PURPOSE: This rule establishes the MO
HealthNet payment policy for the Nurse-Midwife Services Program. The goal of
the Nurse-Midwife Services Program is to provide care of a pregnant woman and
her unborn/newborn infant throughout the maternity
cycle.
PUBLISHER'S NOTE: The secretary of state has
determined that the publication of the entire text of the material which is
incorporated by reference as a portion of this rule would be unduly cumbersome
or expensive. This material as incorporated by reference in this rule shall be
maintained by the agency at its headquarters and shall be made available to the
public for inspection and copying at no more than the actual cost of
reproduction. This note applies only to the reference material. The entire text
of the rule is printed here.
(1) Administration. The Nurse-Midwife Program
shall be administered by the Department of Social Services, MO HealthNet
Division. The medical services covered and not covered, the program
limitations, and the maximum allowable fees for all covered services shall be
determined by the Department of Social Services, MO HealthNet Division, and
shall be included in the Nurse-Midwife Program provider manual, which is
incorporated by reference and made a part of this rule as published by the
Department of Social Services, MO HealthNet Division, 615 Howerton Court,
Jefferson City, MO 65109, at its website at
http://manuals.momed.com/collec-tions/collection_nmw/print.pdf,
November 25, 2020. This rule does not incorporate any subsequent amendments or
additions.
(2) Persons Eligible.
Any person who is eligible for MO HealthNet benefits from the Department of
Social Services and is in need of medical services in accordance with the
procedures described in this regulation.
(3) Provider Participation. To be eligible
for participation in the MO HealthNet Nurse-Midwife Program, a provider must
meet the following criteria:
(A) Be currently
licensed and maintain an active license as a registered nurse.
1. A nurse-midwife who resides in or outside
Missouri and who practices in whole or in part in Missouri must be a currently
licensed registered nurse (RN) in Missouri.
2. A nurse-midwife who provides services, in
whole or in part, to MO HealthNet participants in a state other than Missouri
must be a currently licensed registered nurse (RN) in that state and be legally
authorized under that state's law to practice as a nurse-midwife; and
(B) Be currently certified and
maintain active certification by the American College of
Nurse-Midwives.
(4) MO
HealthNet reimbursement for nurse-midwives will be limited to the following
types of care in accordance with federal and state laws. The
MO
HealthNet Nurse-Midwife Provider Manual will contain a listing of
covered and noncovered services:
(A) Complete
care, management and monitoring of a woman in the absence of medical
complications and her unborn/newborn infant throughout the course of the normal
cycle of gestation including pregnancy, labor and delivery, and the initial
post-delivery/postpar-tum period not to exceed six (6) weeks; and
(B) Routine post-delivery care of the
neonate, including physical examination of the baby and conference with
parents.
(5)
Nurse-midwives may be reimbursed by MO HealthNet for services performed in the
following locations:
(A) Inpatient
hospital;
(B) Outpatient
hospital;
(C) Office; and
(D) Home.
(6) Reimbursement. MO HealthNet reimbursement
for service(s) rendered will be the lower of the provider's usual and customary
charge to the general public or the MO HealthNet maximum allowable
amount.
(7) General Regulations.
This rule shall not encompass all of the general regulations of the MO
HealthNet Program. These regulations, however, shall be in effect for
nurse-midwife services.
