Managing Healthcare Compliance in Missouri

Healthcare compliance in Missouri is uniquely challenging due to state-specific regulations, such as the surgical smoke plume evacuation system requirement. Missouri providers and organizations must know how to successfully navigate both federal and state laws to avoid legal and financial risks. 

Effective compliance management at any facility requires comprehensive programming to monitor and adapt to changing regulations, such as those related to hospital and surgery centers, among others. This article provides a concise overview of Missouri’s healthcare compliance, highlighting the state-specific requirements to be aware of.

Missouri Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

• The Missouri Department of Health and Senior Services (DHSS) plays a crucial role in promoting health and well-being through various departments and initiatives, including addressing public health concerns, providing regulatory oversight, and advocating for seniors’ health and welfare.
• The Missouri Hospital Association (MHA) is a statewide organization dedicated to advocating for and supporting hospitals and healthcare providers across Missouri, with a focus on improving healthcare quality, access, and affordability for all residents.
• The Missouri Department of Social Services (DSS) is the state agency responsible for providing essential support and services to vulnerable individuals and families, including child welfare, assistance programs, and oversees the MO HealthNet Division, which is the state’s Medicaid program.
• The Missouri State Board of Registration for the Healing Arts, which operates under the Division of Professional Registration, is a regulatory body responsible for licensing and overseeing medical professionals in Missouri, ensuring they meet the necessary standards and qualifications to provide safe and competent healthcare.
• Missouri’s Division of Professional Registration comprises a variety of committees and boards, including those that oversee regulatory licensure for counselors, marriage and family therapists, social workers, and more.

These agencies help maintain the integrity and quality of healthcare services in Missouri, protecting the public and promoting patient safety. The resources provided by these Missouri state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of Missouri.

Regulations Unique to Missouri

To meet the standards of healthcare compliance in Missouri, there are a few additional regulations.

Hospital and Ambulatory Surgery Center Smoke Evacuation Law

For compliance officers and healthcare leaders in Missouri, understanding the surgical smoke plume evacuation system requirement is crucial. Signed into law on August 28, 2023 with an enforcement date of January 1, 2026, Missouri joins other states in mandating surgical smoke evacuation systems within hospitals and ambulatory surgery centers (ASCs). The requirement aims to mitigate risks associated with surgical smoke, a common byproduct in procedures using lasers or electrosurgical units. It’s essential for compliance officers and facilities to integrate this requirement into their compliance strategies and training programs, upholding Missouri’s patient and worker safety standards. Also effective January 1, 2026, all hospital and ambulatory surgical centers in the state and accredited by The Joint Commission (TJC) are required to adopt and implement smoke evacuation policies and procedures specifically required by The Joint Commission. 

Certificate of Need Required

Missouri’s Certificate of Need (CON) law serves as a critical component of the state’s healthcare system. Its primary objectives are to contain healthcare costs, improve service quality, and enhance access to health services in the state. CON regulations are administered by the Missouri Health Facilities Review Committee, a volunteer body that provides guidance and decision-making in its execution. The key functions of the CON program include reviewing proposed healthcare services, promoting economic value, evaluating competing interests, preventing unnecessary duplication of services, and providing relevant health-related information. This regulatory framework plays an important role in ensuring that Missouri’s healthcare services are both economically viable and effectively meet consumer needs.

Tips To Manage Healthcare Compliance in Missouri

Effectively managing healthcare compliance in Missouri is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

• Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers Missouri-approved training.
• Organize Policies By Requirement: Including “MO” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
• Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
• Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in Missouri

Medical credentialing in Missouri has a few distinctive features that are beneficial to providers and facility credentialing teams. First, the carrier, or health plan, must acknowledge receipt of credentialing applications within two working days of a provider’s submission. This offers peace of mind for providers knowing that their application was received and is being processed. Second, plans must provide access to an online portal where providers can track the status of their application. Third, health plans are obligated to evaluate a provider’s completed credentialing application and provide notification of approval or denial within 60 days of receipt, rather than the typical 90 day requirement in many other states. Lastly, if a provider’s application is approved, the plan is responsible for providing payments for covered health services performed during the credentialing period, under specific conditions and guidelines. Combined, these regulations ensure a more streamlined and transparent credentialing process, fostering efficient communication and decision-making between healthcare providers, organizations, and carriers in the state of Missouri.

Meet Missouri Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in Missouri. 

MedTrainer’s all-in-one compliance platform can streamline management of Missouri healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!