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 calculation for HCBS providers to utilize prior to the Web Tool update taking effect. This calculation applies when Personal Care or Advanced Personal Care services are provided in either an Assisted Living Facility (ALF) or Residential Care Facility (RCF). Click here to read the memo, number PM-16-02.
On August 7, 2015, the MO HealthNet Division issued a Provider Bulletin regarding the same topic. Click here to read the bulletin.
The bulletin states, in part, “For RCF and ALF personal care providers, when a participant’s plan of care includes at least one task that is to be performed daily, then the participant’s monthly maximum allotment cannot be reached in a month containing fewer than 31 days.
When determining compliance with this limitation, the following method shall be used:
- Step 1: Identify the daily tasks (tasks shown on the care plan as daily or with a frequency of seven times a week).
- Step 2: Identify the total number of minutes for these daily tasks in a week (this may appear directly on the care plan, or you can multiply the total number of daily task minutes by seven).
- Step 3: Divide the number in step 2 by 15. Round up to the nearest whole number (.5 or more rounds up). This gives you the daily task units per week.
- Step 4: Divide the number in step 3 by seven (7). Round up to the nearest whole number (.5 or more rounds up). This gives you the daily task units per day.
- Step 5: Multiply the number in step 4 by the number of days fewer than 31 in the month. (Take the number for step four (4) and multiply it by one (1) for April, June, September, and November. Multiply it by three (3) for February. Multiply it by two (2) for February in a leap year.
- Step 6: Take your total from step 5 and subtract it from the total number of authorized units. This gives you the new total of authorized units for your shorter month.”
The Missouri Medicaid Audit and Compliance Unit (MMAC) defers to and supports the guidance provided above.