The Missouri Medicaid Audit and Compliance Unit (MMAC) has been made aware that some HCBS providers have not been conducting FCSR checks on new employees/personal care attendants, under a mistaken assumption it was not required during the declared COVID health emergency. The Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS) did grant limited flexibility on their COVID-19 Flexibility Authority Chart to “Suspend requirements for background and Good Cause Waiver to be returned prior to aides providing care”. That flexibility did not mean that FCSR checks didn’t have to be initiated before the individuals had their first contact with Medicaid participants.

On the DSDS webpage for COVID-19 HCBS Provider Information, DSDS guidance that has been in place since March 2020 states:

Family Care Safety Registry (FCSR)

The state will waive the requirement for the FCSR background check to be returned prior to the start of the individual providing care as it is anticipated there may be a delay in background check processing. The provider shall file the FCSR request prior to the aide providing care, and the aide/attendant may begin providing care immediately. If a potential aide/attendant requires a Good Cause Waiver, the state will waive the requirement for the waiver to be returned prior to the individual providing care. Providers shall only make this exception for crimes that are typically waived with the Good Cause Waiver.

HCBS providers that have not conducted FCSR checks on employees/personal care attendants that were hired since the beginning of the COVID-19 health emergency should do so immediately. Providers with questions may contact LTSS@health.mo.gov or MMACProviderReview@dss.mo.gov

In order to allow additional Personal Care Service providers to participate in a virtual stakeholder meeting introducing Sandata Technologies as Missouri’s EVV Aggregator Solution (EAS) vendor, a second meeting has been scheduled.

August 2, 2021

2:00 – 3:00

Registration

The presentation will have the same content as the stakeholder meeting hosted on July 26, 2021 and will clarify the process for integration with the EAS. There will also be an opportunity for questions regarding implementation of the EAS. This meeting’s intended audience is Personal Care Service providers.

If you have questions or need assistance with the online EVV Vendor Registration contact Sandata Technologies at MOAltEVV@Sandata.com.

The State of Missouri (State) Office of Administration (OA) has awarded Contract #CT210348001 to Sandata Technologies, LLC. (Sandata) to implement the State’s Electronic Visit Verification (EVV) Aggregator Solution effective April 1, 2021. This contract was issued in order to meet the requirements established by the federal 21st Century Cures Act (the Cures Act), the Centers for Medicare & Medicaid Services (CMS) rules and regulations, and Missouri Rule 13 CSR 70-3.320.

As part of this contract, Sandata will implement an EVV vendor-neutral aggregator system designed to interface and store the data from the EVV vendors operating in Missouri. Sandata will be responsible for interfacing with the EVV systems and ensuring the required data elements are being captured and exchanged. Sandata is experienced in developing interfaces with EVV vendors and has done so across multiple states. Sandata will provide the necessary specifications for EVV vendor integration. In addition, Sandata will offer training for both EVV vendors and personal care service providers regarding utilization of the aggregator system.

Based on the State’s Provider Choice model, each personal care service provider can choose their preferred EVV vendor and is responsible for ensuring the EVV data is recorded into the EVV vendor’s system accurately and in a timely manner. Communications from Sandata regarding initial steps for data and system integration will be forthcoming. EVV-related bulletins, administrative rules, and other announcements can be found at the MO HealthNet Division’s website.

Project implementation for personal care services will take place over the next twelve months. The State will be working closely with personal care service providers, EVV vendors, and Sandata to achieve successful implementation.

208.919.2, RSMo, requires CDS vendors to submit an annual financial statement audit performed by a certified public accountant if the vendor’s annual gross revenue is two hundred thousand dollars or more or, if the vendor’s annual gross revenue is less than two hundred thousand dollars, an annual financial statement audit or annual financial statement review performed by a certified public accountant.  The financial statement audits/reviews are normally required to be submitted to MMAC within 150 days of the end of the CDS vendor’s fiscal year.

Due to the COVID-19 health emergency, the Missouri Department of Health and Senior Services (DHSS) requested and received authority to grant flexibilities for certain statutory requirements, including the annual CDS audits/reviews.  The deadline date for CDS vendors to submit their annual CDS audits/reviews has been extended until the expiration of the declared COVID-19 public health emergency, which is currently August 31, 2021.  The current deadline may or may not be extended further.

Complete listing of the current COVID-19 Flexibilities authorized by DHSS and MO HealthNet.

