MEMORANDUM FOR HOME AND COMMUNITY BASED SERVICES STAFF AND STAKEHOLDERS
FROM: Veronica Jameson, Bureau Chief: Bureau of Policy and Quality Enhancements
SUBJECT: General Health Evaluation (GHE) Completion Rates
This memorandum is to inform Home and Community Based Services (HCBS) providers, who are responsible for completing General Health Evaluations (GHEs), that the Division of Senior and Disability Services (DSDS) has conducted additional reviews of GHE completion rates. These reviews show that completion of GHEs remains low, indicating a continued need for improvement to support participant health and compliance with program standards.
As referenced in INFO 05-26-02, Missouri State Statute 192.2475.14 RSMo requires Agency Model Personal Care providers (PC) to complete semi‑annual GHE nurse visits. All participants receiving Agency Model PC and Advanced Personal Care (APC) shall be authorized two (2) nurse visits annually to perform GHEs. Participants receiving only Consumer Directed Services (CDS) are not required to have GHEs.
To ensure program compliance, providers shall adhere to the following requirements:
- GHEs must be completed as authorized, in the 4th and 10th months of the care plan period.
- GHEs must be completed by an RN or LPN with RN oversight.
- Completed GHEs must be uploaded into Fusion by the 15th day of the following month.
- GHEs that are not completed shall not be billed.
- If a GHE is missed, it must be completed the following month; however, it will not be reimbursable unless the delay is outside the provider’s control. Contact the Person Centered Care Planning (PCCP) team for care plan authorization adjustments in these instances.
- Completed GHEs that indicate a need for a care plan adjustment to adequately meet participants’ needs, or case closure due to no longer being eligible for HCBS, shall be submitted to the PCCP team through the online PCCP Request Form for appropriate action.
DSDS will continue to closely monitor GHE completion and is actively coordinating with Missouri Medicaid Audit & Compliance (MMAC) to reinforce provider accountability and ensure full adherence to all program and statutory obligations. Providers should take immediate action to correct any deficiencies to avoid potential compliance consequences.
Questions regarding this memorandum should be directed to the Bureau of Policy and Quality Enhancements via e-mail at LTSS@health.mo.gov.