Provider Reassessment Information | Home & Community Based Services

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);
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.

SharePoint registration is required to obtain reassessment assignments. To register for SharePoint, contact DSDS HCBS Systems and Data Reporting Unit at providerreassessments@health.mo.gov and provide the following:

Provider agency name
Medicaid provider type 27 number
Contact name
Contact telephone
Contact e-mail

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. The assignments on SharePoint are only to be accessed by the enrolled HCBS provider. Log in information shall not be shared with subcontractors.

Training

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 are responsible for ensuring that all qualified assessors have completed the online reassessment training and passed the exam.

Trainings are now available online. The online modules are best viewed on a laptop or personal computer. Upon completion of all training modules, proof of qualifications and the request for the Provider Reassessment Training Exam shall be emailed to ReassessorTraining@health.mo.gov. Emails shall be sent by the individual requesting to complete the exam from a person specific email address. Emails that have more than one individual requesting an exam will not be accepted. A link to the exam will be emailed back to that individual once qualifications have been verified. An exam will not be graded if a link was not emailed to the tester by DSDS. Exam links will expire 3 days after the link has been emailed.

Note, although you may access and return to the exam once the exam has begun for the entirety of the three days, you will not be able to save your progress.

An individual must pass the test with an 80% or better to receive a certificate. Training certification must be maintained in the assessor’s personnel file and made available upon DSDS or Missouri Medicaid Audit and Compliance (MMAC) request. Individuals that do not pass may request a different test version up to 4 times. After the 4th attempt, no further requests for the exam will be accepted. Training modules, HCBS Policy Manual and quick guides should be reviewed as needed to prepare for a retake. When prepared, the individual should request a new link to the test as stated above.

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 through HCBS Policy Memos and INFO Memos. To receive electronic notification of updates all HCBS providers are to subscribe to DSDS E-News.

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. The assignments located on SharePoint 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.

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 in pending status; and
the Participant Case Summary Screen 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 CyberAccess Web Tool 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 participants care plan is scheduled to expire. Delaying entry of reassessment and documentation into CyberAccess Web Tool should not occur for any reason. The DSDS Provider Reassessor Review Team should be notified immediately once a reassessment and all required documentation is completed via Provider Reassessor Notification Portal.

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 incomplete reassessments should be made using the Provider Reassessor Notification Portal.

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. Provider Reassessors have three (3) business days to complete the requested remediations. Reassessor 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 Quality Assurance Unit 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.

Provider Reassessor Notification Tool Instructions

To submit notification a reassessment’ status, open the Provider Reassessor Notification Portal and enter the following information:

Provider Name.
Name and DCN of the Participant.
Month the current care plan will expire using the drop down menu.
Yes for a completed reassessment.
No for an incomplete reassessment.
- If no is selected, a Reason field will populate, select the most appropriate option from the menu.
Select yes if the Participant needs a provider list mailed to them.
Click submit, this will notify the Provider Reassessment Review Team of the reassessment’s status.

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.
Contact DSDS HCBS Systems and Data Reporting Unit at providerreassessments@health.mo.gov to:

Provider agency name
Medicaid provider type 27 number
Contact name
Contact telephone
Contact e-mail

Communicate issues involving utilization of SharePoint or accessing assigned reassessments.
Inform DSDS 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 providerreassessments@health.mo.gov.