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Rhonda Schenewerk Provider Education Representative
Missouri Medicaid Audit & Compliance Annual Update Meetings October 24, 25, 26- 2017
Personal Care (PC) and Consumer Directed Personal Care Services (CDS) Aged & Disabled Waiver Services (Homemaker/Chore/Respite)
Department of Social Services (DSS) http://dss.mo.gov/mhd/providers/fee-for-service-providers Department of Health & Senior Services (DHSS) - Department of Senior & Disability Services (DSDS) http://www.health.mo.gov/seniors/hcbs/info.php Missouri Medicaid Audit & Compliance (MMAC) https://mmac.mo.gov
Home and Community Based Services Pursuant to Federal and State Laws & Regulations
Contact: (888) 581- 9797 or (573) 632-9797
Email: [email protected]
Cyber Access Helpful Tips: https://www.cyberaccessonline.net
Personal Care Agency Model
eMOMED Electronic Claim Filing
CMS/Medical 1500
Always check eligibility
Monitor Remittance Advice
CMS/Medical 1500
15 minutes of direct service to the participant, include: • Time spent completing work vouchers • Obtaining participant signatures Not included:
• Time spent for travel, lunch, breaks • Administrative activities such as completing other
reports or paperwork
Unit of Service
1 unit = 15 minutes
Allowed reimbursement $4.47 per unit. $4.47 x 170 units = $759.90
U&C: The US government healthcare website defines usual, customary and reasonable as being “The amount paid for a medical service in a geographic area based on what providers In the area usually charge for the same or similar medical service.”
Allowed reimbursement $4.47 per unit. $4.47 x 170 units = $759.90
1 unit = 15 minutes
U&C: The US government healthcare website defines usual, customary and reasonable as being “The amount paid for a medical service in a geographic area based on what providers In the area usually charge for the same or similar medical service.”
$4.47 x 32 units = $143.04
1 unit = 15 minutes
U&C: The US government healthcare website defines usual, customary and reasonable as being “The amount paid for a medical service in a geographic area based on what providers In the area usually charge for the same or similar medical service.”
Claims Processing and Payment Schedule Financial Cycle Date Provider Check Date
Note: closeout is 5:00 p.m. Revised: 05/17/2017
Units are billed in 15 minute increments
Accrued minutes can be accumulated and billed on the first date a whole 15 minute(s) is accrued
Accrued minutes can be accumulated throughout the month
Note: cannot carry over through the following month
Accrued Units
Personal Care Agency Model
Day Time In Time Out Saturday AM/PM AM/PM Make Bed/Linens, Meal Prep/Dishes, Mobility/Transfer/Position, Bathing, Dressing/ Grooming, Clean Bathroom Sunday AM/PM AM/PM Make Bed/ Linens, Meal Prep/Dishes, Mobility/Transfer/Position, Bathing, Dressing/ Grooming
Monday AM/PM AM/PM Make Bed/ Linens, Meal Prep/Dishes, Mobility/Transfer/Position, Bathing, Dressing/ Grooming, Laundry, Clean Kitchen, Trash
Tuesday AM/PM AM/PM Make Bed/ Linens, Meal Prep/Dishes, Mobility/Transfer/Position, Bathing, Dressing/ Grooming
Wednesday AM/PM AM/PM Make Bed/ Linens, Meal Prep/Dishes, Mobility/Transfer/Position, Bathing, Dressing/ Grooming, Laundry
Thursday AM/PM AM/PM
Make Bed/ Linens, Meal Prep/Dishes, Mobility/Transfer/Position, Bathing, Dressing/ Grooming, Shopping/Errands/Correspondence Friday AM/PM AM/PM Make Bed/ Linens, Meal Prep/Dishes, Mobility/Transfer/Position, Bathing, Dressing/ Grooming, Laundry, Cleaning Livingroom
Aide / Attendant Schedule
Home and Community Based Waiver granted by Centers for Medicare & Medicaid services (CMS)
Under a waiver, certain services that could not otherwise be reimbursed under Title XIX may be provided to a select group of recipients, in order to provide an alternative to institutional care.
Services provided through the Aged & Disabled Waiver include: homemaker services chore services basic and advanced respite care institutional respite nurse respite care home delivered meals Adult Day Care Waiver
Essential Transportation Consumer Direct Services/ Personal Care
Provided for what: For essential shopping/errands, school, or
employment (types of trips may vary) Provided when: Any time throughout the month= Flexibility Submit units on the day transportation was provided Units submitted do not exceed the monthly authorization
Electronic Visit Verification (EVV) Regulation
https://www.sos.mo.gov/CMSImages/AdRules/csr/current/19csr/19c15-9.pdf Bureau of Program Integrity at [email protected] or 573/526-8557.
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QUESTIONS?
