The Missouri Medicaid Audit and Compliance (MMAC) Provider Enrollment Unit (PEU) frequently receives requests to backdate provider enrollment applications. MMAC will not backdate the effective date of a provider’s Missouri Medicaid enrollment prior to the date MMAC received the provider’s application, except in very specific situations, such as out of state emergency services. This is outlined in state regulation. 

13 CSR 62-2.020 Provider Enrollment and Application

     (1)  Enrollment;

          For any person to receive payment from the MO HealthNet Program for items or services other than out-of-state emergency services, the billing providers and the performing providers of such items or services must be enrolled providers in the MO HealthNet Program on the date the items or services are provided unless applicable rules or manuals permit enrollment as of an earlier date, up to a maximum of three hundred sixty-five (365) days prior to the actual enrollment date.

Questions regarding enrolling with the MO HealthNet program can be emailed to MMAC.ProviderEnrollment@dss.mo.gov

MMAC continues to receive questions from MO HealthNet providers about whether gifts of “nominal value” violate federal or state Medicaid kickback statutes or regulations. Gifts of nominal value are things like calendars, mugs, pens, refrigerator magnets, small plants, and gift certificates for a small amount. The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued advisory opinions indicating gifts of “nominal value” do not violate federal Medicare or Medicaid regulations. The OIG interprets “nominal value” as having a retail value of no more than $15 per item or $75 in aggregate per participant on an annual basis. Click here for the OIG Policy Statement Regarding Gifts of Nominal Value.

§191.905.2 RSMo parallels the federal anti-kickback statute. The state statute prohibits knowingly offering or paying, or soliciting or receiving in a manner whatsoever, remuneration (anything of value) in exchange for referring another person for health care services or for purchasing or furnishing of health care. The statute provides for an exception for discounts that are properly disclosed and accounted for in cost reports. The statute also incorporates the safe harbors provided for in federal regulations as additional exceptions.

With regard to written complaints or hot-line calls that a particular Missouri Medicaid provider is violating federal or state anti-kickback statutes, MMAC will adhere to OIG’s advisory option in determining whether a violation has likely occurred and/or whether further investigation is needed.