Missouri Revised Statutes













Chapter 208

Old Age Assistance, Aid to Dependent Children and General Relief

←208.927

Section 208.930.1

208.950→

August 28, 2015

Consumer-directed personal care assistance services, reimbursement for through eligible vendors--eligibility requirements--documentation--service plan required--premiums, amount--annual reevaluation--denial of benefits, procedure--expiration date.

208.930. 1. As used in this section, the term "department" shall mean

the department of health and senior services.



2. Subject to appropriations, the department may provide financial

assistance for consumer-directed personal care assistance services through

eligible vendors, as provided in sections 208.900 through 208.927, to each

person who was participating as a non-MO HealthNet eligible client pursuant to

sections 178.661 through 178.673* on June 30, 2005, and who:



(1) Makes application to the department;



(2) Demonstrates financial need and eligibility under subsection 3 of

this section;



(3) Meets all the criteria set forth in sections 208.900 through

208.927, except for subdivision (5) of subsection 1 of section 208.903;



(4) Has been found by the department of social services not to be

eligible to participate under guidelines established by the MO HealthNet

plan; and



(5) Does not have access to affordable employer-sponsored health care

insurance or other affordable health care coverage for personal care

assistance services as defined in section 208.900. For purposes of this

section, "access to affordable employer-sponsored health care insurance or

other affordable health care coverage" refers to health insurance requiring a

monthly premium less than or equal to one hundred thirty-three percent of the

monthly average premium required in the state's current Missouri consolidated

health care plan.

Payments made by the department under the provisions of this section shall be

made only after all other available sources of payment have been exhausted.



3. (1) In order to be eligible for financial assistance for

consumer-directed personal care assistance services under this section, a

person shall demonstrate financial need, which shall be based on the adjusted

gross income and the assets of the person seeking financial assistance and

such person's spouse.



(2) In order to demonstrate financial need, a person seeking financial

assistance under this section and such person's spouse must have an adjusted

gross income, less disability-related medical expenses, as approved by the

department, that is equal to or less than three hundred percent of the

federal poverty level. The adjusted gross income shall be based on the most

recent income tax return.



(3) No person seeking financial assistance for personal care services

under this section and such person's spouse shall have assets in excess of

two hundred fifty thousand dollars.



4. The department shall require applicants and the applicant's spouse,

and consumers and the consumer's spouse, to provide documentation for income,

assets, and disability-related medical expenses for the purpose of

determining financial need and eligibility for the program. In addition to

the most recent income tax return, such documentation may include, but shall

not be limited to:



(1) Current wage stubs for the applicant or consumer and the applicant's

or consumer's spouse;



(2) A current W-2 form for the applicant or consumer and the applicant's

or consumer's spouse;



(3) Statements from the applicant's or consumer's and the applicant's or

consumer's spouse's employers;



(4) Wage matches with the division of employment security;



(5) Bank statements; and



(6) Evidence of disability-related medical expenses and proof of payment.



5. A personal care assistance services plan shall be developed by the

department pursuant to section 208.906 for each person who is determined to

be eligible and in financial need under the provisions of this section. The

plan developed by the department shall include the maximum amount of financial

assistance allowed by the department, subject to appropriation, for such

services.



6. Each consumer who participates in the program is responsible for a

monthly premium equal to the average premium required for the Missouri

consolidated health care plan; provided that the total premium described in

this section shall not exceed five percent of the consumer's and the

consumer's spouse's adjusted gross income for the year involved.



7. (1) Nonpayment of the premium required in subsection 6 shall result

in the denial or termination of assistance, unless the person demonstrates

good cause for such nonpayment.



(2) No person denied services for nonpayment of a premium shall receive

services unless such person shows good cause for nonpayment and makes

payments for past-due premiums as well as current premiums.



(3) Any person who is denied services for nonpayment of a premium and

who does not make any payments for past-due premiums for sixty consecutive

days shall have their enrollment in the program terminated.



