How to Start a Home Care Business: The Proposal (part 2)

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Today I looked a little more fully into this extensive licensure I would need by calling the Missouri Department of Health and Senior Services at 866-835-3505 and they directed me to a website entitled Missouri Department of Health and Senior Services: Home and Community Based Services Provider Information. I plan to go to the website tomorrow to see what I have to do to get the ball rolling. They also told me to call the Provider and Revalidation Unit at 573-751-3399. I did and I left a detailed message telling them I wish to enroll as a Medicaid provider. The teleprompter told me to allow 3-5 business days for them to respond, which I will do. However, they said via the teleprompter, for a faster response email them at mmac.providerenrollment@dss.mo.gov, which I am going to do right now (Be back in a couple minutes.). So I sent them an email and put "ENROLLMENT AS A MEDICAID PROVIDER" as the subject. This was my message: 

Hi,

My name is Charles Lamson, I wish to enroll as a Medicaid provider. I left a detailed message on the phone at the Provider Enrollment and Revalidation Unit 573-751-3399#, but I was looking to expediate the process as much as possible so I'm sending this email as ordered by the teleprompter. Email works great for me or please feel free to call me at 636-946-3688 (By the way, that goes for my audience as well. If you want to call in or email for any reason, blog suggestions, podcast suggestions, or whatever. I'm a pretty open and hospitable business oriented guy with an interest in customer service and relationship marketing. I want to be your friend. My email address is clamson11@gmail.com. Look forward to hearing from you soon.).

So, I just received an auto-reply email from MMAC Provider Enrollment. They said I should receive a response in three days. So there you go. I did all I could on this particular aspect of my little project. So, moving on. 

 I went to the above mentioned website to see what I have to do to get the ball rolling on this home care business. This website is wonderful. At first glance, it looks like everything I need to know to put together a good proposal for my business plan is all right right there. Also, I feel it worth mentioning that the state got back back with me yesterday to tell me what I had to do to get started in the process of becoming a Medicaid provider. She told me to go the above mentioned website and begin work on my proposal which basically lays out the plan for my home care business. I said I had already been to the site and I had already started working on the proposal. She said that was fine because that is the first step to becoming a Medicaid provider is to complete and submit my proposal. So for the rest of this proposal, I will be borrowing heavily from the above mentioned website of the Missouri Department of Health and Senior Services. So here goes...

Home and Community Based Services Provider Information

Home and community based care providers play an integral role in allowing the Department of Health and Senior Services (DHSS) to provide home-based services to eligible individuals who wish to remain in a community setting.

All potential contractors must submit a proposal outlining their business practices and demonstrating an ability to serve the needs of the frail populations served by DHSS. Home and community based care providers must also make assurances regarding compliance with applicable federal and state laws, regulations, and orders relative to the provision of services.

The information provided on this site is intended as a resource for current home and community based care providers and potential contractors. You may click on any of the links listed to obtain additional information.

So I got kind of lost at this point and couldn't really find a link to help me write this proposal. So I went back to Google, typed "how to start my own home care business" in the search field, and found this link, Missouri Department of Social Services: IHS and CDS Proposal Information. Eureka! That's exactly what I needed.

IHS and CDS Proposal Information

Home and Community Based Services (HCBS) programs are intended to provide necessary assistance in meeting the unmet needs of seniors and adults with disabilities and enable the individuals to remain in the least restrictive environment. HCBS consists of two separate programs: In-home services (IHS) and consumer directed directed (CDS). Separate proposals are required in order to be considered for the two programs.

The HCBS programs are operated by three state agencies:

• Missouri Department of Social Services (DSS), MO HealthNet Division (MHD). MHD is the single state Medicaid agency responsible for administering the Medicaid program, including HCBS programs.
• Missouri Department of Social Services, Missouri Medicaid Audit and Compliance Unit (MMAC). MMAC is responsible for determining potential business entities' eligibility to participate in HCBS programs as a Medicaid provider.
• Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS). DSDS is responsible for assessing and authorizing HCBS services for eligible participants.

Purpose of Proposal

In order to be considered for Medicaid enrollment with MMAC, a proposal must be submitted to MMAC for consideration for a participation agreement ("contract"). A proposal is necessary for MMAC to evaluate the potential capability of business entities to provide HCBS in compliance with minimum, regulatory program standards designed to ensure the health, safety and welfare of program participants.

