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

Universal Citation: 22 MO Code of State Regs 10-2.140

Current through Register Vol. 49, No. 6, March 15, 2024

PURPOSE: This amendment clarifies eligibility for and services available at the Strive for Wellness ® Health Center.

EMERGENCY STATEMENT: This emergency amendment must be in place by January 1, 2024, in accordance with the new plan year. Therefore, this emergency amendment is necessary to serve a compelling governmental interest of protecting members (employees, retirees, officers, and their families) enrolled in the Missouri Consolidated Health Care Plan (MCHCP) from the unintended consequences of confusion regarding eligibility or availability of benefits and will allow members to take advantage of opportunities for reduced premiums for more affordable options without which they may forego coverage. Further, it clarifies member eligibility and responsibility for various types of eligible charges, beginning with the first day of coverage for the new plan year. It may also help ensure that inappropriate claims are not made against the state and help protect the MCHCP and its members from being subjected to unexpected and significant financial liability and/or litigation. It is imperative that this amendment be filed as an emergency amendment to maintain the integrity of the current health care plan. This emergency amendment fulfills the compelling governmental interest of offering access to more convenient and affordable medical services to members as one (1) method of protecting the MCHCP trust fund from more costly expenses. This emergency amendment reflects changes made to the plan by the Missouri Consolidated Health Care Plan Board of Trustees. A proposed amendment, which covers the same material, is published in this issue of the Missouri Register. This emergency amendment complies with the protections extended by the Missouri and United States Constitutions and limits its scope to the circumstances creating the emergency. The MCHCP follows procedures best calculated to assure fairness to all interested persons and parties under the circumstances. This emergency amendment was filed October 27, 2023, becomes effective January 1, 2024, and expires June 28, 2024.

(1) Eligibility. Members aged eighteen (18) years and older 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 contracted services for treatment for uncomplicated minor illnesses and preventive health care services.

(3) Limitations and exclusions.

(A) The following MCHCP eligibles are not able to utilize the health center:
1. Active employees and members who are not enrolled in MCHCP medical coverage; and

2. Members enrolled in the Medicare Advantage plan.

(B) Services that are beyond the scope 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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