{"pack":"mo-hca","path":"/policies/missouri/home-care/","name":"Missouri Home Care Policy and Procedure Manual","state":"Missouri","service":"Home care","license":"Missouri in-home services provider (no state license)","count":50,"forms":68,"categories":[{"name":"Client rights","count":4},{"name":"Service delivery","count":9},{"name":"Clinical tasks","count":5},{"name":"Safeguarding","count":3},{"name":"Infection control","count":2},{"name":"Emergency preparedness","count":1},{"name":"Records","count":1},{"name":"Privacy","count":3},{"name":"Human resources","count":9},{"name":"Governance","count":4},{"name":"Quality","count":2},{"name":"Business","count":4},{"name":"Ethics","count":3}],"policies":[{"ref":"MO-HC-CMP-01","path":"/policies/missouri/home-care/participant-grievances-and-complaints/","title":"Participant Grievances and Complaints","category":"Client rights","citation":"19 CSR 15-7.021(18)(P)","summary":"The Agency's grievance system: how participants learn about it, the many ways to complain, logging and acknowledgment within 5 and resolution within 30 as the Agency's own standard, matters that must go to DHSS first, the right to complain to DSDS at any time and how DSDS handles HCBS grievances, protection from retaliation, and how grievances feed the quality program.","sample":true},{"ref":"MO-HC-CR-01","path":"/policies/missouri/home-care/participant-rights-and-grievance-information/","title":"Participant Rights and Grievance Information","category":"Client rights","citation":"19 CSR 15-7.021(18)(O)","summary":"Sets out the written statement of participant rights the Agency gives and reviews with each participant (and the primary caregiver when appropriate) at the time service is initiated: the six minimum rights in 19 CSR 15-7.021(18)(O), the further rights the Agency grants, the confidentiality statement covering both personal and medical information, how participants learn the grievance procedure and the state contacts, and how receipt is documented. With Policy MO-HC-ETH-01 it is the Agency's policy under MMAC Proposal for Contract, Section VI, item 5.","sample":false},{"ref":"MO-HC-CR-02","path":"/policies/missouri/home-care/nondiscrimination-accessibility-and-language-access/","title":"Nondiscrimination, Accessibility, and Language Access","category":"Client rights","citation":"19 CSR 15-7.010(14)","summary":"Commits the Agency to accept and serve participants without discrimination, to make its services accessible to people with disabilities through reasonable accommodation and auxiliary aids, and to give people with limited English proficiency meaningful access through qualified interpreters, translated documents and multilingual staff, free of charge. Sets out the notices of nondiscrimination and language assistance, the Section 1557 coordinator and grievance procedure for an agency with 15 or more employees, and how staff arrange an interpreter.","sample":false},{"ref":"MO-HC-CR-03","path":"/policies/missouri/home-care/participant-choice-representatives-consent-and-advance-directives/","title":"Participant Choice, Representatives, Consent, and Advance Directives","category":"Client rights","citation":"19 CSR 15-7.021(18)(O)3","summary":"Protects the participant's choice of provider and direction over services within the authorized care plan; explains who may act for a participant and how the Agency confirms a representative's authority; sets how the Agency obtains the participant's agreement to services and handles refusals; and requires that, before services start, each participant is told of his or her rights under Missouri advance directive law and the record shows whether the participant has executed an advance directive (PC Manual §2.5).","sample":false},{"ref":"MO-HC-ADM-01","path":"/policies/missouri/home-care/referrals-service-authorizations-and-acceptance-of-participants/","title":"Referrals, Service Authorizations, and Acceptance of Participants","category":"Service delivery","citation":"19 CSR 15-7.021(18)(J)","summary":"Sets out how the Agency receives referrals and DSDS service authorizations, records the date it receives each authorization, checks the authorization and the participant's MO HealthNet eligibility, decides on the basis of a reasonable expectation that it can meet the participant's needs whether to accept, and starts services within ten calendar days of receipt or on the beginning date the authorization specifies, whichever is later, sending DSDS a detailed written justification when it cannot.","sample":false},{"ref":"MO-HC-ADM-02","path":"/policies/missouri/home-care/initiation-of-services-and-participant-information-packet/","title":"Initiation of Services and Participant Information Packet","category":"Service delivery","citation":"19 CSR 15-7.021(18)(O)","summary":"Sets out the start-of-services visit at which the Agency gives and reviews, at the time service is initiated, the statement of participant rights, the confidentiality statement, the code of ethics, the grievance procedure, the office contact notice, the EVV notice, the nondiscrimination and language assistance notice, advance directive information, the Notice of Privacy Practices and the other start-of-services information, confirms the care plan with the participant, makes sure the worker has the care plan before the first visit, and records it all on one signed checklist.","sample":false},{"ref":"MO-HC-DC-01","path":"/policies/missouri/home-care/discontinuing-services-discharge-and-transfer/","title":"Discontinuing