Missouri - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Missouri funds Support Coordination, the state's official term for Targeted Case Management, through the Department of Mental Health (DMH) Division of Developmental Disabilities across its four HCBS waivers. The state restricts this service delivery primarily to statutory County Senate Bill 40 (SB40) Boards or state-operated Regional Offices, meaning independent private agencies cannot enroll directly as standalone case management providers without a specific subcontracting relationship or state designation.

Entities seeking to provide these services must first secure a contract with the Division of Developmental Disabilities or an existing SB40 Board, followed by certification from the DMH Office of Licensure and Certification (OLC). Once certified and contracted, the entity submits a provider enrollment application through the Missouri Medicaid Audit and Compliance (MMAC) unit via the eMOMED portal to bill MO HealthNet.

1. Service Definition and Scope

In Missouri, Case Management is officially designated as Support Coordination or Targeted Case Management (TCM). It encompasses the comprehensive assessment of individuals with developmental disabilities, the development of the Individualized Support Plan (ISP), and the ongoing monitoring of HCBS waiver services.

The service ensures that waiver participants receive appropriate, person-centered care while maintaining compliance with federal HCBS settings regulations.

• Official Name: Support Coordination or Targeted Case Management (TCM)
• Core Function: Development and annual updating of the Individualized Support Plan (ISP)
• Monitoring Requirement: Monthly face-to-face or telehealth contacts to verify service delivery and health/safety
• Target Population: Individuals enrolled in Missouri's DD waivers (Comprehensive, Community Support, Partnership for Hope, MOCDD)
• Conflict of Interest: Support Coordination must be administratively separated from direct HCBS service delivery under the CMS HCBS Settings Rule

2. Regulatory and Oversight Agencies

Multiple state entities govern Support Coordination in Missouri. The Department of Mental Health sets the programmatic rules and issues certifications, while the Department of Social Services handles the financial and Medicaid enrollment aspects.

Providers must maintain compliance with both programmatic standards and Medicaid billing regulations.

• Missouri Department of Mental Health (DMH): https://dmh.mo.gov/
• DMH Division of Developmental Disabilities (DD): https://dmh.mo.gov/dev-disabilities
• DMH Office of Licensure and Certification (OLC): https://dmh.mo.gov/about/licensure-certification
• Missouri Department of Social Services (DSS) MO HealthNet Division (MHD): https://dss.mo.gov/mhd/
• Missouri Medicaid Audit and Compliance (MMAC): https://mmac.mo.gov/
• eMOMED Provider Portal: https://www.emomed.com/

3. Gatekeeping Prerequisites: Who Can Even Apply

Missouri operates a closed network for Developmental Disabilities Targeted Case Management. The state relies on statutory county boards and state regional offices to provide these services.

Private entities cannot simply apply to become Support Coordination providers; they must navigate specific statutory and contractual barriers first.

• Statutory Designation: Primary providers are County Senate Bill 40 (SB40) Boards for Developmental Disabilities
• State Operation: In counties without an active SB40 Board providing TCM, DMH Regional Offices provide the service directly
• Subcontracting Requirement: Private agencies cannot enroll as independent TCM providers; they must be procured as a subcontractor by an existing SB40 Board or DMH
• Conflict of Interest Prohibition: Agencies providing direct waiver services (like personal care or residential habilitation) are barred from providing Support Coordination to the same individuals

4. Licensure and Certification Requirements

DMH does not issue a traditional license for Support Coordination; instead, it requires Certification through the DMH Office of Licensure and Certification (OLC).

The certification process involves a comprehensive review of the agency's policies, procedures, and personnel records to ensure compliance with state standards.

• Authority: 9 CSR 40-1.010 through 9 CSR 40-1.120 (General Program Procedures)
• Application Form: DMH Certification Application submitted to [email protected]
• Review Process: OLC conducts a Certification Survey using the 2024 Medicaid Waiver Certification Survey Instrument
• Outcome: Issuance of a Certification Survey Report with a required Plan of Correction (POC) for any deficiencies
• Renewal: Certification is typically granted for up to three years based on survey performance

5. Medicaid Provider Enrollment

After obtaining DMH certification and the necessary contracts, the entity must enroll with MO HealthNet through the Missouri Medicaid Audit and Compliance (MMAC) unit.

Enrollment is conducted entirely online through the state's designated portal.

