Sunset date 8-28-11, unless reauthorized.

*Sections 208.550 to 208.574 were repealed by S.B. 539, 2005.

1. Persons institutionalized in nursing homes who are Medicaid
eligible and who wish to move back into the community shall be eligible
for a one-time Missouri transition to independence grant. The Missouri
transition to independence grant shall be limited to up to fifteen
hundred dollars to offset the initial down payments and setup costs
associated with housing a person with disabilities as such person moves
out of a nursing home. Such grants shall be established and administered
by the division of vocational rehabilitation in consultation with the
department of social services. The division of vocational rehabilitation
and the department of social services shall cooperate in actively seeking
federal and private grant moneys to fund this program; except that, such
federal and private grant moneys shall not limit the general assembly's
ability to appropriate moneys for the Missouri transition to independence
grants.

2. The division of medical services within the department of social
services, the department of health and senior services and the division
of vocational rehabilitation within the department of elementary and
secondary education shall work together to develop information and
training on community-based service options for residents transitioning
into the community. Representatives of disability-related community
organizations shall complete such training before initiating contact with
institutionalized individuals. (L. 2001 S.B. 236)

As used in sections 208.900 to 208.927, the following terms mean:

(1) "Consumer", a physically disabled person determined by the department
to be eligible to receive personal care assistance services. "Consumer"
does not include any individual with a legal limitation of his or her
ability to make decisions, including the appointment of a guardian or
conservator, or who has an effective power of attorney that authorizes
another person to act as the agent or on behalf of the individual for any
of the duties required by the consumer-directed program;

(2) "Consumer-directed", the hiring, training, supervising, and directing
of the personal care attendant by the consumer;

(3) "Department", the department of health and senior services;

(4) "Live independently", to reside and perform routine tasks in a
noninstitutional or unsupervised residential setting;

(5) "Personal care assistance services", those routine tasks provided to
meet the unmet needs required by the consumer to enable him or her to
live independently;

(6) "Personal care attendant", a person, other than the consumer's
spouse, who performs personal care assistance services for the consumer;

(7) "Physically disabled", loss of, or loss of use of, all or part of the
neurological, muscular, or skeletal functions of the body to the extent
that a person requires the assistance of another person to accomplish
routine tasks;

(8) "Routine tasks":

(a) Bowel and bladder elimination;

(b) Dressing and undressing;

(c) Moving into and out of bed;

(d) Preparation and consumption of food and drink;

(e) Bathing and grooming;

(f) Use of prostheses, aids, equipment, and other similar devices; or

(g) Ambulation, housekeeping, and other functions of daily living;

(9) "Unmet needs", those routine tasks which are allowable by the
Medicaid state plan but which cannot reasonably be met by the members of
the consumer's household or other current support systems;

(10) "Vendor", any organization having a written agreement with the
department to provide services including monitoring and oversight of the
personal care attendant, orientation, and training of the consumer, and
fiscal conduit services necessary for delivery of personal care
assistance services to consumers. (L. 2005 S.B. 539 § 660.661)

1. Subject to appropriations, the department shall provide
financial assistance for consumer-directed personal care assistance
services through eligible vendors to each person determined eligible to
participate under guidelines established by the Medicaid state plan and
who:

(1) Is capable of living independently with personal care assistance
services;

(2) Is physically disabled;

(3) Is eighteen years of age or older;

(4) Is able to direct his or her own care;

(5) Is able to document proof of Medicaid eligibility under Title XIX of
the Social Security Act under federal and state laws and regulations;

(6) Requires at least a nursing home level of care under regulations
established by the department;

(7) Participates in an assessment or evaluation, or both, by the
department; and

(8) Can have their unmet needs safely met at a cost that shall not exceed
the average monthly Medicaid cost of nursing facility care as determined
by the department of social services.