Services, Discharge, and Transfer","category":"Service delivery","citation":"19 CSR 15-7.021(16)","summary":"Sets out when and how the Agency discontinues a participant's services: immediately when DSDS closes the case; immediate written notice to DSDS of death, nursing home entry or other circumstances that may require closing, and of threats or abuse toward staff; and, when a participant is noncompliant with the care plan or the Agency can no longer meet the needs of a participant still in need, conferences with DSDS and the participant, written notice of discharge to the participant or family and DSDS at least 21 days before the discharge date, and continued care under the care plan for those 21 days or until DSDS arranges alternatives, whichever comes first. This is the Agency's policy under MMAC Proposal for Contract, Section VI, item 8.","sample":false},{"ref":"MO-HC-SAF-01","path":"/policies/missouri/home-care/participant-safety-medical-emergencies-and-death-in-the-home/","title":"Participant Safety, Medical Emergencies, and Death in the Home","category":"Service delivery","citation":"19 CSR 15-7.010(6)","summary":"How workers keep participants safe during visits and respond to emergencies: the Agency's emergency arrangements and posted instructions with the 911 number; calling 911 first, staying with the participant and then calling the office; falls, choking, a participant who is not breathing, other urgent problems, a participant who does not answer the door or is missing; Outside the Hospital Do-Not-Resuscitate orders and participants who have elected hospice; supervision during respite; a death in the home, with immediate written notice to DSDS; everyday home safety; and the emergency information sheet kept in each home.","sample":false},{"ref":"MO-HC-SP-01","path":"/policies/missouri/home-care/care-plans-care-plan-changes-and-communication-with-dsds/","title":"Care Plans, Care Plan Changes, and Communication with DSDS","category":"Service delivery","citation":"19 CSR 15-7.021(15)","summary":"Explains that the care plan is the state-approved plan DSDS authorizes and the Agency delivers strictly in accordance with it; requires the Agency always to have an active care plan for each participant; sets how workers, the administrative supervisor and the Agency's registered nurse identify an ongoing need for more or fewer units or different tasks, how the supervisor approves changes in advance and the Agency recommends them to DSDS, and how the Agency puts DSDS changes into effect without billing more than the higher authorization or any units not delivered.","sample":false},{"ref":"MO-HC-SP-02","path":"/policies/missouri/home-care/changes-in-condition-and-coordination-with-physicians-and-other/","title":"Changes in Condition and Coordination with Physicians and Other Providers","category":"Service delivery","citation":"13 CSR 70-91.010(3)(D)","summary":"Requires the Agency to monitor each participant's overall physical care needs; sets out what workers report and how fast, how the administrative supervisor and the Agency's registered nurse respond, when the participant's physician is contacted and DSDS informed, and how the Agency coordinates with home health agencies, hospices, Division of Developmental Disabilities support coordinators and other providers, including during hospital and nursing facility stays. Every contact is recorded in the participant record.","sample":false},{"ref":"MO-HC-SUP-01","path":"/policies/missouri/home-care/monthly-supervisory-monitoring-of-service-delivery/","title":"Monthly Supervisory Monitoring of Service Delivery","category":"Service delivery","citation":"19 CSR 15-7.021(21)(A)","summary":"Each month the administrative supervisor compares every in-home services worker's record of services delivered, from electronic visit verification, with each participant's care plan: the units authorized, the tasks specified and the authorized frequency against the units, tasks and frequency delivered. The supervisor documents every authorized unit not delivered and the reason, acts on gaps, tells DSDS and the Agency's registered nurse about changes, and keeps the monitoring reports ready for DSS and DHSS. The Agency also makes random visits to check records.","sample":false},{"ref":"MO-HC-SVC-01","path":"/policies/missouri/home-care/scheduling-reliable-service-delivery-undelivered-services-and-holidays/","title":"Scheduling, Reliable Service Delivery, Undelivered Services, and Holidays","category":"Service delivery","citation":"19 CSR 15-7.021(18)(L)","summary":"Requires the Agency to deliver authorized services dependably and regularly, strictly under the care plan, including on weekends, holidays and when workers are absent; sets how visits are scheduled from the care plan's task frequency, how absences, lateness, missed visits and backup coverage by substitute workers are handled, what workers do when a participant does not answer, how every undelivered service is documented with its reason and never billed, how a gap in services is prevented, and the Agency's written policy on holidays and special event days.","sample":false},{"ref":"MO-HC-SVC-02","path":"/policies/missouri/home-care/scope-of-in-home-services-and-prohibited-activities/","title":"Scope of In-Home Services and Prohibited Activities","category":"Service delivery","citation":"19 CSR 15-7.021(13)","summary":"The Agency delivers only the in-home services that MMAC has approved it to provide and that DSDS authorizes in each