The Department of Health and Senior Services, Division of Senior and Disability Services recently distributed PM-04-08 to all in-home services providers on Feb. 7, 2012. This memo is available at http://health.mo.gov/seniors/hcbs/ihsmemos.php. The memo announced the schedule of regional provider meetings being held by the Division of Senior and Disability Services.
19 CSR 15-7(14)(D) states, “all providers must…ensure the designated managers annually attend division sponsored training designed to update certified managers.” The Missouri Medicaid Audit and Compliance Unit (MMAC) has made the decision to allow attendance at one of these regional provider meetings to meet this annual training requirement.
Certified managers should maintain a copy of the agenda or handouts as proof of attendance at the meeting.
If you have any questions regarding this notice, please contact Provider Contracts via email at mmac.ihscontracts@dss.mo.gov
The Centers for Medicare and Medicaid Services issued State Medicaid Director Letter #09-001 dated January 16, 2009 regarding excluded persons. The letter advises States of their obligation to direct providers to screen their employees and contractors for excluded persons. In particular, the letter states, in part:
Policy Clarification: States Should Advise Medicaid Providers to Screen for ExclusionsTo further protect against payments for items and services furnished or ordered by excluded parties, States should advise all current providers and providers applying to participate in the Medicaid program to take the following steps to determine whether their employees and contractors are excluded individuals or entities:
States should advise providers of their obligation to screen all employees and contractors to determine whether any of them have been excluded. States should communicate this obligation to providers upon enrollment and reenrollment.
States should explicitly require providers to agree to comply with this obligation as a condition of enrollment.
States should inform providers that they can search the HHS-OIG website by the names of any individual or entity.
States should require providers to search the HHS-OIG website monthly to capture exclusions and reinstatements that have occurred since the last search.
States should require that providers immediately report to them any exclusion information discovered.
The letter can be viewed in its entirety at:
https://www.cms.gov/SMDL/downloads/SMD011609.pdf
The Missouri Medicaid Audit and Compliance Unit does consider compliance with the steps outlined in the letter and summarized above as an integral part of a providers’ provision of service delivery to MO HealthNet program participants. Compliance with these requirements may be subject to review by the Missouri Medicaid Audit and Compliance Unit.
The Missouri Medicaid Audit & Compliance Unit (MMAC) issues final decision letters to providers after conducting reviews of post-payment claims. Providers must be aware that the overpayment amount detailed in their final decision (demand) letter is a sanction according to 13CSR 70-3.030. Providers are prohibited from submitting on-line claim adjustments for erroneous payment to correct the overpayment. Providers must submit payment to MMAC Unit via check or electronic transfer from future remittance advice.
Questions and concerns regarding repayment can be directed to the MO HealthNet Division Provider Education Unit representative.
MMAC enforces this sanction per authority of 13 CSR 70-3.030.
