Regulations

The Missouri Medicaid Program is primarily governed by the Code of State Regulations (CSR), Code of Federal Regulations (CFR), Missouri State Statutes (RSMo.), and Provider Manuals incorporated by CSR.

Providers are required to maintain sufficient knowledge as to the various program requirements and expectations that accompany their participation in Medicaid. While this list is by no means intended to serve as an all encompassing compilation of regulations and statutes, it may serve as a good foundation for providers.

Provider Enrollment

13 CSR 70-3.020 Title XIX Provider Enrollment
13 CSR 70-3.140 Direct Deposit of Provider Reimbursement
42 CFR 455.400-470 Provider Screening and Enrollment
13 CSR 65-2 Missouri Medicaid Audit and Compliance Chapter 2—Medicaid

Provider Reviews

42 CFR 455 Program Integrity
13 CSR 70-3 Conditions of Provider Participation, Reimbursement and Procedure of General Applicability

Provider Sanctions

13 CSR 70-3.030 Sanctions for False or Fraudulent Claims for MO HealthNet Services
RSMo 208.164 Medical Assistance Abuse or Fraud Definitions
42 CFR 455.23 Suspension of Payments in Cases of Fraud

Participant Lock-In

13 CSR 65-3.010 Conditions of Recipient Participation, Rights and Responsibilities

Regulations

Helpful Links

Report Public Assistance Fraud