Proposal Submission Requirements

All information listed in the appropriate Proposal for Contract must be submitted in order to be considered for a contract. The following preliminary requirements must be met or the proposal will be denied. The proposal must:

• Confirmation of Attendance CDS Orientation Training (CDS proposals only);
• Follow the current fiscal year Proposal for Contract;
• Be in the same order as the Proposal for Contract; 
• Each policy and procedure must:
• Be on a separate sheet of paper;
• Include corresponding headings and numbering as the Proposal for Contract;
• Be signed (printed and signed name) by an authorized representative of the entity;
• Include the correct legal name of the entity throughout the proposal.
• Not use plastic page protectors or bind the proposal in any (three-ring binder, brads, etc.)

Once a proposal is submitted to MMAC, it becomes the property of MMAC and will not be returned to the applying provider. Prior to mailing the proposal and/or any additional information requested, providers are encouraged to make a copy of the proposal for their records. Hand-delivered proposals must be left with the receptionist. No receipts will be provided unless a prepared receipt is brought with the proposal. The receptionist will then date stamp the receipt.

Proposal Review and Approval Process

Upon receipt of a proposal. MMAC Provider contracts:

• Will review the proposal to determine the applying provider's eligibility for a contract. MMAC will conduct any investigation necessary to verify or supplement the information contained within the proposal.
• If the proposal is incomplete or further information is needed from the applying provider to verify or supplement the proposal, MMAC will mail a written request for additional information.
• The applying provider is given thirty (30) days to submit the additional information. The proposal will be held pending receipt of the requested information. The written request will include Medicaid enrollment information that must be completed in order to process the MD enrollment later in the process. Failure to properly complete the enrollment information will result in denial of the proposal.
• Failure to provide the additional information by the deadline noted in the written request will result in denial of the proposal.
• Requests for extension of the deadline will not be granted.
• MMAC will not pre-review policies and procedures prior to their official submission.
• Failure to submit all requested information that complies with requirements of the applicable program in response to the written request will result in denial of the proposal.
• If the written proposal is approved, a visit will be scheduled and conducted by MMAC staff. The visit will include interviews with the applying provider's director, designated manager and RN supervisor. Staff must be knowledgeable of the requirements of the program.
• After the site visit, if a decision is made to offer a contract, the contract will be mailed to the applying provider for completion. The applying provider is never to assume the receipt of a contract for signature constitutes a binding contract until MMAC signs the contract.
• Upon return of the properly completed contract to MMAC Provider Contracts, MMAC will execute the contract. The applying provider will receive a copy of the fully executed contract and written notification of their SSBG/GR provider number. At this same time, the Medicaid enrollment information that was completed during the proposal process will be forwarded to MMAC Provider Enrollment Unit for their review. If approved, MMAC Provider Enrollment Unit will notify the Provider by mail. MMAC Provider Enrollment Unit, at its discretion, may deny or limit the applying Provider's enrollment and participation in the Missouri Title XIX Medicaid program as outlined in 13 CSR 70-3.020.
• Upon receipt of the notification from MMAC Provider Enrollment Unit of approval, providers can begin providing services to participants when authorizations are received from DSDS.

After submission of a proposal, it is approximately six months before provider numbers are issued and services can be provided to DSDS participants. The amount of time required may be longer depending on the quality of the proposal submitted, the current workload of MMAC staff, and how quickly the applying provider responds to requests for additional information.

Provider Reimbursement Rates

Provider reimbursement rates are subject to and determined by the State Legislature on an annual basis. MHD publishes information on the reimbursement rates each year. MHD's Provider Bulletin Vol. 41 No. 2 dated July 5, 2018 contains the current maximum rate that will be paid for each service type provided. For example the in-home services basic personal care current maximum rate is $4.53 per unit (or 15 minutes). While the rates listed in MHD's Provider Bulletin are the maximum rates that will be paid for each service type provided should be billed.

Number of Participants

MMAC's approval of the business entity's proposal or subsequent Medicaid enrollment does not guarantee any particular volume of participants or that the services of a provider will be utilized by any state agency. Participants have the right to choose the care option, care setting and provider to deliver his/her care. When necessary to assist participants, questions will be answered by state agency staff using information obtained through the proposal and enrollment processes and subsequent contacts by state agencies with the provider.

MMAC is not aware of any organizations available to assist with the completion of a proposal or any grants available to defray the cost of starting a business.

The Missouri Business Portal includes information for starting a business in Missouri.

*SOURCE: https://www.youtube.com/watch?v=cCj9wdOcVg0*

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