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 verify the information submitted to Missouri Medicaid Audit and Compliance (MMAC) is accurate and to determine compliance with federal and state enrollment requirements.
In July of 2015, MMAC began conducting pre-enrollment and post-enrollment site visits of new, reenrolling or revalidating providers assigned to moderate and high risk categories. Click here to see the risk category assigned to each Medicaid provider type in Missouri. If you are a “revalidating” provider that is assigned to a moderate or high risk category, you may receive notice of a site visit, although you might not have been subject to one in the past. MMAC personnel will conduct site visits during regular business hours, provide you with advance notice of the site visit, and will utilize another current regulatory site visit in lieu of conducting a redundant visit, when appropriate. As well, site visits conducted by Medicare or other state Medicaid agencies within the previous two years may suffice in place of an MMAC site visit.
MMAC will attempt to accommodate all requests from other state Medicaid programs needing a pre-enrollment or post-enrollment site visit to be conducted in Missouri. If you are a provider who is attempting to enroll in another state’s Medicaid program and are advised you will need a site visit, please ask that state to contact the MMAC Provider Enrollment Manager at MMAC.ProviderEnrollment@dss.mo.gov. If you are an out of state provider attempting to enroll with Medicaid in Missouri and require a pre-enrollment site visit before you can be enrolled, MMAC will request that the Provider Enrollment unit in your state conduct the site visit on MMAC’s behalf.
Please contact MMAC.Provider.Enrollment@dss.mo.gov with any questions.