(4) No person whose enrollment in the program is terminated for

nonpayment of a premium when such nonpayment exceeds sixty consecutive days

shall be reenrolled unless such person pays any past-due premiums as well as

current premiums prior to being reenrolled. Nonpayment shall include payment

with a returned, refused, or dishonored instrument.



8. (1) Consumers determined eligible for personal care assistance

services under the provisions of this section shall be reevaluated annually

to verify their continued eligibility and financial need. The amount of

financial assistance for consumer-directed personal care assistance services

received by the consumer shall be adjusted or eliminated based on the outcome

of the reevaluation. Any adjustments made shall be recorded in the

consumer's personal care assistance services plan.



(2) In performing the annual reevaluation of financial need, the

department shall annually send a reverification eligibility form letter to

the consumer requiring the consumer to respond within ten days of receiving

the letter and to provide income and disability-related medical expense

verification documentation. If the department does not receive the

consumer's response and documentation within the ten-day period, the

department shall send a letter notifying the consumer that he or she has ten

days to file an appeal or the case will be closed.



(3) The department shall require the consumer and the consumer's spouse

to provide documentation for income and disability-related medical expense

verification for purposes of the eligibility review. Such documentation may

include but shall not be limited to the documentation listed in subsection 4

of this section.



9. (1) Applicants for personal care assistance services and consumers

receiving such services pursuant to this section are entitled to a hearing

with the department of social services if eligibility for personal care

assistance services is denied, if the type or amount of services is set at a

level less than the consumer believes is necessary, if disputes arise after

preparation of the personal care assistance plan concerning the provision of

such services, or if services are discontinued as provided in section 208.924.

Services provided under the provisions of this section shall continue during

the appeal process.



(2) A request for such hearing shall be made to the department of social

services in writing in the form prescribed by the department of social

services within ninety days after the mailing or delivery of the written

decision of the department of health and senior services. The procedures for

such requests and for the hearings shall be as set forth in section 208.080.



10. Unless otherwise provided in this section, all other provisions of

sections 208.900 through 208.927 shall apply to individuals who are eligible

for financial assistance for personal care assistance services under this

section.



11. The department may promulgate rules and regulations, including

emergency rules, to implement the provisions of this section. Any rule or

portion of a rule, as that term is defined in section 536.010, that is

created under the authority delegated in this section shall become effective

only if it complies with and is subject to all of the provisions of chapter

536 and, if applicable, section 536.028. Any provisions of the existing

rules regarding the personal care assistance program promulgated by the

department of elementary and secondary education in title 5, code of state

regulations, division 90, chapter 7, which are inconsistent with the

provisions of this section are void and of no force and effect.



12. The provisions of this section shall expire on June 30, 2019.



(L. 2005 S.B. 74 & 49 § 1, A.L. 2006 S.B. 1084, A.L. 2007 S.B. 577)



Expires 6-30-19



*Sections 178.661 to 178.673 were repealed by S.B. 539, 2005.





2006

2005



2006



208.930. 1. As used in this section, the term "department" shall

mean the department of health and senior services.



2. Subject to appropriations, the department may provide financial

assistance for consumer-directed personal care assistance services through

eligible vendors, as provided in sections 208.900 through 208.927, to each

person who was participating as a non-Medicaid eligible client pursuant to

sections 178.661 through 178.673*, RSMo, on June 30, 2005, and who:



(1) Makes application to the department;



(2) Demonstrates financial need and eligibility under subsection 3 of

this section;



(3) Meets all the criteria set forth in sections 208.900 through

208.927, except for subdivision (5) of subsection 1 of section 208.903;



(4) Has been found by the department of social services not to be

eligible to participate under guidelines established by the Medicaid state

plan; and



(5) Does not have access to affordable employer-sponsored health care

insurance or other affordable health care coverage for personal care

assistance services as defined in section 208.900. For purposes of this

section, "access to affordable employer-sponsored health care insurance or

other affordable health care coverage" refers to health insurance requiring

a monthly premium less than or equal to one hundred thirty-three percent of

the monthly average premium required in the state's current Missouri

consolidated health care plan.





