Handling Suspended Personal Care Claims
Handling Suspended Personal Care Claims
If your claim for personal care services enters a "Suspended" status, the most important thing to do first is wait. A suspended status is a normal part of the processing cycle. In most cases, the system is simply verifying data, and the claim will resolve itself within a few business days—moving automatically to either "To Be Paid" or "To Be Denied."
If a claim remains suspended or is denied, use the following tips to identify and correct the issue.
Electronic Visit Verification Claims Validation Hard Launch begins April 1, 2026
Electronic Visit Verification Claims Validation Hard Launch begins April 1, 2026
Provider Types 26 and 28: Beginning April 1, 2026, any claim for services that requires Electronic Visit Verification (EVV) and is authorized by the Department of Health and Senior Services, Division of Senior and Disability Services (DSDS) (provider types 26 and 28 that provide personal care, advanced personal care, consumer directed services, homemaker, chore, and respite), will be denied if there is no matching visit in the EVV Aggregator Solution (EAS).
Updated DHSS Regional Office Maps
Updated DHSS Regional Office Maps
The MO HealthNet Division (MHD) Provider Forms webpage has been updated to include the following revised Department of Health and Senior Services (DHSS) regional office maps:
New Electronic Case Management System for Home and Community Based Services
New Electronic Case Management System for Home and Community-Based Services (HCBS)
To meet the demands of an ever-growing HCBS population, the Division of Senior and Disability Services (DSDS) transitioned from CyberAccess to HCBS Fusion on May 5, 2025.
PACE Benefit Table
Program of All-Inclusive Care for the Elderly (PACE) Benefit Table
The Program of All-Inclusive Care for the Elderly (PACE) is administered by MO HealthNet and Medicare to provide comprehensive health care, social, recreational, and wellness services to its participants. One of the main goals of PACE is to allow older adults to live safely in their homes instead of nursing facilities. As of May 3, 2024, PACE organizations are active in St. Louis and Kansas City, with a new PACE organization coming to the Springfield area later this year.
Consumer Directed Services Manager Requirement
Consumer Directed Services Manager Requirement
Per the updated Consumer Directed Services (CDS) regulation 19 CSR 15-8.400(1)(D), all CDS providers are required to have a Certified CDS Manager. This CDS Manager is required to pass Certified CDS Manager Test administered by Missouri Medicaid Audit and Compliance (MMAC). All currently enrolled CDS providers will be required to be compliant by December 31, 2024. For more information, review the MMAC Post.