From the Director Archive
Public Notice
November 8th, 2024
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 Festus Manor as a provider of services in the MO HealthNet (Medicaid) program, … Continued
ELECTRONIC SIGNATURE REQUIREMENTS
November 8th, 2024
All forms submitted to MMAC must have an original handwritten signature or a verifiable electronic signature using an electronic signature software such as; DocuSign,Adobe Sign, DropBox Sign.Some of these software offer free limited accounts. If in the course of reviewing … Continued
HCBS Settings Final Rule 2024 Training Sessions
October 15th, 2024
This training is MANDATORY for Adult Day Cares, Doorways or Pathways to maintain enrollment (MO HealthNet) and license (DHSS). MMAC will not accept attestations this year from providers who fail to attend. At least one person from each enrolled Adult … Continued
MO HealthNet Providers: Call Us For FREE!
October 8th, 2024
The Mo HealthNet Provider Communications Unit assists providers with eligibility and coverage verification, enrollment status, annual review dates, questions regarding proper claim filing, claims resolution and disposition, billing errors, verifying check amounts, and more. Providers are encouraged to communicate with … Continued
FALL 2024 UPDATE MEETINGS FOR HOME AND COMMUNITY BASED PROVIDERS
September 23rd, 2024
The registration links for the October 23 & 24, 2024 HCBS Provider Update Meetings have been added to the MMAC website – Update Meeting webpage Provider Update Meetings. If you are a Designated Manager (DM) for an in-home or a … Continued
4TH ROUND TESTING FOR THOSE WHO MISSED OR DIDN’T PASS THE FIRST AND SECOND ROUNDS, NEW CDS PROVIDERS – CONSUMER DIRECTED SERVICES (CDS) MANAGER REQUIREMENT – PER 19 CSR 15-8.400(1)D
August 12th, 2024
4TH ROUND TESTING FOR THOSE WHO MISSED OR DIDN’T PASS THE FIRST AND SECOND ROUNDS, NEW CDS PROVIDERS APRIL/MAY – CONSUMER DIRECTED SERVICES (CDS) MANAGER REQUIREMENT – PER 19 CSR 15-8.400(1)D PLEASE READ TO THE END Per the updated CDS … Continued
PUBLIC NOTICE
July 8th, 2024
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 Senath South Health Care Center as a provider of services in the MO … Continued
PERM
June 18th, 2024
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 contractor, … Continued
3RD ROUND TESTING FOR CERTIFIED CONSUMER DIRECTED SERVICES (CDS) MANAGER REQUIREMENT – PER 19 CSR 15-8.400(1)D
June 6th, 2024
3RD ROUND TESTING FOR THOSE WHO MISSIED OR DIDN’T PASS THE FIRST AND SECOND ROUNDS, NEW CDS PROVIDERS APRIL/MAY – CONSUMER DIRECTED SERVICES (CDS) MANAGER REQUIREMENT – PER 19 CSR 15-8.400(1)D PLEASE READ TO THE END Per the updated CDS … Continued
Public Notice
May 14th, 2024
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 Levering Regional Health Care Center as a provider of services in the MO … Continued
2ND ROUND TESTING – CONSUMER DIRECTED SERVICES (CDS) MANAGER REQUIREMENT – PER 19 CSR 15-8.400(1)D
April 24th, 2024
2ND ROUND TESTING FOR THOSE WHO MISSED OR DIDN’T PASS THE FIRST ROUND, NEW CDS PROVIDERS MARCH 2024 – CONSUMER DIRECTED SERVICES (CDS) MANAGER REQUIREMENT – PER 19 CSR 15-8.400(1)D PLEASE READ TO THE END Per the updated CDS … Continued
PUBLIC NOTICE
April 8th, 2024
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 Timberlake Care Center as a provider of services in the MO HealthNet (Medicaid) … Continued
PUBLIC NOTICE
March 27th, 2024
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 Hidden Lake Care Center as a provider of services in the MO HealthNet … Continued
Consumer Directed Services (CDS) Quarterly Financial and Service Reports and Annual Service Reports are now contracted with DocuSign
March 15th, 2024
Missouri Medicaid Audit & Compliance (MMAC) Provider Review recently contracted with DocuSign to make it more efficient for you to complete and submit the required CDS Quarterly Financial and Service Reports and the Annual Service Reports. The reports are … Continued
SPRING 2024 UPDATE MEETINGS FOR HOME AND COMMUNITY BASED PROVIDERS
March 12th, 2024
The registration links for the April 17 & 18, 2024 HCBS Provider Update Meetings have been added to the MMAC website – Update Meeting webpage Provider Update Meetings. If you are a designated manager for an in-home services provider, … Continued
CONSUMER DIRECTED SERVICES (CDS) MANAGER REQUIREMENT
March 8th, 2024
CONSUMER DIRECTED SERVICES (CDS) MANAGER REQUIREMENT – PER 19 CSR 15-8.400(1)D PLEASE READ TO THE END Per the updated CDS regulation (19 CSR 15-8.400(1)(D), all CDS providers are required to have a Certified CDS Manager. This manager will be required … Continued
MHD EVV BULLETIN
March 1st, 2024
The MO HealthNet Division (MHD) has posted an updated resource regarding Electronic Visit Verification (EVV). This Missouri EVV Aggregator Solution Provider Training provides a brief overview of EVV and offers instruction regarding accessing the EVV Aggregator Solution (EAS). This resource … Continued
NEW CONSUMER DIRECTED SERVICES REGULATION
February 27th, 2024
The Consumer Directed Services (CDS) regulation 19 CSR 15-8, chapters 2 & 4 have been updated. The new regulation goes into effect February 29, 2024. CDS providers are required to read through and educate themselves on the updated chapters. MMAC … Continued
MEDICAID ENROLLMENT APPLICATION FEE FOR 2024
January 1st, 2024
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 … Continued
PAYMENT ERROR RATE MEASUREMENT (PERM) AUDIT
November 20th, 2023
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 … Continued
HCBS Setting Requirements – Updates and Training Session
October 11th, 2023
Currently enrolled Adult Day Care providers and Doorways (AIDS Waiver) are REQUIRED to attend a one-hour training session hosted by MMAC at 9:00 am on Wednesday, November 1, 2023. The training will be held virtually via WebEx and registration is … Continued
ENROLLMENT APPLICATION PORTAL ENHANCEMENT
September 15th, 2023
On October 15, 2023, the Missouri Medicaid Audit and Compliance (MMAC) online provider enrollment application portal for newly enrolling providers will have a new look. For those familiar with the eMomed Revalidation portal, you may recognize the design and functionality. … Continued
UPDATE TO IN HOME REGULATIONS AND PROVIDER MANUALS
September 14th, 2023
Due to the new changes to the In Home Service Standards 19 CSR 15-7.021, Personal Care Services 13 CSR 70-91.010 and Mo HealthNet Provider Manuals for Personal Care and Aged and Disabled Waiver Programs; MMAC has updated the In Home Service … Continued
FALL UPDATE MEETINGS FOR HOME AND COMMUNITY BASED PROVIDERS
August 4th, 2023
The Fall 2023 HCBS Provider Update Meeting dates are October 18 & 19, 2023. Please save these dates to your calendar and watch for the registration link to be added to the website within 30 days of the meeting … Continued
Family Care Safety Registry (FCSR) Fee Increase
May 1st, 2023
Family Care Safety Registry (FCSR) Fee Increase: Effective May 1, the FCSR registration fee will increase to $15.00 due to the Highway Patrol’s name-based criminal record search fee increasing to $15. The fee increase results from statute and is … Continued
