Legal Expense Fund Coverage

PURPOSE: This rule defines terms, prescribes contract procedures, and procedures for documentation of care provided under paragraphs (b), (c), (d), (e), and (f) of subdivision (3) of subsection 2 of section 105.711, RSMo. (1) Definitions. The following definitions shall be used in the interpretation and enforcement of this rule: (A) Child care means all physician child health services provided to a child for a condition or conditions that occurred or arose out of pregnancy or childbirth; (B) Community health clinic means a nonprofit community health center qualified as exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code of 1987, as amended, that provides primary care and preventive health services to people without health insurance coverage; (C) Department refers to the Department of Health and Senior Services; (D) Federally funded community health center means a federally funded community health center organized under Section 315, 329, 330, or 340 of the Public Health Services Act (42 U.S.C. Section 216, 254c); (E) Health care provider refers to any nurse, physician assistant, dental hygienist, dentist, or other health care professional licensed or registered under Chapter 330, 331, 332, 334, 335, 336, 337, or 338, RSMo, who provides health care services within the scope of his or her license or registration; (F) Health care refers to any health or dental care provided by any physician or health care provider within the scope of his or her license or registration; (G) Health department refers to a city or county health department organized under Chapter 192, RSMo, or Chapter 205, RSMo, or a city health department operating under a city charter, or a combined city-county health department; (H) Nonprofit community health center means a nonprofit community health center qualified as exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended; (I) Physician refers to any physician licensed to practice medicine in the state of Missouri under the provisions of Chapter 334, RSMo, who provides care within the scope of his or her license; (J) Pregnancy means all medical care given by a physician during the course of pregnancy for any condition related to pregnancy including the postpartum period sixty (60) days, including all medical care for any pregnancy-related condition for which treatment was begun during that pregnancy and postpartum period until resolution of that condition is reached; (K) Primary care and preventive health care services means any essential health or dental care of a noninvasive nature except that injections, the suturing of minor lacerations and incisions of boils or superficial abscesses are permitted. Obstetrical care and other specialized care or treatment are not included; (L) School includes public, private, or parochial elementary or secondary school; (M) State Legal Expense Fund refers to the fund created by section 105.711, RSMo; and (N) Summer camp means a summer camp as defined by section 210.201, RSMo. (2) Scope of Coverage. This regulation applies to payment of any claim or any amount required by any final judgment rendered by a court of competent jurisdiction against individuals qualifying for State Legal Expense Fund Coverage under section 105.711.2(3)(b)-(f), RSMo. (3) Contract Procedures. A physician or health care provider who provides services as described in this rule shall enter into a written agreement with the health department, federally funded community health center, nonprofit entity, nonprofit community health center, community health clinic, school, or summer camp through which the physician or health care provider is employed, contracted, affiliated or associated with, receives referrals, or otherwise provides services described in this rule. This agreement shall include, at a minimum: (A) The physician’s or health care provider’s name, address, place of employment, if any, daytime telephone number, and professional license or registration number or similar identifier; (B) The physician or health care professional is assigned or referred patients under procedures adopted by the health department, federally funded community health center, nonprofit entity, nonprofit community health center, community health clinic, school, or summer camp; (C) The physician or health care provider has no preexisting caregiver patient relationship with any patient under which a fee has been collected or contracted for; (D) The patient is informed in writing, at the outset of any care that no fee will be charged, sought, or accepted for care regardless of the outcome of care, except as otherwise allowed by section 105.711, RSMo; (E) The physician or health care provider does not discriminate in providing health care on the basis of race, sex, religion, national origin, or ethnic background; (F) Neither the physician or health care provider or the health department, federally funded community health center, nonprofit entity, nonprofit community health center, community health clinic, school, or summer camp receives, or contracts for the receipt of a fee, donation or contribution of money, goods, services or any other thing of value in any way related to the health care provided, except as otherwise allowed by section 105.711, RSMo; (G) No other individual or entity, other than the patient and his or her heirs or assigns and beneficiaries, receives anything of value in any way related to the health care services provided at or through the health department, federally AND SENIOR SERVICES funded community health center, nonprofit entity, nonprofit community health center, community health clinic, school, or summer camp; (H) No health care services shall be provided to a child under the age of eighteen (18) years old without the express written permission of the child’s parent or legal guardian. (4) Documentation of Care Provided. (A) Each physician or health care provider who provides care as described in this rule shall annually during the month of June provide to the department— 1. The physician or health care provider’s name, address, and day-time telephone number; 2. A copy of the physician or health care provider’s license, registration, or authority to act or other evidence that the physician or health care provider may lawfully practice in Missouri; 3. A copy of any contract(s) or agreement(s) as described in section (2) of this rule to which the physician or health care provider is a party; 4. If services described in this rule are provided without compensation through a nonprofit community health center, a copy of the nonprofit community health center’s federal tax exemption letter or other verification of tax-exempt status under Section 501(c)(3) of the Internal Revenue Code; and 5. An approximate breakdown of the hours per year of health care services provided, as described in this rule, including: A. The entities through which the health care services were provided during the previous twelve (12) months; B. The inclusive dates of service provided through each entity; and C. The approximate number of hours and approximate number of patients for whom services were provided through each entity during the previous twelve (12) months. (B) Physicians and health care providers providing health care services as described in this rule shall maintain records of the care provided in a manner consistent with relevant state and federal laws and regulations. (C) Documentation of coverage shall be maintained by the department for a period of twenty-one (21) years. AUTHORITY: section 105.711, RSMo 2016.* Original rule filed Jan. 23, 2023, effective Aug. 30, 2023. *Original authority: 105.711, RSMo 1983, amended 1987, 1989, 1990, 1993, 1995, 1999, 2004, 2005, 2007, 2008, 2009, 2013, 2014.