Provider Reassessment Information

HCBS providers may choose to participate in the reassessment of participants of Division of Senior and Disability Services (DSDS) that they serve by becoming a Type 27 provider.

Enrollment in the provider reassessment program is voluntary. Enrolled providers will conduct the reassessments during face-to-face visits utilizing the InterRAI HC assessment. For participants whose HCBS provider is not enrolled as a Type 27 provider or those with multiple HCBS providers, the reassessment will be completed by either DSDS staff or their designee.

Participation Requirements

Participation in the provider reassessment process is voluntary. If a Home and Community Based Services (HCBS) provider chooses to participate they must meet all requirements outlined below.

HCBS providers must be assigned a Medicaid provider type 27 number by Missouri Medicaid Audit and Compliance (MMAC) to participate and receive payment.
- Participation in provider reassessment training is required for all assessors. All assessors must meet one of the following experience or education requirements:
  - A bachelor's degree from an accredited college or university;
  - A Registered Nurse (RN) who is licensed and in good standing in Missouri;
  - A Licensed Practical Nurse (LPN) who is licensed and in good standing in Missouri with one or more years of experience working as an LPN;
  - One or more years of experience as a Social Services Specialist with the Division of Senior and Disability Services (DSDS);
  - Four or more years of experience with DSDS or an Area Agency on Aging (AAA);
    OR
  - Multilingual and approved through DSDS.
Completion of provider reassessment training is required before submitting a request for an exam to certify as eligible to complete provider reassessments. An application for a type 27 number shall include proof of the successful certification of at least 1 assessor.
To obtain reassessment assignments, contact DSDS HCBS Systems and Data Reporting at HCBS.Systems@health.mo.gov and provide the following information:
- Provider Agency Name
- Medicaid provider type 27 number
- Contact name
- Contact phone number
- Contact e-mail address
Once the contract is in place and the assessor has been approved, contact DSDS HCBS Systems and Data Reporting to set up the assigning process.
All Protected Health Information (PHI) must be exchanged securely. HCBS providers must either have their own encryption software or utilize the Proofpoint software initiated by DSDS.

For HCBS providers who choose to subcontract with another qualified entity, provider agency or individual assessor to complete participant reassessments, the following guidelines have been established by DSDS. It is recommended that any HCBS provider who utilizes this option consult with their legal representative before finalizing the contract.

Be enrolled as a Medicaid provider type 27 with MMAC. The enrolled HCBS provider is responsible for billing MO HealthNet Division for the reassessment.
Ensure the subcontracting entity is a qualified assessor and maintain proof of the assessor’s qualifications and certification on-site for monitoring purposes.
Assign the participant reassessments to the subcontractor. Log in information shall not be shared with subcontractors.

Training

The Division of Senior and Disability Services (DSDS) provides training for new provider assessors to ensure consistent application of Home and Community Based Services (HCBS) policy related to reassessments. HCBS reassessment providers (Type 27 providers) are responsible for ensuring that all qualified assessors have completed the online reassessment training and passed the exam.

All training courses are available through the Relias Learning Management System (LMS.) Potential provider assessors must register and create an account to begin the training and certification process: https://modsds.training.reliaslearning.com/.

Refer to the navigation document for help using the Relias Learning Management System (coming soon).

Once an account is created, individuals will be automatically enrolled in the provider reassessor learning path. The first module requires the individual to upload proof of required credentials into the Relias system to confirm qualifications to participate as a provider reassessor. When credentials are uploaded, an email notification will be sent to DSDS to review and verify the credentials. Individuals will not be able to complete the training modules until DSDS reviews and approves the credentials. Allow 3-5 business days for DSDS to verify the individuals’ credentials. The individual will receive an email from HCBS.Training@health.mo.gov once credentials have been reviewed.

Acceptable credentials include one of the following:

Bachelor’s Degree: Official transcripts from an accredited college or university
Registered Nurse (RN): Licensure information in MO (must be in good standing)
Licensed Practical Nurse (LPN): Licensure in MO (must be in good standing) and information pertaining to 1 more year(s) of experience working as an LPN
Work Experience: include information outlining work history that meets one of the following:
- 1 or more years at DSDS as a Social Service Specialist
- 4 or more years at DSDS
- 4 or more years at an Area Agency on Aging (AAA)
- Experience as a multilingual employee to serve a specific population

Once credentials are verified by DSDS, the course content will be unlocked, and the learner may begin the courses. In addition to the LMS modules, individuals should review the HCBS Policy Manual, Policy Clarification Questions, and Quick Guides to ensure they are fully prepared.

