In-home Services

Policies/ProceduresPolicy = a principle or rule to guide decisions and achieve rational outcomes.(what, why)

Procedure = an act composed of steps; course of action (who, when, where and how)

address the topic onlyclearconcisepunctuation, grammar, etc.detailedanswer who, what, where, when and how

There is a section of the proposal that consists of the entitys policies and procedures. These are some guidelines to help you when you are developing your policies and procedures. A policy is defined as a principle or rule to guide decisions and achieve rational outcomes. It answers what and why. Procedures are an act composed of steps; a course of action. The procedures answer who, when, where and how. When developing your policies and procedures, be sure they include each of these. What is the policy, who is going to do something, when will certain actions occur, where will documentation be kept, etc.

Make sure your policy and procedures only address the topic. I believe some people think that if they put everything possible into their policy and procedures either well get tired of reading it or surely with everything in there theyll hopefully get the things were looking for. Thats not true. If it is too confusing it could be denied.

Be clear. For example, dont just say staff will do this or that. Tell whose responsibility it is. Will it be the nurses responsibility? The designated manager? Dont say the appropriate state agency will be notified. Tell exactly what state agency you are referring to.

Be concise. These policies and procedures dont have to go on and on for pages and pages. And we arent looking for flowery writing. Just state as simply as you can what your agencys policy and procedures for ensuring the specific requirements are met.

Watch grammar, spelling and punctuation. As you know, improper usage of these can totally change the meaning of things.

Be very detailed. Include all scenarios, steps and outcomes. For example, with the Family Care Safety Registry, be sure to include all possibilities: When can a person be employed? What if the screening results in a finding? What if there is no finding? What if the finding is a certain type of crime? What are those certain types of crimes?

After the policy is complete, read back over it and make sure you answered who, what, where, when and how.

1AssurancesAssurance = promise or guaranteeA signed formAll requirements of the Assurance document must be incorporated into business practices and adhered to.Example:Applying Provider understands and agrees to post the Elder Abuse & Neglect Hotline number (800/392-0210) in each of its office locations.

An assurance is defined as a promise or guarantee. The assurances portion of the proposal consists of a form. The first three items on the form are disclosures that must be answered regarding any current or past relationships between the agency and the state agencies. Nothing else needs to be done on the form except to complete the bottom of the page with the agency name, signature, etc. You dont have to submit any written assurances with this form. However, by signing that document, you are making a promise or guaranteeing that you will abide by each of the assurances listed.

For example, one of the assurances states Applying Provider understands and agrees to post the Elder Abuse and Neglect Hotline number in each of its office locations. When staff come to your office, they should see that number posted because the Assurance document was signed and you agreed to meet the requirement.

2Proposal ProcessProposal reviewedSite visitParticipation agreement (contract) to agency for completionAgreement executed by MMACExecuted agreement to agency and Medicaid enrollment applications to MHD Letter from MHD confirming enrollmentBegin serving authorized clients

As I said earlier, when a proposal is received, a preliminary review is done to ensure it meets the submission requirements. If the proposal does meet the preliminary requirements, a full review will be done. If there are any areas of the proposal that do not meet requirements, a letter will be sent to the applicant. The letter will include a Review Summary that lists all areas of the proposal that did not meet requirements of the program. The left side of the Review Summary will include the citation from the Proposal for Contract and the right side will have a comment. The comment does not always tell exactly what the problem is in a certain area. The comment may be simply that it does not meet requirements of the code of state regulations or state statutes. It is up to the applicant to review the code of state regulations or state statutes to determine what is wrong. The applicant is given thirty days to reply to the letter. The information is reviewed and, if the proposal still does not meet requirements of the program, it is denied. A new proposal can be submitted at any time.

If the written proposal is approved, a site visit is scheduled. Staff will call you to schedule the visit and will come to your physical location. If the insurance coverage is not in place already, it must be made effective at this time.

If the site visit is successful and the insurance coverage is effective, a Participation Agreement for Home and Community Based Services, or contract, is sent to the applicant for completion. You must complete the first page of the agreement and complete the E-Verify information. The E-verify information consists of a form to complete, an affidavit that must be notarized and verification from the Department of Homeland Security that the agency is enrolled in the E-Verify program. Failure to complete all of these documents will delay the processing of the contract.

Once the properly completed agreement is returned, it is then executed by the Missouri Medicaid Audit and Compliance Units director. You will be sent a letter and a copy of the executed agreement. Also included in the letter will be instructions for enrolling the HCBS Web Tool. It is important to enroll in this system as it will place your agency on the list of providers contracted to provide services. The list is given to participants to choose a provider when they do not have a preference and also to authorize an agency to provide services to participants. So, if your agency is not on the list, you cant be authorized to provide services.

