1.00 Introduction
Home and Community Based Services Manual
1.00 Introduction
Revised - June 2024
Department of Health and Senior Services’ (DHSS) Vision
Optimal health and safety for all Missourians, in all communities, for life.
DHSS Mission
To promote health and safety through prevention, collaboration, education, innovation, and response.
Division of Senior and Disability Services’ (DSDS) Vision
Missourians regardless of their age or abilities can live their optimal life.
DSDS Mission
To protect, support, and empower seniors and individuals with disabilities through assessment and connection to community resources to age with dignity.
DSDS Role
DSDS is the designated state agency, carrying out mandates of the state, regarding programs and services for seniors and individuals with disabilities.
DSDS is responsible for the administration and operation of the Medicaid Funded Home and Community Based Services (HCBS) programs. HCBS provides services that meet the unmet needs of individuals with disabilities allowing them to remain in their least restrictive environment. HCBS DSDS staff and/or its designee process initial referrals, assessments, reassessments, person centered care plans (PCCP), and PCCP maintenance services for the HCBS program.
DSDS investigates reports of abuse, neglect, and financial exploitation, provides crisis intervention, and Adult Protective Services for eligible adults. The Central Registry Unit (CRU) operates the state’s toll-free hotline for reporting alleged abuse, neglect, or financial exploitation of adults with disabilities and seniors aged 60 and above. CRU also registers complaints against hospitals, licensed long-term care facilities, and home-health agencies.
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Table of Contents
Legal Authority
Home and Community Based Services Manual
1.00 Introduction
| Chapter 192: Department of Health and Senior Services | |
|---|---|
| 192.2000 | DSDS Duties |
| 192.2005 | Definitions |
| 192.2400 - 192.2505 | Protective Services for Adults: Reporting, Investigations, Employee Disqualification, Criminal Background Check |
| Chapter 208: Old Age Assistance, Aid to Dependent Children and General Relief | |
|---|---|
| 208.865 | Definitions – Personal Care Attendant and Vendor |
| 208.895 - 208.896 | HCBS Referrals – Department Duties, Assessments, Care Plans, Structured Family Caregiving Waiver |
| 208.900 - 208.930 | Personal Care Assistance Services – Eligibility, Consumer and Vendor Responsibilities/Requirements, Electronic Visit Verification (EVV), Denial of Services, Discontinuation of Services |
| Chapter 660: Department of Social Services | |
|---|---|
| 660.023 | In-Home Service Providers, Telephone Tracking System |
| Chapter 7 - Service Standards | |
|---|---|
| 19 CSR 15-7.021 | In-Home Service Standards |
| Chapter 8 - Consumer-Directed Services | |
|---|---|
| 19 CSR 15-8.100 | Definitions |
| 19 CSR 15-8.200 | Eligibility |
| 19 CSR 15-8.400 | Vendors |
| 19 CSR 15-8.500 | Hearing Rights |
| Division 30 – Division of Regulation and Licensure | |
| Chapter 81 – Certification | |
| 19 CSR 30-81.030 | 19 CSR 30-81.030 Evaluation and Assessment Measures for Title XIX Recipients and Applicants in Long-Term Care Facilities |
| Division 70 – MO HealthNet Division | |
|---|---|
| Chapter 91 – Personal Care Program | |
| 13 CSR 70-3.320 | Electronic Visit Verification (EVV) |
| 13 CSR 70-91.010 | Personal Care Program |
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Table of Contents
HCBS Waivers
Home and Community Based Services Manual
1.00 Introduction
A link to the current approved waivers on file with the Centers for Medicare & Medicaid Services (CMS) can be found at the following website:
Current Approved Waivers:
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Table of Contents
1.05 Abbreviations
Home and Community Based Services Manual
1.00 Introduction
Programmatic Terms/Services
| Abbreviation | Term |
|---|---|
| AAA | Area Agency on Aging |
| ADC | Adult Day Care |
| ADCW | Adult Day Care Waiver |
| ADW | Aged and Disabled Waiver |
| AFL | Assisted Living Facility |
| ANE | Abuse, Neglect, and Exploitation |
| APC | Advanced Personal Care |
| AR | Advanced Respite |
| ASA | Administrative Support Assistant |
| BR | Basic Respite |
| CDS | Consumer Directed Services |
| CFR | Code of Federal Regulations |
| CIL | Center for Independent Living |
| CM | Case Management |
| CSR | Code of State Regulation |
| EAA | Environmental Accessibility Adaptations |
| F2F | Face to Face |
| FMS | Financial Management Service |
| GHE | General Health Evaluation |
| H&I | Hourly and Intermittent |
| HC | Homemaker/Chore Services |
| HCB | Home and Community Based Medicaid |
| HCBS | Home and Community Based Services |
| HDM | Home Delivered Meals |
| Hh, hh | Household |
| IA | Initial Assessment |
| IHS | In-Home Services |
| ILW | Independent Living Waiver |
| ITP | Individualized Treatment Plan |
| LASA | Lead Administrative Support Assistant |
| LOC | Level of Care |
| LTC | Long Term Care |
| ME | Medicaid Eligibility |
| MFP | Money Follows the Person |
| MSP | Medicaid State Plan |
| ORA | Online Reporting Application |
| PA | Prior Authorization |
| PC | Personal Care |
| PCCP | Person Centered Care Plan |
| Pt/pt | Participant |
| R&R | Rights and Responsibilities |
| RM | Regional Manager |
| SME | Specialized Medical Equipment |
| SMS | Specialized Medical Supplies |
| SNF | Skilled Nursing Facility |
| SSS | Social Service Specialist |
| SSUS | Social Service Unit Supervisor |
| TC | Track Changes |
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Table of Contents
State and Federal Entities
Home and Community Based Services Manual
1.00 Introduction
| Abbreviation | Term |
|---|---|
| APS | Adult Protective Services |
| CMS | Centers for Medicare and Medicaid Services |
| CO | Central Office |
| CRU | Central Registry Unit |
| DCN | Departmental Client Number (MO HealthNet Number) |
| DDD | Division of Developmental Disabilities |
| DHSS | Department of Health and Senior Services |
| DLS | Division of Legal Services |
| DMH | Department of Mental Health |
| DSDS | Division of Senior and Disability Services |
| DSS | Department of Social Services |
| EVV | Electronic Visit Verification |
| FAMIS | Family Assistance Management Information System |
| FSD | Family Support Division |
| HCY | Healthy Children and Youth Program |
| HH | Home Health |
| HIPAA | Health Insurance Portability and Accountability |
| MHD | MO HealthNet Division |
| MMAC | Missouri Medicaid Audit and Compliance Unit |
| OAA | Older Americans Act |
| RCF | Residential Care Facility |
| Reg | Region |
| RSMo | Revised Statutes of the State of Missouri |
| SD | Spenddown |
| SIU | Special Investigations Unit |
| SLUMS | St. Louis Mental Status Exam |
| SS | Social Security |
| SSN | Social Security Number |
| WT | WebTool |
Table of Contents
On this page
Medical
Home and Community Based Services Manual
1.00 Introduction
| Abbreviation | Term |
|---|---|
| AD | Alzheimer’s disease |
| ADL | Activities of daily living |
| AIDS | Acquired immunodeficiency syndrome |
| ALS | Amyotrophic lateral sclerosis (Lou Gehrig’s Disease) |
| AMA | Against medical advice |
| Appt/appt | Appointment |
| bid, b.i.d. | Twice a day |
| BM | Bowel movement |
| BP | Blood pressure |
