Missouri Code of State Regulations
Title 22 - MISSOURI CONSOLIDATED HEALTH CARE PLAN
Division 10 - Health Care Plan
Chapter 2 - State Membership
Section 22 CSR 10-2.140 - Strive for Wellness[®] Health Center Provisions, Charges, and Services
Universal Citation: 22 MO Code of State Regs 10-2.140
Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This amendment revises members who are eligible for services at the health center.
(1) Eligibility. Non-Medicare primary members over eighteen (18) years old enrolled in an MCHCP medical plan shall be eligible for and able to access the services available at the health center as described in this rule.
(2) Available Services. The health center provides access to treatment for uncomplicated minor illnesses and to preventive health care services including, but not limited to, the following:
(A) Sore
throats/ears/headache;
(B)
Strains/sprains/musculoskeletal problems;
(C) Non-specific abdominal pain;
(D) Non-specific chest pain;
(E) Cough;
(F) Sinus conditions;
(G) Allergies;
(H) Hormone injections;
(I) Vaccinations including influenza
vaccine;
(J) Rashes;
(K) Acute urinary complaints;
(L) Personal hygiene related
problems;
(M) Acute injuries/acute
routine office procedures;
(N)
Minor surgical procedures, such as sutures for laceration treatment;
(O) Ordinary and routine care of the nature
of a visit to the health care provider's office; and
(P) Clinical Laboratory Improvement
Amendments (CLIA)-waived lab services.
(3) Limitations and exclusions.
(A) The following employees are not eligible
for the health center:
1. Active employees who
are not enrolled in an MCHCP medical plan; and
2. Medicare primary retirees and their
Medicare primary dependents.
(B) Services that are beyond the scope of
practice of the health center including, but not limited to, the following:
1. Emergency services;
2. Urgent care services;
3. Radiology services;
4. Specialist services;
5. Pharmacy services;
6. Occupational, speech, and physical therapy
services; and
7. Chiropractic
services.
(4) Charges for the following services apply:
(A)
Office visit-
1. For members enrolled in the
MCHCP PPO 750 or PPO 1250 Plan, fifteen dollars ($15) payable at the time of
service;
2. For members enrolled in
the Health Savings Account (HSA) Plan, forty-five dollars ($45) payable at the
time of service; and
3. The office
visit includes the evaluation and management of the patient and any associated
laboratory services performed by the health center;
(B) Preventive services-
1. For members enrolled in the MCHCP PPO 750
Plan, PPO 1250 Plan, or HSA Plan, preventive services are covered at one
hundred percent (100%); and
2.
Preventive services shall have the same meaning as in
22 CSR
10-2.055; and
(C) Health center services are outside the
MCHCP PPO 750 Plan, PPO 1250 Plan, and HSA Plan benefits and payments for
health center services do not apply toward any associated deductible or
out-of-pocket maximum.
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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