participant's care plan: respite care, homemaker, chore, basic and advanced personal care, and authorized nurse visits. This policy sets out what each service includes under Missouri rules and the activities the Agency must never perform or bill, including health-related tasks that belong to a nurse or home health aide, transportation, administering medication, household services the participant does not need, and friendly visiting.","sample":false},{"ref":"MO-HC-SUP-03","path":"/policies/missouri/home-care/registered-nurse-oversight-and-clinical-integrity/","title":"Registered Nurse Oversight and Clinical Integrity","category":"Clinical tasks","citation":"19 CSR 15-7.021(20)","summary":"The Agency's registered nurse is primarily responsible for making sure the Agency's policies and procedures meet clinical standards for proper care of participants, training of staff, and general clinical integrity. This policy sets out the nurse's qualifications, employment and availability; the seven functions 19 CSR 15-7.021(20) assigns; the initialing and review of every on-site visit report made by the administrative supervisor; oversight of LPNs and graduate nurses and the duties only a registered nurse may perform; clinical policy review; and the nurse's review log.","sample":false},{"ref":"MO-HC-SVC-03","path":"/policies/missouri/home-care/basic-personal-care-tasks/","title":"Basic Personal Care Tasks","category":"Clinical tasks","citation":"13 CSR 70-91.010(2)","summary":"How in-home workers carry out the basic personal care tasks Missouri allows: help with meals and eating, dressing and grooming, bathing and hygiene, toileting and continence, mobility and transfers, self-administered medication, and medically related household tasks. Workers give hands-on help only, follow the care plan, use safe technique and universal precautions, never use transfer devices or do advanced personal care unless certified, and report changes they notice.","sample":false},{"ref":"MO-HC-SVC-04","path":"/policies/missouri/home-care/advanced-personal-care-and-advanced-respite/","title":"Advanced Personal Care and Advanced Respite","category":"Clinical tasks","citation":"13 CSR 70-91.010(5)","summary":"If the Agency provides advanced personal care (APC) or advanced respite, this policy sets the conditions: an APC addendum to the Title XIX personal care agreement and an MMAC contract that includes APC; the ability to provide authorized nurse visits; qualified aides certified in each task; an APC care plan developed by the Agency's registered nurse with DSDS and approved by the participant's physician; the nine APC tasks and their limits; a nurse visit every month; an RN evaluation at intervals of no more than six months; referral when complications arise; and 21 days' written notice before discharge.","sample":false},{"ref":"MO-HC-SVC-05","path":"/policies/missouri/home-care/authorized-nurse-visits-and-general-health-evaluations/","title":"Authorized Nurse Visits and General Health Evaluations","category":"Clinical tasks","citation":"13 CSR 70-91.010(6)","summary":"How the Agency's nurses make the authorized nurse visits DSDS prior-authorizes: who may make them; eligibility and limits (a unit is the visit, and no more than 26 in six months); the duties at every visit, including evaluating the plan of care and reviewing it with the participant; the services a visit may include; the General Health Evaluation at least twice a year, in the 4th and 10th months after the annual assessment, uploaded by the 15th of the following month; physician contact, referrals and reports to DSDS; and documentation.","sample":false},{"ref":"MO-HC-SVC-06","path":"/policies/missouri/home-care/assistance-with-self-administered-medication/","title":"Assistance with Self-Administered Medication","category":"Clinical tasks","citation":"19 CSR 15-7.021(13)(C)","summary":"In-home workers never administer medication. A worker may assist a participant who takes his or her own medication, for example by opening bottles and getting water, and may apply nonprescription topical products to unbroken skin. A certified APC aide may give manual assistance with medications a licensed nurse has set up. A nurse on an authorized visit may fill insulin syringes and set up oral medications. Workers watch for and report missed doses, refusals, side effects and errors.","sample":false},{"ref":"MO-HC-ANE-01","path":"/policies/missouri/home-care/recognizing-and-reporting-abuse-neglect-and-exploitation-of-adults/","title":"Recognizing and Reporting Abuse, Neglect, and Exploitation of Adults","category":"Safeguarding","citation":"RSMo 192.2475","summary":"How every Agency worker recognizes and immediately reports abuse, neglect, financial exploitation, bullying and likelihood of serious physical harm involving participants and other eligible adults, including when an Agency employee is involved: the legal definitions, who must report under Missouri law, the hotline and online route, what to say, what the Agency does next, confidentiality, protection from retaliation, penalties, facility residents and posting the hotline.","sample":true},{"ref":"MO-HC-ANE-02","path":"/policies/missouri/home-care/reporting-suspected-child-abuse-or-neglect/","title":"Reporting Suspected Child Abuse or Neglect","category":"Safeguarding","citation":"RSMo 210.115","summary":"How Agency workers report suspected abuse or neglect of any child they see or serve: who the law makes a mandated reporter, the Agency's rule that every worker