Proposal Packet - In-Home Services

Home and Community Based Care Provider Information

Thank you for your interest in the in-home services program.  This program is intended to offer a safe and affordable option to seniors and adults with disabilities in Missouri who choose to remain in their home or community as an alternative to facility placement. 

The in-home services program is operated by the Missouri Department of Health and Senior Services, Division of Senior and Disability Services (Department) and the Missouri Department of Social Services (DSS), MO HealthNet Division (MHD), the single state agency responsible for administering the Medicaid program. 

In order to be considered for enrollment as an in-home services Medicaid provider with MHD, individuals/entities must first have a fully executed contract with the Department.   Although the contract is a prerequisite for enrollment in the Medicaid programs, Provider’s may choose to only serve clients authorized and eligible for Medicaid reimbursement.

SERVICES
All Providers of in-home services are required to provide basic Personal Care services.  Other services that may be provided to maximize the ability of clients to remain in the community include Homemaker; Chore; Advanced Personal Care; Basic, Advanced, and Nurse Respite; and Authorized Nurse Visits.  Providers electing to offer Advanced Personal Care and Advanced/Nurse Respite must also provide/deliver Authorized Nurse Visits.  Authorized Nurse Visits may, however, be offered without providing Advanced Personal Care or Advanced/Nurse Respite.

FUNDING SOURCES
For consumers who are found to be eligible for participation, in-home services are authorized by Department staff and may be reimbursed to private entities using two major funding sources:

• Medicaid (Title XIX of the Social Security Act) through MHD; and
• Social Services Block Grant/General Revenue (SSBG/GR) through the Department. 

Other funding streams (such as Older Americans Act, local contributions, etc.) may be available in some counties. 
REIMBURSEMENT RATES
Services and reimbursement rates are subject to and determined by the State Legislature on an annual basis.  While the amounts listed are the maximum rate that will be paid, providers should bill Medicaid their usual and customary charges for each service provided.

NUMBER OF CLIENTS
Neither the Department contract nor Medicaid enrollment guarantees any particular volume of clients nor does it guarantee the services of a Provider will be utilized by the state agency.  Clients of the Department have the right to choose the care option, care setting, and Provider that will deliver his/her care.  When necessary to assist the client, questions will be answered objectively by Department case managers using information obtained through the proposal process and subsequent contacts between the Department and the Provider. 

PURPOSE OF PROPOSAL
In order to be considered for a contract with the Department, a written proposal must be submitted.  A proposal is necessary for the Department to evaluate the potential capability of individuals/entities to provide services in compliance with the minimum regulatory program standards designed to ensure the health, safety and welfare of program participants. 

CONTENTS
The proposal submitted to the Department represents policies and assurances made by a potential Provider and is fully incorporated into the contract.  Falsification, misrepresentation of fact, failure to meet the contract requirements or program standards, and/or breach of promise made within the proposal may adversely affect participation in the program.  The Department will verify all areas of information pertaining to qualifications to ensure proposed personnel meet the requirements of program participation.  The Department may require additional information necessary to determine the potential Provider’s ability to comply with program standards.

REQUIREMENTS
As the applying Provider, you must submit written policies and assurances and comply with program requirements including all regulations affecting Providers of Medicaid services.  The requirements include the following:
13 CSR 70-3.020 Title XIX Provider Enrollment (pg. 3-4);
13 CSR 70-3.030 Sanctions for False or Fraudulent Claims for Title XIX Services (pg. 5-8);
13 CSR 70-91.010 Personal Care (pg. 3-8);
19 CSR 15-7.021 In-home Service Standards (pg. 6-12);
Section 13 of the Aged and Disabled Medicaid Manual (choose Provider Manuals);
Section 13 of the Personal Care Manual (choose Provider Manuals);
Medicaid provider enrollment agreement; and
Program Requirements of the Participation Agreement for Home and Community Based Care. 