When the agreement is executed, the Medicaid enrollment forms that were completed during the proposal process are forwarded to the Provider Enrollment Unit. You will be notified via e-mail by the Provider Enrollment Unit when they have completed the enrollment. When the Medicaid enrollment is complete, you can then begin serving participants.

From the time a proposal is submitted until Medicaid enrollment if finalized and the agency can begin providing services to participants is a very long process. On average, it takes six months. This amount of time can be shorter or longer depending on the quality of the proposal submitted, the current workload of staff or how quickly information is returned.

3Maintaining PARegulations/Proposal/Participation Agreement

Training

Criminal background screenings

Employee Disqualification List

Insurance coverage

Once the participation agreement is in place, you must abide by the regulations of the program in order to maintain that agreement. Some of the requirements are to abide by all state and federal regulations governing the program, the proposal that was submitted and approved and the participation agreement.

You must ensure all staff receive the appropriate training including the basic training, advanced personal care training and in-service training. Proper documentation of all training provided and any training waived must be maintained for each employee.

All employees must be properly screened with the Family Care Safety Registry and the Employee Disqualification List. Proper documentation of the screenings must be maintained.

Insurance coverage must be maintained. When your insurance coverage expires annually, you must submit a copy of the new certificate of insurance to the Provider Contracts Unit. Also, be sure to get Workers Compensation coverage in place when it is required. Many agencies are not required to have Workers compensation coverage when they first begin because they do not meet the requirements. It is up to the agency to know the requirements for coverage and get the coverage in place when it is required. 4Changes to contact/demographic information and staff

24/7 phone contact

Termination of contract

Failure to abide by requirements of the program could result in recoupment of funds, PA special terms or termination of PA.

You must also notify the Provider Contracts Unit when you want to change certain information such as the address, phone numbers, hours of operation, designated manager or registered nurse. The request to change this information must be submitted five days prior to the change taking place and must be submitted on a Change Request form. This form is available on this website under Applications and Forms.

The agency must be available by telephone 24 hours a day/7 days per week and phone calls received after business hours must be returned within two hours. The agency should use common sense regarding calls received after business hours. It does not mean we expect you to talk to a client for an hour at 1:00 a.m. because the client is lonely. But, if a participant calls at 1:00 a.m. and says their aide did not show up, the agency must respond immediately and provide an alternative aide.

The agency can terminate their participation agreement and Medicaid enrollment by notifying the Provider Contracts Unit in writing 30 days prior to the desired termination date. This will allow time for participants to be contacted and reauthorized to other provider agencies that are contracted to provide services.

Failure of the provider to abide by these requirements and all other requirements of the program could result in special terms being added to the participation agreement, recoupment of funds the agency received for providing services or even termination of the participation agreement and Medicaid enrollment. 5Expiration of PAsParticipation agreements are effective for a one year period, July 1 through June 30

Information must be submitted, within set deadlines, in order to be considered for a new agreement

The participation agreement is effective for a one year period and follows the state fiscal year which begins July 1 and ends June 30 of each year. If a participation agreement is granted anytime after July 1, it will expire June 30. In order to be considered for a new participation agreement that would become effective July 1, certain information must be submitted. Prior to the expiration of the participation agreement, you will be notified by letter as to what information must be submitted in order to be considered for a new agreement. If the information is not submitted, the current participation agreement would end June 30 and you would no longer be authorized to provide services beginning July 1.

6Direct DepositDHSS and MHD reimbursements are direct deposited

To change bank information, complete

Vendor ACH-EFT Application (SSBG/GR)http://www.dhss.mo.gov/seniors/hcbs/appsforms.php

Application for Provider Direct Deposit (Medicaid)http://manuals.momed.com/manuals/presentation/forms.jsp

Must complete a form for each provider number

Both the Department of Health and Senior Services and the MO HealthNet Division require that reimbursement to providers be made via direct deposit. The necessary forms to establish direct deposit are completed during the proposal process. If at anytime you need to change your banking information, you must complete a Vendor Input/ACH-EFT Application to change the SSBG/GR funds and two Applications for Provider Direct Deposit forms. Remember, for Medicaid, you are enrolled in two programs, the personal care program and the aged & disabled waiver program. Therefore, you must complete a direct deposit form for each program. If a form is not submitted for both programs, one of the accounts will not get changed.

Be sure to keep the old account active until at least one deposit has been made to the new account. If direct deposit is not in place, a paper check will be issued but it will be held until direct deposit is in place.

7Contact InformationMMAC Provider Contractsmmac.ihscontracts@dss.mo.gov

For questions regarding proposals, the participation agreement or Medicaid enrollment, please contact the Provider Contracts Unit via e-mail. E-mail allows the least interruptions to staff and provides a written record of communications.

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