General Information Missouri Medicaid Audit and Compliance Provider Certification Review Materials

Program Information Home and Community Based Services (HCBS) Program Provides assistance to seniors and adults with disabilities. Enables individuals to remain out of nursing facilities. Consists of Consumer Directed Services (CDS) and In-Home Services (IHS) programs. Provider Certification Testing Requirement Required by 19 CSR 15-7.021 (14) for the Designated Manager of any contracted IHS agency. In-home services are offered under the Home and Community Based Services (HCBS) Program. HCBS programs are intended to provide necessary assistance in meeting the unmet needs of seniors and adults with disabilities and enable the individuals to remain in the least restrictive environment. HCBS consists of two separate programs. Consumer Directed Services (CDS) and In-Home Services (IHS). Provider Certification Testing is required for the Designated Manager of any In-Home Services agency contracted to provide services to Missouri Medicaid participants by Missouri Code of State Regulation 19 CSR 15-7.021 (14).

The HCBS program is operated by three state agencies: Program Information The HCBS program is operated by three state agencies: MO HealthNet Division (MHD) Administers the Missouri Medicaid program. Missouri Medicaid Audit and Compliance (MMAC) Determines eligibility and compliance of Missouri Medicaid providers. Division of Senior and Disability Services (DSDS). Assesses and authorizes services for Missouri Medicaid participants. Missouri Department of Social Services (DSS) MO HealthNet Division (MHD). MHD is the single state Medicaid agency responsible for administering the Medicaid program. This includes the HCBS program. Missouri Department of Social Services, Missouri Medicaid Audit and Compliance (MMAC). MMAC is responsible for determining potential business entities eligibility to participate in HCBS programs as a Medicaid provider. MMAC also monitors the continuous eligibility and compliance of enrolled Medicaid providers. Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS). DSDS is responsible for assessing and authorizing HCBS services for eligible participants.

Proposal Review Site Visit Completion Contract Execution Provider Contracts Proposal Review Site Visit Completion Contract Execution MMAC Provider Contracts is responsible for the review of submitted proposals (including any denials/rejections), completion of site visits and execution of contracts. Provider contracts will review the proposal to determine the applying provider’s eligibility for a contract. MMAC will conduct any investigation necessary to verify or supplement the information contained within the proposal. If the proposal is incomplete or further information is needed from the applying provider, MMAC will mail a written request for additional information. The applying provider is given thirty (30) days to submit the additional information. The proposal will be held pending receipt of the requested information. The written request will include Medicaid enrollment information that must be completed in order to process the MD enrollment later in the process. Failure to properly complete the enrollment information will delay the enrollment process. Failure to submit all requested information that complies with requirements of the applicable program in response to the written request will result in rejection of the proposal. Failure to provide the additional information by the deadline noted in the written request will result in rejection of the proposal. Once the written proposal review is complete, a site visit will be scheduled and conducted by MMAC staff. After the site visit, if a decision is made to offer a contract, the contract will be mailed to the applying provider for completion. The applying provider is never to assume the receipt of a contract for signature constitutes a binding contract until MMAC signs the contract. Upon return of the properly completed contract to MMAC Provider Contracts, MMAC will enroll the provider and execute the contract. The applying provider will receive a copy of the fully executed contract and written notification of their approval.

Contract Information Contracts include State and Federal regulations. Contracts expire at least every five (5) years. Revalidation of all Medicaid providers is required at least every five (5) years by federal regulations Contracts are based on both state and federal regulations. Compliance with all regulations must be maintained to remain contracted. Contracts expire every 5 years. This is was changed effective July 1, 2014 to accommodate for the federally required revalidation of all enrolled Medicaid providers, under the Affordable Care Act. Revalidation will be similar to annual contract renewal. More information will be provided as guidelines become available.

MMAC – Provider Contracts Questions ?? MMAC – Provider Contracts mmac.ihscontracts@dss.mo.gov