Provided by the Department of Health & Senior Services, the Health Care Data Analysis department publishes statistics on data reported by commercial, Medicare, and MC+ managed care plans on access to care, quality of care, and member satisfaction.

The Department of Health and Senior Services covers services for seniors or adults with disabilities in Missouri. The department is responsible for the promotion and protection of the public's health through education, disease and injury prevention, regulation, and direct delivery of health care.

The Section for Long-Term Care, among other things, certifies intermediate care and skilled nursing facilities for participation in the federal Medicare and Medicaid programs. Facilities requesting certification must meet additional requirements to participate in both federal programs. State law requires that the Department of Health & Human Services (DHHS) inspect each long-term care facility twice in a fiscal year (July 1-June 30). Federal law requires an inspection every 9-15 months for Medicare- and/or Medicaid-certified facilities. DHHS handles both the state and federal inspections, which usually occur at the same time and are unannounced.

The Department of Social Services is responsible for coordinating programs to provide public assistance for children and their parents, access to health care, child support enforcement assistance, and specialized assistance for troubled youth. While many programs give needed financial assistance and services, other units work toward reducing the financial dependency of the citizens on government.

The Missouri Ethics Commission receives reports and is charged with enforcement of campaign finance, conflict of interest, and lobbying and personal financial disclosure. Enforcement includes conducting investigations from complaints received, on the reports (and related records) required to be filed with the commission, and independent investigations. The commission also issues advisory opinions. The commission is governed by six governor-appointed commissioners. The commissioners are all from different congressional districts and not more than three of the six commissioners can be from the same political party. The commissioners are appointed by the governor with the advice and consent of the Senate and serve a four-year term.

The Bureau of Home Care and Rehabilitative Standards conducts on-site surveys for Title XVIII (Medicare) certification at home health agencies, hospices, comprehensive outpatient rehabilitation facilities and outpatient physical therapy providers through contracts with the Centers for Medicare & Medicaid Services (CMS). The bureau also provides technical consultation regarding Missouri licensing requirements for home health agencies and hospices, as well as Medicare standards for home health agencies, hospices, outpatient physical therapy providers, and comprehensive outpatient rehabilitation facilities.

The Board of Health is within the Department of Health and Senior Services (DHSS). Members review and advise on the rules and regulations promoted by the DHSS. They also comment to the DHSS director on the promulgation of rules and regulations by the Department of Health, formulation of the department's proposed budget, and planning for and operation of the DHSS. (Promulgation is the act of formally proclaiming or declaring a new statutory or administrative law after its enactment. In some jurisdictions, this additional step is necessary before the law can take effect.

MoRx is Missouri’s State Pharmacy Assistance Program. MoRx was created by the 93rd General Assembly to provide prescription drug assistance to Missourians in need by coordinating benefits with Medicare’s Prescription Drug Plans (Part D). MoRx works with all Part D plans, paying 50 percent of members' out-of-pocket costs on medications that are covered by Part D.

Missouri's Department of Insurance regulates the insurance industry in Missouri. Medicare Supplement Insurance (Medigap) sold in Missouri by insurance companies is regulated by the Department of Insurance. Medicare Prescription Drug Plans (Part D) and Medicare Advantage Plans (Part C) are sold by insurance companies regulated by the federal government. Medicare Hospital Insurance (Part A) and Medicare Medical Insurance (Part B) are provided directly by the federal government, rather than by an insurance company.

Provided by the Department of Health & Senior Services, the Medicare Rural Hospital Flexibility Program provides support to critical access hospitals to implement or expand the quality of health care they provide and to improve their financial and operational performance. The program also develops collaborative regional and local health-delivery systems and coordinates activities with the Missouri Hospital Association and the Missouri Quality Improvement Office. Other program activities include expanding training opportunities to integrate local EMS systems into the health care network to improve health outcomes in rural Missouri.

Medicare Supplement Insurance (Medigap) is a Medicare supplement insurance policy sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. Every state except Massachusetts, Minnesota and Wisconsin has 10 standardized plans labeled Plan A through Plan J. Medigap policies only work with the Original Medicare Plan. The Missouri Department of Insurance website provides information about Medigap plans in Missouri, including rates.

Among other things, Health Services Regulation conducts survey activities through a contract with the Centers for Medicare & Medicaid Services (CMS) related to certification of providers participating in Title XVIII (Medicare) and Title XIX (Medicaid).

The Health Professional Loan Repayment Program provides financial incentives for: licensed primary care physicians (family or general practice, pediatrics or general internal medicine); general practice dentists and primary care nurse practitioners; and psychiatrists, psychologists, licensed professional counselors, licensed clinical social workers, and dietitians/nutritionists. Participants agree to accept Medicare and MO HealthNet (formerly called Medicaid) patients and to provide a discounted fee schedule, based on family size and income, for all uninsured individuals.