Payments made by the department under the provisions of this section shall

be made only after all other available sources of payment have been

exhausted.



3. (1) In order to be eligible for financial assistance for

consumer-directed personal care assistance services under this section, a

person shall demonstrate financial need, which shall be based on the

adjusted gross income and the assets of the person seeking financial

assistance and such person's spouse.



(2) In order to demonstrate financial need, a person seeking

financial assistance under this section and such person's spouse must have

an adjusted gross income, less disability-related medical expenses, as

approved by the department, that is equal to or less than three hundred

percent of the federal poverty level. The adjusted gross income shall be

based on the most recent income tax return.



(3) No person seeking financial assistance for personal care services

under this section and such person's spouse shall have assets in excess of

two hundred fifty thousand dollars.



4. The department shall require applicants and the applicant's

spouse, and consumers and the consumer's spouse, to provide documentation

for income, assets, and disability-related medical expenses for the purpose

of determining financial need and eligibility for the program. In addition

to the most recent income tax return, such documentation may include, but

shall not be limited to:



(1) Current wage stubs for the applicant or consumer and the

applicant's or consumer's spouse;



(2) A current W-2 form for the applicant or consumer and the

applicant's or consumer's spouse;



(3) Statements from the applicant's or consumer's and the applicant's

or consumer's spouse's employers;



(4) Wage matches with the division of employment security;



(5) Bank statements; and



(6) Evidence of disability-related medical expenses and proof of

payment.



5. A personal care assistance services plan shall be developed by the

department pursuant to section 208.906 for each person who is determined to

be eligible and in financial need under the provisions of this section.

The plan developed by the department shall include the maximum amount of

financial assistance allowed by the department, subject to appropriation,

for such services.



6. Each consumer who participates in the program is responsible for a

monthly premium equal to the average premium required for the Missouri

consolidated health care plan; provided that the total premium described in

this section shall not exceed five percent of the consumer's and the

consumer's spouse's adjusted gross income for the year involved.



7. (1) Nonpayment of the premium required in subsection 6 shall

result in the denial or termination of assistance, unless the person

demonstrates good cause for such nonpayment.



(2) No person denied services for nonpayment of a premium shall

receive services unless such person shows good cause for nonpayment and

makes payments for past-due premiums as well as current premiums.



(3) Any person who is denied services for nonpayment of a premium and

who does not make any payments for past-due premiums for sixty consecutive

days shall have their enrollment in the program terminated.



(4) No person whose enrollment in the program is terminated for

nonpayment of a premium when such nonpayment exceeds sixty consecutive days

shall be reenrolled unless such person pays any past-due premiums as well

as current premiums prior to being reenrolled. Nonpayment shall include

payment with a returned, refused, or dishonored instrument.



8. (1) Consumers determined eligible for personal care assistance

services under the provisions of this section shall be reevaluated annually

to verify their continued eligibility and financial need. The amount of

financial assistance for consumer-directed personal care assistance

services received by the consumer shall be adjusted or eliminated based on

the outcome of the reevaluation. Any adjustments made shall be recorded in

the consumer's personal care assistance services plan.



(2) In performing the annual reevaluation of financial need, the

department shall annually send a reverification eligibility form letter to

the consumer requiring the consumer to respond within ten days of receiving

the letter and to provide income and disability-related medical expense

verification documentation. If the department does not receive the

consumer's response and documentation within the ten-day period, the

department shall send a letter notifying the consumer that he or she has

ten days to file an appeal or the case will be closed.



(3) The department shall require the consumer and the consumer's

spouse to provide documentation for income and disability-related medical

expense verification for purposes of the eligibility review. Such

documentation may include but shall not be limited to the documentation

listed in subsection 4 of this section.



