Missouri Medicaid Audit and Compliance (MMAC) has received questions from providers regarding signature requirements as they pertain to personal care services in a Residential Care Facility (RCF).

 

Missouri regulation states a signature is required as follows: “For each date of service: the signature of the recipient, or the mark of the recipient witnessed by at least one (1) person, or the signature of another responsible person present in the recipient’s home or licensed Residential Care Facility I or II at the time of service. “Responsible person” may include the personal care aide’s supervisor, if the supervisor is present in the home at the time of service delivery. The personal care aide may only sign on behalf of the recipient when the recipient is unable to sign and there is no other responsible person present. (See 13 CSR 70-91,010(4)(A)2.F).

 

Providers with questions are encouraged to contact MMAC at MMAC.ProvderReview@dss.mo.gov

The Missouri Medicaid Audit and Compliance Unit (MMAC) wishes to remind all In-Home Services and Consumer Directed Services providers that telephony or Electronic Visit Verification (EVV) is a program requirement.  Please visit our website post dated June 3, 2016  for more information.

 

Providers who do not utilize telephony or EVV may face sanctions, so providers are encouraged to contact MMAC at MMAC.IHSCONTRACTS@DSS.MO.GOV with any questions.

Missouri Medicaid Audit and Compliance (MMAC) wishes to remind Consumer Directed Services (CDS) providers about reporting requirements.  Please visit the MMAC website at mmac.mo.gov to review the “From the Director” post dated February 23, 2016.

 

CDS providers are required to file quarterly service and financial reports, annual service reports, and annual financial audits.

 

CDS providers who fail to submit these reports may face sanctions, so providers are encouraged to contact MMAC at MMAC.IHSCONTRACTS@dss.mo.gov with any questions.

 

The Missouri Medicaid Audit and Compliance Unit (MMAC) wishes to remind providers about incentives that are “kick-backs” and therefore not allowed.

 

The federal Anti-Kickback Statute is a criminal law that prohibits health care providers in a federal health care program from offering to exchange, or actually exchanging, anything of value to reward someone for referring business. Medicaid is a state and federally funded program.  Conviction for a single violation can result in a fine of up to $25,000 and imprisonment.  With or without a conviction, individuals may still be excluded from federal health care programs.

 

Missouri state regulation also prohibits these types of incentives.  It is a violation to make any payment to any person for referring someone for goods or services, when MO HealthNet is providing payment.  MMAC has received notice of providers offering incentives to MO HealthNet participants, and also offering incentives to employees to induce or refer participants.  Providers may face sanctions for these practices.

 

Please contact MMAC at MMAC.ReportFraud@dss.mo.gov with any questions.

 

The CDS Vendor’s responsibilities can be found in Missouri state regulation, at 19 CSR 15-8.400.  The Missouri Medicaid Audit and Compliance Unit (MMAC) would like to encourage CDS vendors to be familiar with the program’s responsibilities and requirements.  Some of the requirements are listed below:

 

Collect timesheets and certify their accuracy Transmit individual payments to the personal care attendant on behalf of the consumer Ensure all payroll, employment, and other taxes are paid timely Ensure each attendant is registered, screened, and employable pursuant to the FCSR, the EDL, and applicable state laws and regulations Ensure the attendant is not the consumer’s spouse Perform case management activities with the consumer at least monthly to provide ongoing monitoring of the services Ensure the consumer is properly trained to properly recruit, employ, instruct, supervise, and maintain the services of the attendant(s).  This training and orientation includes, but is not limited to the following: Time sheet preparation Identification of program fraud Allowable and non-allowable tasks Attendants’ rights and responsibilities Identification of abuse, neglect, and exploitation

 

If you have any questions, please contact MMAC at mmac.providerreview@dss.mo.gov

In 2010, the Missouri Department of Health and Senior Services (DHSS) established a pilot project for In-Home Services (IHS) and Consumer-Directed Services (CDS) providers to test the implementation of electronic telephone tracking systems, also known as Telephony.  Participation in the program, at that time, was voluntary.

 

On July 1, 2015, the telephone tracking system became a requirement by law, for IHS and CDS providers.  Residential Care Facilities, Assisted Living Facilities, and Adult Day Centers are not required to use telephony.  The telephony requirements for IHS providers are found at RSMo 660.023.1.  The requirements for CDS providers are found at RSMo 208.909.1.   Theses statutes define specific requirements that a telephony system must meet, in order to be implemented by an IHS or CDS provider.  They say, at a minimum, the telephone tracking system shall:

 

Record the exact date services are delivered. Record the exact time the services begin and the exact time the services end. Verify the telephone number from which the services were registered. Verify that the number from which the call is placed is a telephone number unique to the client. Require a personal identification number unique to each personal care attendant. Be capable of producing reports or services delivered, tasks performed, client identity, beginning and ending times of service, and date of service in summary fashion that constitutes adequate documentation of services.

