The Spring session of Missouri Medicaid Audit and Compliance’s (MMAC) Annual Update Meetings for Home and Community Based providers is scheduled for April 10, 11, and 12, 2018. The meetings will be held in Rooms 490-492 at the Harry S. Truman Building in Jefferson City from 10:00 a.m. to 3:00 p.m. each day. Providers should plan to attend one day only (material is the same for each day and providers pick the day they wish to attend).
The content of the Spring Session will focus on In-Home Services (IHS) and Consumer-Directed Services (CDS).
Our Adult Day Center, Residential Care Facility, and Assisted Living Facility providers are all welcome to attend, but it is not required and the content will focus on IHS and CDS.
The Fall Session meetings are scheduled for October 23, 24, and 25, 2018.
MO HealthNet Providers, please read this important message:
In an effort to address Missouri’s emergent opioid crisis, the Departments of Social Services, Health and Senior Services and Mental Health are expanding upon the Opioid Prescription Intervention (OPI) Program. The OPI Program helps ensure MO HealthNet participant safety by enforcing national standards through the use of Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain. For more information about the OPI Program, please reference the MO HealthNet provider OPI webpage and Governor Greitens’ press release.
Providers whose prescribing habits recently fell outside the CDC guidelines will receive a letter in the mail regarding the OPI program. If you do not receive a letter, that means you are prescribing within the guidelines.
In addition, on March 6, 2018, MO HealthNet will implement the following revisions to the short-acting opioid and short-acting combination opioid clinical edits. The revisions to the edits are listed below:
Initial Rx for Opioid-Naïve participants will be limited to 50 MME’s Acute opioid therapy will be limited to 60 days AND Acute opioid therapy is not to exceed 90 MME’s Opioid therapy > 60 days will be considered Chronic and will require a PA Chronic Non-Malignant Pain (CNMP) diagnoses have been streamlined AND PA for CNMP will be limited to approved diagnoses only
DSS and MO HealthNet are committed to providing consultation, training, and assistance in an effort to improve a providers’ compliance with CDC opioid prescription guidelines. Please contact MMAC.OPICompliance@dss.mo.gov if you have questions.
For provider and policy issues regarding MHD Clinical Services Programs, including Pharmacy, The Missouri Rx Plan (MORx), Psychology, Exceptions, and Medical Precertifications, email us at: clinical.services@dss.mo.gov.
Questions and comments regarding any other issues should be directed to: ask.MHD@dss.mo.gov
The Missouri Department of Social Services (DSS) is developing and prioritizing many new initiatives to increase the efficiency of our programs and move resources to the areas where they are needed the most. To that end, DSS would like to know what causes you frustration when dealing with any of the divisions within DSS. What are your personal “pain points” that we could address to make your interactions with DSS more efficient and less frustrating. DSS has formed an executive leadership committee to seek out and compile input on those pain points from all our customers, including but not limited to, Medicaid participants, health care providers, social workers, and even representatives of other local, county, state, and federal agencies.
If you have one or more pain points you would like to share, please respond by email to MMAC.General@dss.mo.gov
I will make sure your input gets to the committee and is given full consideration. Thank you in advance for taking the time to communicate your concerns to DSS.
A Provider Bulletin on “Telehealth” is now available online at: https://dss.mo.gov/mhd/providers/pages/bulletins.htm
For provider and policy issues regarding MHD Clinical Services Programs, including Pharmacy, The Missouri Rx Plan (MORx), Psychology, Exceptions, and Medical Precertifications, email MHD at: clinical.services@dss.mo.gov.
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 $560.00, and it will increase to $569.00 on January 1, 2018.
Click here to read more about the application fee and hardship waivers
Cyberattacks are a growing threat to healthcare organizations. Ransomware is one form of a cyberattack which can cripple a healthcare provider’s services. With ransomware, the attacker encrypts the victim’s system or data, holding it hostage until payment is received. Paying the ransom to restore your system and recover your data is not a good emergency response plan. What if the attacker demands more ransom? Think about assessing your preparedness for a cyberattack; has your healthcare organization developed emergency response strategies, assigned a proper response team, conducted exercises, or planned for other health care providers to maintain continuity of care for your patients?
Federal regulations at 42 CFR § 485.727require Medicaid providers to take an all-hazards approach to emergency preparedness planning, including cyberattacks. In August, MMAC posted information regarding the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. For your convenience, here are links directly related to the cybersecurity information:
Homeland Security Threats emergency preparedness general guidance, with downloads, at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Homeland-Security-Threats.html How to Protect Your Networks from Ransomware: A letter from HHS Secretary Burwell at https://asprtracie.s3.amazonaws.com/documents/burwell-colleague-letter-ransomware-tipsheet.pdf
Taking steps to assess, plan for, and respond to a cyberattack will go a long way in warding off this man-made emergency.