Reminder of EVV Requirements for Personal Care Service Providers
April 24th, 2023
EVV Requirements Reminder for personal care service providers of the requirements to utilize Electronic Visit Verification (EVV) and to draw attention to common data transmittal errors identified within the EVV Aggregator Solution (EAS). This information can also … Continued
MO HealthNet Offering FREE Continuing Education Sessions Presented by Relias for Doctors, Nurses, and Pharmacists
April 7th, 2023
MO HealthNet (MHD) is offering FREE continuing education (CE) sessions for doctors, nurses, and pharmacists. Each session is created and presented by Relias and all are available as live webinars and will be recorded so you can earn continuing education … Continued
UPDATE MEETINGS FOR HOME AND COMMUNITY BASED PROVIDERS
March 21st, 2023
The spring session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for April 19 and 20, 2023. DEADLINE TO REGISTER IS APRIL 18, 2023.The meetings will be held virtually via Webex … Continued
MO HealthNet Offering FREE Continuing Education Sessions for Doctors, Nurses, and Pharmacists
February 22nd, 2023
MO HealthNet (MHD) is offering FREE continuing education (CE) sessions for doctors, nurses, and pharmacists. Each session is created and presented by Relias and all are available as live webinars and will be recorded so you can earn continuing education … Continued
Revised Standing Order for Naloxone
January 27th, 2023
The Missouri Dept. of Health and Senior Services has revised the Naloxone standing order. Dr. Heidi B. Miller, MD, is now the authorizing physician for the standing order. The revised order are available DHSS website at: https://health.mo.gov/data/opioids/pdf/naloxone-standing-order.pdf
UPDATE MEETINGS FOR HOME AND COMMUNITY BASED PROVIDERS
January 12th, 2023
The 2023 HCBS Provider Update Meeting dates are April 19 & 20, 2023 and October 18 & 19, 2023. Please save these dates to your calendar and watch for the registration link to be added to the website within 30 … Continued
MEDICAID ENROLLMENT APPLICATION FEE FOR 2023
December 23rd, 2022
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 … Continued
PUBLIC NOTICE
November 7th, 2022
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 Aspire Senior Living Fayette, as a provider of services in the MO HealthNet … Continued
HCBS PROVIDER UPDATE MEETING – ADDITIONAL MEETING DATE FOR FALL 2022 SESSION
November 7th, 2022
On NOVEMBER 17, 2022, MMAC is hosting a one day additional provider update meeting for all HCBS providers who did not attend the October 20, 2022 meeting. The meeting will be the exact same format as the October 20, 2022 … Continued
PROVIDER UPDATE MEETING FOLLOW-UP
October 25th, 2022
Due to technical issues, the 10/20/2022 HCBS Provider Update Meeting Proof of Attendance emails have been delayed. Staff are working on this issue and expect to have Proof of Attendance/Thank You For Attending emails go out by October 28th. The … Continued
HCBS SETTING REQUIREMENTS – UPDATES AND TRAINING SESSION
October 13th, 2022
Currently enrolled Adult Day Care providers and Doorways (AIDS Waiver) are REQUIRED to attend a one hour training session hosted by MMAC at 10:00 am on Wednesday, November 2, 2022. The training will be held virtually via WebEx and registration … Continued
UPDATE MEETINGS FOR HOME AND COMMUNITY BASED PROVIDERS
September 28th, 2022
The Fall 2022 session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for October 19 & 20, 2022. DEADLINE TO REGISTER IS OCTOBER 18, 2022. The meetings will be … Continued
MHD TRAINING RESOURCES AVAILABLE
September 28th, 2022
Medicaid Providers: Interested in learning how to navigate MO HealthNet resources, learn more about claim filing, crossover claims, eligibility, spend down and more? Check out our MHD MHD Education and Training Resources and register for trainings on our Provider Training … Continued
PROPER BILLING FOR DRUGS BILLED TO MO HEALTHNET
July 11th, 2022
MO HealthNet Division (MHD) will begin desk audits of providers to ensure proper billing units are used for drugs billed to MO HealthNet. Providers are responsible for proper billing of claims as outlined in Section 15 of the Pharmacy Provider … Continued
ENROLLMENT OF PACE PROVIDERS
March 30th, 2022
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 … Continued
ENROLLING PHARMACISTS AS INDIVIDUAL MO HEALTHNET PROVIDERS
March 9th, 2022
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 … Continued
CDS VENDORS REQUIRED TO UPLOAD TAX INFORMATION TO HCBS WEB TOOL
January 26th, 2022
On August 26, 2020, the Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS), issued Directive 3.25 (Appendix 1) for Consumer Directed Services (CDS) Tax Information Documentation Requirements. DSDS directed all CDS vendors to … Continued
GROUP HOME, INDIVIDUALIZED SUPPORTED LIVING, SHARED LIVING AND REMOTE SERVICES WAIVER CHANGES
October 21st, 2021
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 … Continued
FEDERAL PUBLIC HEALTH EMERGENCY EXTENDED
October 20th, 2021
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 … Continued
PROVIDER REASSESSOR PARTICIPATION TERMS AND CONDITIONS – FINAL NOTICE
October 19th, 2021
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 … Continued
REMINDER: UPDATE MEETINGS FOR HOME AND COMMUNITY BASED PROVIDERS
October 6th, 2021
The fall session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for October 20 & 21, 2021. DEADLINE TO REGISTER IS OCTOBER 19, 2021. We have a full agenda … Continued
PUBLIC NOTICE
September 30th, 2021
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) … Continued
UPDATE MEETINGS FOR HOME AND COMMUNITY BASED PROVIDERS
September 9th, 2021
The fall session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for October 20 & 21, 2021. DEADLINE TO REGISTER IS OCTOBER 19, 2021. The meetings will be held virtually … Continued
IMPORTANT INFORMATION FOR PERSONAL CARE SERVICES PROVIDERS – ACTION NEEDED
September 8th, 2021
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 … Continued
PERSONAL CARE SERVICES PROVIDERS NEED TO REGISTER WITH ELECTRONIC VISIT VERIFICATION AGGREGATOR SOLUTION
August 16th, 2021
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 … Continued
CMS REQUESTS FOR MEDICAID CLAIM DOCUMENTATION TO BE SENT DIRECTLY TO MO HEALTHNET PROVIDERS
August 16th, 2021
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 … Continued
FCSR CHECKS REQUIRED TO BE CONDUCTED DURING DECLARED COVID HEALTH EMERGENCY
August 5th, 2021
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 … Continued
ELECTRONIC VISIT VERIFICATION VENDOR REGISTRATION
July 30th, 2021
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 Registration … Continued
ELECTRONIC VISIT VERIFICATION VENDOR REGISTRATION
July 19th, 2021
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 … Continued
ELECTRONIC VISIT VERIFICATION AGGREGATOR SOLUTION CONTRACT AWARDED
May 27th, 2021
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 … Continued
EXTENSION OF SUBMISSION DEADLINE FOR CDS ANNUAL AUDITS/REVIEWS
May 24th, 2021
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 … Continued
DOCUSIGN NOW AVAILABLE!