Questions regarding submission of annual CDS audits or quarterly Financial and Services reports should be emailed to:  MMAC.CDS@dss.mo.gov

MO HealthNet (MHD) and Missouri Medicaid Audit and Compliance (MMAC) are contracted with Health Management Systems (HMS) to conduct post payment reviews of claims for Hospital and Long Term Care facility Credit Balance Audits and the Commercial Insurance Disallowance Audit Cycles.

MO HealthNet is the payer of last resort with all other insurances being primary to Medicaid. The Long Term Care Audits and Hospital Credit Balance Audits are designed to assist providers in identifying when another insurer has paid and Medicaid is due a refund due to a coordination of benefits billing error.

The Commercial Insurance Disallowance Cycles are post payment reviews conducted by HMS to identify Liable Third Party resources that should have been billed prior to MO HealthNet. HMS conducts a data match between the MO HealthNet participant eligibility data and the information they receive from the Commercial Carriers to identify insurers that may have been unknown to the provider at the time of service. As part of Medicaid reclamation, the provider is instructed to bill the commercial plan identified for payment of the claim. The Commercial Insurance Disallowance Audit Cycles are conducted every 90 days for medical and pharmacy claims.

HMS, acting on behalf of MMAC/MHD, has been instructed to send all audit notices via mail to the providers address on record with MMAC. MO HealthNet providers should ensure HMS audit notices are being routed to the correct person or office within their organization.

If you have any questions, comments or concerns about this update, please contact MMAC/HMS Audits at 573-751-3399 OR Via Email at MMAC.Financial@dss.mo.gov

MO HealthNet providers can verify their addresses on file by sending an email to

MMAC.ProviderEnrollment@dss.mo.gov

The spring session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for April 21 & 22, 2021. DEADLINE TO REGISTER IS APRIL 20, 2021.

The meetings will be held virtually via Webex Events Center from 9:00 a.m. to 1:00 p.m. 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.

MO HealthNet Division (MHD) and Missouri Medicaid Audit & Compliance (MMAC) contract with HMS to conduct commercial insurance disallowance audits on various provider types, including pharmacies. For the current cycle of pharmacy audits, HMS and MMAC sent audit letters which included questioned claims of less than $100. Subsequently, HMS and MMAC decided to exclude all claims under $100. Pharmacies that received audit letters and only had claims of less than $100 will receive notification their audit is being cancelled. Pharmacies that received audit letters for claims both above and below $100 will be notified the claims less than $100 are being carved out of their audit. If you have already submitted those claims to the commercial insurance carrier, please continue to process the claims. If you have received a denial from the carrier for those claims, you can resubmit the claim to MO HealthNet for repayment. 

MMAC will be sending letters as soon as possible to the pharmacies with claims that are being removed from this cycle. 

If you have any additional questions, please contact MMAC at 573-522-5633 or via email at MMAC.FINANCIAL@DSS.MO.GOV

Missouri Governor Parson approved Executive Order 20-04 on March 19, 2020, waiving 13 CSR 65-2.020(5) and 13 CSR 65-2.020(9) to allow the Missouri Medicaid Audit and Compliance Unit to expedite new provider enrollment applications and to waive certain requirements such as application fees and onsite visits. The Order was effective March 1, 2020 through May 15, 2020, “unless extended in whole or in part.”

MMAC did not request an extension to our part of the order, and resumed regular enrollment and revalidation activities after May 15, 2020.

On August 26, 2020, the Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS), issued Directive 3.25 (Appendix 1) for Consumer Directed Services (CDS) Tax Information Documentation Requirements. DSDS directed all CDS vendors to upload proof of the assignment of a Federal Employer Identification Number (FEIN) and a Missouri Tax Information Number (MO-TIN) for each CDS participant into the Home and Community Based Services (HCBS) Web Tool.

The DSDS Directive can be located here. HCBS Section 3.25, Appendix 1, with detailed information for CDS vendors on uploading the tax numbers can be located here.

CDS vendors who do not upload their participants’ federal and state employer tax ID numbers to the HCBS Web Tool within the timeframes specified in HCBS Section 3.25, Appendix 1, will be subject to administrative sanctions including, but not limited to, suspension of their Medicaid payments or participation in the CDS program.

Any questions should be directed to the DSDS Bureau of Long Term Services and Supports via email at LTSS@health.mo.gov