In-Home Services Proposal Packet

In-home services (IHS) include:

• Personal Care - assistance with activities of daily living;
• Homemaker - general household activities to assist with housekeeping activities;
• Chore - short-term, intermittent tasks necessary to maintain a clean, sanitary and safe home environment;
• Advanced Personal Care - maintenance services to assist with activities of daily living when such assistance requires devices or procedures related to altered body functions;
• Authorized Nurse Visits - maintenance or preventative services provided by a registered nurse or licensed practical nurse; and
• Respite – provides temporary relief for the caregiver of a dependent adult;
  • Basic – provided to participants with non-skilled needs;
  • Advanced - provided to participants with special care needs requiring a higher level of oversight; and
  • Nurse - provided to participants with skilled nursing needs.

If Advanced Personal Care, Advanced Respite and Nurse Respite are elected to be an offered service, Authorized Nurse Visits must also be chosen. However, Authorized Nurse Visits may be provided without providing Advanced Personal Care, Advanced Respite or Nurse Respite.

Funding Sources

Services are authorized by Department staff and are reimbursed using two major funding sources:

• Medicaid (Title XIX of the Social Security Act) through MHD; and
• Social Services Block Grant/General Revenue (SSBG/GR) through the Department.

Other funding streams (such as Older Americans Act, local contributions, etc.) may be available in some counties.

Reimbursement Rates

Reimbursement rates are subject to and determined by the State Legislature on an annual basis. While the amounts listed are the maximum rate that will be paid, the usual and customary charge for each service provided should be billed.

Regulatory Requirements

Policies/procedures and assurances must comply with requirements of the program including all state laws, rules and regulations affecting Providers of Medicaid services. The requirements include:

• 13 CSR 70-3.020 Title XIX Provider Enrollment (pg. 3-4);
• 13 CSR 70-3.030 Sanctions for False or Fraudulent Claims for MO HealthNet Services (pg. 5-8)
• 13 CSR 70-91.010 Personal Care (pg. 3-8)
• 19 CSR 15-7.010 General Requirements for All Service Providers (pg. 4-6)
• 19 CSR 15-7.021 In-home Service Standards (pg. 6-12)
• 660.050, RSMo Alzheimer’s Disease
• Section 13 of the Medicaid Aged and Disabled Provider Manual
• Section 13 of the Medicaid Personal Care Provider Manual
• Program Requirements of the Participation Agreement for Home and Community Based Care
• Terms and Conditions of the Participation Agreement for Home and Community Based Care
• 610.120, RSMo Closed records;
• 660.300, RSMo RSMo Abuse, neglect;
• 660.305, RSMo Misappropriation of Property;
• 660.315, RSMo Employee Disqualification List;
• 660.317, RSMo Criminal Background Checks;
• 210.900 through 210.936, RSMo Family Care Safety Registry; and
• 19 CSR 30-82.060 Hiring Restrictions - Good Cause Waiver (pg. 13-15)

Additionally, the Department periodically issues Provider Memos to clarify program requirements, announce changes, etc. These memos are a valuable resource and can be found at In-Home Services Provider Memos.

State Fiscal Year (SFY) 2011 Proposal Outline

Proposals following this outline must be received by the Department between July 2, 2010 and March 31, 2011

A cover letter that is on the applicant’s letterhead and signed by an authorized representative of the entity. The cover letter must include statements indicating whether any persons, individuals or business entities identified within the proposal

• are currently contracted with the Division of Senior and Disability Services to provide any other service. If so, list the type of service and the name of the company;
• have ever previously contracted with the Department, and, if so, the name of the company and the position held; and
• have ever been sanctioned, suspended, terminated from participation, or denied enrollment in Medicaid, Medicare, SSBG/GR, or any other government public assistance program.

Section I – Provider Profile

Document the following information on the Provider Profile form:

Section I: Provider Information

SSBG/GR No.     Leave this field blank

1. Full legal name of applying entity as filed with the Missouri Secretary of State, Internal Revenue Service (IRS) and Missouri Department of Revenue (DOR) and used throughout the proposal.
   Use of “Home Health” is discouraged for entities that are not licensed by the Department to provide Medicare certified home health services.
2. Physical Address for main office
3. Mailing Address for main office, if different
4. Business Telephone Number
5. Business FAX Number
6. Emergency Telephone Number, pager, etc. for nights, weekends, holidays, etc.
7. E-Mail Address
8. Federal Employer Identification Number (FEIN)
9. State (Missouri) Employer Identification Number (SEIN)
10. Business days and hours of operation (when the office is open and staff are onsite)
11. If a satellite office is listed in Section IV, indicate the counties served by this main office (if there is no satellite office, leave this field blank)

Section II:  Personnel Information

12. Director Name (the owner(s) or highest-ranking person in charge of Provider operations)
13. Telephone Number for the Director
14. E-Mail Address for the Director
15. Designated Manager Name
16. Telephone Number for the Designated Manager
17. E-mail Address for the Designated Manager
18. Registered Nurse Name
19. Missouri RN License number of the Registered Nurse
20. Telephone Number for the Registered Nurse
21. E-Mail Address for the Registered Nurse

Section III:  Indicate whether an automated telephone tracking system is being utilized, and, if so, the name of the company providing the service. (NOTE:  Prior permission must be granted by the Department to use an automated telephone tracking system.)

