General Proposal Information for In-Home Services and Consumer Directed Services
Home and Community Based Services (HCBS) programs are intended to provide necessary assistance in meeting the unmet needs of seniors and adults with disabilities and enable the individuals to remain in the least restrictive environment. HCBS consists of two separate programs, in-home services (agency model) and consumer directed services (consumer-directed model). Separate proposals are required in order to be considered for the two programs.
The HCBS programs are operated by three state agencies:
- Missouri Department of Social Services (DSS), MO HealthNet Division (MHD). MHD is the single state Medicaid agency responsible for administering the Medicaid program, including HCBS programs.
- Missouri Department of Social Services, Missouri Medicaid Audit and Compliance Unit (MMAC). MMAC is responsible for determining potential business entities’ eligibility to participate in HCBS programs as a Medicaid provider.
- Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS). DSDS or its designee is responsible for assessing, developing an individualized care plan, and authorizing HCBS services for eligible DSDS participants.
Purpose of Proposal
In order to be considered for Medicaid enrollment with MMAC, a proposal must be submitted to MMAC for consideration for a participation agreement (“contract”). A proposal is necessary for MMAC to evaluate the potential capability of business entities to provide HCBS in compliance with minimum regulatory program standards designed to ensure the health, safety and welfare of program participants.
Proposal Submission Requirements
All information listed in the appropriate Proposal for Contract must be submitted in order to be considered for a contract. The following preliminary requirements must be met or the proposal will be denied. The proposal must:
- Follow the current fiscal year Proposal for Contract;
- Be in the same order as the Proposal for Contract;
- Each policy and procedure must:
- Be on a separate sheet of paper;
- Include corresponding headings and numbering as the Proposal for Contract;
- Be signed (printed and signed name) by an authorized representative of the entity;
- Include the correct legal name of the entity throughout the proposal.
- Not use plastic page protectors or bind the proposal in any way (three-ring binder, brads, etc.)
Once a proposal is submitted to MMAC, it becomes the property of MMAC and will not be returned to the applying provider. Prior to mailing the proposal and/or any additional information requested, make a copy of the proposal for your records.
Hand-delivered proposals must be left with the receptionist. No receipts will be provided unless a pre-prepared receipt is brought with the proposal. The receptionist will then date stamp the receipt.
Proposal Review and Approval Process
Upon receipt of a proposal, MMAC Provider Contracts:
- Will review the proposal to determine the applying provider’s eligibility for a contract. MMAC will conduct any investigation necessary to verify or supplement the information contained within the proposal.
- If the proposal is incomplete or further information is needed from the applying provider to verify or supplement the proposal, MMAC will mail a written request for additional information.
- The applying provider is given thirty (30) days to submit the additional information. The proposal will be held pending receipt of the requested information. The written request will include Medicaid enrollment information that must be completed in order to process the Medicaid enrollment later in the process. Failure to properly complete the enrollment information will delay the enrollment process.
- Failure to provide the additional information by the deadline noted in the written request will result in denial of the proposal.
- Requests for extension of the deadline will not be granted.
- MMAC will not pre-review policies and procedures prior to their official submission.
- Failure to submit all requested information that complies with requirements of the applicable program in response to the written request will result in denial of the proposal.
- If the written proposal is approved, a site visit will be scheduled and conducted by MMAC staff. The visit will include interviews with the applying provider’s director, designated manager and RN supervisor. Staff must be knowledgeable of the requirements of the program.
- After the site visit, if a decision is made to offer a contract, the contract will be mailed to the applying provider for completion. The applying provider is never to assume the receipt of a contract for signature constitutes a binding contract until MMAC signs the contract.
- Upon return of the properly completed contract to MMAC Provider Contracts, MMAC will execute the contract. The applying provider will receive a copy of the fully executed contract and written notification of their SSBG/GR provider number. At this same time, the Medicaid enrollment information that was completed during the proposal process will be forwarded to MMAC Provider Enrollment Unit for their review. If approved, MMAC Provider Enrollment Unit will notify the Provider by mail. MMAC Provider Enrollment Unit, at its discretion, may deny or limit the applying Provider’s enrollment and participation in the Missouri Title XIX Medicaid program as outlined in 13 CSR 70-3.020.
- Upon receipt of the notification from MMAC Provider Enrollment Unit of approval, providers can begin providing services to participants when authorizations are received from DSDS or its designee.
After submission of a proposal, it is approximately six months before provider numbers are issued and services can be provided to DSDS participants. The amount of time required may be longer depending on the quality of the proposal submitted, the current workload of MMAC staff, and how quickly the applying provider responds to requests for additional information.
Provider Reimbursement Rates
Reimbursement rates are subject to and determined by the State Legislature on an annual basis. MHD publishes information on the reimbursement rates each year. MHD’s Provider Bulletin Vol. 34, #2 dated July 27, 2011 contains the current maximum rate that will be paid for each service type provided. For example, the in-home services basic personal care current maximum rate is $4.24 per unit (or 15 minutes). While the rates listed in MHD’s Provider Bulletin are the maximum rates that will be paid, the provider’s usual and customary charge for each service provided should be billed.
Number of Participants
MMAC’s approval of the business entity’s proposal or subsequent Medicaid enrollment does not guarantee any particular volume of participants or that the services of a provider will be utilized by any state agency. Participants have the right to choose the care option, care setting and provider to deliver his/her care. When necessary to assist participants, questions will be answered by state agency staff, or their designee using information obtained through the proposal and enrollment processes and subsequent contacts by state agencies with the provider.
MMAC is not aware of any organizations available to assist with the completion of a proposal or any grants available to defray the cost of starting a business.
The Missouri Business Portal includes information for starting a business in Missouri. The website address is http://business.mo.gov/.
Should you require additional information or have questions regarding the proposal process, you must review the Frequently Asked Questions (FAQs) prior to contacting MMAC. If you still have questions, you must contact MMAC Provider Contracts by e-mail at firstname.lastname@example.org. Submitting questions through e-mail will provide a written record of MMAC Provider Contracts’ response. Your e-mail must include the name of your agency.