Missouri Code of State Regulations
Title 9 - DEPARTMENT OF MENTAL HEALTH
Division 10 - Director, Department of Mental Health
Chapter 31 - Reimbursement for Services
Section 9 CSR 10-31.040 - Community Mental Health Center Clinic UPL
Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule establishes the formula to determine supplemental payments under Medicaid subject to the clinic upper payment limit to Community Mental Health Center Clinics (CMHC).
(1) Definitions. The terms used in this rule shall mean
(2) Supplemental Payment to Community Mental Health Centers. The Department of Mental Health (DMH) contracts with privately owned and operated Community Mental Health Centers (CMHCs), which act as administrative entities of DMH. The CMHCs are designated as entry and exit points for DMH services and are required to provide a comprehensive array of services to any DMH patients in their designated service areas who seek care.
(3) To recognize the CMHCs' higher costs of doing business and their role as safety net providers, each Missouri CMHC will be paid an annual supplement, calculated at the beginning of each state fiscal year, and payable in quarterly installments. The supplemental payment will increase reimbursement for CMHC provided clinics to 1.36 times the Medicare rate for such services, an amount that the state reasonably estimates to be comparable to that paid by private commercial payers. The payment will be subject to the clinic upper payment limit established at 42 CFR 447.321.
(4) Amount of Annual Supplemental Payment. Each CMHC's annual payment will be determined using the following methodology.
*Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008; 630.655, RSMo 1980; and 632.050, RSMo 1980.