Section IV:  Satellite Office Information
A satellite office is defined as an office that is regularly staffed. Offices used solely to drop off timesheets, pick up schedules, etc. do not need to be reported. List the following information for each satellite office the agency may have:

• Supervisor/Manager
• Address
• City
• State, Zip Code
• Telephone Number
• Fax Number
• Emergency Telephone No. (nights, weekends, etc.)
• E-Mail Address
• Days & Hours of Operation
• Counties Served by This Office (this office will be contacted regarding clients residing in this county(ies)

Section II – Service Area Commitment

Service Area Commitment form indicating the services and geographic areas (counties) the applicant plans to serve.

Section III – Business Organization

The entity’s correct legal name must be the same on all of the following documents and must be used throughout the proposal.

1. Business Organizational Structure form:
   • fill in the entity’s correct legal name on the first page;
   • complete only one section of the form;
   • submit the required documents as indicated on the form according to the section of the form completed; and
   • sign the bottom of page two of the form.
2. Application for Employer Identification Number submitted to the IRS. If the application was submitted online, submit the application after the number has been assigned. If a paper application was submitted to the IRS, submit a copy of the application and the number notification received from the IRS.
3. Notification from the Missouri Department of Revenue (DOR) of the Missouri Employer Identification Number.
4. Vendor registration verification e-mail. Register as a vendor with the State of Missouri through the Missouri Office of Administration at https://www.moolb.mo.gov/Glue/default.asp. The Standard Registration (no fee) is required. The Premium Registration ($50 annual fee) is not required. If the name and federal employer identification number are already registered, do not submit anything.
5. A current Vendor No Tax Due certificate issued by the Missouri Department of Revenue. Information regarding this certificate is available at http://www.dor.mo.gov/tax/business/sales/hb600.htm, Obtaining a Vendor No Tax Due.
6. An organization chart for the entity.

Section IV – Insurance and Bonding

1. Certificate of Insurance that:
   • is issued in the full legal name of the Provider;
   • names the Division of Senior and Disability Services, P.O. Box 570, Jefferson City, MO 65102 as a certificate holder;
   • includes the policy numbers;
   • is in effect for a minimum of one year;
   • is in effect prior to the proposal being approved;
   • verifies a commercial general liability policy. The policy must be an occurrence policy for no less than $1 million per event and $3 million aggregate; and.
   • verifies a professional liability policy for no less than $1 million per event and $3 million aggregate.
     • The above policies must be coordinated to ensure coverage for negligent acts and omissions by employees and/or volunteers in the provision of services to the clients in such clients’ homes.
     • Self-insured retention, if any, can be no more than $1,000.
2. A copy of the Employee Dishonesty Bond issued in the entity’s correct legal name verifying bond coverage for employees and volunteers who are connected with the delivery and performance of in-home services in clients’ homes.

Section V – Business Plan

Applicants must assure the Department that sufficient financial resources exist to provide continuous service to clients of the Department. The use of a Business Plan will help entities manage their business and ensure financial stability.

The Business Plan, at a minimum, must include the following information:

• Company - Correct legal name of entity as filed with the Missouri Secretary of State, IRS and Missouri DOR and used throughout the proposal. Description of the entity including if it is new or existing, its history, purpose, etc.
• Office/Plant - Office address and description of area and building. State whether the office is rented, leased or owned. If the business is located in a home, describe the space that is dedicated exclusively for business. Describe how the location meets Americans with Disabilities Accessibility requirements and handicap accessibility.
• Personnel - Describe how employees will be recruited to provide direct care.
  Describe how employees will be recruited for administrative and billing functions.
  Describe the prior experience or education that qualifies management to run this type of business.
• Marketing - Describe the local market for this service.
  Describe the methods to be used to obtain clients in this market.
  Describe what efforts, if any, will be used to expand beyond the local market.
  Describe what kind of payments that will be sought (Medicaid, Medicare, private pay, etc.).
• Financial Management - State the name and qualifications of the person(s) handling the financial matters of the entity.
  Submit a financial management plan. The plan must include a budget for starting the business and operating costs for the first year of operation.
  State the sources of revenue to be used to start the business.