All training modules must be completed before accessing the final exam. A score of 80% or higher is required to receive a certificate of completion. Individuals are allowed up to four attempts to pass. Individuals are not expected to memorize all content; training materials may be used as references during the exam.

Training certification must be maintained in the assessor’s personnel file and made available upon request by DSDS or Missouri Medicaid Audit and Compliance (MMAC). Assessors will no longer have access to Relias after 1 year of enrollment. Assessors must ensure credentials are saved outside of Relias before their enrollment ends. DSDS cannot issue replacement copies after system access expires.

Type 27 providers shall ensure that all assessors receive and review DSDS updates of policy and procedure information regarding reassessments that are disseminated by DSDS. Subscribe to DSDS E-News to receive important information and updates regarding the HCBS program.

Process

Distribution Process

Standardized criteria is applied to determine assignment of reassessments. Only those assigned to the provider by Division of Senior and Disability Services (DSDS) are to be completed. Home and Community Based Services (HCBS) providers may only bill for reassessments assigned by DSDS. Assignments will be available on the provider queue within the Electronic Case Record, Fusion, and will include all participants the provider should reassess within 90 days. HCBS providers are expected to review their assigned reassessments monthly to identify participants who no longer need a reassessment. Please refer to HCBS Policy Manual, Chapter 4.25 Provider Reassessment Process for further assessment details.

Assessment/Care Planning Process

Provider reassessors are acting on behalf of DSDS and are therefore held to the same expectations as DSDS assessors. Providers are expected to follow policy and procedure outlined in the reassessor training, HCBS Manual, and other DSDS resources. For a reassessment to be complete and thorough, the Provider Reassessor must ensure:

All required forms are attached;
Appropriate HCBS provider is selected;
Case note documentation is clear and aligns with case note documentation policy;
The reassessment and PCCP are entered correctly and submitted for review;
Selection of care plan tasks meets participant needs appropriately, and
The participant case information is updated with correct demographics, living arrangements, contact information, physician information, and other responsible person information.

Return/Notification Process

All HCBS Provider reassessments and corresponding documentation should be entered into the Electronic Case Record upon completion of the reassessment. This should occur within five (5) business days of completion of the reassessment, and no later than the last day of the month preceding the month the participant’s care plan is scheduled to expire. If the reassessment and documentation is not entered into the Electronic Case Record at this time, the case will automatically return to the Provider Reassessor Review Team for processing.

If, for any reason, an HCBS Provider is unable to complete the reassessment process by the set deadline, they are required to notify the DSDS Provider Reassessor Review Team immediately, but no later than the last calendar day of the month preceding the month the participant’s care plan is scheduled to expire. Notification of the inability to complete assessments should be made by taking the ‘Unable to Complete’ action within the Electronic Case Record.

The Provider Reassessor Review Team will review completed reassessments to ensure all requirements are met and documented before approving the case. If it is determined a reassessment was not completed per DSDS’s standards, the review specialist will contact the Provider Reassessor via encrypted email for additional information and/or remediation completion. Provider Reassessors have three (3) business days to complete the requested remediations. Reassessors should make (3) attempts to contact the Participant to complete remediations. If the remediations are not completed within the three (3) business days, the reassessment will be considered incomplete and the provider should not request reimbursement. Incomplete remediations are tracked by the Bureau of HCBS Policy and Quality Enhancements and routine failure to meet these requirements may result in the discontinuation of the non-compliant reassessor. For all other inquiries, contact the Provider Reassessment Review Team at ProviderReassessmentReview@health.mo.gov.

Reimbursement Process

Providers will be reimbursed $100.00 per completed reassessment assigned to their agency. The provider will electronically file their claim for the completed reassessments with eMOMED per Department of Social Services (DSS), MO HealthNet (MHD) requirements. The procedure code for reassessments is T1028TS and the diagnosis code is Z02.89. Any billing concerns should be addressed to MHD’s Interactive Voice Response (IVR) at 573-751-2896.

Registration and Communication

Home and Community Based Services (HCBS) reassessment providers shall:

Complete the online provider reassessment training, submit qualifications to DSDS, and pass the exam.
Complete the Electronic Case Record, Fusion, registration form to be added as a Fusion user
- Inform DSDS and MMAC of any changes impacting the reassessment process or assignments. This includes changes to a provider agency name, contact information, or e-mail update.

For questions related to the registration and reassessment assignment contact DSDS HCBS Systems and Data Reporting at HCBS.Systems@health.mo.gov.

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