Additionally, the Department contracts with Providers to deliver services to the most vulnerable residents in the state.  The premise of the contractual agreement is that the health, safety and welfare of the clients of the Department will not be compromised and that services will be a safe alternative to more costly care.  In an effort to maximize protection, the Contract contains provisions that prohibit certain individuals from serving as employees or volunteers in the delivery of in-home services.  It is the responsibility of the Provider to ensure prospective employees are screened sufficiently to fulfill this expectation.  State statute and Code of State Regulations governing screening requirements can be found at: 

• 660.315, RSMo Employee Disqualification List;
• 660.317, RSMo Criminal Background Checks, Employee Disqualification List and Family Care Safety Registry;
• 210.900 through 210.936, RSMo Family Care Safety Registry; and
• 19 CSR 30-82.060 Hiring Restrictions - Good Cause Waiver (pg. 13-15).

PRE-APPROVAL REQUIREMENTS
In addition to the policies and assurances of the written proposal, the following pre-contract criteria must be met before the Department will consider eligibility for contract issuance. 

• The Provider must employ a designated manager who is responsible for the day-to-day operations of the agency.  This manager must meet both of the following requirements:
  • education/experience:  be a registered nurse, or have at least a baccalaureate degree, or be an LPN with at least one year experience caring for the elderly/disabled, or have at least three years experience with direct care of elderly/disabled, and
  • successfully complete Designated Manager Training.  Information regarding Designated Manager Training is available by choosing “Training” from the menu on the top left side of this page.   
• A background screening check must be completed by the Department’s Family Care Safety Registry (FCSR) on behalf of the provider director and all individuals listed on the Business Organizational Structure form.  Additional information regarding these screenings is available within the Proposal Outline. 
• After the written proposal has been approved, an on-site visit at the Provider agency will be conducted prior to final approval of the Provider’s eligibility for a contract with the Department.  This visit includes interviews with the owner(s), designated manager, registered nurse, and billing personnel.

PROCESS OF REVIEW AND APPROVAL
Upon receipt of a proposal, the Department:

• will process the proposal and determine the potential Provider’s eligibility for a contract.  The Department will conduct any investigation necessary to verify, supplement or change the information contained within the proposal. 
• If the proposal is incomplete or further information is needed from the applicant to verify or supplement the proposal, the Department will request the information in writing twice. 
• After each written request, the potential Provider is given thirty (30) days to submit the requested information.  The proposal will be held pending receipt of the requested information. 
• Failure to provide the requested information by the given deadline, or failure to submit all requested information after the second request will result in rejection and return of the proposal to the potential Provider.  
• If the Department approves the proposal, a site visit will be scheduled and conducted by Departmental staff. 
• After a site visit has been successfully completed, the following will be forwarded to the Provider:
  • A Participation Agreement for Home and Community Based Care (contract) for the potential Provider’s signature; and
  • Medicaid enrollment forms.
• Upon return of the signed contract to the Department, the Department will execute the contract.  The contract will not become effective until the Department’s Director, Division of Administration signs the contract.  The potential Provider is never to assume the receipt of a contract for signature constitutes a binding contract until the Department’s Director signs it. 
• Once the Contract has been fully executed by the Department, the Provider will receive a copy of the fully executed contract and written notification of their SSBG/GR provider number.  At this same time, the completed Medicaid forms for Personal Care and Aged and Disabled Waiver enrollment submitted with the contract will be forwarded to MHD.  MHD will review the Medicaid enrollment forms, and, if approved, will notify the Provider by mail regarding the assignment of Medicaid provider numbers authorizing Medicaid participation.  MHD, at its discretion, may deny or limit the applying Provider enrollment and participation in the Missouri Title XIX Medicaid program as outlined in 13 CSR 70-3.020.
• Upon receipt of the Medicaid provider numbers, Providers can begin providing services to clients of the Department authorized by the Department to receive services.
• After submission of a proposal, it is at least three months before provider numbers are issued and services can be provided to Department clients.  The amount of time can be longer depending on the quality of the proposal submitted, the current workload of Department staff, and how quickly the potential Provider responds to requests for additional information.   