| c/o | Complains of |
| CAD | Coronary artery disease |
| CHF | Congestive heart failure |
| COPD | Chronic obstructive pulmonary disease |
| CP | Cerebral palsy |
| CVA | Cerebral vascular accident (stroke) |
| CXR | Chest x-ray |
| DM | Diabetes mellitus |
| DO | Doctor of osteopathic medicine |
| Dr | Doctor |
| Dx | Diagnosis |
| ECG or EKG | Electrocardiogram |
| ED | Emergency department |
| ER | Emergency room |
| Fr | Fracture |
| GERD | Gastroesophageal reflux disease |
| gtt, gtts | Drop(s) |
| H&P | History and physical |
| HIV | Human immunodeficiency virus |
| HOH | Hard of hearing |
| HR | Heart rate |
| HTN | Hypertension (high blood pressure) |
| Hx, hx | History |
| IADL | Instrumental activities of daily living |
| IDDM | Insulin dependent diabetes mellitus |
| IM | Intramuscular |
| IV | Intravenous |
| L | Liter |
| MD | Medical doctor |
| mg | Milligram |
| ml | Milliliter |
| MS | Multiple sclerosis |
| MVA | Motor vehicle accident |
| N/V, N&V | Nausea and vomiting |
| NG, ng | Nasogastric |
| NPO, n.p.o | Nothing by mouth |
| O2 | Oxygen |
| OT | Occupational therapy |
| PCP | Primary care physician |
| PO, po | By mouth |
| Post-op, post-op | Postoperative (after surgery) |
| Pre-op, pre-op | Preoperative (before surgery |
| prn | as needed |
| PROM | Passive range of motion |
| PT | Physical therapy |
| PTSD | Post-traumatic stress disorder |
| Q2h, q.2h (number can vary) | Every two hours (number can vary) |
| qd, q.d. | Every day |
| qh, q.h. | Every hour |
| qid, q.i.d. | Four times a day |
| RA | Rheumatoid arthritis |
| RN | Registered nurse |
| ROM | Range of motion |
| Rx | Prescriptions |
| S/S, s/s, | Signs and symptoms |
| SLP | Speech-language pathology (Speech Therapy) |
| SOB | Shortness of breath |
| sub-q | Subcutaneous |
| tab | Tablet |
| TB | Tuberculosis |
| TBI | Traumatic brain injury |
| TID, tid, t.i.d | Three times a day |
| Tx, tx | Treatment |
| Vs | Vital signs |
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On this page
Other
Home and Community Based Services Manual
1.00 Introduction
| Abbreviation | Term |
|---|---|
| AKA | Also known as |
| ATC | Attempt to contact |
| d/t | due to |
| DOB | Date of Birth |
| DPOA | Durable power of attorney |
| E: | |
| F: | Fax |
| hr | Hour |
| LKA | Last known addres |
| LM | Left message |
| mn | Minutes |
| Mo, mo | Month |
| Msg, msg | Message |
| OV | Office Visit |
| POA | Power of attorney |
| Rcvd | Received |
| TCF/TF | Telephone call from |
| TCT/TT | Telephone call to |
| VM | Voice mail |
| Wk, wk | Week |
Table of Contents
On this page
1.15 Code of Ethics
Home and Community Based Services Manual
1.00 Introduction
Division of Senior and Disability Services (DSDS) is charged with the responsibility to provide aid and assistance to the elderly and adults with disabilities living in the state. One component of DSDS’ operational responsibilities is the administration of Home and Community Based Services (HCBS) which align with the ethical and culturally competent standards of the Department of Health and Senior Services (DHSS).
In coordination with the Department Director, the Division Director, and Deputy Division Director, DSDS staff have the opportunity to serve vulnerable individuals and have a positive impact on their quality of life. Understanding and adhering to ethical and culturally competent standards helps to ensure quality services are delivered.
It is the responsibility of DSDS staff to understand and follow the policies outlined in the HCBS Manual and the DHSS Administrative Policies. The National Association of Social Workers (NASW) Code of Ethics is an additional resource for DSDS staff.