 

For IHS, the system shall also be used to process payroll for employees and for submitting claims for reimbursement to the MO HealthNet division.    For CDS, the system shall also be capable of producing reimbursement requests for consumer approval that assures accuracy and compliance with program expectations for both the consumer and vendor.

 

DHSS, Division of Senior and Disability Services (DSDS) published a state regulation entitled, “Electronic Visit Verification”.  This rule further explains the telephony requirements.  It states that the system may be telephone and computer-based (telephony), or the system may utilize some other form of electronic technology (EVV).  In addition, DSDS published Policy Clarification Questions and Answers.   This Q&A addresses several categories of  questions for Home and Community Bases Providers including Telephony/EVV.

 

Missouri Medicaid Audit and Compliance (MMAC) has published website posts regarding telephony in September 2014, June 2015, July 2015, and August 2015.  The August 2015 post provides a Telephony Tool for IHS and CDS providers.  This tool supplies providers with questions to ask potential telephony or EVV vendors, in order to help ensure the vendors’ systems meet the necessary requirements.

 

It is important for providers to know that small companies are not exempt from the telephony requirement.  On July 1, 2016, the telephony statutes will have been in effect for one year.  MMAC encourages providers to ensure they are compliant with the laws and regulation, to avoid possible sanctions.  Telephony is a requirement to be an IHS or CDS provider.

 

Please contact MMAC at mmac.ihscontracts@dss.mo.gov with any questions.

What are Home and Community-Based Setting Requirements?

 

The Centers for Medicare & Medicaid Services (CMS) published a final rule to enhance the quality of Home and Community-Based Services (HCBS) and to provide protections for participants.  The rule, or “setting requirements” makes sure individuals receiving HCBS have full access to the benefits of community living and have the opportunity to receive services in the most integrated and still appropriate type of setting.

 

Missouri, like other states, is in a transition period, during which the state agencies will assess the HCBS programs, and the rules and regulations that govern the programs, to ensure services will be delivered in settings that meet the new requirements.

 

The Missouri Medicaid Audit and Compliance Unit (MMAC) is participating in the state’s transition plan and transition activities in the following ways:

 

MMAC conducted on-site visits of all the Adult Day Care and AIDS Waiver locations, and completed HCBS surveys with those providers.  You can access the report here.

 

 

MMAC will include the HCBS surveys in future pre-enrollment site visits and provider revalidation site-visits, for all HCBS providers.  This means MMAC personnel will go over the survey with you and give you the opportunity to ask questions and discover where you may need to make improvements in order to be compliant in the future when these requirements take effect.  The state is expected to promulgate rules that will require providers to be compliant with the new setting requirements.

 

MMAC will include the survey in future audits and investigations of HCBS providers to ensure we continue to monitor the locations for the new setting requirements as well. Auditors will provide you with the survey and go over it with you.  Investigators may be on-site in consumers’ and participants’ homes and will verify the services are being delivered in the most integrated and still appropriate setting.

 

MMAC will also provide education and information about the new setting requirements to all HCBS providers at Provider Update Training and Designated Manager Training.

 

MMAC is not citing any errors or violations at this time.  This is a transition time.  MMAC will give information about the new setting requirements and how to achieve compliance.  In the future, MMAC will inform providers about any new regulatory language that will require them to become compliant or face possible sanctions.

 

MMAC is also giving providers the opportunity to complete an annual self-assessment. In the future, MMAC will inform providers about any new regulatory language that will require them to complete the annual self-assessment or face possible sanctions.  Click here for the Annual Self-Assessment.

 

What else do providers need to know?

 

See below for links to the full content of the final rule, including all the requirements.  Some highlights:

 

Home and Community-Based settings will be expected to be integrated in the community, and support access to the greater community.

 

The HCBS setting should also provide opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources.

 

The HCBS setting should ensure the participant’s or consumer’s rights of privacy, dignity, respect, and freedom from coercion and restraint.

 

Participants and consumers should be able to have visitors at any time.

 

The setting should be physically accessible to the participants and consumers.

 

Additional Resources:

 

Click here to see a PowerPoint presentation of the final rule and the new requirements.

 

Click here to be directed to the MO HealthNet Division’s webpage where you can access the state’s Transition Plan, Transition Plan Summary, and Settings Analysis (see Alerts and Notifications).

 

Click here to see more information about Home & Community Based Services, including the final rule, and questions and answers at Medicaid.gov.