ADDITIONAL ASSISTANCE
Should you require additional information or have questions regarding the proposal, please feel free to contact the Contract Administrator, HCS Provider Contracts Unit by e-mail at ihscontracts@dhss.mo.gov. 
The Department is not aware of any organizations available to assist with the completion of the proposal or any grants available to defray the cost of starting a business.

PROPOSAL SUBMISSION
In order to expedite the process, the proposal must follow the Proposal Outline.  Each policy and assurance must be on a separate sheet of paper and include corresponding headings and numbering as the Proposal Outline.  Numbering the pages of the proposal in the lower right hand corner will be helpful when identifying areas that may need to be revised.

Prior to submission of the proposal, review the Proposal Checklist to ensure all information is included and is in the same order as the Proposal Outline.   

All documents, with the exception of the original Bureau of Quality Assurance Registration and Screening Request form that is submitted directly to the FCSR, must be submitted to:

Department of Health and Senior Services
HCS Provider Contracts Unit
920 Wildwood Dr.
P.O. Box 570
Jefferson City, MO 65102

SECTION I - PROVIDER PROFILE

Document the following information on the Provider Profile form:
Section I:  Provider Information

1. Full legal name of Provider as filed with the Missouri Secretary of State, Internal Revenue Service and Missouri Department of Revenue.
   
   Use of “Home Health” is discouraged for entities that are not licensed by the Department to provide Medicare certified home health services.  The term “In-home” is considered more appropriate.  Also, as a courtesy, the Department will notify you if your proposed Provider name is very similar or the same as that of a current provider.
2. Physical Address for main office
3. Mailing Address for main office, if different
4. Business Telephone Number
5. Business FAX Number
6. Emergency Telephone Number, pager, etc. for nights, weekends, holidays, etc.
7. E-Mail Address
8. Federal Employer Identification Number (FEIN)
9. State (Missouri) Employer Identification Number (SEIN)
10. Business days and hours of operation

Section II:  Personnel Information

11. Director Name (the owner(s) or highest-ranking person in charge of Provider operations)
12. Telephone Number for the Director
13. E-Mail Address for the Director
14. Designated Manager (the person designated to be responsible for the day-to-day operations.  The manager must successfully complete Provider Certification Training and meet the education/experience requirements).
15. Telephone Number for Designated Manager
16. E-mail Address for Designated Manager
17. Registered Nurse (with MO license in good standing)
18. Missouri RN License number of the Registered Nurse
19. Telephone Number for Registered Nurse
20. E-Mail Address for Registered Nurse

Section III:  Indicate whether an automated telephone tracking system is being utiltized.

Section IV:  Satellite Office Information

List the following information for each satellite office the agency may have:

• Supervisor/Manager
• Address
• City, State, Zip Code
• Days & Hours of Operation
• Telephone Number
• Fax Number
• Emergency Telephone No. (nights, weekends, etc.)
• Days & Hours of Operation
• E-Mail Address
• Counties Supervised by This Office

SECTION II –BUSINESS ORGANIZATION

1. Complete the Business Organizational Structure form and submit the required documents as indicated on the form according to the organization’s business structure.
2. Submit a copy of the Application for Employer Identification Number submitted to the IRS.  If the application was submitted online, submit the application after the number has been assigned.  If a paper application was submitted to the IRS, you must submit a copy of the application and the number notification received from the IRS.
3. Submit a copy of the notification from the Department of Revenue of the Missouri Employer Identification Number.
4. Register as a vendor with the State of Missouri through the Missouri Office of Administration website at www.oa.mo.gov/purch, then choose the following links:  Show Me….where to register as a vendor, New Vendor Registration.
5. Submit a copy of a current Vendor No Tax Due certificate issued by the Missouri Department of Revenue.  Information regarding this certificate is available at http://www.dor.mo.gov/tax/business/sales/hb600.htm.  