9. (1) Applicants for personal care assistance services and

consumers receiving such services pursuant to this section are entitled to

a hearing with the department of social services if eligibility for

personal care assistance services is denied, if the type or amount of

services is set at a level less than the consumer believes is necessary, if

disputes arise after preparation of the personal care assistance plan

concerning the provision of such services, or if services are discontinued

as provided in section 208.924. Services provided under the provisions of

this section shall continue during the appeal process.



(2) A request for such hearing shall be made to the department of

social services in writing in the form prescribed by the department of

social services within ninety days after the mailing or delivery of the

written decision of the department of health and senior services. The

procedures for such requests and for the hearings shall be as set forth in

section 208.080.



10. Unless otherwise provided in this section, all other provisions

of sections 208.900 through 208.927 shall apply to individuals who are

eligible for financial assistance for personal care assistance services

under this section.



11. The department may promulgate rules and regulations, including

emergency rules, to implement the provisions of this section. Any rule or

portion of a rule, as that term is defined in section 536.010, RSMo, that

is created under the authority delegated in this section shall become

effective only if it complies with and is subject to all of the provisions

of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. Any

provisions of the existing rules regarding the personal care assistance

program promulgated by the department of elementary and secondary education

in title 5, code of state regulations, division 90, chapter 7, which are

inconsistent with the provisions of this section are void and of no force

and effect.



12. The provisions of this section shall expire on June 30, 2008.



2005



208.930. 1. As used in this section, the term "department" shall

mean the department of health and senior services.



2. Subject to appropriations, the department may provide financial

assistance for consumer-directed personal care assistance services through

eligible vendors, as provided in sections 208.900 through 208.927, to each

person who was participating as a non-Medicaid eligible client pursuant to

sections 178.661 through 178.673, RSMo, on June 30, 2005, and who:



(1) Makes application to the department;



(2) Demonstrates financial need and eligibility under subsection 3 of

this section;



(3) Meets all the criteria set forth in sections 208.900 through

208.927, except for subdivision (5) of subsection 1 of section 208.903;



(4) Has been found by the department of social services not to be

eligible to participate under guidelines established by the Medicaid state

plan; and



(5) Does not have access to affordable employer-sponsored health care

insurance or other affordable health care coverage for personal care

assistance services as defined in section 208.900. For purposes of this

section, "access to affordable employer-sponsored health care insurance or

other affordable health care coverage" refers to health insurance requiring

a monthly premium less than or equal to one hundred thirty-three percent of

the monthly average premium required in the state's current Missouri

consolidated health care plan.





Payments made by the department under the provisions of this section shall

be made only after all other available sources of payment have been

exhausted.



3. (1) In order to be eligible for financial assistance for

consumer-directed personal care assistance services under this section, a

person shall demonstrate financial need, which shall be based on the

adjusted gross income and the assets of the person seeking financial

assistance and such person's spouse.



(2) In order to demonstrate financial need, a person seeking

financial assistance under this section and such person's spouse must have

an adjusted gross income, less disability-related medical expenses, as

approved by the department, that is equal to or less than three hundred

percent of the federal poverty level. The adjusted gross income shall be

based on the most recent income tax return.



(3) No person seeking financial assistance for personal care services

under this section and such person's spouse shall have assets in excess of

two hundred fifty thousand dollars.



4. The department shall require applicants and the applicant's

spouse, and consumers and the consumer's spouse to provide documentation

for income, assets, and disability-related medical expenses for the purpose

of determining financial need and eligibility for the program. In addition

to the most recent income tax return, such documentation may include, but

shall not be limited to:



(1) Current wage stubs for the applicant or consumer and the

applicant's or consumer's spouse;



(2) A current W-2 form for the applicant or consumer and the

applicant's or consumer's spouse;



(3) Statements from the applicant's or consumer's and the applicant's

or consumer's spouse's employers;



(4) Wage matches with the division of employment security;



(5) Bank statements; and



(6) Evidence of disability-related medical expenses and proof of

payment.



