Home and Community Based Services Manual Table of Contents Toggle submenu 1.00 Introduction Legal Authority HCBS Waivers Toggle submenu 1.05 Abbreviations State and Federal Entities Medical Other 1.15 Code of Ethics 1.20 Final Rule Medicaid HCBS 1.25 Electronic Visit Verification Toggle submenu 2.00 Medicaid Eligibility 2.00 Appendix 1 Missouri's Medicaid Program 2.00 Appendix 2 Medicaid Income Information 2.00 Appendix 3 Medical Eligibility (ME) Category Chart Toggle submenu 3.00 Available Home and Community Based Services 3.05 Basic Personal Care – State Plan (Agency Model) 3.10 Advanced Personal Care - State Plan (Agency Model) 3.15 Authorized Nurse Visits – State Plan (Agency Model) 3.20 RCF/ALF Personal Care – State Plan (Agency Model) Toggle submenu 3.25 Personal Care Assistance – State Plan (Consumer-Directed Service Model) Self Direction Determination Personal Care Assistance - State Plan (Consumer-Directed Services Model) Authorization Tasks Calculating Essential Transportation 3.31 Adult Day Care Waiver 3.35 Chore (Aged and Disabled Waiver) 3.40 Home Delivered Meals (Aged and Disabled Waiver) 3.45 Homemaker (Aged and Disabled Waiver) 3.50 Respite Care (Aged and Disabled Waiver) 3.51 Adult Day Care (Aged and Disabled Waiver) 3.55 Independent Living Waiver 3.60 Structured Family Caregiving Waiver 3.70 Social Services Block Grant/General Revenue Protective Services Participants 3.00 Appendix 1 Services Units and Rates 3.00 Appendix 2 HCBS Cost Maximums 3.25 Appendix 1 Consumer Directed Services Tax Information 3.55 Appendix 2 Waiting List Notice for ILW Services Instructions Toggle submenu 4.00 Home and Community Based Services Process Introduction 4.05 Intake Process 4.10 Explanation of Level of Care Determination 4.15 Assessment Process 4.20 Person Centered Care Planning and Maintenance 4.25 Provider Reassessment Process 4.30 Case Record Documentation 4.35 Service Coordination 4.35.1 Department of Mental Health Service Coordination 4.35.2 Healthy Children and Youth Service Coordination 4.35.3 HCBS and PACE Coordination 4.35.4 Brain Injury Waiver Service Coordination 4.40 Case Closure 4.00 Appendix 1 Person Centered Care Planning Collateral Contacts 4.00 Appendix 2 Participant Choice Statement Instructions 4.00 Appendix 2c Adult Day Care Rights and Responsibilities 4.00 Appendix 2d Agency Model Rights and Responsibilities 4.00 Appendix 2e Consumer Directed Services Rights and Responsibilities 4.00 Appendix 2f Residential Care Facilities/Assisted Living Facilities Rights and Responsibilities 4.00 Appendix 2g Structured Family Caregiving Waiver Rights and Responsibilities 4.00 Appendix 3 In-Home Services Worksheet Instructions 4.00 Appendix 4 Worksheet for Consumer Directed Services Instructions 4.00 Appendix 5 Physician Notification of Care Plan Instructions 4.00 Appendix 6 Department of Mental Health Customer Management, Outcomes, and Reporting (CIMOR) 4.00 Appendix 7 Department of Mental Health, Division of Developmental Disabilities Contact Information 4.00 Appendix 8 SLUMS 4.00 Appendix 9 Community Options Information 4.00 Appendix 10 Instructions for Self-Direction Assessment Questions Instructions 4.00 Appendix 11 Contact Form Instructions 4.00 Appendix 12 Communication: Reason for Contact 4.00 Appendix 13 Healthcare Professional Inquiry 4.00 Appendix 14a 4.00 Appendix 14b 4.00 Appendix 15 Healthcare Information Request Form Instructions 4.00 Appendix 16 Structured Family Caregiving Waiver Diagnosis Verification Form Instructions Toggle submenu 5.00 Adverse Actions 5.00 Appendix 1 Legal References for Adverse Action 5.00 Appendix 3 Adverse Action Notice Instructions 5.00 Appendix 4 Application for State Hearing Instructions 5.00 Appendix 5 Reversal of Adverse Action Notice Instructions 5.00 Appendix 6 Notice of Closure Instructions Toggle submenu 6.00 Appeal and Hearing Process 6.00 Appendix 1 Department of Social Services, Division of Legal Services Regional Offices 6.00 Appendix 2 Home and Community Based Services Witness Information 6.00 Appendix 3 Qualifying Witness Statement 6.00 Appendix 6 - CMS Letter 6.00 Appendix 7 - Cover Letter 6.00, Appendix 8 Agency Witness List Instructions Toggle submenu 7.00 Show-Me Home 7.00 Appendix 1 Show Me Home Services Specialist 7.00 Appendix 6 SMH/MFP Approval Notice 7.00 Appendix 7 Ombudsman SMH/MFP Referral Instructions Toggle submenu 8.00 Abuse, Neglect and Exploitation 8.00 Appendix 1 Abuse, Neglect and Exploitation Indicators 8.00 Appendix 2 Abuse, Neglect and Exploitation Alleged Perpetrator Indicator List 8.00 appendix 3 - HCBS Referral Form 8.00 Appendix 4 General Health Evaluation & Level of Care Recommendation Instructions 8.00 appendix 5 - Physician Prescription for Personal Care Services 8.00 Appendix 6 - FSD HCB Medicaid Referral 8.00 Appendix 7 - Provider Complaint Report 8.00, Appendix 9 Person Centered Care Plan Instructions 8.05 Participant Case Records 8.15 Provider Complaint Process Toggle submenu 9.00 Confidentiality Requirements 9.00 Appendix 5 Acknowledgement Instructions 9.00 Appendix 6, Authorization For Disclosure Of Consumer Medical/Health Information Instructions Toggle submenu HCBS Policy Clarification Questions Advanced Personal Care Agency Model Personal Care (In-Home Services) Assessment / Reassessment Assisted Living Facility/Residential Care Facility Personal Care Authorized Nurse Visits Consumer Directed Services Consumer Directed Services/Transportation (Essential Transportation) General Overview Respite Care Shared Living Spaces Structured Family Caregiving Waiver (SFCW) Task Chart Print On this page 1.00 Introduction 2.00 Medicaid Eligibility 3.00 Available Home and Community Based Services 4.00 Home and Community Based Services Process Introduction 5.00 Adverse Actions 6.00 Appeal and Hearing Process 7.00 Show-Me Home 8.00 Abuse, Neglect and Exploitation 9.00 Confidentiality Requirements HCBS Policy Clarification Questions Book traversal links for 20846 1.00 Introduction ›