Code of Ethics
DSDS staff shall implement the following ethical principles while interacting with participants, stakeholders and coworkers. DSDS staff shall:
Work to serve in the best interest of the participant;
Ensure a participant’s rights of privacy, dignity, respect, and freedom from coercion and restraint;
Ensure a participant’s HCBS optimizes individual initiative, autonomy, and independence in making life choices;
Ensure a participant is able to facilitate individual choice regarding services and supports, and who provides them;
Maintain professional interactions with participants and recognize potential placement of personal bias and values upon participant, stakeholders or coworkers;
Attain informed consent from the participant prior to assessing for HCBS;
Respect, verbalize, and explain the participant’s right to confidentiality by utilizing the DHSS Notice of Privacy Practices form;
Endeavor to understand the vast cultural and linguistic diversity among participants and ensure proper cultural considerations are implemented;
Interact and communicate with participants in a clear, concise and easy to understand manner;
Encourage the inclusion of family or other informal support systems in the development of the Person Centered Care Plan (PCCP) or other decisions regarding HCBS;
Maintain professional boundaries by refraining from personal relationships, business arrangements or other possible conflicts with participants, stakeholders and coworkers;
Do no harm. Communication and interaction with participants, stakeholders and coworkers shall be conducted in a way that promotes the professional relationship and builds upon a strengths based perspective.
DSDS staff shall understand, acknowledge and adhere to the DSDS Code of Ethics in conducting all state business. Any deviation from the Code of Ethics shall be subject to supervisory approval, up and including to the Division Director.
Table of Contents
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1.20 Final Rule Medicaid HCBS
Home and Community Based Services Manual
1.00 Introduction
Revised - January 2018
The Home and Community Based Services (HCBS) Final Rule established by the Centers for Medicare and Medicaid Services (CMS) defines HCBS settings and Person Centered Care Planning (PCCP) (Policy 4.20) requirements in Medicaid HCBS Waiver programs. The purpose of the rule is to ensure individuals receive HCBS in settings that are integrated in and support full access to the greater community. This includes opportunities to seek employment and work in competitive and integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree as individuals who do not receive HCBS.
Home and Community Based (HCBS) Setting
The Final Rule establishes mandatory requirements for the qualities of HCBS settings and identifies settings that are not HCBS. All HCBS settings must meet the following requirements:
- Be integrated in and support access to the greater community;
- Provide opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources;
- Ensure the individual receives services in the community to the same degree of access as individuals not receiving HCBS;
- Is selected by the individual from among setting options, including non-disability specific settings;
- Ensure an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint;
- Optimizes individual initiative, autonomy, and independence in making life choices;
- Facilitates individual choice regarding services and supports; and who provides them.
Each participant is informed of their right to receive services in a setting in the above requirements through the HCBS Care Plan and Participant Choice Statement (HCBS-3).
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Table of Contents
1.25 Electronic Visit Verification
Home and Community Based Services Manual
1.00 Introduction
The 21st Century Cures Act mandates the use of Electronic Visit Verification (EVV) for all Medicaid personal care services (PCS). This applies to PCS provided under sections 1905(a) (24), 1915(c), 1915(j), 1915(k), and Section 1115.
Missouri Code of State Regulations (CSR) 13 70-3.320 sets forth additional requirements for use of EVV for services identified by MO HealthNet Division and provided to a MO HealthNet participant with a prior authorization or care plan as approved by the Department of Health and Senior Services.
Purpose
EVV improves the quality of care provided to individuals and enhances quality control by utilizing technology to capture point-of-service information related to the delivery of in-home services.
EVV is required for the following services authorized by the Division of Senior and Disability Services (DSDS):
EVV is not required for the following services authorized by DSDS:
Neither the 21st Century Cures Act nor MO CSR 13 70-3.320 provides HCBS participants the opportunity to opt out of these requirements. Refusal to comply with EVV requirements will result in closure of authorized HCBS through DSDS. DSDS shall initiate the Adverse Action process when a participant refuses to comply with EVV requirements. Participants not utilizing EVV, but who wish to comply with EVV requirements, shall be directed to contact their HCBS provider to ensure compliance. If a participant’s provider cannot accommodate the participant’s EVV needs, a provider change shall be initiated.
Providers and/or participants identified as noncompliant with EVV requirements by Missouri Medicaid Audit and Compliance (MMAC) will be forwarded to DSDS for a provider change or closure of HCBS.