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