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
The Missouri Department of Mental Health (DMH), Division of Developmental Disabilities (DD), issued a notice that the Centers for Medicare & Medicaid Services (CMS) approved Missouri’s request to renew the 1915(c) Home and Community Based Services (HCBS) waivers. Upon CMS waiver approval, changes were implemented that impact Group Home, Individualized Supported Living, Shared Living providers and Remote Services for the 1915(c) Home & Community Based Service waivers. The Implementation of Waiver Service Changes in Response to CMS Waiver Renewal memo has been posted and applies to all four 1915(c) waivers and individuals serviced by those waivers statewide.
The DMH DD memo contains information for transition of Personal Assistant, Individualized Skill Development, or Community Networking Service from Group Home, Individualized Supported Living, and Shared Living. It also contains information for transition of Remote Monitoring from Personal Assistant Service to Assistive Technology Service.
Effective October 18, 2021, the U.S. Department of Health and Human Services issued a declaration that a federal public health emergency is still in existence related to COVID19. The previous declaration was set to expire October 18, 2021. The renewal will be effective for 90 days or until Sunday, January 16, 2022.
The Missouri State Public Health Emergency ended on August 31, 2021. Missouri Executive Order (EO) 21-09 was signed declaring a Targeted State of Emergency for Health Care System through December 31, 2021. All DMH and DHSS Code of State Regulations waived under the previous state public health emergency will remain waived through under EO 21-09 through December 31, 2021.
The CMS Appendix K Addendum will expire no later than six (6) months after the expirations of the federal public health emergency.
The DMH COVID-19 Flexibility Authority Chart was updated with the renewed federal public health emergency expiration date. The DHSS COVID-19 Flexibility Authority Chart has also been updated to reflect the new expiration dates.
The Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS), issued final notice earlier today to all Type 27 (State Designee – Reassessments) providers who have not yet returned their updated Provider Reassessor Terms and Conditions forms. All Type 27 providers must have the updated Terms and Conditions signed and returned to Missouri Medicaid Audit and Compliance Unit (MMAC) by November 30, 2021 in order to continue conducting reassessments on behalf of DSDS. Providers who have not returned a signed copy by November 30th will have their Type 27 enrollment deactivated by MMAC.
Please refer to INFO 07-21-01 for more information. The Type 27 Terms and Conditions form can be found on the MMAC Reassessor Page.
If you have questions regarding this memorandum, please contact the Bureau of Long Term Services and Supports (BLTSS) via e-mail at LTSS@health.mo.gov
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 North Village Park, as a provider of services in the MO HealthNet (Medicaid) program, will be terminated at the close of business October 15, 2021.
To facilitate the orderly relocation of MO HealthNet beneficiaries, for residents admitted June 6, 2021 or earlier, payment may continue for up to 30 days for services furnished after October 15, 2021.
Kirk Mathews, Acting Director
MO HealthNet Division
Department of Social Services
Shelly Williamson, Administrator
Section for Long-Term Care Regulation
Department of Health and Senior Services
Some Personal Care Services (PCS) providers have still not registered with the Electronic Visit Verification (EVV) Aggregator Solution (EAS), hosted by Sandata Technologies. All PCS providers that currently have Medicaid participants authorized to receive PCS services are required to register with the EVV EAS using this link: Missouri DSS EAS (EVV Aggregator Solution): Provider Online EVV Vendor Registration (office.com)
To register with the EAS, you will need your nine-digit MO HealthNet provider ID number(s). This number is not your NPI, IRS Employer Identification Number (EIN), MO DOR EIN, or Social Services Block Grant (SSBG) number on your PCS contracts. Some providers may have more than one MO HealthNet provider ID number, depending on whether you provide state plan In-Home Personal Care and Consumer Directed Services (CDS) and whether you enrolled with more than one legal entity using different IRS EINs. If you do not know your assigned MO HealthNet provider ID number(s), you can request that information by sending an email with your NPI number(s) to MMAC.EVV@dss.mo.gov.
PCS Providers who fail to register with the EVV EAS are subject to having their Medicaid payments suspended by MMAC.
PCS providers that are enrolled with MO HealthNet, but don’t currently have any participants authorized by the Missouri Department of Health and Senior Services (DHSS) or the Missouri Department of Mental Health (DMH) are not required to register with EAS until such time as they contract with an EVV vendor and begin providing PCS services.
If you have questions or need assistance with the online EVV provider registration, contact Sandata Technologies at MOAltEVV@Sandata.com
MO HealthNet has posted a lot of useful information for PCS providers about EVV requirements, including detailed Frequently Asked Questions (FAQs) on their website at https://dss.mo.gov/mhd/providers/electronic-visit-verification.htm
Providers can also submit EVV questions to MO HealthNet as ASK.EVV@dss.mo.gov
The DHSS Division of Senior and Disability Services (DSDS) has posted EVV information on their website at https://health.mo.gov/seniors/hcbs/