reports, the Children's Division hotline and online route, the rule that no internal investigation starts before the report, the employer's duty not to impede reporting, immunity, penalties, and records.","sample":false},{"ref":"MO-HC-ANE-03","path":"/policies/missouri/home-care/misappropriation-falsification-and-protecting-participants-during-an/","title":"Misappropriation, Falsification, and Protecting Participants During an Investigation","category":"Safeguarding","citation":"RSMo 192.2480","summary":"How the Agency reports misappropriation of participant property or funds and falsification of service delivery documents, and how it protects participants whenever an employee is accused of abuse, neglect, exploitation, misappropriation or falsification: removing the worker from the participant, keeping services going, preserving records, cooperating with DHSS and MMAC investigators, the Agency's own review, outcomes, repayment and protection from retaliation.","sample":false},{"ref":"MO-HC-IC-01","path":"/policies/missouri/home-care/infection-control-universal-precautions-and-communicable-disease/","title":"Infection Control, Universal Precautions, and Communicable Disease","category":"Infection control","citation":"13 CSR 70-91.010(3)(C)","summary":"Workers give care using universal precautions as the Centers for Disease Control and Prevention defines them, with gloves and other supplies the Agency provides at no cost. Under the Agency's communicable disease policy, no employee with a communicable condition, including a cold or flu, has contact with participants. The Agency's registered nurse makes sure that communicable diseases, including hepatitis and tuberculosis, are reported to the local health authority or DHSS within the times 19 CSR 20-20.020 sets.","sample":true},{"ref":"MO-HC-IC-02","path":"/policies/missouri/home-care/bloodborne-pathogens-exposure-control-plan/","title":"Bloodborne Pathogens Exposure Control Plan","category":"Infection control","citation":"29 CFR §1910.1030","summary":"The Agency's written exposure control plan under the OSHA bloodborne pathogens standard: which jobs have occupational exposure; how exposure is prevented through universal precautions, work practices and protective equipment provided at no cost; hepatitis B vaccination made available within 10 working days of initial assignment, with a signed declination if refused; what happens after an exposure incident, including a confidential medical evaluation and the healthcare professional's written opinion within 15 days; training at assignment and at least annually; the records kept; and the annual review of the plan.","sample":false},{"ref":"MO-HC-EP-01","path":"/policies/missouri/home-care/emergency-preparedness-disaster-service-delivery-and-service/","title":"Emergency Preparedness, Disaster Service Delivery, and Service Interruptions","category":"Emergency preparedness","citation":"MMAC In-Home Services Program Requirements 5.10","summary":"The Agency's emergency and disaster plan for in-home services: the types of emergencies, who decides to interrupt scheduled services, the participant emergency priority list, working with DSDS, MMAC and local emergency operations centers, keeping services going on holidays, weekends, in bad weather and during staff shortages, notifying participants of interruptions, EVV and records during outages, recovery, and annual review and exercise.","sample":false},{"ref":"MO-HC-REC-01","path":"/policies/missouri/home-care/participant-records-service-documentation-and-retention/","title":"Participant Records, Service Documentation, and Retention","category":"Records","citation":"19 CSR 15-7.021(24)","summary":"Sets out what goes into every participant case record, how service entries are made, corrected and stored, who may see the record, how fast copies go to MO HealthNet and the state agencies, how long each kind of record is kept (six years from the date of service and six years after the participation agreement expires, whichever is later, never less than five years), and how records are destroyed.","sample":false},{"ref":"MO-HC-PRV-01","path":"/policies/missouri/home-care/hipaa-privacy-and-confidentiality-of-participant-information/","title":"HIPAA Privacy and Confidentiality of Participant Information","category":"Privacy","citation":"45 CFR §164.530","summary":"The Agency's confidentiality and HIPAA privacy policy: the privacy official, the everyday rules workers follow in participants' homes, when participant information may be used or shared (and the stricter limits in the MMAC agreement), minimum necessary access, participants' privacy rights and the time limits for access, amendment and accounting, requests from the state agency as its business associate, privacy complaints, sanctions and training.","sample":false},{"ref":"MO-HC-PRV-02","path":"/policies/missouri/home-care/hipaa-security-devices-and-electronic-records/","title":"HIPAA Security, Devices, and Electronic Records","category":"Privacy","citation":"45 CFR §164.308","summary":"How the Agency protects electronic participant information under the HIPAA Security Rule and its business associate duties to the state agency: the security official, the annual risk analysis, administrative, physical and technical safeguards, encryption of portable devices and transmissions, rules for phones and the EVV application, e-mail, text and fax, backups and system outages, security incidents, and