5. A personal care assistance services plan shall be developed by the

department pursuant to section 208.906 for each person who is determined to

be eligible and in financial need under the provisions of this section.

The plan developed by the department shall include the maximum amount of

financial assistance allowed by the department, subject to appropriation,

for such services.



6. Each consumer who participates in the program is responsible for a

monthly premium equal to the average premium required for the Missouri

consolidated health care plan; provided that the total premium described in

this section shall not exceed five percent of the consumer's and the

consumer's spouse's adjusted gross income for the year involved.



7. (1) Nonpayment of the premium required in subsection 6 shall

result in the denial or termination of assistance, unless the person

demonstrates good cause for such nonpayment.



(2) No person denied services for nonpayment of a premium shall

receive services unless such person shows good cause for nonpayment and

makes payments for past-due premiums as well as current premiums.



(3) Any person who is denied services for nonpayment of a premium and

who does not make any payments for past-due premiums for sixty consecutive

days shall have their enrollment in the program terminated.



(4) No person whose enrollment in the program is terminated for

nonpayment of a premium when such nonpayment exceeds sixty consecutive days

shall be reenrolled unless such person pays any past-due premiums as well

as current premiums prior to being reenrolled. Nonpayment shall include

payment with a returned, refused, or dishonored instrument.



8. (1) Consumers determined eligible for personal care assistance

services under the provisions of this section shall be reevaluated annually

to verify their continued eligibility and financial need. The amount of

financial assistance for consumer-directed personal care assistance

services received by the consumer shall be adjusted or eliminated based on

the outcome of the reevaluation. Any adjustments made shall be recorded in

the consumer's personal care assistance services plan.



(2) In performing the annual reevaluation of financial need, the

department shall annually send a reverification eligibility form letter to

the consumer requiring the consumer to respond within ten days of receiving

the letter and to provide income and disability-related medical expense

verification documentation. If the department does not receive the

consumer's response and documentation within the ten-day period, the

department shall send a letter notifying the consumer that he or she has

ten days to file an appeal or the case will be closed.



(3) The department shall require the consumer and the consumer's

spouse to provide documentation for income and disability-related medical

expense verification for purposes of the eligibility review. Such

documentation may include but shall not be limited to the documentation

listed in subsection 4 of this section.



9. (1) Applicants for personal care assistance services and

consumers receiving such services pursuant to this section are entitled to

a hearing with the department of social services if eligibility for

personal care assistance services is denied, if the type or amount of

services is set at a level less than the consumer believes is necessary, if

disputes arise after preparation of the personal care assistance plan

concerning the provision of such services, or if services are discontinued

as provided in section 208.924. Services provided under the provisions of

this section shall continue during the appeal process.



(2) A request for such hearing shall be made to the department of

social services in writing in the form prescribed by the department of

social services within ninety days after the mailing or delivery of the

written decision of the department of health and senior services. The

procedures for such requests and for the hearings shall be as set forth in

section 208.080.



10. Unless otherwise provided in this section, all other provisions

of sections 208.900 through 208.927 shall apply to individuals who are

eligible for financial assistance for personal care assistance services

under this section.



11. The department may promulgate rules and regulations, including

emergency rules, to implement the provisions of this section. Any rule or

portion of a rule, as that term is defined in section 536.010, RSMo, that

is created under the authority delegated in this section shall become

effective only if it complies with and is subject to all of the provisions

of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. Any

provisions of the existing rules regarding the personal care assistance

program promulgated by the department of elementary and secondary education

in title 5, code of state regulations, division 90, chapter 7, which are

inconsistent with the provisions of this section are void and of no force

and effect.



12. The provisions of this section shall expire on June 30, 2006.



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