208.431. Medicaid managed care organization reimbursement allowance, amount.

248 words·~1 min read·/mo/chapter-208/208-431

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

208.431. Medicaid managed care organization reimbursement allowance, amount. — 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 , 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.

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(L. 2005 S.B. 189)

Effective 5-13-05

Expires 9-30-29; see § 208.437