2. Upon certification of the employment of a personal care attendant
chosen by the consumer in accordance with sections 208.900 to 208.927,
the vendor shall perform the payroll and fringe benefit accounting
functions for the consumer. The vendor shall be responsible for filing
claims with the Missouri Medicaid program. Statutorily required fringe
benefit costs shall be paid from the personal care assistant
appropriation. The department shall establish the statewide rate for
personal care attendant services. For purposes of this section, the
personal care attendant is considered the employee of the consumer only
for the period of time subsidized by personal care assistant funds.
Nothing in this section shall be construed to mean that the attendant is
the employee of the vendor, the department, or the state of Missouri. (L.
2005 S.B. 539 § 660.664)

1. The department shall initiate the determination of an
applicant's eligibility for personal care assistance services as follows:

(1) For all persons who had been receiving personal care assistance
services on August 28, 2005, the department shall initiate reverification
of the consumer's eligibility for personal care assistance services not
later than one year following August 28, 2005. For all such
reverifications in which the person is found to remain eligible, the
department shall also review the person's personal care assistance
authorized by the department to determine if it shall be maintained,
adjusted, or eliminated according to the person's current situation at
the reverification;

(2) For all applicants for personal care assistance services who apply
for such services on or after August 28, 2005, the department shall
initiate the determination of an applicant's eligibility for personal
care assistance services within thirty days of receipt of a completed
application;

(3) After the assessment described in subdivisions (1) and (2) of this
subsection, the department shall reverify the applicant's eligibility for
personal care assistance services at least every twelve months;

(4) All such determinations made under subdivisions (1), (2), and (3) of
this subsection shall be made using the same common assessment tool used
by the department for assessment of other disabled and aged adults;

(5) All such determinations made under subdivisions (1), (2), and (3)
shall be made in strict compliance with the provisions of subsection 3*
of section 208.909.

2. The applicant shall be notified of the initial determination of the
department on his or her eligibility for personal care assistance
services within ten days of determination.

3. Upon a determination of eligibility, the department shall develop a
personal care assistance services plan which shall include, but is not
limited to, the following:

(1) The maximum number of units of fifteen-minute increments of personal
care assistance services to be provided; and

(2) Dates of initiation of, and reverification of the personal care
assistance services provided.

4. Upon a determination of eligibility and completion of a personal care
assistance services plan, the consumer shall choose a vendor of personal
care assistance services from a list of eligible vendors maintained by
the department. The vendor shall be responsible for maintaining a list of
eligible personal care attendants. The personal care assistance services
plan shall be signed by the consumer and a representative of the
department. Copies of the plan shall be provided to the consumer, the
vendor, and the department.

5. The needs of the consumer shall be reevaluated annually by the
department, and the amount of assistance authorized by the department
shall be maintained, adjusted, or eliminated accordingly. (L. 2005 S.B.
539 § 660.667)

*Original rolls contain "subsection 2", a typographical error.

1. Consumers receiving personal care assistance services shall
be responsible for:

(1) Supervising their personal care attendant;

(2) Verifying wages to be paid to the personal care attendant;

(3) Preparing and submitting time sheets, signed by both the consumer and
personal care attendant, to the vendor on a biweekly basis;

(4) Promptly notifying the department within ten days of any changes in
circumstances affecting the personal care assistance services plan or in
the consumer's place of residence; and

(5) Reporting any problems resulting from the quality of services
rendered by the personal care attendant to the vendor. If the consumer is
unable to resolve any problems resulting from the quality of service
rendered by the personal care attendant with the vendor, the consumer
shall report the situation to the department.

2. Participating vendors shall be responsible for:

(1) Collecting time sheets and certifying their accuracy;

(2) The Medicaid reimbursement process, including the filing of claims
and reporting data to the department as required by rule;

(3) Transmitting the individual payment directly to the personal care
attendant on behalf of the consumer;

(4) Monitoring the performance of the personal care assistance services
plan.

3. No state or federal financial assistance shall be authorized or
expended to pay for services provided to a consumer under sections
208.900 to 208.927, if the primary benefit of the services is to the
household unit, or is a household task that the members of the consumer's
household may reasonably be expected to share or do for one another when
they live in the same household, unless such service is above and beyond
typical activities household members may reasonably provide for another
household member without a disability.