Effectively immediately, the Missouri Medicaid Audit and Compliance Unit (MMAC) is changing our policy regarding the enrollment of Federally Qualified Health Centers (FQHCs) and “FQHC look-alikes”. Previously, MMAC required FQHCs to be enrolled with Medicare before applying for enrollment with MO HealthNet. Recent analysis determined there is no federal or state requirement for a FQHC to be enrolled with Medicare and Missouri’s policy was not consistent with how other states are enrolling FQHCs in their Medicaid programs.
Effective immediately, a FQHC applying for enrollment with MO HealthNet must submit, from among the following, a copy of the current Notice of Grant Award from Public Health Services (PHS): 1) Section 329-Migrant Health Centers, 2) Section 330-Community Health Centers or 3) Section 340-Services to Homeless Individuals.
Non-federally funded health centers, which the Secretary of the Department of Health and Human Services has designated as a FQHC (“FQHC look-alikes”), must submit a copy of the letter from PHS designating the facility as an “FQHC look-alike” or as a non-federally funded health center.
Non-federally funded health centers that the Secretary of the Department of Health and Human Services determines may, for good cause, qualify through waivers of the PHS requirements, must submit a copy of the letter from PHS designating the facility as an “FQHC look-alike.” Waivers may be granted for up to two (2) years.
All other requirements for a provider applying for enrollment with MO HealthNet as a FQHC remain the same.
Any questions regarding this change of policy for the enrollment of FQHCs should be directed to the MMAC Provider Enrollment Unit at 573-751-3399 or MMAC.ProvderEnrollment@dss.mo.gov
On November 30, 2017, a new state rule (13 CSR 65-3.050) will be effective for electronic signatures in the MO HealthNet Program. The new rule establishes the basis on which health care providers and participants under Missouri Title XIX programs may use electronic signatures when validating services rendered and received.
As defined in the new rule, an “electronic signature” means a computer data compilation of any symbol or series of symbols executed, adopted, or authorized by an individual with the intent to be the legally binding equivalent of the individual’s handwritten signature. The use of biometrics does not constitute an electronic signature; however, biometrics may be used as part of electronic signature verification. A signature stamp or typing the name of the provider or participant on a form does not constitute an electronic signature. If a law or regulation requires a signature to be in writing, an electronic signature shall satisfy such law for MO HealthNet purposes.
Providers are not required to conduct business electronically, but if they choose to do so – they need to comply with the requirements of the new electronic signature rule. The new rule does not eliminate the requirement for certain Home and Community Based Services (HCBS) providers to utilize telephony/electronic visit verification.
All providers are encouraged to review the requirements of the new rule. There are specific requirements for any electronic signature system, including (but not limited to) the tracking of: (1) User log-in and log-out dates and times; (2) User identification; (3) Device Identification; (4) Dates and times when records are created, updated, viewed, or modified; and (5) The process of affixing an electronic signature shall require at least two (2) distinct identification components, such as an identification code and a password.
Any questions regarding the proper use of electronic signatures for services that will be billed to MO HealthNet should be directed to Missouri Medicaid Audit & Compliance (MMAC) at 573-751-3399 or MMAC.General@dss.mo.gov
Current state and federal regulations (13 CSR 65-2 and 42 CFR 455.410) require Ordering, Prescribing or Referring (OPR) providers to enroll with Medicaid, even if they do not accept Medicaid. In response, MO HealthNet (MHD) began implementing changes in the claims processing system to deny all claims that require an order, prescription or referral from a physician or other licensed health care professional unless that physician or provider has an active enrollment record on file.
Effective November 1, 2017, claims for Durable Medical Equipment (DME), Home Health, Independent Laboratories, and Radiology (Imaging) providers will deny unless the OPR provider’s National Provider Identifier (NPI) is listed on the claim, and the OPR provider is actively enrolled with MO HealthNet.
DME providers – The claims system will not recognize referring providers submitted in the Ordering provider field until additional systems work has been completed. Put the NPI of ordering providers in the referring provider field until further notice.
Home Health – The claims system will not recognize referring providers submitted in the attending provider field until additional systems work has been completed. Put the NPI of attending providers in the referring provider field until further notice.
Independent Laboratory – Put the NPI of the referring physician or non-physician practitioner in the referring provider field.
Radiology (Imaging) – Put the NPI of the referring physician or non-physician practitioner in the referring provider field.
In order to assist with this process, the Missouri Medicaid Audit and Compliance Unit (MMAC) provides an OPR Application that can be downloaded (link) or utilized as a fillable PDF form (link).
MMAC’s provider enrollment personnel will expedite all OPR applications received.
For more information please choose “Providers” from the MMAC home page, and then choose “Provider Enrollment” and then choose “Ordering, Prescribing, and Referring” providers.
Please submit any questions to MMAC.ProviderEnrollment@dss.mo.gov
