The Department of Health and Senior Services, Division of Senior and Disability Services recently distributed PM-04-08 to all in-home services providers on Feb. 7, 2012. This memo is available at http://health.mo.gov/seniors/hcbs/ihsmemos.php. The memo announced the schedule of regional provider meetings being held by the Division of Senior and Disability Services.
19 CSR 15-7(14)(D) states, “all providers must…ensure the designated managers annually attend division sponsored training designed to update certified managers.” The Missouri Medicaid Audit and Compliance Unit (MMAC) has made the decision to allow attendance at one of these regional provider meetings to meet this annual training requirement.
Certified managers should maintain a copy of the agenda or handouts as proof of attendance at the meeting.
If you have any questions regarding this notice, please contact Provider Contracts via email at mmac.ihscontracts@dss.mo.gov
The Centers for Medicare and Medicaid Services issued State Medicaid Director Letter #09-001 dated January 16, 2009 regarding excluded persons. The letter advises States of their obligation to direct providers to screen their employees and contractors for excluded persons. In particular, the letter states, in part:
Policy Clarification: States Should Advise Medicaid Providers to Screen for ExclusionsTo further protect against payments for items and services furnished or ordered by excluded parties, States should advise all current providers and providers applying to participate in the Medicaid program to take the following steps to determine whether their employees and contractors are excluded individuals or entities:
States should advise providers of their obligation to screen all employees and contractors to determine whether any of them have been excluded. States should communicate this obligation to providers upon enrollment and reenrollment.
States should explicitly require providers to agree to comply with this obligation as a condition of enrollment.
States should inform providers that they can search the HHS-OIG website by the names of any individual or entity.
States should require providers to search the HHS-OIG website monthly to capture exclusions and reinstatements that have occurred since the last search.
States should require that providers immediately report to them any exclusion information discovered.
The letter can be viewed in its entirety at:
https://www.cms.gov/SMDL/downloads/SMD011609.pdf
The Missouri Medicaid Audit and Compliance Unit does consider compliance with the steps outlined in the letter and summarized above as an integral part of a providers’ provision of service delivery to MO HealthNet program participants. Compliance with these requirements may be subject to review by the Missouri Medicaid Audit and Compliance Unit.
The Missouri Medicaid Audit & Compliance Unit (MMAC) issues final decision letters to providers after conducting reviews of post-payment claims. Providers must be aware that the overpayment amount detailed in their final decision (demand) letter is a sanction according to 13CSR 70-3.030. Providers are prohibited from submitting on-line claim adjustments for erroneous payment to correct the overpayment. Providers must submit payment to MMAC Unit via check or electronic transfer from future remittance advice.
Questions and concerns regarding repayment can be directed to the MO HealthNet Division Provider Education Unit representative.
MMAC enforces this sanction per authority of 13 CSR 70-3.030.
The Centers for Medicare & Medicaid Services (CMS) is hosting six Payment Error Rate Measurement (PERM) program provider education webinar/conferences calls during PERM Cycle 1 (2012) of which Missouri is included. The purpose is to provide an opportunity for the providers of the Medicaid and Children’s Health Insurance Program (CHIP) communities to enhance your understanding of specific provider responsibilities during PERM.
The PERM program is designed to measure improper payments in the Medicaid and CHIP programs as required by the Improper Payments Information Act (IPIA) of 2002 (amended in 2010 by the Improper Payments Elimination and Recovery Act (IPERA). Webinar/Conference call participants will learn from presentations that feature:
The PERM process and provider responsibilities during a PERM review Frequent mistakes and best practices The Electronic Submission of Medical Documentation (esMD) programParticipant call in information will be posted on the Provider Education Calls link: http://www.cms.gov/Research‐Statistics‐Data‐and‐Systems/Monitoring‐ Programs/Perm/Provider_Education_Calls.html approximately 10 days prior to the calls.
The PERM Cycle 1 (2012) Provider Education Webinar/Conference calls Webinar links are being presented on a Connect Pro platform. To test your connect launch: https://webinar.cms.hhs.gov/common/help/en/support/meeting_test.htm
The webinar dates are:
May 23, 2012 1:00 to 2:00 PERM Cycle 1‐2012‐Web1
To join the meeting: https://webinar.cms.hhs.gov/perm1web1/
June 21, 2012 1:00 to 2:00 PERM Cycle 1‐2012‐Web2
To join the meeting: https://webinar.cms.hhs.gov/perm1web2/
July 24, 2012 1:00 to 2:00 PERM Cycle 1‐2012‐Web3
To join the meeting: https://webinar.cms.hhs.gov/perm1web3/
August 23, 2012 1:00 to 2:00 PERM Cycle 1‐2012‐Web4
To join the meeting: https://webinar.cms.hhs.gov/perm1web4/
September 25, 2012 1:00 to 2:00 PERM Cycle 1‐2012‐Web5
To join the meeting: https://webinar.cms.hhs.gov/perm1web5/
October 24, 2012 1:00 to 2:00 PERM Cycle 1‐2012‐Web6
To join the meeting: https://webinar.cms.hhs.gov/perm1web6/
There will be time available for questions and answers at the end of the presentations however; CMS encourages all participants to submit questions in advance to our designated PERM Provider email PERMProviders@cms.hhs.gov or you may also contact your State PERM representative, Carissa Duewell, at MMAC Carissa.duewell@dss.mo.gov or 573/751‐3399 with any questions and for education and training in your state.
Please check the CMS Website and PERM Provider’s page regularly for helpful education materials, FAQS, and updates at http://www.cms.gov/PERM/.
Claims have incorrectly paid for dentures/partials for adults with a limited benefits package. Dentures/partials of any kind are not a covered service for adults with a limited benefits package. Please reference the MO HealthNet Dental Manual, Sections 19.1.G(1) and (2), which states,” dentures/partials are coverable for children under 21 or for persons under a category of assistance for pregnant women, the blind or vendor nursing facility residents.”
Due to the incorrect payment of these claims, a mass adjustment will be initiated in the near future to correct this error. Please check all future remittance advices for the specific claims that were mass adjusted. In addition, we are requesting that you perform a self-audit to identify any incorrectly paid claims for dentures/partials for adults with a limited benefits package that may have paid during or after the mass adjustment process.