The Section for Health Standards and Licensure (SHSL) is responsible for licensing and regulating a wide variety of health care entities, investigating complaints involving those entities, performing inspection activities for numerous Medicare-certified programs, and ensuring the safe and legal handling and distribution of controlled substances in Missouri. The SHSL consists of four bureaus: the Bureau of Health Services Regulation; the Bureau of Emergency Medical Services; the Bureau of Home Care and Rehabilitative Standards; and the Bureau of Narcotics and Dangerous Drugs.

The Specified Low-income Medicare Beneficiary (SLMB) program provides payment of Medicare Medical Insurance (Part B) premiums to individuals who would be eligible for the Qualified Medicare Beneficiary (QMB) program except for excess income. Income must be more than 100 percent of the federal poverty level (FPL) but not exceed 120 percent.

The Family Support Division (FSD) operates Missouri’s Medicare Savings Program (MSP), called the Qualified Medicare Beneficiary (QMB) program. It also runs the related Specified Low-income Medicare Beneficiary (SLMB) program. MSPs help millions of people with Medicare save money each year. States have programs for people with limited income and have resources that pay some or all of Medicare’s premiums and may pay Medicare deductibles and coinsurance. Missouri’s program - the QMB - is specifically for people enrolled in Medicare Hospital Insurance (Part A), whose income and resources are within the program guidelines. The QMB program pays Medicare premiums and coinsurance, as well as deductibles for Medicare-covered services. The primary responsibility of the FSD is administering Missouri’s programs for the welfare of its people. FSD maintains an office in each of the 114 counties of the state and in the city of St. Louis.

The Qualified Medicare Beneficiary (QMB) program is available to those who: receive Medicare Hospital Insurance (Part A) or enroll in Part A on the condition that the state will pay the premium; have net income that does not exceed 100 percent of the federal poverty level for the assistance group size; and if single, own resources with a value no greater than $6,680 or if married and living with the spouse, do not own resources of more than $10,020.

AARP, formerly the American Association of Retired Persons, is a nonprofit, nonpartisan organization with a membership that advocates for people ages 50 and older. Since 1958, AARP has lobbied for senior issues, including the passage of Medicare in 1965. AARP offers support from staffed offices in all 50 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands.

The Missouri Hospital Association is a not-for-profit membership association in Jefferson City that represents 151 Missouri hospitals. In addition to representation and advocacy on behalf of its membership, the association offers continuing education programs on current health care topics and seeks to educate the public, as well as legislative representatives, about health care issues.

The Missouri Health Care Association is an association representing the long-term health care profession in Missouri. Membership in the association consists of licensed proprietary and nonproprietary nursing facilities and residential care facilities. The Missouri Health Care Association is dedicated to improving the quality of life of residents of long-term care.

Wisconsin Physicians Service (WPS) is a Medicare Administrative Contractor (MAC), a company contracted by the CMS to process Medicare claims. WPS processes Medicare Part A and Part B payments and claims for Jurisdiction 5, which consists of Iowa, Kansas, Missouri and Nebraska. WPS also administers Part A and Part B legacy contracts. The Part A legacy contracts are former Mutual of Omaha providers who will eventually transition to Jurisdiction 1 (covered by Palmetto Government Benefit Administrators). They cover Hawaii, Delaware and New York. The Part B legacy contracts cover Illinois, Michigan, Minnesota and Wisconsin.

Community Leaders Assisting the Insured of Missouri (CLAIM) is part of a national program known in other states as the State Health Insurance Assistance Program (SHIP), which offers counseling and assistance to people with Medicare and to their families. Coordinators provide counseling on Medicare benefits, Medicare Prescription Drug Plans (Part D), Social Security, Medicaid and veterans' benefits. CLAIM was created under section 4360 of the Omnibus Budget Reconciliation Act of 1990. This act authorized the Centers for Medicare & Medicaid Services (CMS) to make grants to states for health advisory services programs for people with Medicare. The Missouri Department of Insurance subcontracts CLAIM out to Primaris, the state Quality Improvement Organization.

The Area Agencies on Aging (AAA) were established under the Older Americans Act (OAA) Comprehensive Services Amendments in 1973 to respond to the needs of Americans 60 and older in every local community. The amendments added a new Title V, which authorized grants to local community agencies in every state. The AAAs provides a range of options that allow older adults to choose the home- and community-based services and living arrangements that suit them best. Missouri has 10 such agencies across the state. Missouri's Area Agencies on Aging, either directly through their own staff or through contracts with other agencies, also provide information and assistance; public education and outreach, and legal services.