4. No state or federal financial assistance shall be authorized or
expended to pay for personal care assistance services provided by a
personal care attendant who is listed on any of the background check
lists in the family care safety registry under sections 210.900 to
210.937, RSMo, unless a good cause waiver is first obtained from the
department in accordance with section 660.317, RSMo. (L. 2005 S.B. 539 §
660.670)

1. When any adult day care worker; chiropractor, Christian
Science practitioner, coroner, dentist, embalmer, employee of the
departments of social services, mental health, or health and senior
services; employee of a local area agency on aging or an organized area
agency on aging program; funeral director; home health agency or home
health agency employee; hospital and clinic personnel engaged in
examination, care, or treatment of persons; in-home services owner,
provider, operator, or employee; law enforcement officer; long-term care
facility administrator or employee; medical examiner; medical resident or
intern; mental health professional; minister; nurse; nurse practitioner;
optometrist; other health practitioner; peace officer; pharmacist;
physical therapist; physician; physician's assistant; podiatrist;
probation or parole officer; psychologist; vendor as defined in section
208.900; personal care attendant; or social worker has reasonable cause
to believe that a consumer has been abused or neglected as defined in
section 660.250, RSMo, as a result of the delivery of or failure to
deliver personal care assistance services, he or she shall immediately
report or cause a report to be made to the department. If the report is
made by a physician of the consumer, the department shall maintain
contact with the physician regarding the progress of the investigation.

2. When a report of deteriorating physical condition resulting in
possible abuse or neglect of a consumer is received by the department,
the department's case manager and the department nurse shall be notified.
The case manager shall investigate and immediately report the results of
the investigation to the department nurse.

3. If requested, local area agencies on aging shall provide volunteer
training to those persons listed in subsection 1 of this section
regarding the detection and reporting of abuse and neglect under this
section.

4. Any person required in subsection 1 of this section to report or cause
a report to be made to the department who fails to do so within a
reasonable time after the act of abuse or neglect is guilty of a class A
misdemeanor.

5. The report shall contain the names and addresses of the vendor, the
personal care attendant, and the consumer, and information regarding the
nature of the abuse or neglect, the name of the complainant, and any
other information which might be helpful in an investigation.

6. In addition to those persons required to report under subsection 1 of
this section, any other person having reasonable cause to believe that a
consumer has been abused or neglected by a personal care attendant may
report such information to the department.

7. If the investigation indicates possible abuse or neglect of a
consumer, the investigator shall refer the complaint together with his or
her report to the department director or his or her designee for
appropriate action. If, during the investigation or at its completion,
the department has reasonable cause to believe that immediate action is
necessary to protect the consumer from abuse or neglect, the department
or the local prosecuting attorney may, or the attorney general upon
request of the department shall, file a petition for temporary care and
protection of the consumer in a circuit court of competent jurisdiction.
The circuit court in which the petition is filed shall have equitable
jurisdiction to issue an ex parte order granting the department authority
for the temporary care and protection of consumer, for a period not to
exceed thirty days.

8. Reports shall be confidential, as provided under section 660.320, RSMo.

9. Anyone, except any person who has abused or neglected a consumer, who
makes a report pursuant to this section or who testifies in any
administrative or judicial proceeding arising from the report shall be
immune from any civil or criminal liability for making such a report or
for testifying, except for liability for perjury, unless such person
acted negligently, recklessly, in bad faith, or with malicious purpose.

10. Within five working days after a report required to be made under
this section is received, the person making the report shall be notified
of its receipt and of the initiation of the investigation.

11. No person who directs or exercises any authority as a vendor, and no
personal care attendant, shall harass, dismiss or retaliate against a
consumer because he or she or any member of his or her family has made a
report of any violation or suspected violation of laws, standards or
regulations applying to the vendor or personal care attendant which he or
she has reasonable cause to believe has been committed or has occurred.

12. The department shall place on the employee disqualification list
established in section 660.315, RSMo, the names of any persons who have
been finally determined by the department to have recklessly, knowingly
or purposely abused or neglected a consumer while employed by a vendor,
or employed by a consumer as a personal care attendant.

13. The department shall provide the list maintained pursuant to section
660.315, RSMo, to vendors as defined in section 208.900.

14. Any person, corporation or association who received the employee
disqualification list under subsection 13 of this section, or any person
responsible for providing health care service, who declines to employ or
terminates a person whose name is listed in this section shall be immune
from suit by that person or anyone else acting for or in behalf of that
person for the failure to employ or for the termination of the person
whose name is listed on the employee disqualification list. (L. 2005 S.B.
539 § 660.673)

1. Any person having reasonable cause to believe that a
misappropriation of a consumer's property or funds, or the falsification
of any documents verifying personal care assistance services delivery to
the consumer, has occurred may report such information to the department.