Section VI – Staff Training

1. A detailed training plan for new aides. Do not submit training materials to be used.
   • Describe each section of the required training. Break out each section and provide a copy of the agendas. Agendas must include a short description of each topic.
2. If offering Advanced Personal Care, a detailed training plan for aides that will deliver Advanced Personal Care. Provide a copy of the agenda that includes a short description of each topic.
3. A detailed in-service training plan including a short description of each topic.
4. Hiring requirements for basic personal care aides and advanced personal care aides.

Section VII – Policies and Procedures

The following policies and procedures must be detailed, step-by-step instructions of how your company will comply with the requirements of the program. The policies and procedures must answer who, what, where, when and how.

1. The telephone system to be used.
2. The telephone system that will allow contact with the applicant after business hours. Include the process for responding to messages received within two hours.
3. Utilization of the Change Request form (available on this web page).
4. Notification to clients of any changes in telephone number, address, and/or posted business hours.
5. Maintaining service delivery on holidays, weekends, and in the event of inclement weather, worker absence, vacation, or labor shortage.
6. Ensuring service delivery during times of natural or man-made disasters.
7. Informing clients, client representatives, and employees of the Provider’s Client Rights, Code of Ethics and Confidentiality statements.
8. Abuse, neglect and exploitation.
9. Misappropriation of client property or funds including falsification of service delivery documents.
10. Nurse assessments/visits.
11. Closing or discontinuing services to clients.
12. Staff serving their family members.
13. Staff residing in the same household as a client.
14. Transportation of clients.
15. Allowable/non-allowable services and providing unnecessary tasks.
16. Client files.
17. Employee files.
18. Drug free workplace.
19. Waiver of training and the form used to document the waiver.
20. Training documentation.
21. The employment application.
22. New employee reference checks.
23. Criminal background record checks.
24. Employee Disqualification List (EDL) checks.
25. Documentation of criminal background record checks and EDL checks.
26. Verification of certifications, licenses and degrees of all personnel and ongoing verification.
27. Employment of a designated manager.

Section VIII – Assurances

1. Maintain internet access and an e-mail address at all times in order to retrieve information posted on the Department web site and to communicate with the Department.
2. Maintain subscription to DSDS E-News.
3. Maintain the required insurance coverage at all times.
4. Authorize the entity’s insurance carrier, broker, agent and/or premium finance company to release information regarding required insurance coverage to the Department.
5. Operate in accordance with the proposal as submitted, amended and approved by the Department.
6. Comply with all applicable federal and state laws including laws authorizing or governing the use of federal funds paid to the Provider through the in-home services program.
7. Comply with the Fair Labor Standards Act as amended, Title VII of the Civil Rights Act of 1991 as amended, the Americans with Disabilities Act of 1990, and all other applicable federal and state laws, regulations and executive orders regarding employment practices.
8. Comply with all applicable rules and laws administered by the Occupational Safety and Health Administration including the provision of medical supplies to ensure universal precautions, including, but not limited to, gloves.
9. Comply with all applicable Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations and all amendments thereafter.
10. Enroll and comply with all requirements of the E-Verify federal work authorization program. Information regarding E-Verify is available at http://www.dhs.gov/files/programs/gc_1185221678150.shtm.
11. Maintain employment of a registered nurse who will be available during hours of operation to handle nursing issues.

Section IX - Appendixes

1. Client Rights to be distributed.
2. Code of Ethics to be distributed.
3. Confidentiality statement to be distributed.
4. Nurse assessment form to be used.
5. Employment application to be used.
6. Qualifications of the Designated Manager.
   • Current employment application and/or resume;
   • copy of any/all license(s), degree(s) or certification(s) verifying education, work history, licensure and/or certification; and
   • copy of the certificate for successfully completing Certified Manager Training.
7. Qualifications of the Registered Nurse supervisor.
   • Current employment application and/or resume verifying education and work history; and
   • copy of the registered nurse license allowing practice in the State of Missouri.
8. A copy of the HCS Provider Contracts Registration and Screening Request form that was completed and submitted to the Family Care Safety Registry (FCSR) for the director listed on the Provider Profile and each individual listed on the Business Organizational Structure form. The original form(s) must be mailed directly to the address listed on the form. If an individual is not already registered with the FCSR, a copy of their social security card and the one time registration fee must be attached to the original form.
   
   The HCS Provider Contracts Registration and Screening Request is a special form used only during the proposal process so that the FCSR will forward the results of these screenings directly to HCS Provider Contracts (the FCSR notifies the registrant of the results also).
   
   For all other screening requests, the FCSR Employer Background Screening Request form must be used. Screening results will not be accepted from the applicant. HCS Provider Contracts must receive the screening results directly from the FCSR.