   The agency’s correct legal name must be the same on all of the above documents.

6. Submit an organization chart for the agency/entity.

SECTION III - SERVICE AREA COMMITMENT
Complete the Service Area Commitment form indicating the services and geographic areas (counties) to serve.

SECTION IV - INSURANCE AND BONDING

1. Submit a copy of a Certificate of Insurance that includes:
   • Issued in the full legal name of the Provider;
   • Names the Division of Senior and Disability Services, P.O. Box 570, Jefferson City, MO 65102 as a certificate holder;
   • Includes the policy numbers;
   • In effect for a minimum of one year;
   • In effect prior to the proposal being approved;
   • Verifies a commercial general liability policy.  The policy must be an occurrence policy for no less than $1 million per event and $3 million aggregate.
   • Verifies a professional liability policy for no less than $1 million per event and $3 million aggregate. 
   • Includes coverage for negligent acts and omissions of the Provider’s employees and/or volunteers in the provision of services to the clients in such clients’ homes.

Self-insured retention, if any, shall be no more than $1,000.

2. Submit a copy of the Employee Dishonesty Bond issued in the correct legal name verifying bond coverage for employees and volunteers who are connected with the delivery and performance of in-home services in the client’s home.

SECTION V - BUSINESS ADMINISTRATION
Submit a Business Plan for the agency/entity.  Potential Providers must assure the Department that sufficient financial resources exist to provide continuous service to clients of the Department.  The use of a Business Plan will help potential Provider’s manage their business and ensure financial stability.
If assistance is needed in developing a business plan, contact the Missouri Business Assistance Center (MBAC) at 573/751-2863 for a complete start-up package.  Additional information is also available on their website at www.missouribusiness.net.  Their business counselors will help identify the requirements and considerations involved in starting and operating a business in Missouri. 
The Business Plan, at a minimum, must include the following information:

• Name of Company - Correct legal name of Provider as filed with the Secretary of State, Internal Revenue Service and Department of Revenue.
• Office/Plant - Give office address and description of area and building.  State whether the office is rented, leased or owned.  If the business is located in a home, state whether there is space dedicated exclusively for business.  If so, please describe.
• Personnel - Describe how employees will be recruited to provide direct care.
  Describe how employees will be recruited for administrative and billing functions.
  Describe the prior experience or education that qualifies management to run this type of business.
• Marketing - Describe the local market for this service.
  Describe the methods to be used to get clients in this market.
  Describe what efforts, if any, will be used to expand beyond the local market.
  Describe what kind of payments the Provider will seek (Medicaid reimbursement, Medicare, SSBG/GR, private pay, etc).
• Financial Management - State the name and qualifications of the person(s) handling the financial matters of the agency.

State the sources of revenue other than Medicaid and SSBG/GR reimbursement to be used to start the business.

SECTION VI - STAFF TRAINING

1. Submit a detailed plan that outlines the complete training program that meets the training requirements pursuant to 19 CSR 15-7.021(22) and 13 CSR 70-91.010 (3)(E).  Do not submit training materials to be used. 

• Describe each section of the required twenty (20) hours of training.  Break out each section (classroom and on-the-job*) and provide a copy of the planned training agenda. 
  • An agenda outlining the eight (8) hours of initial classroom training required prior to first client contact, including the time spent on each topic and a short description of each topic. (2 hours must be orientation to the Provider); and
  • An agenda outlining the twelve (12) hours of other related training required within 30 days of hire, including the time to be spent on each topic and a short description of each topic. 
    
    * Should the Provider choose to make on-the-job training part of the curriculum for new employees, the Medicaid manual limits inclusion to four of the twelve hours (of other training rather than allowing this as part of the initial classroom requirement.)  OJT training sessions are limited to a maximum of two-hour increments.
    
