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Missouri Department of Social Services MMAC Missouri Medicaid Audit & Compliance Missouri Department of Social Services MMAC Missouri Medicaid Audit & Compliance
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      • Organized Health Care Delivery System Providers
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    • Participant Enrollment
    • Participant Lock-In
  • Report Fraud, Waste & Abuse
  • Contact Us
MMAC
  • Home
  • About MMAC
    • Administration
    • Financial Section
    • Investigations & Terminations
    • Provider Enrollment
    • Provider Review & Lock-In
  • Providers
    • Home and Community Based Services
    • Provider Manuals
    • Provider Reviews
    • Provider Sanctions
      • Regulations
    • Provider Self-Disclosures
    • IHS Designated Manager & Certified CDS Manager Training/Testing
    • Provider Enrollment
      • MCO Network Providers
      • New Providers
      • Revalidating Providers
      • Ordering, Prescribing & Referring (OPR) Providers
      • Organized Health Care Delivery System Providers
  • Participants
    • Participant Enrollment
    • Participant Lock-In
  • Report Fraud, Waste & Abuse
  • Contact Us

HCBS Provider Forms

Missouri Medicaid Audit & Compliance Post

If you prefer not to print and scan paper documents the HCBS Change Request and common attachment forms are available with DocuSign. To receive our menu of DocuSign forms send an email to  MMAC.DocuSign-NOREPLY@dss.mo.gov with “HCBS” in the subject line.

  • ADC Assurances
  • AIDS Waiver Addendum
  • Attestation of Medical Records Loss or Destruction
  • Business Organizational Structure
  • CDS Annual Service Report
  • CDS Assurances
  • CDS Quarterly Financial & Services Report
  • CDS Service Area Commitment
  • CDS Vendor Profile
  • Change Request – HCBS Providers
  • EFT – Paper Form
  • EVV Attestation Form
  • Financial Management Services (FMS) Addendum
  • HCBS-Ownership-and-Structure-Change-Request-22
  • HCBS Voluntary Termination Form
  • IHS Assurances
  • IHS Provider Profile
  • IHS Service Area Commitment
  • Medically Fragile Adult Waiver (MFAW) Addendum
  • PC (APC) Addendum
  • Respite Timesheet – PDF
  • Respite Timesheet- Excel
  • Structured Family Caregiving Waiver

HCBS Related

  • Provider Certification Training
  • Provider Update Meeting
  • DSDS e-News
  • DHSS Provider Memos
  • FUSION

Governor
Mike Kehoe

mo.gov

MMAC Director
Richard Ferrari

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