May 12th, 2021
Many of MMAC’s Provider Enrollment forms are now available through DocuSign, including the Provider Update Request form, EFT Change form, and others. This DocuSign process allows for authenticated signatures without the need to print and fax/scan documents. To receive … Continued
HMS HOSPITAL/LONG TERM CARE AUDITS AND COMMERCIAL INSURANCE DISALLOWANCE AUDITS
April 27th, 2021
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 … Continued
UPDATE MEETINGS FOR HOME AND COMMUNITY BASED PROVIDERS
March 19th, 2021
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 … Continued
PHARMACY COMMERCIAL INSURANCE DISALLOWANCE AUDITS
March 16th, 2021
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 … Continued
Provisional Enrollment of Providers Discontinued May 15, 2020
February 10th, 2021
Missouri Governor Parson approved Executive Order 20-04 on March 19, 2020, waiving 13 CSR 65-2.020(5) and 13 CSR 65-2.020(9) to allow the Missouri Medicaid Audit and Compliance Unit to expedite new provider enrollment applications and to waive certain requirements such … Continued
CDS VENDORS REQUIRED TO UPLOAD TAX INFORMATION TO HCBS WEB TOOL
February 1st, 2021
On August 26, 2020, the Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS), issued Directive 3.25 (Appendix 1) for Consumer Directed Services (CDS) Tax Information Documentation Requirements. DSDS directed all CDS vendors to … Continued
IMPORTANT REMINDER – EVV ATTESTATION FORMS DUE FROM ALL PERSONAL CARE SERVICES (PCS) PROVIDERS BY JANUARY 1, 2021
December 28th, 2020
Section 12006(a) of the 21st Century Cures Act (Cures Act) mandated that states implement Electronic Visit Verification (EVV) for all Medicaid PCS by January 1, 2020. Missouri applied for and received a Good Faith Effort Exemption from the Centers for … Continued
IMPORTANT – ALL PERSONAL CARE SERVICES (PCS) PROVIDERS – ACTION REQUIRED
December 14th, 2020
Electronic Visit Verification (EVV) is a method of utilizing technology to capture point of service information related to the delivery of personal care services, including homemaker chores and respite (PCS). Section 12006(a) of the 21st Century Cures Act (Cures Act) … Continued
MEDICAID ENROLLMENT APPLICATION FEE FOR 2021
November 25th, 2020
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 … Continued
UPDATE MEETINGS FOR HOME AND COMMUNITY BASED PROVIDERS
October 8th, 2020
The fall session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for October 20 and 21, 2020. DEADLINE TO REGISTER IS OCTOBER 15, 2020. The meetings will be held virtually via … Continued
FALL UPDATE MEETING FOR HOME AND COMMUNITY BASED PROVIDERS
September 1st, 2020
The fall session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for October 20 and 21, 2020. The meetings will be held virtually via Webex Events Center from 9:00 a.m. to … Continued
MEDICAID RECORD RETENTION POLICY
August 28th, 2020
MO HealthNet providers must retain for six years (seven years for the Nursing Home, CSTAR and Community Psychiatric Rehabilitation Programs), from the date of service, fiscal and medical records that coincide with and fully document services billed to the Missouri … Continued
CDS ORIENTATION
August 17th, 2020
Registration is now open for the September 17, 2020 CDS Orientation Training session. This training will be held online. To register please go to https://mmac.mo.gov/providers/hcbs-provider-certification-training/ If you had already registered for the March 26th session, you will automatically be enrolled … Continued
IHS DESIGNATED MANAGER TRAINING
August 17th, 2020
Registration is now open for the September 29, 2020 Designated Manager Testing session. This test will be administered online. To register please go to https://mmac.mo.gov/providers/hcbs-provider-certification-training/ If you had already registered for the June 10th session, you will automatically be … Continued
NONPROFIT RELIEF AND RECOVERY GRANT
July 23rd, 2020
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 … Continued
UPDATED- BACKDATING ENROLLMENT APPLICATIONS
June 19th, 2020
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 … Continued
POLICY REGARDING GIFTS OF NOMINAL VALUE
June 5th, 2020
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 … Continued
REQUIREMENT TO REPORT CHANGES
May 21st, 2020
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 … Continued
CDS ANNUAL AUDIT DEADLINE
May 18th, 2020
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 … Continued
CHANGES TO HCBS UPDATE MEETINGS
May 1st, 2020
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 … Continued
EXPEDITED SERVICE FOR ENROLLING PROVIDERS – UPDATE
March 26th, 2020
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 … Continued
EXPEDITED SERVICE FOR ENROLLING PROVIDERS
March 16th, 2020
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 … Continued
COVID-19
March 11th, 2020
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 … Continued
MEDICAID ENROLLMENT APPLICATION FEE FOR 2020
December 10th, 2019
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 … Continued
SOCIAL SECURITY NUMBER REMOVAL INITIATIVE
October 25th, 2019
The Medicare Access and CHIP Reauthorization Act (MACRA) requires CMS to remove Social Security Numbers (SSNs) from the current SSN-based Health Insurance Claim Number (HICN) and issue a new Medicare card with a Medicare Beneficiary Identification (MBI) number. CMS … Continued
IMPORTANT INFORMATION FOR MO HEALTHNET PROVIDERS
October 17th, 2019
Effective: November 1, 2019 Applies to: Hospitals, Mental Health Hospitals, State Institution Long Term Care facilities, Nursing Homes, Private Home-ICF/IDs, Home Health agencies, Rural Health Clinics, and Hospice claims. All claims submitted to MO HealthNet must have the … Continued
FALL UPDATE MEETING FOR HCBS PROVIDERS
October 3rd, 2019
The fall session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for October 22, 23, 24, 2019. The meetings will be held in Rooms 490-492 at the Harry S. Truman … Continued
MO HEALTHNET PROVIDERS AND NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT)
September 27th, 2019
The increased cost of insurance rates is affecting NEMT vendors across all Missouri geographical areas. MO HealthNet is aware of this issue and is working with NEMT vendors to explore options to ensure MO HealthNet participants have transportation to … Continued
THE DEPARTMENT OF SOCIAL SERVICES ALERT, GENETIC TESTING SCHEME THAT IS CURRENTLY HAPPENING IN MANY STATES, INCLUDING MISSOURI!
July 24th, 2019
The Department of Social Services (DSS) wants to alert providers to a genetic testing scheme that is currently happening in many states, including Missouri. On June 3, 2019, the U.S. Department of Health and Human Services (DHHS) Office of Inspector … Continued
THE CONTRACT UNIT IS EXPERIENCING DELAYS IN GETTING NEW PARTICIPATION AGREEMENTS FOR HOME AND COMMUNITY BASED SERVICES
July 1st, 2019
The Missouri Medicaid Audit & Compliance (MMAC) Contracts Unit is experiencing delays in getting new “Participation Agreements for Home and Community Based Services” (contracts) to all enrolled In-Home Services (IHS) and Consumer Directed Services (CDS) providers. Most contracts expired on … Continued
PROVIDER DOCUMENTATION LOST DUE TO WEATHER EVENTS
May 28th, 2019
Missouri Medicaid Audit & Compliance (MMAC) requests that any provider who believes documentation in support of servicing Missouri Medicaid participants is no longer available due to recent weather events, complete the Attestation of Medical Record Loss or Destruction Form which … Continued
SPRING 2019 ANNUAL UPDATE MEETING FOR HOME AND COMMUNITY BASED PROVIDERS
April 8th, 2019
The Spring session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for April 9, 10, and 11, 2019. The meetings will be held in Rooms 490-492 at the Harry S. Truman … Continued
PROVIDER REVALIDATION DEADLINE
April 4th, 2019
Over 6,535 currently enrolled MO HealthNet providers are past due for revalidation and have not submitted an application to MMAC. If your NPI is past due and you do not submit your revalidation application within the next 30 days, … Continued
CDS ORIENTATION
February 25th, 2019
Effective March 1, 2019, all CDS proposals submitted to MMAC must include proof that a representative of the company has attended a CDS Orientation training session. Current CDS providers are also encouraged to attend the training, pending availability … Continued
QUARTERLY AND ANNUAL REPORT REQUIREMENTS FOR CONSUMER DIRECTED SERVICE PROVIDERS
February 19th, 2019
As a reminder, all Consumer Directed Service (CDS) providers are required to file quarterly and annual reports. For your convenience, these reports may now be submitted to our new e-mail address or fax at: EMAIL: MMAC.CDS@DSS.MO.GOV FAX: … Continued
LEVEL OF CARE (LOC) TRANSFORMATION PROJECT – DRAFT LOC ALGORITHM RELEASE
December 27th, 2018
The Level of Care Transformation Project Web Page has been updated by the Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS) and includes the Level of Care (LOC) Transformation Project – Draft LOC Algorithm … Continued
MEDICAID ENROLLMENT APPLICATION FEE FOR 2019
December 26th, 2018
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 … Continued
COMING SOON: A NEW MO HEALTHNET PROVIDER REVALIDATIONS PORTAL!!
