Healthy Communities Incentive Program

PURPOSE: This rule establishes the requirements and the process for participation of a health professional in the Healthy Communities Incentive Program. (1) The following definitions shall be used in interpretation and enforcement of this rule: (A) Approved practice site means the practice location for which the department agreed to provide support; (B) Area of defined need means a geographic area or population designated by the Missouri Department of Health and Senior Services as experiencing a shortage of accessible primary and preventive health care services; (C) Dentist means an individual licensed and registered pursuant to section 332.071, RSMo; (D) Department means the Missouri Department of Health and Senior Services; (E) Director means the director of the Missouri Department of Health and Senior Services; (F) Hospital means a facility licensed in the state of Missouri pursuant to Chapter 197, RSMo; (G) Licensing board means the Board of Registration for the Healing Arts and the Missouri State Dental Board within the Missouri Department of Economic Development; (H) Physician means an individual licensed and registered pursuant to Chapter 334, RSMo; (I) Sliding scale fee means a fee structure that provides adjustment to charges for all individuals under two hundred percent (200%) of the federal poverty limit, based upon family income and size. (2) The department may contract with selected primary care physicians and general dentists to provide health care services to populations in need within the state. (3) Applicants must submit a written request that contains all of the following information and documentation presented in the order they are listed in subsections (3)(A)–(H). Applications for participation that do not comply with these requirements will not be considered. Each request shall contain: (A) A written request from the applicant for participation in the program; (B) A detailed written description of the proposed practice site, including the facility in which the applicant will be working and the health care services currently provided at that site; (C) Official notification from the applicable Missouri licensing board that the applicant is licensed in good standing; (D) For physicians, a letter from the medical director of all hospitals at which the physician has or will have privileges delineating the status of the privileges. This should include when the privileges began or will begin, how they may have changed over time and an explanation for any changes; (E) A written statement from the applicant’s malpractice insurance carrier setting forth any claims that have been made against the applicant and the disposition of those claims; (F) A written statement from the local public health agency, whose jurisdiction includes the applicant’s proposed practice site, that the applicant’s services are required by and are in the interest of the community; (G) A copy of the applicant’s employment contract for the proposed practice site for a period of no less than four (4) years; and (H) Documentation of agreement to provide care to the populations in the area of defined need, including: 1. Acceptance as a provider by the Missouri Medicaid agency; and 2. A copy of the sliding scale fee. (4) Selection for participation in the Healthy Communities Incentive Program will be prioritized utilizing the following criteria: (A) The degree of need for health professional services (areas with a lack of access for the entire population will be given priority over those areas without access for specific populations); (B) Recruitment of health professionals into an area will be given priority over retention of existing providers; (C) Those employed by an organization with a history of service to the underserved may be given priority over other employment types including self-employed applicants; and (D) Those approved practice sites participating with the department in the financing of the incentive payments. (5) Participation in the Healthy Communities Incentive Program shall consist of payments to individual health professionals under a written contract. (A) The contract period shall be, at a minimum, four (4) years in length; (B) Contract amount shall be one hundred thousand dollars ($100,000) for each four (4)-year period; (C) Payment for the contract shall be due the final quarter of the last year of the contract period; and (D) Pre-payment of the contract amount may be made to facilitate placement in areas of defined need within the state. (6) Participants shall supply the following to the department by July 1 of each year: (A) Participant’s name; (B) Address of the contracted practice site(s); (C) The number and characteristics of the patients served including: 1. Gender; 2. Age distributions; and 3. Payor source (Medicaid, Medicare, Commercial Insurance or Sliding Scale Fee); (D) Letters of continued support from the Local Public Health Agency; and (E) Letter from the applicable licensing board stating that the participant is licensed in good standing in Missouri. (7) If an individual violates the written contract the state shall be entitled to recover from the individual an amount equal to the sum of: (A) The total of the amounts prepaid by the state on behalf of the individual; (B) The interest on the amounts which would be payable if at the time the amounts were paid they were loans bearing interest at the maximum prevailing rate as determined by the Treasurer of the United States; and (C) Any legal fees or associated costs incurred by the department or the state of Missouri in the collection of damages. AUTHORITY: section 191.411, RSMo Supp. 2001. Original rule filed Feb. 15, 2002, effective Aug. 30, 2002. *Original authority: 191.411, RSMo 1993, amended 2001.