Quality Improvement Organizations (QIOs) are private, mostly not-for-profit organizations, staffed by doctors and other health care professionals who are trained to review medical care, to help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. QIOs are required under Sections 1152-1154 of the Social Security Act. Primaris receives complaints about the quality of care provided by Medicare-reimbursed service providers (in hospitals or Medicare skilled nursing units). Missouri beneficiaries also can call this organization to complain when a hospital denies them admission or wants them to leave before they are ready.

The Senior Medicare Patrol (SMP) program helps Medicare and Medicaid beneficiaries avoid, detect and prevent health care fraud. The goal is to protect older people and to preserve the integrity of the Medicare and Medicaid programs. The federal program was created in 1996 by the Health Insurance Portability and Accountability Act (HIPAA) and amended in 2006 by Titles II and IV of the Older Americans Act. Senior Medicare Patrols (SMPs) are overseen by the Missouri Department of Health and Human Services' Office of Elder Rights but administered by the nonprofit organization Care Connection for Aging Services.

The long-term care ombudsman advocates for residents of nursing homes and assisted living facilities. The office resolves complaints and educates seniors and long-term care providers about their rights and good care practices. The ombudsman also provides information to the public on nursing homes and other long-term care facilities and services, residents' rights, and legislative and policy issues. In 1978, an amendment to the federal Older Americans Act required every state to have an ombudsman program that addresses complaints and advocates for improvements in the long-term care system. The ombudsman program is administered by the Administration on Aging (AoA).

Phillip Sowa became CEO of St. Louis University Hospital in January 2011. Previously, he served as CEO of Park Plaza Hospital in Houston as well as CEO of Tenet Corp.’s Meadowcrest Hospital in Louisiana, a role in which he helped with the reconstruction after Hurricane Katrina. He holds a master’s degree in hospital and health care administration from Saint Louis University.

David Feess became administrator and CEO of Liberty Hospital in July 2011. He previously served as assistant administrator of finance and assistant administrator of information and support services for the facility. In addition to his professional experience, he served as chairman of the Liberty Area Chamber of Commerce in 2009.

As president and CEO of the North Kansas City Hospital, David Carpenter has helped fund 11 preventative health initiatives in northwest Missouri as part of the Healthy Partnership program. He received a 2010 Visionary Leadership Award from the Missouri Hospital Association.

Melinda Estes served as president and CEO of Fletcher Allen Health Care before joining the St. Luke’s Health System leadership team in 2011. Her professional experience also includes serving as CEO at Cleveland Clinic Florida and as senior vice president of medical affairs and executive vice president of the MetroHealth System in Cleveland. She is a board-certified neurologist and neuropathologist. She earned her MBA from Case Western Reserve University.

Melinda Estes served as president and CEO of Fletcher Allen Health Care before joining the St. Luke’s Health System leadership team in 2011. Her professional experience also includes serving as CEO at Cleveland Clinic Florida and as senior vice president of medical affairs and executive vice president of the MetroHealth System in Cleveland. She is a board-certified neurologist and neuropathologist. She earned her MBA from Case Western Reserve University.

Gary Olson became president and CEO of St. Luke’s Hospital in 1999. He previously served as the facility’s executive vice president, senior vice president and associate administrator. Before he joined St. Luke’s, he was assistant administrator at Lafayette Home Hospital in Indiana. He received his master’s in health care administration from Washington University in St. Louis.

Joan Magruder became president of Missouri Baptist Medical Center in May 2006. Before obtaining her current position, she directed strategic planning, physician services and market research for BJC HealthCare. Earlier in her career, she was the administrator of the department of surgery at Johns Hopkins Hospital in Baltimore, Md. She earned her MBA from the Wharton School of Business at the University of Pennsylvania.

Melinda Estes served as president and CEO of Fletcher Allen Health Care before joining the St. Luke’s Health System leadership team in 2011. Her professional experience also includes serving as CEO at Cleveland Clinic Florida and as senior vice president of medical affairs and executive vice president of the MetroHealth System in Cleveland. She is a board-certified neurologist and neuropathologist. She earned her MBA from Case Western Reserve University.

Before joining DePaul Health Center in 2008, Patrice Komoroski was president and executive vice president/chief operating officer of SSM St. Joseph Hospital West. Earlier in her career, she was also the assistant administrator of patient care services at St. Elizabeth’s Hospital in Belleville, Ill. She is a member of various professional organizations, including the American College of Health Care Executives, the American Organization of Nurse Executives and the St. Louis Metropolitan Organization of Healthcare Executives. She earned her Ph.D. and M.S. in nursing administration from Saint Louis University.