November 30th, 2018
MMAC is pleased to announce that a new Provider Revalidation Portal will be available for MO HealthNet providers starting January 7, 2019. Federal and state regulations require all providers to revalidate their Medicaid enrollment at least every five years. To … Continued
FCSR UPDATE FOR IN-HOME AND CONSUMER DIRECTED SERVICES
October 18th, 2018
HB1350 was enacted into law as section 192.2495 RSMo effective August 28, 2018. Providers are responsible for ensuring aides are registered with the Family Care Safety Registry (FCSR), that screenings are done at the time of hire and before … Continued
NEW PROPOSAL PROCESS FOR IN-HOME SERVICES AND CONSUMER DIRECTED SERVICES PROVIDERS
October 10th, 2018
Applicants desiring to contract with MO HealthNet for the purpose of providing In-Home Personal Care Services (IHS) or Consumer Directed Services (CDS) to Medicaid participants are required by 19 CSR 15-7.021(5) to submit a complete proposal packet to Missouri Medicaid … Continued
PRESCRIBING PROVIDER NPI REQUIREMENT
September 20th, 2018
Current state and federal regulations (13 CSR 65-2 and 42 CFR § 455.410) require Ordering, Prescribing, or Referring (OPR) physicians or other professionals providing services under the state plan or under a waiver of the plan to be enrolled as … Continued
DEADLINE FOR ENROLLMENT OF MANAGED CARE ORGANIZATION NETWORK PROVIDERS
September 13th, 2018
The “Medicaid and CHIP Managed Care Final Rule” and 42 CFR 438.602(b)(1), require states to screen and enroll, and periodically revalidate, all network providers of Managed Care Organizations (MCOs); including Ordering, Prescribing, and Referring (OPR) providers. This requirement was effective … Continued
CONSUMER DIRECTED SERVICES TAX REMINDER
August 21st, 2018
The Missouri Medicaid Audit and Compliance (MMAC) unit conducts post-payment reviews (audits) of Medicaid-enrolled providers’ billing. As a service to our enrolled providers, MMAC wishes to remind providers of the requirements to file and pay taxes. Consumer Directed Services … Continued
EHR AND EVV SYSTEMS DOCUMENTATION
August 16th, 2018
MMAC employees conduct announced or unannounced reviews (audits) of MO HealthNet providers to collect documentation supporting claims that were submitted for services provided to Medicaid participants. Providers are increasing utilization of Electronic Health Record (EHR) and/or Electronic Visit Verification (EVV) … Continued
FALL UPDATE MEETING FOR HOME AND COMMUNITY BASED PROVIDERS
July 12th, 2018
The fall session of Missouri Medicaid Audit and Compliance’s (MMAC) Update Meetings for Home and Community Based providers is scheduled for October 23, 24, and 25, 2018. The meetings will be held in Rooms 490-492 at the Harry S. Truman … Continued
ANNUAL UPDATE MEETING FOR HOME AND COMMUNITY BASED PROVIDERS
March 30th, 2018
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. … Continued
IMPORTANT MESSAGE – OPIOID PRESCRIPTION INTERVENTION PROGRAM
March 7th, 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 … Continued
THE DEPARTMENT OF SOCIAL SERVICES WANTS TO KNOW ABOUT YOUR “PAIN POINTS”
February 6th, 2018
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 … Continued
TELEHEALTH PROVIDER BULLETIN
February 2nd, 2018
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.
PROVIDER APPLICATION FEE UPDATE
December 21st, 2017
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 … Continued
ANNOUNCEMENT REGARDING CYBERSECURITY EMERGENCY PREPAREDNESS
November 28th, 2017
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 … Continued
MO HEALTHNET ENROLLMENT OF FEDERALLY QUALIFIED HEALTH CENTERS
November 8th, 2017
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 … Continued
NEW STATE REGULATION REGARDING ELECTRONIC SIGNATURES FOR THE MO HEALTHNET PROGRAM
November 8th, 2017
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 … Continued
NOTICE: ORDERING, PRESCRIBING OR REFERRING PROVIDERS
October 11th, 2017
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 … Continued
ENROLLMENT OF MANAGED CARE NETWORK PROVIDERS
September 14th, 2017
Beginning January 1, 2018, according to federal regulation 42 CFR 438.602, states must screen and enroll, and periodically revalidate, all network providers of managed care organizations (MCOs). This requirement applies to ordering, prescribing, and referring “OPR” providers in the managed … Continued
GOVERNOR ERIC GREITENS’ EXECUTIVE ORDER 17-03
September 12th, 2017
Dear Stakeholder: Re: Governor Eric Greitens’ Executive Order 17-03 Due to public interest, the Missouri Department of Social Services’ public rule review comment period has been extended and will now end on October 15, 2017. And, we have … Continued
MEDICAID PROVIDER EMERGENCY PREPAREDNESS
August 2nd, 2017
On September 8, 2016 the Federal Register posted the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. The regulation went into effect on November 16, 2016. The purpose of the rule is to ensure providers … Continued
ORDERING, PRESCRIBING, AND REFERRING (OPR) PROVIDER UPDATE
July 27th, 2017
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 has begun implementing changes in the … Continued
REMINDER: NOTICE OF OPPORTUNITY TO COMMENT: EXECUTIVE ORDER 17-03 – DSS RULE REVIEW
July 25th, 2017
Missouri Medicaid Audit and Compliance (MMAC), as part of the Department of Social Services (DSS) and in response to Governor Eric Greitens’ Executive Order 17-03, encourages public input on DSS’ Administrative Rules. Please click here to view the dates, … Continued
ENROLLMENT OF MANAGED CARE NETWORK PROVIDERS
July 19th, 2017
Beginning January 1, 2018, according to federal regulation 42 CFR 438.602, states must screen and enroll, and periodically revalidate, all network providers of managed care organizations. This requirement applies to ordering, prescribing, and referring “OPR” providers in the managed care … Continued
MISSOURI MEDICAID AUDIT AND COMPLIANCE: RULES REVIEW
July 13th, 2017
Missouri Medicaid Audit and Compliance (MMAC), as part of the Department of Social Services (DSS) and in response to Governor Eric Greitens’ Executive Order 17-03, encourages public input on DSS’ Administrative Rules. Please click here to view the News … Continued
EXTENDED WOMEN’S HEALTH SERVICES PROGRAM UPDATE:
July 12th, 2017
Extended Women’s Health Services cover family planning-related services, pregnancy testing, sexually transmitted disease testing and treatment, including pap tests and pelvic exams, and follow-up services. They are covered by MO HealthNet for uninsured women who are 18-55 years of age … Continued
PROVIDER ENROLLMENT THROUGH CREDENTIALING AGENCIES
April 20th, 2017
The Missouri Medicaid Audit and Compliance Unit (MMAC) enrolls MO HealthNet Fee for Service providers. Many providers utilize credentialing agencies to submit their enrollment paperwork and any subsequent updates. All enrollment approvals and updates are confirmed when MMAC sends an … Continued
KEEP INFORMATION UPDATED
April 19th, 2017
The Missouri Medicaid Audit and Compliance Unit (MMAC) encourages all enrolled MO HealthNet providers to keep their information up to date. Any changes can be reported to MMAC by using the Provider Update Request Form. Please click here to … Continued
SPRING SESSION ANNUAL UPDATE MEETING REMINDER
April 12th, 2017
The Spring session of Missouri Medicaid Audit and Compliance’s (MMAC) Annual Update Meetings for Home and Community Based providers is scheduled for April 18, 19, and 20, 2017. The meetings will be held in Rooms 490-492 at the Harry S. … Continued
REMINDER: CONSUMER DIRECTED SERVICES CASE MANAGEMENT REQUIREMENT
March 14th, 2017
Missouri Medicaid Audit and Compliance (MMAC) wishes to remind providers of Consumer Directed Services (CDS) that case management activities are a program requirement per Missouri regulation. 19 CSR 15-8 states that it is a program requirement to do the … Continued
