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Missouri enacts new Medicaid regulations for abortion providers: What to know

New Medicaid regulations for abortion providers in Missouri took effect Wednesday, enacting requirements some said could potentially jeopardize funding for Planned Parenthood. 

Filed late last month, the emergency regulations tighten reporting requirements, allow state departments to work together to consider licensure, and enact new safety requirements. The rule expires April 10, 2022. 

Here’s a look at the new regulations and the response from both sides of the conversation. 

What are the new regulations?

Under the new rules, the Department of Health and Senior Services (DHSS) can turn over its inspection records of abortion providers to the Department of Social Services (DSS). 

The Medicaid Audit and Compliance Unit then evaluates Medicaid eligibility for the provider, a change DHSS said would “increase further compliance with state and federal laws and regulations governing abortion facilities.”

“As a result, the Department of Health and Senior Services finds that there is a compelling governmental interest that requires an early effective date,” the notice read

The regulations also reinforce standards requiring providers to notify pathology labs of failed abortions within 24 hours, ensure all surgical tools are sterilized, perform pelvic exams on patients 72 hours before the procedure if medically necessary, and participate in yearly fire drills. 

What has been the response thus far? 

Sen. Bill White, the Republican chair of the Senate Interim Committee on Medicaid Accountability and Taxpayer Protection, said the new regulations were based on recommendations from his committee that would allow DSS to deny or revoke licenses based on DHSS investigations rather than having to conduct their own reviews. 

The emergency rule was filed five days after the recommendation was unveiled.

“We say very general things, and the departments tighten them up and flush them out,” White told The Missouri Times. “The states are given the authority to establish standards for Medicaid providers and decide how to handle those that fail to keep them. These are very good rules.”

White said the documentation and collaborative aspects of the rule had been in the works for months, having been suggested as a possible response to the legislature’s battle over Medicaid funding and the state’s Federal Reimbursement Allowance (FRA). 

White, who also chairs the Joint Committee on Administrative Rules, said he did not believe the regulations put Missouri out of compliance with CMS or jeopardized any federal funding. 

However, representatives from Planned Parenthood of the St. Louis Region and Southwest Missouri (PPSLRSWMO) called on the Biden administration to intervene during a call with reporters Wednesday even though the new regulations will not impact Planned Parenthood’s services at this time. 

Dr. Colleen McNicholas, the group’s chief medical officer, said the Centers for Medicare & Medicaid Services (CMS) should “clarify” that it will not allow Missouri to to eliminate a single provider from the Medicaid system because one facility offers abortion services. PPSLRSWMO is the lone abortion provider in Missouri. 

A CMS spokesperson did not immediately respond to a request for comment. 

Yamelsie Rodriguez, president and CEO of PPSLRSWMO said the new regulation  “discriminates” specifically against Planned Parenthood and treats it differently than other qualified Medicaid providers in the state. She called the new regulations “another political attempt to punish the most marginalized communities who rely on Medicaid” for basic health services. 

Still, Planned Parenthood officials said although they are prepared for a surprise inspection at any moment, the new regulations will not affect its services. 

“Our doors are open,” they said. 

What’s next?

Another proposal from White’s committee would allow the departments to deny or revoke Medicaid funding for abortion providers or connected entities found to have violated regulations in other states and facing sanctions or termination. 

The measure would have to be filed by a lawmaker and pass through the full legislature. 

Meanwhile, a state law enacted in 2019 that would ban abortions after eight weeks is caught up in the legal system. Halted by a federal judge the day before it would have gone into effect due to a lawsuit from the Reproductive Health Services of Planned Parenthood, it is now awaiting a decision by the Eighth Circuit Court of Appeals

The U.S. Supreme Court is weighing abortion issues this term.