2. For each report the department shall attempt to obtain the name and
address of the vendor, the personal care attendant, the personal care
assistance services consumer, information regarding the nature of the
misappropriation or falsification, the name of the complainant, and any
other information which might be helpful in an investigation.

3. Any personal care assistance services vendor, or personal care
attendant who puts to his or her own use or the use of the personal care
assistance services vendor or otherwise diverts from the personal care
assistance services consumer's use any personal property or funds of the
consumer, or falsifies any documents for service delivery, is guilty of a
class A misdemeanor.

4. Upon receipt of a report, the department shall immediately initiate an
investigation and report information gained from such investigation to
appropriate law enforcement authorities.

5. If the investigation indicates probable misappropriation of property
or funds, or falsification of any documents for service delivery of a
personal care assistance services consumer, the investigator shall refer
the complaint together with the investigator's report to the department
director or the director's designee for appropriate action.

6. Reports shall be confidential, as provided under section 660.320, RSMo.

7. Anyone, except any person participating in or benefitting from the
misappropriation of funds, who makes a report under this section or who
testifies in any administrative or judicial proceeding arising from the
report shall be immune from any civil or criminal liability for making
such a report or for testifying except for liability for perjury, unless
such person acted negligently, recklessly, in bad faith, or with
malicious purpose.

8. Within five working days after a report required to be made under this
section is received, the person making the report shall be notified in
writing of its receipt and of the initiation of the investigation.

9. No person who directs or exercises any authority in a personal care
assistance services vendor agency shall harass, dismiss or retaliate
against a personal care assistance services consumer or a personal care
attendant because he or she or any member of his or her family has made a
report of any violation or suspected violation of laws, ordinances or
regulations applying to the personal care assistance services vendor or
any personal care attendant which he or she has reasonable cause to
believe has been committed or has occurred.

10. The department shall maintain the employee disqualification list and
place on the employee disqualification list the names of any personal
care attendants who are or have been employed by a personal care
assistance services consumer, and the names of any persons who are or
have been employed by a vendor as defined in subdivision (10) of section
208.900, and who have been finally determined by the department under
section 660.315, RSMo, to have misappropriated any property or funds, or
falsified any documents for service delivery to a personal care
assistance services consumer and who came to be known to the consumer,
directly or indirectly by virtue of the consumer's participation in the
personal care assistance services program. (L. 2005 S.B. 539 § 660.676)

1. In order to qualify for an agreement with the department, the
vendor shall have a philosophy that promotes the consumer's ability to
live independently in the most integrated setting or the maximum
community inclusion of persons with physical disabilities, and shall
demonstrate the ability to provide, directly or through contract, the
following services:

(1) Orientation of consumers concerning the responsibilities of being an
employer, supervision of personal care attendants including the
preparation and verification of time sheets;

(2) Training for consumers about the recruitment and training of personal
care attendants;

(3) Maintenance of a list of persons eligible to be a personal care
attendant;

(4) Processing of inquiries and problems received from consumers and
personal care attendants;

(5) Ensuring the personal care attendants are registered with the family
care safety registry as provided in sections 210.900 to 210.937, RSMo; and

(6) The capacity to provide fiscal conduit services.

2. In order to maintain its agreement with the department, a vendor shall
comply with the provisions of subsection 1 of this section and shall:

(1) Demonstrate sound fiscal management as evidenced on accurate
quarterly financial reports and annual audit submitted to the department;
and

(2) Demonstrate a positive impact on consumer outcomes regarding the
provision of personal care assistance services as evidenced on accurate
quarterly and annual service reports submitted to the department;

(3) Implement a quality assurance and supervision process that ensures
program compliance and accuracy of records; and

(4) Comply with all provisions of sections 208.900 to 208.927, and the
regulations promulgated thereunder. (L. 2005 S.B. 539 § 660.679)

1. Applicants for personal care assistance services and
consumers receiving such services are entitled to a hearing with the
department of social services if eligibility for personal care assistance
services is denied, if the type or amount of services is set at a level
less than the consumer believes is necessary, if disputes arise after
preparation of the personal care assistance services plan concerning the
provision of such services, or if services are discontinued as provided
in section 208.924.