REMINDER: SIGNATURE REQUIREMENT FOR PERSONAL CARE SERVICES IN A RESIDENTIAL CARE FACILITY
March 1st, 2017
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 … Continued
UPDATE/REMINDER: CHANGES IN REIMBURSEMENT FOR EXTENDED WOMEN’S HEALTH SERVICES
February 25th, 2017
Extended Women’s Health Services cover family planning-related services, pregnancy testing, sexually transmitted disease testing and treatment, including pap tests and pelvic exams, and follow-up services. They are covered by MO HealthNet for uninsured women who are 18-55 years of age … Continued
REMINDER: EVV TOOL FOR CDS AND IN HOME PROVIDERS
February 23rd, 2017
Missouri Medicaid Audit and Compliance (MMAC) wishes to remind providers of Consumer Directed Services and In Home Services about an important resource to help them in their choice of telephony or EVV provider. The Missouri Alliance for Home Care … Continued
REMINDER: CDS REPORTING REQUIREMENTS
February 23rd, 2017
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” posts dated November 8, 2016 and February 23, 2016. … Continued
UPDATE: CHANGES IN REIMBURSEMENT FOR EXTENDED WOMEN’S HEALTH SERVICES
January 31st, 2017
Extended Women’s Health Services cover family planning-related services, pregnancy testing, sexually transmitted disease testing and treatment, including pap tests and pelvic exams, and follow-up services. They are covered by MO HealthNet for uninsured women who are 18-55 years of … Continued
THE SELF DISCLOSURE PROCESS
January 5th, 2017
MO HealthNet providers that find they were paid incorrectly for claims resulting in overpayments may use the Self-Disclosure process to repay the overpaid amounts. In order to ensure provider-initiated self-disclosures are processed quickly and efficiently, a form is located on … Continued
“KICK-BACKS” NOT ALLOWED
December 30th, 2016
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 … Continued
MMAC PARTICIPANT LOCK-IN PROGRAM AND THE MO HEALTHNET FEE-FOR-SERVICE PARTICIPANT HANDBOOK
December 29th, 2016
The Missouri Medicaid Audit and Compliance Unit (MMAC) is responsible for reviewing participants who may be subjecting the Medicaid program to fraud, waste and abuse. This includes a review of a variety of factors which include: The number of physicians … Continued
ADEQUATE DOCUMENTATION REMINDER: COUNSELING RECORDS
December 28th, 2016
Missouri state regulation defines “adequate documentation” as documentation from which services rendered and the amount of reimbursement received by a provider can be readily discerned and verified with reasonable certainty. It is a program violation to fail to make available … Continued
UPDATE ON SITE VISITS
December 22nd, 2016
State and federal regulations (13 CSR 65-2 and 42 CFR 455.432) require pre-enrollment and post-enrollment site visits of providers who are designated as “moderate” or “high” categorical risks to the Medicaid program. The purpose of the site visits is to … Continued
ORDERING, PRESCRIBING, & REFERRING (OPR) PROVIDERS
December 21st, 2016
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 has begun implementing changes in the … Continued
PHARMACY REMINDER- OFFER TO COUNSEL AND SIGNATURE LOG
December 19th, 2016
Missouri State Regulation requires documentation of a pharmacist’s offer to counsel, for all MO HealthNet participants’ prescriptions. The regulation states, “Documentation of Offer to Counsel: The pharmacist shall document for each MO HealthNet patient’s prescription in a uniform fashion, whether … Continued
PRESCRIPTION FRAUD REMINDER
December 12th, 2016
In February, 2016, the Missouri Medicaid Audit and Compliance Unit (MMAC) posted a prescription fraud alert on its website. Click here to view the full post. Some of these fraudulent prescriptions are still being presented to Missouri pharmacies. If … Continued
PROVIDER APPLICATION FEE INCREASE
December 6th, 2016
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 … Continued
CHANGES IN REIMBURSEMENT FOR EXTENDED WOMEN’S HEALTH SERVICES
December 2nd, 2016
Extended Women’s Health Services cover family planning-related services, pregnancy testing, sexually transmitted disease testing and treatment, including pap tests and pelvic exams, and follow-up services. They are covered by MO HealthNet for uninsured women who are 18-55 years of age … Continued
ELECTRONIC VISIT VERIFICATION (EVV) REQUIREMENT
November 15th, 2016
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 … Continued
CDS REPORTING REQUIREMENTS
November 8th, 2016
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 … Continued
MO HEALTHNET & ANTI-KICKBACK STATUTES
November 3rd, 2016
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 … Continued
REMINDER: PHYSICIAN PATHOLOGY AND LABORATORY SERVICES
August 31st, 2016
The Missouri Medicaid Audit and Compliance Unit (MMAC) is providing the following reminders for physicians and laboratories that are enrolled in MO HealthNet and for hospitals that bill for non-enrolled laboratory services. The MO HealthNet provider manual for physicians sets forth … Continued
CONSUMER-DIRECTED SERVICES (CDS) VENDOR RESPONSIBILITIES
August 30th, 2016
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 … Continued
TELEPHONY/EVV UPDATE FOR IN-HOME AND CONSUMER-DIRECTED SERVICES PROVIDERS
June 3rd, 2016
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 … Continued
PHARMACY DRUG REBATE – SELF DISCLOSURES
April 27th, 2016
The Deficit Reduction Act of 2005 (DRA) requires states to collect rebates for certain drugs. In order to collect accurate data for the rebate process, all incorrectly billed pharmacy claims must be corrected in the Medicaid billing system so accurate … Continued
LONG-TERM CARE FACILITY CREDIT BALANCE AUDITS
April 26th, 2016
As reported in a previous gov.delivery message by Missouri Medicaid Audit and Compliance (MMAC), HMS will soon begin conducting credit balance audits on behalf of the Missouri Department of Social Services, MO HealthNet Division, (MHD) and MMAC. Click here to … Continued
HOSPITAL CREDIT BALANCE AUDITS
April 14th, 2016
As reported in a previous gov.delivery message by Missouri Medicaid Audit and Compliance (MMAC), HMS will soon begin conducting credit balance audits on behalf of the Missouri Department of Social Services, MO HealthNet Division, (MHD) and MMAC. Click here … Continued
HOME AND COMMUNITY BASED SETTING REQUIREMENTS
April 12th, 2016
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 … Continued
HMS TO CONDUCT CREDIT BALANCE AUDITS (CBA) AND LONG TERM CARE AUDITS (LTC) ON PATIENT ACCOUNTS
April 5th, 2016
Credit balances on patient accounts occur for a variety of reasons. For instance, providers sometimes receive duplicate payments, charges may be reversed, billing data may be incomplete, and third party liabilities may be incorrectly applied. Providers routinely identify and refund these … Continued
PHARMACY REMINDER: OFFER TO COUNSEL AND SIGNATURE LOG
March 30th, 2016
Missouri State Regulation requires documentation of a pharmacist’s offer to counsel, for all MO HealthNet participants’ prescriptions. The regulation states, “Documentation of Offer to Counsel: The pharmacist shall document for each MO HealthNet patient’s prescription in a uniform fashion, whether … Continued
HCBS PROVIDERS: ANNUAL UPDATE MEETING MATERIALS
March 25th, 2016
The 2016 Spring Session of the Annual Provider Update Meeting for Home and Community Based Providers (HCBS), hosted by Missouri Medicaid Audit and Compliance (MMAC) is scheduled for April 19, 20, and 21, 2016. Click here for information about the … Continued
PARTICIPANT LOCK-IN PROGRAM
March 16th, 2016