  
  Providers must include an overview of Alzheimer’s Disease and related dementias as part of the new employee orientation.  For employees who will be providing direct care, curricula must also include training employees about methods for communicating with persons with dementia.  (Ref: RSMo § 660.050 (22) 8.)
  

2. Providers offering Advanced Personal Care must submit a complete training plan for aides that will deliver Advanced Personal Care.  Training requirements must be in compliance with 19 CSR 15-7.021 and 13 CSR 70-91.010. 
   • An agenda outlining the eight (8) hours of training  including the time spent on each topic and a short description of each topic.
   • Include the procedures for performing the required task training. 
   • List the requirements for an employee to be an advanced personal care aide.
3. Submit a complete in-service training plan.  The training must be in compliance with 19 CSR 15-7.021 and 13 CSR 70-91.010. 
   • An agenda that identifies the training to be provided, the time spent on each topic and a short description of each topic.  
4. Submit the policy and procedures regarding how/when any training may be waived and the form used to document the waiver.
5. Submit an assurance to maintain all employment and training documentation in each employee file and to maintain a master training manual.

SECTION VII - POLICIES/PROCEDURES AND ASSURANCES

1. Submit the following policies, procedures, assurances and/or information as listed below:

• Describe the system used to allow clients, family members, employees and the Department to have verbal contact with the Provider at all times, including:
• Assurance the main phone line will be answered by clearly identifying the Provider agency by name.
• An explanation of the system (voice mail, pager, answering system, etc.) that allows contact with the Provider after business hours.
• Assurance answering machines or services will clearly identify the Provider.
• Process for responding to messages received after business hours within two hours.
• Assurance not to utilize services intended to block or restrict incoming calls.

2. Assurance to utilize the Change Request form provided by the Department to notify the Department of changes in office locations, business hours, telephone numbers, e-mail address, ownership, director, designated manager and/or RN staff.
3. Assurance to immediately notify all authorized clients of the Department being served by the Provider and the client’s representative of any changes in Provider’s telephone number, address, and/or posted business hours.
4. Assurance to maintain Internet access in order to retrieve information posted on the Department website.
5. Assurance to maintain an e-mail address in order to communicate with the Department and receive written communications.
6. Policy and procedures for maintaining service delivery on holidays, weekends, and in the event of inclement weather, worker absence, vacation, or labor shortage.  Include a description of special efforts that will be made in instances of staff shortages to maintain service to clients determined by the Department to be a priority.
7. Policy and procedures for working with the Department regarding service delivery to clients during times of natural or man-made disasters.
8. Policy and procedures for informing clients, families, and employees of the Provider’s Client Rights, Code of Ethics and Confidentiality statements. 
9. Assurance to maintain the required insurance coverage at all times.
10. Policy authorizing the Provider’s insurance carrier, broker, agent and/or premium finance company to release information regarding required insurance coverage to the Department.
11. Policy and procedures regarding reports of abuse, neglect, and exploitation, including falsification of service delivery documents.
12. Policy and procedures regarding compliance with the requirements for accepting, reporting, and accounting for SSBG/GR contributions.
13. Policy and procedures for conducting nurse assessments. 
14. Policy and procedures regarding closing or discontinuing services to clients still in need of services, including specific procedures regarding advanced personal care clients.
15. Policy regarding employees serving members of his/her immediate family or residing in the same household as a client.
16. Policy regarding employees transporting clients or providing unnecessary homemaker tasks.
17. Assurance all client and employee files will be maintained in a central location with all required documentation will be kept in the respective files. 
18. Assurance to operate in accordance with the proposal as submitted, amended and approved by the Department.
19. Assurance to comply with all applicable federal and state laws including laws authorizing or governing the use of federal funds paid to the Provider through the in-home services program.
20. Assurance to comply with the Fair Labor Standards Act as amended, Title VII of the Civil Rights Act of 1991 as amended, the Americans with Disabilities Act of 1990, and all other applicable federal and state laws, regulations and executive orders regarding employment practices.
21. Assurance to comply with all applicable rules and laws administered by the Occupational Health and Safety Administration.  This shall include the provision of medical supplies to ensure universal precautions, including, but not limited to, gloves.
22. Assurance to comply with all applicable Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations.
23. Policy and procedures regarding a drug free workplace.
24. A statement indicating whether any persons, individuals, or business entities identified herein have ever been sanctioned, suspended, terminated from participation, or denied enrollment in Medicaid, Medicare, SSBG/GR, or any other government public assistance program.
25. Assurance that all persons who may provide direct care or who may otherwise have contact with a client being served by the Provider will complete an employment application prior to any contact with a client.
26. Policy and procedures for checking at least two (2) references for each potential employee, including the timeframe. 
27. Policy and procedures for conducting criminal background record checks on all prospective employees, including the timeframe.
28. Assurance to conduct a check of closed criminal records when there is notification there may be a closed record on an individual.
29. Policy and procedures regarding the employment of persons with certain criminal backgrounds, as required by the in-home services contract and statutory requirements (660.317 RSMo). 
    