2. A request for a hearing shall be made to the department of social
services in writing in the form prescribed by the department of social
services within ninety days after the mailing or delivery of the written
decision of the department of health and senior services. The procedures
for such requests and for the hearings shall be as set forth in section
208.080. (L. 2005 S.B. 539 § 660.681)

A consumer's personal care assistance services may be
discontinued under circumstances such as the following:

(1) The department learns of circumstances that require closure of a
consumer's case, including one or more of the following: death, admission
into a long-term care facility, no longer needing service, or inability
of the consumer to consumer-direct personal care assistance service;

(2) The consumer has falsified records or committed fraud;

(3) The consumer is noncompliant with the plan of care. Noncompliance
requires persistent actions by the consumer which negate the services
provided in the plan of care;

(4) The consumer or member of the consumer's household threatens or
abuses the personal care attendant or vendor to the point where their
welfare is in jeopardy and corrective action has failed;

(5) The maintenance needs of a consumer are unable to continue to be met
because the plan of care hours exceed availability; and

(6) The personal care attendant is not providing services as set forth in
the personal care assistance services plan and attempts to remedy the
situation have been unsuccessful. (L. 2005 S.B. 539 § 660.684)

The department may promulgate rules and regulations to implement
the provisions of sections 208.900 to 208.927. Any rule or portion of a
rule, as that term is defined in section 536.010, RSMo, that is created
under the authority delegated in this section shall become effective only
if it complies with and is subject to all of the provisions of chapter
536, RSMo, and, if applicable, section 536.028, RSMo. Any provisions of
the existing rules regarding the personal care assistance program
promulgated by the department of elementary and secondary education in
title 5, code of state regulations, division 90, chapter 7, which are
inconsistent with the provisions of sections 208.900 to 208.927 are void
and of no force and effect. (L. 2005 S.B. 539 § 660.687)

1. As used in this section, the term "department" shall mean the
department of health and senior services.

2. Subject to appropriations, the department may provide financial
assistance for consumer-directed personal care assistance services
through eligible vendors, as provided in sections 208.900 through
208.927, to each person who was participating as a non-Medicaid eligible
client pursuant to sections 178.661 through 178.673, RSMo, on June 30,
2005, and who:

(1) Makes application to the department;

(2) Demonstrates financial need and eligibility under subsection 3 of
this section;

(3) Meets all the criteria set forth in sections 208.900 through 208.927,
except for subdivision (5) of subsection 1 of section 208.903;

(4) Has been found by the department of social services not to be
eligible to participate under guidelines established by the Medicaid
state plan; and

(5) Does not have access to affordable employer-sponsored health care
insurance or other affordable health care coverage for personal care
assistance services as defined in section 208.900. For purposes of this
section, "access to affordable employer-sponsored health care insurance
or other affordable health care coverage" refers to health insurance
requiring a monthly premium less than or equal to one hundred
thirty-three percent of the monthly average premium required in the
state's current Missouri consolidated health care plan.

Payments made by the department under the provisions of this section
shall be made only after all other available sources of payment have been
exhausted.

3. (1) In order to be eligible for financial assistance for
consumer-directed personal care assistance services under this section, a
person shall demonstrate financial need, which shall be based on the
adjusted gross income and the assets of the person seeking financial
assistance and such person's spouse.

(2) In order to demonstrate financial need, a person seeking financial
assistance under this section and such person's spouse must have an
adjusted gross income, less disability-related medical expenses, as
approved by the department, that is equal to or less than three hundred
percent of the federal poverty level. The adjusted gross income shall be
based on the most recent income tax return.

(3) No person seeking financial assistance for personal care services
under this section and such person's spouse shall have assets in excess
of two hundred fifty thousand dollars.

