State and federal regulations (13 CSR 65-2 and 42 CFR 455.460) require Missouri Medicaid Audit and Compliance (MMAC) to collect an application fee from all new and revalidating “Institutional” Medicaid providers. “Individual” providers such as physicians, dentists and other individual non-physician practitioners are not required to pay the application fee.
The application fee is currently set at $631.00, and it will increase to $688.00 on January 1, 2023.
Read more about the application fee and hardship waivers
Based on the actions of the Centers for Medicare and Medicaid Services, notice is hereby given that the agreement between the Missouri Department of Social Services and Aspire Senior Living Fayette, as a provider of services in the MO HealthNet (Medicaid) program, will be terminated at the close of business November 24, 2022.
To facilitate the orderly relocation of MO HealthNet beneficiaries, for residents admitted August 23, 2022 or earlier, payment may continue for up to 30 days for services furnished after November 24, 2022.
Todd Richardson, Director
MO HealthNet Division
Department of Social Services
Shelly Williamson, Administrator
Section for Long-Term Care Regulation
Department of Health and Senior Services
On NOVEMBER 17, 2022, MMAC is hosting a one day additional provider update meeting for all HCBS providers who did not attend the October 20, 2022 meeting. The meeting will be the exact same format as the October 20, 2022 meeting. If you missed attending the October 20th meeting, please attend this meeting.
Please go to the link Provider Update Meeting to register.
Due to technical issues, the 10/20/2022 HCBS Provider Update Meeting Proof of Attendance emails have been delayed. Staff are working on this issue and expect to have Proof of Attendance/Thank You For Attending emails go out by October 28th.
The material shared during the 10/20/2022 meeting will be on our website by 10/31/2022 for your reference. Please access https://mmac.mo.gov/providers/hcbs-provider-certification-training/annual-provider-update-meeting/
At this time, we are exploring alternative options for those not able to attend the October 20, 2022 meeting and information will be shared soon about this.
Currently enrolled Adult Day Care providers and Doorways (AIDS Waiver) are REQUIRED to attend a one hour training session hosted by MMAC at 10:00 am on Wednesday, November 2, 2022. The training will be held virtually via WebEx and registration is required prior to joining the session.
HCBS Setting Requirements Nov 2, 2022 – Link to Register WebEx
The training will cover updates to the HCBS Settings Requirements, survey forms, training of employees, and a new provider assurance form. At least one person (Director, owner, or a managing employee) from each provider must attend the session to stay in compliance with enrollment.
Information on the HCBS Setting Requirements, initial findings and assessment/survey can be found on the MMAC website, HCBS provider main page.
https://mmac.mo.gov/providers/provider-enrollment/home-and-community-based-services/
Please DO NOT fill out or return surveys until you have attended the training.
The Fall 2022 session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for October 19 & 20, 2022.
DEADLINE TO REGISTER IS OCTOBER 18, 2022.
The meetings will be held virtually via Webex from 9:00 a.m. to 1:00 p.m. CST each day. Providers will need to register and choose which day they will attend. More information can be found here:
https://mmac.mo.gov/providers/hcbs-provider-certification-training/annual-provider-update-meeting/
If you are a designated manager for an in-home services provider, you are required to attend one of these sessions each year in order to maintain your designated manager certification.
Medicaid Providers: Interested in learning how to navigate MO HealthNet resources, learn more about claim filing, crossover claims, eligibility, spend down and more? Check out our MHD MHD Education and Training Resources and register for trainings on our Provider Training Calendar! For more information, email MHD.ProvTrain@dss.mo.gov.
MO HealthNet Division (MHD) will begin desk audits of providers to ensure proper billing units are used for drugs billed to MO HealthNet. Providers are responsible for proper billing of claims as outlined in Section 15 of the Pharmacy Provider Manual (https://mydss.mo.gov/mhd/provider-manuals). Billing a claim with the incorrect unit of measure may result in greater compensation than entitled. Providers are reminded that they must have adequate documentation, as defined in 13 CSR 70.3.030(2)(A), from which services rendered and the amount of reimbursement received by a provider can be readily discerned and verified with reasonable accuracy. These records must be made available to MO HealthNet upon request.
For more information on what to expect during a desk audit please see here: https://mmac.mo.gov/wp-content/uploads/sites/11/2016/02/Audit-guidance.pdf.