Missouri Medicaid Audit and Compliance (MMAC) is responsible for reviewing Medicaid (MO HealthNet) participants who may be subjecting the Medicaid program to fraud, waste, and abuse due to mis-utilizing or over-utilizing some of their MO HealthNet benefits. MMAC will review … Continued
RESIDENTIAL CARE FACILITY (RCF) AND ASSISTED LIVING FACILITY (ALF) AUDITS
March 11th, 2016
RCFs and ALFs enrolled with Missouri Medicaid (MO HealthNet) may receive payments for personal care services provided in the facilities. Missouri Medicaid Audit and Compliance (MMAC) may conduct an on-site audit or a desk review to determine whether the services … Continued
ANNUAL PROVIDER UPDATE MEETING
March 11th, 2016
Missouri Medicaid Audit and Compliance (MMAC) is holding the spring session of the 2016 Annual Provider Update Meeting for Home and Community Based Providers on April 19, 20, and 21, 2016. The presentation runs from 10:00 a.m. to 3:00 p.m. each … Continued
DRA ATTESTATIONS
February 24th, 2016
Each year, Missouri Medicaid Audit and Compliance (MMAC) sends “DRA Attestations” to Medicaid providers that received at least five (5) million dollars in annual Medicaid payments during the previous federal fiscal year. The Deficit Reduction Act (DRA) of 2005 … Continued
ELECTRONIC HEALTH RECORDS (EHR) AND ADEQUATE DOCUMENTATION
February 23rd, 2016
Medicaid providers have expressed concern to Missouri Medicaid Audit and Compliance (MMAC) about accessing their Electronic Health Records (EHR) during an audit. Some providers have been unfamiliar with the process to access the records due to having a newly acquired … Continued
CONSUMER DIRECTED SERVICES (CDS) REPORTING REQUIREMENTS
February 23rd, 2016
Missouri Medicaid Audit and Compliance (MMAC) recently posted information about CDS quarterly and annual reports on its website. Click here to read that information. MMAC updated the quarterly and annual reports. The quarterly financial report and quarterly service report are … Continued
CDS WORKSHOP – CORRECTION
February 16th, 2016
Please note the earlier post indicated registration was not required. This was stated in error. You must register with Mo Healthnet to attend the workshops. Registration may be completed by email. Instructions for workshop registration are available on the MHD website at … Continued
CDS WORKSHOP
February 16th, 2016
Consumer Directed Services (CDS) vendors are invited to attend a workshop coordinated by Missouri Medicaid Audit and Compliance (MMAC) in conjunction with the MO HealthNet Division (MHD). Presenters from MHD and the Department of Health and Senior Services (DHSS) will … Continued
PRESCRIPTION FRAUD ALERT
February 16th, 2016
Missouri Medicaid Audit and Compliance (MMAC) has seen a recent increase in fraudulent prescriptions passed across Missouri. The prescriptions contain similarities, listed below, and illustrated in a sample template. (click here to view the template) Common characteristics of the … Continued
PROVIDER ON-SITE AND DESK AUDITS GUIDANCE
February 2nd, 2016
Missouri Medicaid Audit and Compliance (MMAC) receives questions from Medicaid providers about our audit procedures. Click here to view audit information and guidance. The audit information and guidance covers commonly used terms, important information found in state regulation, and MMAC audit procedures. … Continued
CDS AUDIT GUIDANCE
January 14th, 2016
Missouri statute and regulation require CDS providers to submit an annual audit. RSMo 208.918.2 states vendors must demonstrate sound fiscal management as evidenced on accurate quarterly reports and an annual audit. 19 CSR 15-8.400(7) states vendors shall submit the … Continued
UPDATE: ORDERING, PRESCRIBING, AND REFERRING PHYSICIAN REQUIREMENTS
January 8th, 2016
Providers submitting claims for laboratory services and durable medical equipment (“DME”) have been receiving an alert on their remittance advices when the Ordering, Prescribing, or Referring (“OPR”) physician is not enrolled and in an active status. Currently those claims are set … Continued
UPDATE ON CONSUMER-DIRECTED SERVICES QUARTERLY AND ANNUAL REPORTS
December 30th, 2015
Consumer-Directed Services (CDS) Vendors who are enrolled with Missouri Medicaid (MO HealthNet) are required to provide certain reports. These reports are submitted either quarterly or annually to Missouri Medicaid Audit and Compliance (MMAC). Currently, Missouri statutes and regulations outline the … Continued
ADEQUATE DOCUMENTATION FOR PROGRESS NOTES
December 23rd, 2015
The Missouri Medicaid Audit and Compliance Unit (MMAC) has received questions from providers whose agencies provide certain types of services under the Department of Mental Health DD Waiver program. Specifically, providers of day habilitation services have requested clarification regarding adequate … Continued
AUDIT GUIDELINES FOR IN-HOME SERVICES AND CONSUMER DIRECTED SERVICES PROVIDERS
December 21st, 2015
Missouri Medicaid Audit and Compliance (MMAC) has received inquiries from personal care providers, regarding MMAC audit guidelines. Providers want to know what types of documents MMAC auditors will request, as well as what constitutes adequate documentation. Providers also want to … Continued
ICD-10 AND THE ADULT DAY CARE WAIVER PROGRAM
December 11th, 2015
ICD-10, or The International Classification of Diseases, 10th Revision, went into effect October 1, 2015. It is a revision of the ICD-9-CM system which physicians and other providers have used to code all diagnoses, symptoms, and procedures recorded in hospitals … Continued
PRIVATE DUTY NURSING UPDATE
December 11th, 2015
Some MO HealthNet-enrolled Private Duty Nursing (PDN) agencies are also enrolled to provide other types of services. For instance, a PDN agency may also be a provider of in-home services. Different program rules apply to PDN than to other programs. … Continued
ORDERING, PRESCRIBING, & REFERRING (OPR) PROVIDERS
November 20th, 2015
Current state and federal regulations (13 CSR 65-2 and 42 CFR 455.410) require all ordering, prescribing, and referring (OPR) providers to enroll in Medicaid, in order for those providing the services to receive payment. These rules apply even if the … Continued
APPLICATION FEE UPDATE – NOVEMBER 2015
November 12th, 2015
Since July 2015, Missouri Medicaid Audit and Compliance (MMAC) has been collecting application fees from certain applying or revalidating providers. More information about the application fee requirement is on our website at https://mmac.mo.gov/providers/provider-enrollment/new-providers/application-fee/ The Missouri Code of State Regulations has … Continued
INFORMATION & UPDATES VIA GOVDELIVERY
September 24th, 2015
The Missouri Medicaid Audit and Compliance Unit (MMAC) is utilizing Gov. Delivery to provide updates and information via e-mail. Please visit our website at mmac.mo.gov to sign up for Gov.Delivery. Currently enrolled Medicaid Fee-for-Service providers and newly enrolling or revalidating … Continued
HCBS PROVIDERS: AUDIT GUIDELINES
September 18th, 2015
For home and community based providers, Missouri Medicaid Audit and Compliance (MMAC) wishes to provide the following audit guidelines. We hope this will assist you with preparation for an audit, and also help you properly retain adequate documentation and help … Continued
TELEPHONY TOOL FOR IN-HOME AND CDS PROVIDERS
August 27th, 2015
Missouri Medicaid Audit and Compliance (MMAC) has been working closely with the Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS), while they draft a regulation to govern the telephony requirements for In-Home and Consumer-Directed … Continued
APPLICATION FEE UPDATE
August 18th, 2015
MISSOURI RECEIVES APPLICATION FEE WAIVER FOR CERTAIN PROVIDER TYPES State and federal regulations (13 CSR 65-2 and 42 CFR 455.460) require MMAC to collect an application fee, currently set at $542.00, from all new and revalidating “institutional” Medicaid providers. “Individual” … Continued