documentation.","sample":false},{"ref":"MO-HC-PRV-03","path":"/policies/missouri/home-care/breach-notification/","title":"Breach Notification","category":"Privacy","citation":"45 CFR §164.404","summary":"What the Agency does when participant or employee information may have been lost, stolen, viewed or sent without permission: immediate reporting and containment, reports to the state agency, the four-factor HIPAA risk assessment, notice to individuals without unreasonable delay and no later than 60 calendar days after discovery, notice to HHS and the media where required, Missouri breach notice under RSMo 407.1500, law enforcement delays, and documentation.","sample":false},{"ref":"MO-HC-HR-01","path":"/policies/missouri/home-care/recruitment-employment-application-and-hiring/","title":"Recruitment, Employment Application, and Hiring","category":"Human resources","citation":"MMAC In-Home Services Program Requirements 4.6.1","summary":"Sets the hiring standards for every person who works with participants: minimum age and literacy, no immediate family members, the employment application with the disclosures and consents MMAC requires before any contact with a participant, reference checks, verification of licenses and certificates, E-Verify, equal employment opportunity and a drug-free workplace.","sample":false},{"ref":"MO-HC-HR-02","path":"/policies/missouri/home-care/family-care-safety-registry-and-criminal-background-checks/","title":"Family Care Safety Registry and Criminal Background Checks","category":"Human resources","citation":"RSMo 192.2495","summary":"Before any employee has contact with a participant, the Agency requests a Missouri State Highway Patrol criminal background check (nationwide when Missouri residence is under five years) and an EDL inquiry, usually through the Family Care Safety Registry; makes sure every employee registers with the Registry within 15 days of starting work; applies the hiring bars in RSMo 192.2495 and the good cause waiver rule; and documents every screening.","sample":false},{"ref":"MO-HC-HR-03","path":"/policies/missouri/home-care/employee-disqualification-list-and-exclusion-screening/","title":"Employee Disqualification List and Exclusion Screening","category":"Human resources","citation":"19 CSR 15-7.021(18)(B)","summary":"Makes sure no one on the DHSS Employee Disqualification List or the federal exclusion list works for the Agency in any capacity: checks before hire and every month during employment, covers every alias, discharges a listed employee, reports any exclusion to MMAC at once, and keeps proof of every check.","sample":false},{"ref":"MO-HC-HR-04","path":"/policies/missouri/home-care/personnel-records-job-descriptions-and-employee-identification/","title":"Personnel Records, Job Descriptions, and Employee Identification","category":"Human resources","citation":"19 CSR 15-7.021(24)(B)","summary":"Lists what every personnel file must hold under 19 CSR 15-7.021(24)(B) and the Personal Care Provider Manual, how files are kept confidential and made available to DHSS investigators, the written job descriptions and annual evaluations the rules require, and the permanent ID every worker carries and returns.","sample":false},{"ref":"MO-HC-HR-05","path":"/policies/missouri/home-care/orientation-and-in-service-training-plan/","title":"Orientation and In-Service Training Plan","category":"Human resources","citation":"19 CSR 15-7.021(22)","summary":"The Agency's written training plan: 12 hours of orientation within 30 days of employment, with at least 6 hours (including the 2-hour agency and emergency orientation and dementia training) before any participant contact; a supervised on-the-job training review within 30 days; the care plan before the first visit; 5 hours of in-service each year after the first year with dementia updates; the waivers the rules allow; and how training is documented.","sample":false},{"ref":"MO-HC-HR-06","path":"/policies/missouri/home-care/contracted-workers-subcontracts-and-volunteers/","title":"Contracted Workers, Subcontracts, and Volunteers","category":"Human resources","citation":"19 CSR 15-7.021(21)(D)","summary":"Sets the conditions for using anyone other than an Agency employee to deliver or support care: subcontracts only during staff shortages, meeting the same standards, with MMAC approval where required; never subcontracting the registered nurse's required duties; a signed agreement for every contracted direct care worker; E-Verify assurances from subcontractors; and the written plan for volunteers.","sample":false},{"ref":"MO-HC-SAF-02","path":"/policies/missouri/home-care/employee-safety-threats-and-work-injuries/","title":"Employee Safety, Threats, and Work Injuries","category":"Human resources","citation":"19 CSR 15-7.021(18)(W)","summary":"How the Agency protects its workers in participants' homes: access to public information sources on potential danger; acting on danger information from DSDS or another reliable source; documented protective steps when a worker reasonably believes someone in the household poses a danger, including a signed conduct agreement, two workers with DSDS approval, or an approved third party on site; no retaliation against a worker who declines to serve because of that belief; immediate written notice to DSDS of threats or abuse; safety in the field; and how work injuries are reported under Missouri workers' compensation law and OSHA rules.","sample":false},{"ref":"MO-HC-SUP-02","path":"/policies/missouri/home-care/annual-on-site-evaluation-of-in-home-workers/","title":"Annual