ADULT DAY CARE WAIVER SERVICES

Thank you for your interest in the Missouri Medicaid ADULT DAY CARE (ADC) Waiver Program.  The ADC Waiver provides adult day care to active MO HealthNet participants ages 18 to 63 who meet the nursing facility level of care.  Adult day care services under the Aged and Disabled Waiver provide adult day care to active MO HealthNet participants aged 63 and over. Adult day care services provide continuous care and supervision to disabled adults in a licensed adult day care setting. Services include, but are not limited to, assistance with activities of daily living, planned group activities, food services, client observation, skilled nursing services as specified in the individual’s plan of care, and transportation. Planned group activities include socialization, recreation and cultural activities that stimulate the individual and help the participant maintain optimal functioning. Meals which are provided as part of the adult day care service do not constitute a “full nutritional regimen” (3 meals a day). The provider must arrange or provide transportation to and from the adult day care facility at no cost to the participant.  MO HealthNet Provider Bulletin, Volume 35 Number 26 on the ADC Waiver Program.

Licensing by Department of Health and Senior Services (DHSS)

A provider of Adult Day Care must be licensed with the Missouri Department of Health and Senior Services (DHSS) to receive reimbursement. The application for License to Operate an Adult Day Care Program can be found at http://health.mo.gov/seniors/nursinghomes/adultdaycare.php. For more information on adult day care licensing and regulation through the Department of Health and Senior Services, please review 19 CSR 30-90.010 and 19 CSR 30-90.020.

Missouri Medicaid Audit and Compliance Enrollment

  1. A provider of Adult Day Care services must be enrolled with the Missouri Department of Social Services (DSS), Missouri Medicaid Audit and Compliance Unit (MMAC) to receive reimbursement.  An investigation of the provider’s professional background will be conducted pursuant to 13 CSR 70-3.020 and 13 CSR 65-2.020.  Each adult day care providing services to Missouri Medicaid participants must enroll separately.

REQUIRED FORMS FOR ENROLLMENT

All required documents listed below must be submitted.  Please read carefully.

  1. MMAC Adult Day Care Profile Form
  2. Business Organizational Structure (BOS) form and all documents as indicated by the section of the form completed. Complete only one section, based on how your business is registered with the IRS and DOR, and provide all the required supporting documents for that section.  BOS Resource/Guide
  3. Notification from the Internal Revenue Service of the applying provider’s assigned Federal Employer Identification Number.
  4. Notification from the Missouri Department of Revenue of the applying provider’s assigned Missouri Employer Identification Number.
  5. Current Vendor No Tax Due letter from the Missouri Department of Revenue. Information available at http://dor.mo.gov/forms/943.pdf. Make sure both the FEIN and state EIN are included on the letter. A Certificate of No Tax Due is NOT sufficient.
  6. Notification from CMS/NPPES of the applying provider’s assigned Type 2 organizational National Provider Identification (NPI) number. Go to https://nppes.cms.hhs.gov/ to obtain and print out confirmation of your assigned NPI.
  7. A copy of the Adult Day Care license issued by the DHSS Section for Long Term Care Regulation.
  8. MMAC Adult Day Care Assurances Form Be sure to answer questions 1, 2 and 3.
  9. MMAC Adult Day Care Questionnaire
  10. MMAC HCBS Enrollment Application Form
  11. Title XIX Participation Agreement
  12. DSS-MMAC Electronic Funds Transfer (EFT) Authorization Agreement form with a copy of a preprinted voided check or a bank letter listing the account holder, routing number and account number.
  13. HCBS Settings Provider Self-Assessment
  14. HCBS Setting Requirements Assurances form
  15. On a separate sheet of paper or attachment (i.e. organizational chart, spreadsheet, etc.) identify individuals and businesses with direct participant contact, ownership or control interests, and all “managing employees” as defined in 13 CSR 65-2.010(25). Those attachments must contain the full name (First, middle, last and suffix Jr., Sr., etc. – including maiden names and any aliases), date of birth, and social security number of each individual who has 5% or greater direct/indirect ownership, controlling interest, partnership interest; any contractor or subcontractor; managing employees; officers or directors; or the legal business name and federal EIN of any organization(s) having direct or indirect ownership or controlling interest.
  16. Provide documentation from DHSS that the owners and managing employees listed in number 15 (above) with direct Medicaid participant contact are registered with the Family Care Safety Registry (FCSR). Go to https://webapp02.dhss.mo.gov/bsees/  to register
  17. Lease agreement or deed for the facility location.
  18. Copy of confirmation of Application Fee Payment – App Fee Vendor Site

Please fax the completed application and supporting documents listed above to 573-634-3105 for review

All applications are processed and reviewed in the order they are received. Upon receipt of this enrollment packet, your application will be reviewed. MMAC staff will contact you if additional information is required.

If you have questions or need assistance completing the enrollment packet, please contact the MMAC Contracts Unit at mmac.ihscontracts@dss.mo.gov

MMAC does not accept photos of documentation taken with a cell phone or camera for enrollment purposes.