• Enrollment Portal: eMOMED online provider enrollment application
• Provider Type: Enrolled specifically as a Targeted Case Management provider (Provider Type 65)
• Required Documentation: DMH Certification letter, IRS W-9, and National Provider Identifier (NPI)
• Application Fee: Subject to the CMS institutional provider application fee unless waived via Medicare enrollment or another state's Medicaid program
• Revalidation: Required every 5 years under 42 CFR 455.414

6. Staffing, Training and Background Checks

Support Coordinators must meet strict educational and background criteria set by DMH to ensure they are qualified to manage complex waiver services.

Agencies must verify and document all credentials before a staff member can bill for services.

• Education Minimum: Bachelor's degree from an accredited college or university in a human services field (e.g., social work, psychology, sociology)
• Experience Substitute: Registered Nurses (RNs) with equivalent experience may qualify under specific waiver definitions
• Background Check 1: Family Care Safety Registry (FCSR) screening required prior to client contact
• Background Check 2: DHSS Employment Disqualification List (EDL) clearance
• Background Check 3: DMH Employment Disqualification Registry clearance
• Training: Completion of DMH-mandated Support Coordination orientation and ongoing annual training hours

7. Documentation, Policies and Records

Certified providers must maintain comprehensive records subject to MMAC and DMH audits.

Failure to maintain accurate and timely documentation can result in immediate recoupment of Medicaid funds.

• ISP Documentation: The Individualized Support Plan must be updated annually or when the participant's needs change
• Contact Notes: Detailed progress notes for all monthly face-to-face and collateral contacts, entered into the state's IT system (CIMOR)
• Policy Requirement: Written policies on abuse/neglect reporting, grievance procedures, and HIPAA compliance
• Record Retention: MO HealthNet requires all clinical and financial records be retained for a minimum of 5 years
• Personnel Files: Must contain verified transcripts, background check results, and annual training logs

8. Billing, Rates and Claims

Targeted Case Management services are billed to MO HealthNet using specific HCPCS codes. Rates are established by the state legislature and published in the MO HealthNet fee schedule.

Providers must ensure claims accurately reflect the time spent and the specific waiver population served.

• Billing System: Claims are submitted electronically via the eMOMED portal
• Primary Code: T1017 (Targeted Case Management, each 15 minutes)
• Modifiers: Specific modifiers may be required to denote the specific waiver or population
• Rate Setting: Rates are published on the DSS MHD fee schedule page and are subject to annual legislative appropriations
• EVV Exemption: Case management is generally exempt from the Electronic Visit Verification (EVV) requirements under 13 CSR 70-3.320, which apply to personal care

9. Approval Sequence and Timeline

The pathway to becoming a billing provider is sequential and depends heavily on the initial contracting phase.

Agencies should expect a multi-month process from initial contract negotiation to final Medicaid enrollment.

• Step 1: Secure a contract or formal affiliation with a County SB40 Board or DMH Regional Office
• Step 2: Submit the Certification Application to DMH OLC
• Step 3: Undergo the DMH OLC Certification Survey
• Step 4: Submit the MO HealthNet enrollment application via eMOMED to MMAC
• Step 5: MMAC review and approval (average 90-120 days, per MMAC guidelines)

10. Common Denials and Survey Findings

Applications and surveys frequently face delays due to incomplete documentation or failure to meet strict structural requirements.

Understanding these common pitfalls can help agencies prepare more robust applications.

• Gatekeeping Denial: Application rejected by MMAC because the agency lacks the required SB40 Board or DMH contract
• Conflict of Interest: Denial of certification because the agency also provides direct HCBS waiver services
• Background Check Failures: Staff beginning work before FCSR and DMH Registry clearances are fully returned and documented
• Incomplete Policies: Missing required elements in the agency's abuse/neglect or grievance policies during the OLC survey
• Credentialing Errors: Support Coordinator transcripts not verifying a degree in a qualifying human services field

11. Key Contacts and Resources

Providers should utilize the official state portals and help desks for guidance through the certification and enrollment processes.

Maintaining contact with these agencies ensures providers stay updated on regulatory changes.

• DMH Office of Licensure and Certification: [email protected] | https://dmh.mo.gov/about/licensure-certification
• MMAC Provider Enrollment Help Desk: [email protected] | https://mmac.mo.gov/
• eMOMED Portal: https://www.emomed.com/
• Family Care Safety Registry (FCSR): https://health.mo.gov/safety/fcsr/
• DHSS Employment Disqualification List: https://health.mo.gov/safety/edl/

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