On-Site Evaluation of In-Home Workers","category":"Human resources","citation":"19 CSR 15-7.021(21)(B)","summary":"Every in-home service aide, including personal care aides, APC aides, homemakers, chore workers and respite care workers, receives a written performance evaluation at least once a year, based in part on at least one on-site visit to a participant's home, which also reviews the adequacy of the care plan with the participant. The evaluation is signed and dated by the supervisor and the aide and kept in the aide's personnel file; a report made by a supervisor who is not a registered nurse is initialed and reviewed by the Agency's registered nurse. If an evaluation is not done or not documented, every payment for that aide's services may be recouped.","sample":false},{"ref":"MO-HC-TRN-01","path":"/policies/missouri/home-care/advanced-personal-care-aide-training-and-task-certification/","title":"Advanced Personal Care Aide Training and Task Certification","category":"Human resources","citation":"13 CSR 70-91.010(5)(E)","summary":"If the Agency provides advanced personal care, every APC aide completes at least six hours of APC training in addition to basic orientation before performing any APC task, unless a waiver the rule allows applies; and every APC aide who is not a licensed nurse is personally observed performing each task, and certified in his or her personnel record, by the registered nurse or by an LPN or GN the registered nurse has certified, before performing it for a participant. This is the Agency's APC training plan, including its agenda, the waiver procedure and the competency certification.","sample":false},{"ref":"MO-HC-GOV-01","path":"/policies/missouri/home-care/governing-body-program-participation-and-adoption-of-policies/","title":"Governing Body, Program Participation, and Adoption of Policies","category":"Governance","citation":"19 CSR 15-7.021(2)","summary":"Explains that Missouri does not license non-medical in-home services and that the Agency operates under an MMAC participation agreement and MO HealthNet personal care enrollment; sets out the governing body's duties and how every policy is adopted, issued, reviewed and withdrawn; and lists each written policy MMAC and the rules require, with where it is found in this manual.","sample":false},{"ref":"MO-HC-GOV-02","path":"/policies/missouri/home-care/designated-manager-administrative-supervisor-and-registered-nurse/","title":"Designated Manager, Administrative Supervisor, and Registered Nurse","category":"Governance","citation":"19 CSR 15-7.021(14)","summary":"Names and qualifies the three roles Missouri requires of an in-home services provider: the designated manager MMAC approves, the administrative supervisor who supervises day-to-day service delivery, and the registered nurse responsible for clinical integrity. Sets out how the designated manager is hired, certified through MMAC and kept current, and what happens when a key person changes.","sample":false},{"ref":"MO-HC-GOV-03","path":"/policies/missouri/home-care/office-telephone-contact-business-hours-and-change-notices/","title":"Office, Telephone Contact, Business Hours, and Change Notices","category":"Governance","citation":"MMAC In-Home Services Program Requirements 2.3","summary":"Keeps the Agency reachable at all times: a business telephone answered 24 hours a day identifying the Agency, a staffed principal place of business with posted hours, a two-hour response to after-hours messages, written notice to participants and MMAC of the Agency's address, hours and numbers and of any change, and the notices MMAC requires for changes in ownership, key personnel, services and counties.","sample":false},{"ref":"MO-HC-GOV-04","path":"/policies/missouri/home-care/program-and-fiscal-monitoring-plans-of-correction-and-access-to/","title":"Program and Fiscal Monitoring, Plans of Correction, and Access to Records","category":"Governance","citation":"19 CSR 15-7.021(18)(T)","summary":"Prepares the Agency for MMAC program and fiscal monitoring and MO HealthNet record requests: who hosts a monitor, how records and staff are made available, the ten-day plan of correction and 45-day correction time frames in the participation agreement, the ten-business-day records rule, the protective actions DSDS and MMAC may take, and how findings are tracked to closure.","sample":false},{"ref":"MO-HC-INC-01","path":"/policies/missouri/home-care/incidents-unusual-occurrences-and-reports-to-dsds/","title":"Incidents, Unusual Occurrences, and Reports to DSDS","category":"Quality","citation":"19 CSR 15-7.021(20)(D)","summary":"The Agency's system for reporting, reviewing and learning from incidents and unusual occurrences: what counts as an incident, what the worker does at once, supervisor and nurse review, the written notices to DSDS that the in-home services rules require (case-closure circumstances, threats or abuse toward staff, changes in condition, care plan noncompliance, nondelivery and the need for more DSDS involvement), physician contact, other notices, follow-up and trend review.","sample":false},{"ref":"MO-HC-QA-01","path":"/policies/missouri/home-care/quality-improvement-and-participant-feedback/","title":"Quality Improvement and Participant Feedback","category":"Quality","citation":"19 CSR 15-7.010(12)","summary":"The Agency's own quality program: participant feedback (annual survey, annual on-site visits, grievances), random unannounced visits to check service delivery and records, quality