    Providers who hire persons from bordering states are encouraged to perform an additional background check through that state’s highway patrol to ensure the potential employee does not have a disqualifying criminal record.
30. Policy and procedures regarding screening the department’s Employee Disqualification List (EDL).  The policy must include the timeframe for completing the check and how often checks will be completed.
31. Assurance to maintain documentation of criminal record checks and EDL checks in employee file.  Criminal history and EDL checks must be completed for all social security numbers and aliases used by an individual.
32. Assurance Provider will maintain employment of a registered nurse and will provide the appropriate supervision of the nurse.
33. Assurance the RN will be available during hours of operation to handle Advanced Personal Care and nursing issues.
34. Assurance Provider will maintain employment of a designated manager responsible for the day-to-day operations of the agency.
35. Assurance Provider will verify and maintain ongoing documentation of certifications, licenses and degrees of all personnel, including any subcontracted personnel.

SECTION VIII - APPENDIXES

1. Attach copies of the Client Rights, Code of Ethics and Confidentiality statements to be used.
2. Attach a copy of the form to be used to conduct nurse assessments.
3. Attach a copy of the employment application used to hire staff.  The application must include:

• A question requiring prospective employees to disclose all criminal convictions, findings of guilt, pleas of guilty, and pleas of nolo contendere, except minor traffic violations.
• A consent to a pre-employment criminal record check.
• A consent to a closed records check pursuant to Section 610.210, RSMo.

4. Submit a copy of the Bureau of Quality Assurance Registration and Screening Request form completed and submitted to the Family Care Safety Registry (FCSR) on behalf of the Provider director and each individual listed on the Business Organizational Structure form. The original forms must be mailed directly to the Department’s FCSR at the address listed on the form.  If an individual is not already registered with the FCSR, a copy of their social security card and the one time registration fee of $9.00 must be attached to the form.
   
   The Bureau of Quality Assurance Registration and Screening Request is a special form used only during the proposal process so that the FCSR will forward the results of these screenings directly to the Bureau of Quality Assurance (the FCSR notifies the registrant of the results also).  For all other screening requests, the FCSR Employer Background Screening Request form must be used.  
   
   Copies of screening results will not be accepted from the potential Provider.  The results must be received directly from the FCSR.
5. Submit the following documents for the Designated Manager responsible for the day-to-day operation of the agency.

• Copy of current employment application and/or resume;
• copy of any/all license(s) or certification(s) verifying education, work history and licensure or certification; and
• a copy of the certificate for successfully completing Provider Certification Training. 

6. Submit the following documents for the Registered Nurse responsible for fulfilling the requirements of the nurse’s responsibilities.

• Copy of current employment application and/or resume verifying education and work history; and
• copy of the current Missouri nurse license.