Home & Community Based Waivers

Missouri Division of Developmental Disabilities Targeted Case Management (TCM), Home and Community Based Waiver Services (HCBS), and Preadmission Screening and Resident Review (PASRR) – Nursing Home Reform are federal programs administered by the Centers for Medicare and Medicaid Services (CMS). Division of Developmental Disabilities Targeted Case Management, Home and Community Based waivers, and Preadmission Screening and Resident Reviews are partly funded through federal dollars.

The Missouri Division of Developmental Disabilities includes a Federal Programs Unit (FPU) that operates these federal programs to ensure all federal regulations and requirements are met. The FPU works closely with the state Medicaid authority – MO HealthNet - regarding implementation of Developmental Disabilities TCM and HCBS Waivers. FPU also partners with the Missouri Department of Health and Senior Services with Preadmission Screening and Resident Review (PASRR) – Nursing Home Reform.

Home & Community Based Waivers

The Missouri Department of Mental Health's Division of Developmental Disabilities (Division of DD) administers four Medicaid Home and Community Based (HCB) Waiver programs for individuals with intellectual and developmental disabilities. The four waivers are the Comprehensive Waiver; Missouri Children with Developmental Disabilities Waiver (MOCDD or Sarah Jian Lopez Waiver) Community Support Waiver and Partnership for Hope. A HCBS Waiver Manual provides additional information regarding services, provider qualifications and other waiver requirements.

http://www.hcbsassurances.org/

Centers for Medicare and Medicaid Services Training for Case Managers - Improving the Quality of Home and Community Based Waiver Services. This training emphasizes the important role of case managers in meeting federal HCBS waiver assurances.

Pre-admission Screening and Resident Review (PASSR)

Federal law requires that a Medicaid-certified nursing facility (NF) may not admit an applicant with serious mental illness (MI), mental retardation (MR), or a related condition, unless the individual is properly screened, thoroughly evaluated and found to be appropriate for NF placement. The Preadmission Screening and Resident Review (PASRR) program protects individuals with serious mental illness or mental retardation from inappropriate placement in nursing facilities and ensures that individuals receive all specialized services necessary to meet the individual's unique MI/MR needs. PASRR provides the opportunity to identify alternative community supports.

Waiting List Information
Corrective Action Plan (CAP)
Other Resources

For additional information please contact your local Regional Office.

Mercer Rate Study

The State has engaged Mercer to conduct a rate study refresh this summer for ID/DD 1915(c) waiver services. The main goals of the rate study refresh include:

  • Comply with CMS requirements to formally review 1915(c) rates at least once every five years
  • Compile and analyze the most current BLS market data to inform key cost components such as wages and employee-related expenses (e.g., health insurance, other employee benefits, employee-related taxes, workers’ compensation insurance)
  • Conduct targeted analyses on other assumptions that providers request be looked at more closely

The State is looking to engage with the provider community throughout the rate study process in order to understand your concerns, share updates along the way, and gather your feedback. To give you a sense for the key steps that will be occurring over the coming months, please refer to this graphic. The yellow boxes outline tasks and months during which the State is specifically looking for input and engagement from the provider community. 

Initial Request for Provider Feedback: 

As part of the onset of this project, the State would like to request the provider community supply feedback on rate study assumptions and specific services that you want the State and Mercer to review closely during the study. As mentioned above, the State already plans to conduct a detailed review of wages and employee-related expenses for all services, so the goal would be to focus the feedback on other cost components. It would also be very helpful if you can supply provider-specific data to support the feedback being provided and to illustrate your concerns. Please send all feedback and supporting data to ddmail@dmh.mo.gov by Friday, May 13, 2022.