indicators drawn from the in-home services rules, quarterly review, corrective action plans tracked to closure, and the annual quality report to the governing body.","sample":false},{"ref":"MO-HC-BUS-01","path":"/policies/missouri/home-care/service-authorization-units-of-service-and-billing/","title":"Service Authorization, Units of Service, and Billing","category":"Business","citation":"19 CSR 15-7.021(17)","summary":"The Agency bills only what DSDS authorized and its workers actually delivered: 15-minute units including EVV entry time but not travel or breaks, partial units only within the month, MO HealthNet eligibility checked for the day of service, claims based on EVV-verified delivery and never on the authorization, a monthly reconciliation before billing, no charge to MO HealthNet participants for covered services, and prompt repayment of overpayments.","sample":false},{"ref":"MO-HC-BUS-02","path":"/policies/missouri/home-care/electronic-visit-verification/","title":"Electronic Visit Verification","category":"Business","citation":"13 CSR 70-3.320","summary":"Every Medicaid-funded personal care, advanced personal care, homemaker, chore and in-home respite visit is recorded in an approved EVV system linked to the state aggregator. Participants are told EVV is required; workers are identified by their Family Care Safety Registry number; manual entries are rare, justified and made by a supervisor; the Agency logs in to the aggregator at least weekly, reports suspected falsification to MMAC within two business days, reports a change of EVV vendor within 30 days, and keeps EVV data at least six years.","sample":false},{"ref":"MO-HC-BUS-03","path":"/policies/missouri/home-care/copayments-contributions-and-private-pay-services/","title":"Copayments, Contributions, and Private-Pay Services","category":"Business","citation":"19 CSR 15-7.021(18)(R)","summary":"Covers money participants may pay: the monthly copayment DSDS sets for some non-Medicaid participants, voluntary contributions that never affect service and that only DSDS may authorize spending, the rule that MO HealthNet participants are never charged for covered services, and written agreements and rate sheets for private-pay services.","sample":false},{"ref":"MO-HC-BUS-04","path":"/policies/missouri/home-care/insurance-bonding-and-indemnification/","title":"Insurance, Bonding, and Indemnification","category":"Business","citation":"19 CSR 15-7.021(18)(E)","summary":"Keeps in force at all times the coverage Missouri's in-home service standards require: occurrence-based commercial general liability and professional liability of at least $1 million per event and $3 million aggregate, each naming MMAC as certificate holder; an employee dishonesty bond; bonding for those with fiscal duties; workers' compensation; and automobile coverage, with renewal tracking and authority for insurers to report to MMAC.","sample":false},{"ref":"MO-HC-ETH-01","path":"/policies/missouri/home-care/code-of-ethics-professional-boundaries-and-participant-property/","title":"Code of Ethics, Professional Boundaries, and Participant Property","category":"Ethics","citation":"19 CSR 15-7.021(18)(I)","summary":"The Agency's written code of ethics under 19 CSR 15-7.021(18)(I): the fourteen prohibited acts, what workers may do (use the bathroom, and with consent eat their own lunch), how the code is given to and reviewed with participants and every employee, how it is enforced, and how participants' money and property are protected.","sample":false},{"ref":"MO-HC-ETH-02","path":"/policies/missouri/home-care/family-members-as-workers-and-transporting-participants/","title":"Family Members as Workers and Transporting Participants","category":"Ethics","citation":"19 CSR 15-7.021(18)(G)","summary":"No in-home services worker may serve a participant who is an immediate family member, and the Agency never provides or bills transportation of participants. This policy sets out how the Agency educates staff and participants, prevents and detects family relationships and transportation, responds to a violation, and repays any funds received for services delivered in breach.","sample":false},{"ref":"MO-HC-ETH-03","path":"/policies/missouri/home-care/compliance-program-preventing-and-detecting-improper-conduct/","title":"Compliance Program: Preventing and Detecting Improper Conduct","category":"Ethics","citation":"13 CSR 70-3.030(3)","summary":"The Agency's program for preventing, detecting, reporting and resolving conduct that is improper or abusive of MO HealthNet, such as misappropriation of participant funds or property, falsified service delivery documents or agency records, false claims and kickbacks. It names a compliance lead, sets standards, training, monitoring and audits, a reporting route without retaliation, investigation, self-disclosure and repayment, conflict of interest rules, information on false claims laws, and the annual Deficit Reduction Act attestation to MMAC.","sample":false}],"copy":{"reviewed":"2026-11-08","intro":"For Missouri in-home services providers. Missouri does not license non-medical home care: providers work under an in-home services participation agreement with the Missouri Medicaid Audit and Compliance Unit (MMAC) and deliver the services the Division of Senior and Disability Services (DSDS) authorizes. The manual has 50 policies and 68 forms, written to 19 CSR 15-7, the in-home services standards, and the MO HealthNet personal care rule (13 CSR 70-91.010). Each policy opens