The Missouri Medicaid Audit and Compliance Unit (MMAC) has been advised that some Personal Care Services (PCS) providers have 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 their EVV vendor with EAS using this link: Missouri DSS EAS (EVV Aggregator Solution): Provider Online EVV Vendor Registration (office.com)
To register with 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 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/
The Centers for Medicare & Medicaid Services (CMS), in partnership with the States, is measuring improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs under their Payment Error Rate Measurement (PERM) process.
CMS and its PERM contractors will be sending records requests directly to Missouri Medicaid/CHIP providers for claims billed during state fiscal year 2021. Additional information about the PERM program is addressed on the CMS PERM website (https://www.cms.gov/PERM). Refer to the “Providers” link on the website.
Federal regulations require that Medicaid/CHIP providers submit the medical record documentation to support claims for Medicaid/CHIP services to CMS upon request. Providing medical records for Medicaid/CHIP patients does not violate the Health Insurance Portability and Accountability Act (HIPAA). Patient authorization is not required to respond to this request. CMS and its contractors will comply with the Privacy Act federal regulations governing the sharing and transmission of Protected Health Information (PHI).
Please refer to the PERM sample letter and to the PERM Provider Frequently Asked Questions document for more information.
Questions regarding the PERM audit may also be directed to the State PERM representative Joyce Chandler at 573-751-7993 or please email MMAC.PERMAUDITS@DSS.MO.GOV.
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
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.
To comply with Missouri state regulation and the 21st Century Cures Act, all Personal Care Service (PCS) providers are required to have fully implemented Electronic Visit Verification (EVV) systems as of January 1, 2021. All PCS providers should now be using an EVV system to collect data related to service delivery. To view more information regarding EVV visit Electronic Visit Verification | Missouri Department of Social Services, MO HealthNet Division.
The link below contains an online EVV Vendor Registration which should take approximately five minutes to complete. The intent of the online EVV Vendor Registration is to collect information from all participating PCS providers to assist with the EVV Aggregator Solution (EAS) implementation. Once registration has been completed, the PCS provider agency will receive confirmation that Sandata Technologies has received the registration information. Sandata Technologies will work with EVV vendors to develop the necessary data interface to the EAS. If you have more than one EVV vendor, you must complete this online EVV Vendor Registration for each EVV vendor utilized.
All PCS provider agencies must complete the online EVV Vendor Registration by July 30, 2021.
PCS providers who fail to complete this online EVV Vendor Registration will be subject to having one or more administrative sanctions listed in 13 CSR 70-3.030(4) imposed by the Missouri Medicaid Audit & Compliance (MMAC) Unit, up to and including termination from the Missouri Medicaid program.
Link to Registration: Missouri DSS EAS (EVV Aggregator Solution): Provider Online EVV Vendor Registration (office.com)
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