MO HealthNet Division will host a series of webinars to aid providers in proper billing of drug claims to MO HealthNet. These webinars will allow for live questions and will be recorded for future reference. Click below to register.
If MO HealthNet providers have questions on proper billing of drug claims, contact PAU at 573-751-6963 or email MHD.PharmacyAdmin@dss.mo.gov.
Webinar Time Link to Register August 3rd, 2022 1:00pm to 2:00pm Here August 31st, 2022 9:00am to 10:00am Here
According to state regulation 13 CSR 65-2.020(1)(A), all persons are required to enroll with the Missouri Medicaid Audit and Compliance unit (MMAC) as a billing or performing provider in the MO HealthNet Program if the services or items they provide will be billed to the MO HealthNet Program. This requirement applies to all Individual and Organizational providers who are affiliated with PACE Organization.
Any Individual or Organizational PACE provider working for a PACE Organization must enroll with MMAC as a non-billing provider unless they are already enrolled with MMAC. Providers who are already enrolled with MMAC as a FFS, MCO, or OPR provider do not need to submit another application as an Individual or Organizational PACE Provider.
MMAC has created an enrollment packet for Individual and Organizational PACE providers to enroll with MO HealthNet as a non-billing provider. Contact the MO HealthNet Division at MHD.PACE@dss.mo.gov, if you are interested in enrolling to become a PACE Organization provider. Click here for the PACE provider Individual and Organizational applications.
Please submit any questions you may have to MHD.PACE@dss.mo.gov
Many pharmacists are currently interested in enrolling as individual MO HealthNet providers to bill MO HealthNet for prescriptions ordered by pharmacists, such as at-home COVID tests. Pharmacists interested in only Ordering, Prescribing, or Referring (OPR) services for MO HealthNet participants should enroll as OPR providers. Pharmacists interested in performing or billing for services rendered to MO HealthNet participants should enroll as Billing or Performing provider.
OPR Provider Enrollment:
Pharmacists interested in enrolling only to be the ordering, prescribing, or referring provider on claims, MO HealthNet recommends pharmacists enroll as OPR Providers.
Examples of items pharmacists can prescribe in Missouri are: COVID Tests and Nicotine Replacement Therapy Note: Providers who choose to enroll as “OPR only” providers cannot submit medical claims to MO HealthNet for payment of services rendered. If the provider wishes to be able to submit claims for payment, the provider must enroll with MO HealthNet as a billing or performing provider. Time to complete enrollment: 3 – 5 days after receipt of the completed enrollment packet Link to Application: https://mmac.mo.gov/wp-content/uploads/sites/11/2022/03/OPR-Application-2022.pdf Additional OPR Provider Information: https://mmac.mo.gov/providers/provider-enrollment/ordering-prescribing-referring-opr-providers/ Helpful Hints to complete OPR application: Pharmacists must have an individual NPI to enroll. Pharmacists who do not already have an individual NPI can request one at: https://nppes.cms.hhs.gov/#/ Section 3 of the application asks for non-physician specialty, pharmacists should indicate: Unlisted Non-Physician Practitioner Type Specify: Pharmacist (E5) Completed applications must: Individually faxed to Provider Enrollment @ 573-634-3105 or email to: mmac.providerenrollment@dss.mo.gov Have the original wet signature of the individual provider No bank account information is needed to complete the application
Billing or Performing Provider Enrollment:
Pharmacists interested in enrolling with MO HealthNet to perform and be reimbursed for clinical services in addition to being able to order, prescribe and refer for MO HealthNet participants. Current pharmacist clinical services include but are not limited to: Medication Therapy Management and administration of healthcare administered drugs.
Time to complete enrollment: 2 to 3 weeks after receipt of the completed enrollment packet Link to application and additional enrollment information:
https://mmac.mo.gov/providers/provider-enrollment/ Helpful Hints to complete Billing or Performing Provider application: Pharmacists must have an individual NPI to enroll. Pharmacists who do not already have an individual NPI can request one at: https://nppes.cms.hhs.gov/#/ Section 3 of the application asks for non-physician specialty pharmacists should indicate: Unlisted Non-Physician Practitioner Type Specify: Pharmacist (E5 When enrolling, providers need to complete electronic funds transfer information for payment Completed Applications with an original wet signature of the individual provider may be submitted by: Email: mmac.providerenrollment@dss.mo.gov Fax: 573-634-3105
