On July 22, 2020, Governor Mike Parson announced a new Nonprofit Relief and Recovery Grant that could provide up to $22 million for Missouri nonprofits assisting communities in response to COVID-19. Organizations eligible for this grant are 501(c)(3) nonprofits, excluding hospitals, schools, and animal charities. Funds can be used to cover hazard pay for direct health care workers, leasing additional space for social distancing, testing costs, program payroll and supply expenses related to increased demand for nonprofit services, direct assistance to individuals and families, and more.  To read the Governor’s press release.

The Missouri Medicaid Audit and Compliance (MMAC) Provider Enrollment Unit (PEU) frequently receives requests to backdate provider enrollment applications. MMAC will not backdate the effective date of a provider’s Missouri Medicaid enrollment prior to the date MMAC received the provider’s application, except in very specific situations, such as out of state emergency services. This is outlined in state regulation. 

13 CSR 62-2.020 Provider Enrollment and Application

     (1)  Enrollment;

          For any person to receive payment from the MO HealthNet Program for items or services other than out-of-state emergency services, the billing providers and the performing providers of such items or services must be enrolled providers in the MO HealthNet Program on the date the items or services are provided unless applicable rules or manuals permit enrollment as of an earlier date, up to a maximum of three hundred sixty-five (365) days prior to the actual enrollment date.

Questions regarding enrolling with the MO HealthNet program can be emailed to MMAC.ProviderEnrollment@dss.mo.gov

MMAC continues to receive questions from MO HealthNet providers about whether gifts of “nominal value” violate federal or state Medicaid kickback statutes or regulations. Gifts of nominal value are things like calendars, mugs, pens, refrigerator magnets, small plants, and gift certificates for a small amount. The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued advisory opinions indicating gifts of “nominal value” do not violate federal Medicare or Medicaid regulations. The OIG interprets “nominal value” as having a retail value of no more than $15 per item or $75 in aggregate per participant on an annual basis. Click here for the OIG Policy Statement Regarding Gifts of Nominal Value.

§191.905.2 RSMo parallels the federal anti-kickback statute. The state statute prohibits knowingly offering or paying, or soliciting or receiving in a manner whatsoever, remuneration (anything of value) in exchange for referring another person for health care services or for purchasing or furnishing of health care. The statute provides for an exception for discounts that are properly disclosed and accounted for in cost reports. The statute also incorporates the safe harbors provided for in federal regulations as additional exceptions.

With regard to written complaints or hot-line calls that a particular Missouri Medicaid provider is violating federal or state anti-kickback statutes, MMAC will adhere to OIG’s advisory option in determining whether a violation has likely occurred and/or whether further investigation is needed.

All MO HealthNet providers are required to keep their enrollment information current. 

13 CSR 70-3.020 Title XIX Provider Enrollment
(7) The provider shall advise the single state agency, in writing, on enrollment forms specified by the single state agency, of any changes affecting the provider’s enrollment records within ninety (90) days of the change, with the exception of change of ownership or control of any provider which must be reported within thirty (30) days.

Changes can be reported to MMAC by using the Provider Update Request Form found here.

Home & Community Based Providers should use the Change Request form found here.

Please follow the submission instructions provided within the forms.

CDS vendors are required by 19 CSR 15-8.400(7)(J) to submit an annual audit performed by a Missouri licensed CPA within 150 days of the end of the vendor’s fiscal year. The majority of CDS vendors’ fiscal years run January 1 – December 31, making the audit due May 31st.

Pursuant to Executive Orders 20-02, 20-04, and 20-10, the Director of the Missouri Department of Health and Senior Services (DHSS) has waived 19 CSR 15-8.400(7)(J) to the extent necessary to extend the annual audit submission deadline until August 31, 2020. To see the DHSS Director’s waiver authorization click here.

MMAC is taking preventive measures and cancelling all Provider Update Meetings scheduled for June 2-4, 2020.

To allow for social distancing, MMAC is researching alternative delivery formats for the Provider Update Meetings scheduled for October. We will announce any changes well in advance of those meetings.

For more information regarding HCBS Update Meetings:

https://mmac.mo.gov/providers/hcbs-provider-certification-training/annual-provider-update-meeting

Thank you for your patience as we respond to the current Covid-19 State of Emergency.

On March 18, 2020, MO HealthNet published the following hot tip:

To expedite provider enrollment into the MO HealthNet program (Missouri’s Medicaid program), Missouri Medicaid Audit & Compliance (MMAC) is providing same day or overnight approvals of most new provider enrollment applications for physicians, advanced practice nurses, and other licensed practitioners. Visit https://mmac.mo.gov/providers/ for more information.

On March 25, 2020, CMS approved the State of Missouri’s Federal Section 1135 Waiver Request.

In accordance with that waiver, MMAC will continue expediting most new provider enrollments for the duration of the public health emergency.  This includes enrolling new providers that want to join the networks of one or more of MO HealthNet’s three managed care organizations.

In some cases, MMAC is provisionally enrolling providers.  If applying providers are missing a piece of information normally required for enrollment, MMAC will provisionally approve the application with an effective date no earlier than March 1, 2020, to allow for claims processing.

No enrolled MO HealthNet providers will be terminated for not revalidating timely for the duration of the public health emergency.

If you have questions about your MO HealthNet provider application, please email:
MMAC.ProviderEnrollment@dss.mo.gov

Questions regarding revalidation can be directed to:
MMAC.Revalidation@dss.mo.gov

In order to provide expedited service for enrolling providers into the MO HealthNet program (Missouri’s Medicaid program), Missouri Medicaid Audit & Compliance (MMAC) will provide same day or overnight approvals of most new provider enrollment applications for physicians, advanced practice nurses, and other licensed practitioners.

Visit https://mmac.mo.gov/providers/ for more information.

The MO HealthNet Division is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).  MO HealthNet providers who test patients for COVID-19 may bill using the newly created HCPCS codes U0001 and U0002.

HCPCS code U0001 is used specifically for CDC testing laboratories to test patients for SARS-CoV-2.  HCPCS code U0002 allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2.

The MO HealthNet claims processing system will accept these codes on April 1, 2020 for dates of service on or after February 4, 2020.

Click here for more information on coronavirus from the Missouri Department of Health & Senior Services.