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. Click here for 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.
State and federal regulations (13 CSR 65-2 and 42 CFR 455.460) require MMAC to collect an application fee, currently set at $631.00 (Jan. 1, 2022), from all new and revalidating “institutional” Medicaid providers. “Individual” providers such as physicians, dentists and other individual non-physician practitioners are not required to pay the application fee. Click here to obtain more information regarding the application fee.
Missouri Medicaid Audit and Compliance Enrollment
- 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.
- Missouri Medicaid Adult Day Care Provider Profile Form
- 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.
- Notification from the Internal Revenue Service of the applying provider’s assigned Federal Employer Identification Number.
- Notification from the Missouri Department of Revenue of the applying provider’s assigned Missouri Employer Identification Number.
- 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.
- 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.
- A copy of the Adult Day Care license issued by the DHSS Section for Long Term Care Regulation.
- MMAC Adult Day Care Assurances form Be sure to answer questions 1, 2 and 3.
- MMAC Adult Day Care Provider Questionnaire form
- MMAC Adult Day Care Provider Enrollment Application form
- MMAC Participation Agreement for Adult Day Care Services form
- DSS-MMAC Electronic Funds Transfer (EFT) Authorization Agreement form with a copy of a preprinted voided check and a bank letter listed the account holder, routing number and account number.
- On a separate sheet of paper, provide the full names (including maiden names and any aliases), addresses, dates of birth, social security numbers of any direct or indirect owners with greater than five (5) percent ownership or control in the applying provider and any “managing employees” as defined in 13 CSR 65-2.010(25). Provide the names, addresses and federal EIN of any business entities that are direct or indirect owners with greater than five (5) percent ownership or control interest in the applying provider.
- Provide documentation from DHSS that the owners and managing employees listed in number 13 who will have direct contact with Medicaid participants are registered with the Family Care Safety Registry (FCSR). Go to https://webapp02.dhss.mo.gov/bsees/ to register.
- HCBS Setting Requirements Self-Assessment form
- HCBS Setting Requirements Assurances form
Upon receipt of the application fee and required documents/attachments, your application will be reviewed by the MMAC Provider Enrollment Unit. You will be notified via email if additional information is needed or the application is finalized.
Please fax the completed application and supporting documents listed above to 573-634-3105 for review
If you have questions or need assistance completing the enrollment forms, please contact Provider Enrollment via email at email@example.com.