How to obtain a MOU
In order to obtain an MOU with the Region Five Hub, you will need to secure the proper documentation, create your staffing plan and submit your documentation, along with your application online.
The following documents are needed:
1. A current copy of Licensure
2. A current copy of insurance
3. VCC Provider Roster with staffing plan spreadsheet – This excel is supplied by the Hub. Scroll down to download and fill out before you submit your application. The excel needs to be downloaded and completed fully with a realistic staffing plan that shows dispatch availability of 24/7 response (it can not just say ‘24/7’ in the Hours.) When you have finished completing the excel, download it and attach it to your application.
4. Copy of MOUs with any other Hub
5. Copy of attestation of enrollment as a Medicaid Provider (This is your DMAS letter that you are enrolled with DMAS. If you do not have it yet, you have 60 days to provide the letter once the MOU has been completed.)
MOU / MOU Renewal Dates
MOUs renew annually, and information pertaining to the renewal will come out prior to expiration of the previous MOU.
The period to enter into or renew your MOU with Region Five will begin annually on April 1st.