PROVIDER SELF DISCLOSURES
August 18th, 2015
Providers who self-audit and discover overpaid amounts are able to “self-disclose” or report those findings. The findings, along with repayment, can be sent to Missouri Medicaid Audit & Compliance (MMAC) by using the Self Disclosure Form, located here. Providers do … Continued
RCF and ALF – MONTHS CONTAINING FEWER THAN 31 DAYS
August 14th, 2015
On August 10, 2015, the Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS) issued a memo regarding modifications to the Home and Community Based Services (HCBS) Web Tool. The memo also describes a manual … Continued
UPDATE ON RECOVERY AUDIT CONTRACTOR (RAC) ACTIVITIES
July 8th, 2015
Cognosante, LLC is the RAC for Missouri. Section 6411 of the Affordable Care Act, Expansion of Recovery Audit Contractor (RAC) Program, amends section 1902(a)(42) of the Social Security Act and requires states to contract with a RAC vendor and allows states … Continued
TELEPHONY TRACKING SYSTEMS UPDATE – JULY 2015
July 7th, 2015
Effective July 1, 2015, all In-Home and Consumer Directed Services providers are required to have, maintain, and use a telephone tracking system “telephony” for the purpose of reporting and verifying the delivery of In-Home and Consumer Directed services authorized by … Continued
MISSOURI’S EHR AUDIT CONTRACTOR
June 8th, 2015
Brown Smith Wallace LLC, Missouri’s EHR Audit Contractor As part of the ongoing program to monitor MO HealthNet’s Electronic Health Record (EHR) Incentive Program payments, the Missouri Department of Social Services has contracted with Brown Smith Wallace LLC to conduct … Continued
TELEPHONY TRACKING SYSTEMS UPDATE
June 5th, 2015
The following is from a memo published by the Director of the Division of Senior and Disability Services on May 26, 2015 regarding the requirement for Telephony Tracking Systems. Click HERE to download the full memo. “Effective July 1, … Continued
IHS & CDS PROVIDER CONTRACT RENEWAL
May 20th, 2015
Currently enrolled In-Home Services (IHS) and Consumer-Directed Services (CDS) providers’ participation agreements are valid for five (5) years. This is consistent with re-validation requirements. Most currently enrolled IHS and CDS providers have a renewal date of June 30, 2019. Providers … Continued
PROVIDER ADDRESS UPDATES
May 1st, 2015
Missouri Medicaid Audit & Compliance (MMAC) has begun implementing new provider enrollment procedures including provider revalidation. Any provider whose address has changed since initial enrollment should submit the updated information to MMAC by downloading the “Provider Update Request” form at … Continued
PROVIDER REVALIDATION
April 29th, 2015
State and federal regulations require all currently enrolled Medicaid providers to revalidate their enrollment at least every five (5) years. MMAC has established a revalidation schedule for all currently enrolled providers. MMAC will contact currently enrolled providers approximately 120 days … Continued
ENROLLMENT-REVALIDATION DISCLOSURE REQUIREMENTS
April 29th, 2015
All MO HealthNet providers are required by state regulations to disclose certain information to Missouri Medicaid Audit & Compliance (MMAC) during their initial enrollment or revalidation processes. Those mandatory disclosures include: The name, address, date of birth, social security number, … Continued
MO HEALTHNET NEWS
April 28th, 2015
MMAC utilizes MO HealthNet (MHD) provider hot-tips and provider bulletins to keep providers informed about its activities. MMAC website updates will be sent to MHD in the form of hot-tips or bulletins for providers. We encourage providers to sign up … Continued
PROVIDER UPDATE TRAINING
April 7th, 2015
Provider Update Training is scheduled for April 21, 22, and 23, 2015. This Provider Update Training is for Home and Community Based Services Providers. Please open this notification and click on the link for additional information. Provider Update Training … Continued
PROVIDER ENROLLMENT
March 17th, 2015
State and federal regulations (13 CSR 65.2 and 42 CFR 455.414) require all enrolled Medicaid providers to do certain things: Revalidate their information at least every five (5) years Certain providers must pay an application fee Providers must be … Continued
2015 UPDATE ON RECOVERY AUDIT CONTRACTOR (RAC) ACTIVITIES
March 3rd, 2015
In March, 2014, MMAC posted an update to the RAC (Recovery Audit Contractor) and MIC (Medicaid Integrity Contractor) activities on its website. See the archived post here March 2014 RAC and MIC update. Cognosante, LLC is the RAC for Missouri. Section 6411 … Continued
NON-EMERGENCY MEDICAL TRANSPORTATION SERVICES: REMINDERS
March 3rd, 2015
MO HealthNet reimburses eligible participants or nonemergency medical transportation (NEMT) providers for medically necessary transportation only if a participant does not have access to transportation services that are available free of charge. For more guidance on the NEMT program and … Continued
REMINDER: KEEP YOUR PROVIDER INFORMATION CURRENT
January 5th, 2015
Missouri Medicaid Audit & Compliance (MMAC) will begin implementing new provider enrollment procedures during 2015 to comply with federal laws requiring all Medicaid providers to revalidate their state enrollments at least every five years. Other changes will include conducting pre-enrollment … Continued
UPDATE ON ENROLLMENT OF PHYSICIAN ASSISTANTS
January 2nd, 2015
The Missouri Medicaid Audit & Compliance (MMAC) Provider Enrollment Unit (PEU) has processed several applications for enrolling Physician Assistants. PEU personnel assign provider numbers and create the appropriate electronic accounts, permitting the new providers to begin submitting claims for health … Continued
HOME AND COMMUNITY BASED SERVICES PROVIDERS: BILLING REMINDERS
October 20th, 2014
Missouri Medicaid Audit and Compliance (MMAC) conducts post-payment reviews (audits) of Medicaid-enrolled providers’ billing. As a service to our enrolled providers, MMAC wishes to remind providers of several requirements, and the regulatory language that provides instruction to providers. Reminders: … Continued
TELEPHONE TRACKING SYSTEMS (“TELEPHONY”)
September 11th, 2014
In 2010, the Missouri Department of Health and Senior Services established a pilot project for In-Home Services and Consumer Directed Services providers to test the implementation of electronic telephone tracking systems, also known as “telephony”. Participation in this pilot project … Continued
ENROLLMENT OF PHYSICIAN ASSISTANTS
August 27th, 2014
Effective August 28, 2014, licensed Physician Assistants will be able to submit enrollment applications to become Medicaid providers. These applications will not be immediately processed. Until the necessary work is completed for the Physician Assistants applications to be processed … Continued
UPDATE ON RECOVERY AUDIT CONTRACTOR (RAC) AND MEDICAID INTEGRITY CONTRACTOR (MIC) ACTIVITIES
March 18th, 2014
Section 6411 of the Affordable Care Act, Expansion of Recovery Audit Contractor (RAC) Program, amends section 1902(a)(42) of the Social Security Act and requires states to contract with a RAC vendor and allows states to reimburse contractors who assist in … Continued
PROVIDER ADDRESSES MUST BE KEPT CURRENT
March 12th, 2014
Missouri Regulation 13 CSR 70-3.020 (7) requires providers to inform the state of any changes affecting their MO HealthNet enrollment records. These changes, including change of address, are to be reported by the provider on specific forms within 90 days … Continued
PROVIDER CERTIFICATION TRAINING TEST UPDATE
November 22nd, 2013
There has been conflicting information posted on the MMAC website in regards to the Provider Certification Training Test date for December 2013. The next review and test will be provided on Friday, December 13, 2013. The review will start at … Continued