4. The department shall require applicants and the applicant's spouse,
and consumers and the consumer's spouse to provide documentation for
income, assets, and disability-related medical expenses for the purpose
of determining financial need and eligibility for the program. In
addition to the most recent income tax return, such documentation may
include, but shall not be limited to:

(1) Current wage stubs for the applicant or consumer and the applicant's
or consumer's spouse;

(2) A current W-2 form for the applicant or consumer and the applicant's
or consumer's spouse;

(3) Statements from the applicant's or consumer's and the applicant's or
consumer's spouse's employers;

(4) Wage matches with the division of employment security;

(5) Bank statements; and

(6) Evidence of disability-related medical expenses and proof of payment.

5. A personal care assistance services plan shall be developed by the
department pursuant to section 208.906 for each person who is determined
to be eligible and in financial need under the provisions of this
section. The plan developed by the department shall include the maximum
amount of financial assistance allowed by the department, subject to
appropriation, for such services.

6. Each consumer who participates in the program is responsible for a
monthly premium equal to the average premium required for the Missouri
consolidated health care plan; provided that the total premium described
in this section shall not exceed five percent of the consumer's and the
consumer's spouse's adjusted gross income for the year involved.

7. (1) Nonpayment of the premium required in subsection 6 shall result in
the denial or termination of assistance, unless the person demonstrates
good cause for such nonpayment.

(2) No person denied services for nonpayment of a premium shall receive
services unless such person shows good cause for nonpayment and makes
payments for past-due premiums as well as current premiums.

(3) Any person who is denied services for nonpayment of a premium and who
does not make any payments for past-due premiums for sixty consecutive
days shall have their enrollment in the program terminated.

(4) No person whose enrollment in the program is terminated for
nonpayment of a premium when such nonpayment exceeds sixty consecutive
days shall be reenrolled unless such person pays any past-due premiums as
well as current premiums prior to being reenrolled. Nonpayment shall
include payment with a returned, refused, or dishonored instrument.

8. (1) Consumers determined eligible for personal care assistance
services under the provisions of this section shall be reevaluated
annually to verify their continued eligibility and financial need. The
amount of financial assistance for consumer-directed personal care
assistance services received by the consumer shall be adjusted or
eliminated based on the outcome of the reevaluation. Any adjustments made
shall be recorded in the consumer's personal care assistance services
plan.

(2) In performing the annual reevaluation of financial need, the
department shall annually send a reverification eligibility form letter
to the consumer requiring the consumer to respond within ten days of
receiving the letter and to provide income and disability-related medical
expense verification documentation. If the department does not receive
the consumer's response and documentation within the ten-day period, the
department shall send a letter notifying the consumer that he or she has
ten days to file an appeal or the case will be closed.

(3) The department shall require the consumer and the consumer's spouse
to provide documentation for income and disability-related medical
expense verification for purposes of the eligibility review. Such
documentation may include but shall not be limited to the documentation
listed in subsection 4 of this section.

9. (1) Applicants for personal care assistance services and consumers
receiving such services pursuant to this section are entitled to a
hearing with the department of social services if eligibility for
personal care assistance services is denied, if the type or amount of
services is set at a level less than the consumer believes is necessary,
if disputes arise after preparation of the personal care assistance plan
concerning the provision of such services, or if services are
discontinued as provided in section 208.924. Services provided under the
provisions of this section shall continue during the appeal process.

(2) A request for such hearing shall be made to the department of social
services in writing in the form prescribed by the department of social
services within ninety days after the mailing or delivery of the written
decision of the department of health and senior services. The procedures
for such requests and for the hearings shall be as set forth in section
208.080.

10. Unless otherwise provided in this section, all other provisions of
sections 208.900 through 208.927 shall apply to individuals who are
eligible for financial assistance for personal care assistance services
under this section.

11. The department may promulgate rules and regulations, including
emergency rules, to implement the provisions of this section. Any rule or
portion of a rule, as that term is defined in section 536.010, RSMo, that
is created under the authority delegated in this section shall become
effective only if it complies with and is subject to all of the
provisions of chapter 536, RSMo, and, if applicable, section 536.028,
RSMo. Any provisions of the existing rules regarding the personal care
assistance program promulgated by the department of elementary and
secondary education in title 5, code of state regulations, division 90,
chapter 7, which are inconsistent with the provisions of this section are
void and of no force and effect.

12. The provisions of this section shall expire on June 30, 2006. (L.
2005 S.B. 74 & 49 § 1)

Expires 6-30-06

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