with a plain-English summary and names the rule section it follows, and every one is filled in with your agency's name and details. You get Word and PDF files to keep, and your staff read and sign each policy on their phone.","rulesTitle":"What Missouri's in-home services rules ask your policies to cover","rules":[{"head":"Starting services.","text":"Services start within ten calendar days of receiving the DSDS authorization, or on the start date it gives, whichever is later. The date of receipt is recorded on each authorization.","cite":"19 CSR 15-7.021(18)(J)"},{"head":"Training.","text":"12 hours of orientation within 30 days of employment, with at least 6 hours, including 2 on the agency and its emergency protocols, before the first day of participant contact. After the first 12 months, 5 hours of in-service a year.","cite":"19 CSR 15-7.021(22)"},{"head":"Supervision.","text":"A monthly review of each worker's service record against the care plan, and a written evaluation of each aide at least once a year, based in part on at least one on-site visit.","cite":"19 CSR 15-7.021(21)"},{"head":"Background checks.","text":"A criminal background check and an Employee Disqualification List check before any contact with a participant, and registration with the Family Care Safety Registry within 15 days of starting work.","cite":"RSMo 192.2495; RSMo 210.906"},{"head":"Abuse and neglect.","text":"Staff who suspect abuse, neglect, exploitation or likelihood of serious physical harm report it immediately to the Department of Health and Senior Services.","cite":"RSMo 192.2475; 19 CSR 15-7.010(8)"},{"head":"Discharge notice.","text":"When the agency cannot meet a participant's needs or the participant does not comply, written notice goes to the participant and DSDS at least 21 days before discharge, and care continues during that time.","cite":"19 CSR 15-7.021(16)(D)"}],"asks":[{"ref":"MO-HC-SVC-01","title":"Scheduling, Reliable Service Delivery, Undelivered Services, and Holidays","category":"Service delivery","q":"A worker calls in sick at 6:00 a.m. Walk me through what happens for her participants that day.","path":"/policies/missouri/home-care/scheduling-reliable-service-delivery-undelivered-services-and-holidays/"},{"ref":"MO-HC-ANE-01","title":"Recognizing and Reporting Abuse, Neglect, and Exploitation of Adults","category":"Safeguarding","q":"Do you report to your supervisor first, or to the state?","path":"/policies/missouri/home-care/recognizing-and-reporting-abuse-neglect-and-exploitation-of-adults/"},{"ref":"MO-HC-HR-02","title":"Family Care Safety Registry and Criminal Background Checks","category":"Human resources","q":"Is every employee registered with the Family Care Safety Registry? When did this employee register?","path":"/policies/missouri/home-care/family-care-safety-registry-and-criminal-background-checks/"},{"ref":"MO-HC-BUS-02","title":"Electronic Visit Verification","category":"Business","q":"Show me last month's manual entries and the justification for each one.","path":"/policies/missouri/home-care/electronic-visit-verification/"},{"ref":"MO-HC-EP-01","title":"Emergency Preparedness, Disaster Service Delivery, and Service Interruptions","category":"Emergency preparedness","q":"Who decides whether visits go ahead in an ice storm, and how do participants find out?","path":"/policies/missouri/home-care/emergency-preparedness-disaster-service-delivery-and-service/"}],"faq":[{"q":"Is this the right manual for my agency?","a":"It is for Missouri in-home services providers with an MMAC participation agreement. Missouri does not license non-medical home care, so the manual never calls your agency licensed. Licensed home health agencies need the Missouri home health manual, and hospices need the Missouri hospice manual."},{"q":"Does it include the 17 policies MMAC asks for?","a":"Yes. MMAC's In-Home Services Proposal for Contract (Section VI) lists 17 policies a provider must have. Each one is in the manual, and the policy says which item it answers."},{"q":"Does it cover advanced personal care?","a":"Yes, for agencies that offer it. The policies cover at least six hours of training before any advanced personal care task, task certification, and on-site registered nurse visits at intervals of no more than six months (13 CSR 70-91.010(5)). An agency that offers advanced personal care must also provide authorized nurse visits."},{"q":"Are the client forms in Spanish?","a":"Yes. The forms participants read and sign come in English and Spanish, filled in with your agency's details."},{"q":"What do the 50 policies cover?","a":"Client rights (4), service delivery (9), clinical tasks (5), safeguarding (3), infection control (2), emergency preparedness (1), records (1), privacy (3), human resources (9), governance (4), quality (2), business (4) and ethics (3)."}]},"guides":[{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"},{"path":"/guides/abuse-neglect-exploitation-reporting/","h1":"Abuse, neglect and exploitation policies: what each state requires"},{"path":"/guides/infection-control-policy/","h1":"What should a home care infection control policy include?"},{"path":"/guides/staff-policy-acknowledgment/","h1":"Staff policy acknowledgment: how read-and-sign works in home care"},{"path":"/guides/how-to-write-policies-and-procedures/","h1":"How to write policies and procedures for a home care agency"},{"path":"/guides/how-often-review-policies/","h1":"How often should policies and procedures be reviewed and updated?"}]}