MEMORANDUM FOR HOME AND COMMUNITY BASED SERVICES PROVIDERS
August 8th, 2013
The Missouri Medicaid Audit and Compliance Unit (“MMAC”) has scheduled provider update meetings for all Home and Community Based Services (HCBS) providers in October 2013. HCBS providers include: In-Home Service (IHS) providers, Consumer Directed Services (CDS) vendors, Residential Care Facilities … Continued
Update to Physician Manual: Section 13.41.E
April 22nd, 2013
In order to effectively treat chronic pain, physicians rely on drug testing to monitor prescribed medications and drugs of abuse. Urine Drug Screening tests which provide qualitative or semi-quantitative initial screen or preliminary results may not be reported with … Continued
Spend Down Update
April 4th, 2013
Home Health Issue: Some FSD offices were requiring home health providers to submit the physician order, or plan of care (485) along with the bill for private services delivered during the time the patient is not receiving MO HealthNet benefits … Continued
Recovery Audit Contractor Sends Out Initial Overpayment Letters
April 2nd, 2013
In an effort to help states reduce improper payments for Medicaid health care claims, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to implement section 6411 of the Affordable Care Act. Section 6411 of the Affordable … Continued
Provider Enrollment Faxing Instructions
February 14th, 2013
In order to facilitate the enrollment process, please fax all documentation other than the “signature” page to (573-751-5065) or you may scan and email the verification documentation to mmac.providerenrollment@dss.mo.gov, which may include tax documents, Medicare enrollment verification, Board of Healing … Continued
Recovery Audit Contractor-approved changes
January 28th, 2013
In an effort to help states reduce improper payments for Medicaid health care claims, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to implement section 6411 of the Affordable Care Act. Section 6411 of the Affordable … Continued
Provider Update Meetings
December 6th, 2012
The Missouri Medicaid Audit and Compliance (MMAC) will not be scheduling provider update meetings for Home and Community Based Services (HCBS) providers for the remainder of this calendar year. HCBS providers include: In-Home Service (IHS) providers, Consumer Directed Services (CDS) … Continued
FAQs Regarding the Personal Care Program
October 31st, 2012
1. How will MMAC conduct audits with regard to the number of authorized units and number of days in a month? 13 CSR 70-91.010(1)(6)(2) provides: The personal care plan will be developed in collaboration with and signed by the recipient. … Continued
Time Sheet Signature Requirement-Personal Care Program
October 16th, 2012
Personal Care Services Provided in a Residential Care Facility Setting or the Participant’s Home Please note that, pursuant to 13 CSR 70-91.010(4)(A) 2.F., documentation for services delivered by the provider in the Personal Care Program must include the following: F. … Continued
Who Can Pay for Medicaid Spend Down?
August 21st, 2012
What is a Medicaid spend down? Medicaid, also known as Title XIX, or MO HealthNet in Missouri, is a medical assistance program for low-income people who are elderly (65 years and older), permanently and totally disabled, blind or who meet … Continued
Speech Language Pathologist Providing Services in a School Setting
August 9th, 2012
Missouri state law (RSMO 345.020) prohibits anyone from practicing speech-language pathology without a Missouri license. RSMO 345.025.1(6) provides: The provisions of sections 345.010 to 345.080 do not apply to an individual who “holds a current valid certificate as a speech-language … Continued
Attestation of Medical Record Loss or Destruction Form
August 9th, 2012
The Missouri Medicaid Audit and Compliance Unit requests that any provider who believes that documentation in support of servicing Missouri Medicaid participants is no longer available, due to extenuating circumstances or unforeseen events, utilize the Attestation of Medical Record Loss … Continued
Federal Anti-Kickback Statute
August 9th, 2012
The following may be a useful resource, but is not intended to be a treatise on federal fraud and abuse laws or answer specific legal questions of providers. Rather, it serves as a basic understanding of the federal Anti-Kickback statute … Continued
Provider Review Tips
May 31st, 2012
In-Home Services and Consumer-Directed Services revised 1/28/13 Follow the current care plan as closely as possible Never serve more than approved units Intermittent changes: If the services provided do not substantially match the care plan, document why and attach the … Continued
Glossary of Definitions Used in the Medicaid Integrity Program
May 31st, 2012
ABUSE: Provider practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary, or that fail to meet professionally recognized … Continued
Certified Manager Training
April 23rd, 2012
Designated Managers Must Attend Division Sponsored Training Annually The Department of Health and Senior Services, Division of Senior and Disability Services recently distributed PM-04-08 to all in-home services providers on Feb. 7, 2012. This memo is available at http://health.mo.gov/seniors/hcbs/ihsmemos.php. The … Continued
Provider Screening
April 23rd, 2012
Providers’ Obligation to Screen Employees and Contractors for Excluded Persons The Centers for Medicare and Medicaid Services issued State Medicaid Director Letter #09-001 dated January 16, 2009 regarding excluded persons. The letter advises States of their obligation to direct providers … Continued
Provider Adjustments Prohibited After Overpayment Letter Received
April 23rd, 2012
The Missouri Medicaid Audit & Compliance Unit (MMAC) issues final decision letters to providers after conducting reviews of post-payment claims. Providers must be aware that the overpayment amount detailed in their final decision (demand) letter is a sanction according to … Continued
CMS hosting Provider Education Webinar/Conference Calls
April 13th, 2012
The Centers for Medicare & Medicaid Services (CMS) is hosting six Payment Error Rate Measurement (PERM) program provider education webinar/conferences calls during PERM Cycle 1 (2012) of which Missouri is included. The purpose is to provide an opportunity for the … Continued
Dental Program Notice
April 11th, 2012
Adults with limited benefits may have received benefits incorrectly Claims have incorrectly paid for dentures/partials for adults with a limited benefits package. Dentures/partials of any kind are not a covered service for adults with a limited benefits package. Please reference … Continued
RAC Credit Balance Transfer Review-Hospitals
February 14th, 2012
Missouri awarded its Recovery Audit Contractor (RAC) Contract to Cognosante, LLC. Under the purview of Cognosante, LLC, Arbor Healthcare has been contracted to perform Credit Balance Transfer Audit services for this contract. The Credit Balance audit process involves reviewing the … Continued
Missouri’s Participation in the Medicare-Medicaid Data Match Program
February 2nd, 2012
Please note that Missouri has decided to participate in the Medicare-Medicaid Data Match Program. The Centers for Medicare and Medicaid Services (CMS) created the Medicare-Medicaid Data Match Program, or Medi-Medi project, in 2001. This integrity program initially began in California … Continued
Recovery Audit Contractor (RAC)
December 2nd, 2011
The Patient Protection and Affordable Care Act (PPACA) is a United States federal statute which was signed into law on March 23, 2010. Section 6411 of PPACA expands to Medicaid the Recovery Audit Contractor (RAC) program, which previously applied only … Continued