Home care billing in Missouri

Split by service. CMS's 2024 state tables list MO HealthNet Managed Care as a statewide MCO program running since September 1, 1995 under 1115(a), 1915(b) and 1932(a) authority, with Show Me Healthy Kids, UnitedHealthcare, Healthy Blue and Home State Health as the plans, and record that all 1915(c) waiver services are carved out and not covered under the plans, while home health through managed care is limited to 100 visits per year and intended as short-term coverage.² Enrollment is mandatory for low-income adults and most children and voluntary for aged, blind or disabled members and children with special health care needs; a member is assigned to a plan on the date of eligibility and has 90 calendar days to change without cause. UnitedHealthcare's 2026 Missouri care provider manual lists HCBS waiver services, nursing facility services and long-term care in a nursing home among the Medicaid services not covered through managed care, and refers members who may benefit from waiver services to the Long-Term Care Division/HCBS Branch to determine eligibility and availability.

Open model: Missouri lets each provider select its EVV vendor, and every system must integrate with the state's EVV Aggregator Solution (EAS), managed by Sandata. Home State Health's 2026 provider notice says MO HealthNet began requiring EVV on April 1, 2026 for personal care and home health services, and that the requirement applies to all Medicaid and MCO-reimbursed services with no exclusions for live-in caregivers.³ The EVV record must capture the service performed with any required task or memo details, the member, the date, the start and end location, the rendering provider and the start and end times. Providers are told to monitor the aggregator at least weekly to confirm visit data was submitted and is accurate, and to resolve missing or incorrect data with their vendor. UnitedHealthcare's Missouri provider page states that starting September 21, 2026 MO DSS begins the Claims Validation Hard Launch phase, in which claims that do not match EVV data in the aggregator may be denied. CMS lists Missouri compliant with the federal EVV requirement for personal care from January 1, 2021 and for home health from January 1, 2024.

Services under EVV³

• Home health nursing by an RN or LPN
• Home health occupational, physical and speech therapy
• Home health personal care aide visits
• Personal care and advanced personal care
• Consumer-directed personal care
• Homemaker and chore services
• In-home respite through the Division of Senior and Disability Services

By the payer that covers the service. Every 1915(c) waiver service is carved out of the MO HealthNet Managed Care plans and is authorized and paid outside them, while home health delivered through a plan is limited to 100 visits a year, is meant to be short term and follows that plan's rules.² UnitedHealthcare's 2026 Missouri manual has the discharge planner ordering home care call the plan's Provider Services to arrange it, requires prior authorization for postpartum home health follow-up visits, and routes members who may benefit from waiver services to the Long-Term Care Division/HCBS Branch for eligibility. From September 21, 2026 Home State Health also requires the procedure code, modifiers and units on a claim to match the verified visit in the aggregator, so the units billed have to be the units verified.

Plan members' personal care and home health claims go to the plan, and from September 21, 2026 a Home State Health claim must match a verified visit in the EVV Aggregator Solution on member Medicaid ID, dates of service, provider Medicaid ID, procedure code and modifiers, and units billed, or it is denied. The notice lists the failure modes: the provider is not using EVV, the vendor is not sending visits to the aggregator, visits are not in a verified status, or the claim went out before the vendor sent the visit.³ UnitedHealthcare's 2026 Missouri manual treats a rejected claim whose corrections are not received within 90 days from the date of service, or from the close of business with the primary carrier, as late billed and denies it for timely filing; it adds that timely filing limits vary with state requirements and contracts, and that a submission report alone is not proof of timely filing for an electronic claim without the acceptance report. The same manual lists HCBS waiver among the care covered by Medicaid but not through managed care, so carved-out waiver services are billed to MO HealthNet fee-for-service rather than to a plan, and it points providers to emomed.com for eligibility.

CGS Administrators, LLC, the A/B MAC for Jurisdiction 15, processes Medicare home health and hospice claims for Missouri, alongside Colorado, Delaware, the District of Columbia, Iowa, Kansas, Maryland, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia and Wyoming.⁶ For Medicaid, home health through the MO HealthNet Managed Care plans is limited to 100 visits a year as short-term coverage. Section 12006 of the 21st Century Cures Act set the January 1, 2023 federal deadline for Medicaid home health EVV, CMS's December 19, 2023 letter found Missouri compliant for home health under both the state plan and its 1915(c) waivers, and Home State Health matches home health nursing, therapy and aide claims to verified visits in the state aggregator from September 21, 2026.