MHCP provider news and updates

The Centers for Medicare & Medicaid Services (CMS) approved amendments to Minnesota Department of Human Services (DHS) waiver plans. The amendments authorized the CDCS enhanced budget and the enhanced rate for extended PCA waiver services effective immediately. Financial Management Service (FMS) providers and PCA provider agencies should follow the instructions below.

• FMS providers - Changes to the individual’s CDCS budget and plan are directed by the individual and approved by the lead agency. Then, the FMS provider implements changes by following the instructions found on the CDCS enhanced budget process webpage.
• PCA provider agencies - PCA agencies working with a person authorized for extended PCA services follow the instructions on the Provider agency/FMS provider requirements for enhanced rate or budget webpage.

(pub. 2/11/2019)

Beginning Jan. 1, 2019, all PCA and HCN services for people under age 65 will be covered under FFS. Members will continue to be enrolled in the Managed Care Organization (MCO) they were enrolled in, but MCO contracts for Minnesota Health Care Programs (MHCP) members under age 65 will no longer cover PCA and HCN. MHCP will cover these services on a FFS basis beginning Jan. 1, 2019.

Additional information for PCA agencies regarding this change:

• Due to the large volume of fax requests, it will take the Resource Center approximately 3-4 weeks to process your request. Do not resend your request for an authorization.
• Do not send multiple forms within the same fax. Send one fax for each person.  
• Only fax the health plan authorization letter. Do not fax the PCA assessment and service plan. 
• Attach the page of the service plan or an EOMB to show shared care was authorized if you need to cite shared care not authorized on the health plan authorization letter.
• We are issuing the FFS authorizations with line items instead of two 6-month lines for the remainder of the service agreement to increase data entry efficiency. If you need the units divided differently due to a different flexible use plan, indicate this in the comments section of form DHS-4074A. For example, if the person had planned on a 25/75% division of units. 
• Do not send a request for an authorization for people receiving PCA services through a waiver or Alternative Care program. If you are providing PCA services to a person on a waiver or the Alternative Care program, contact your county or tribal nation case manager to have your authorization entered into MMIS. 
• Do not send a request for an authorization for people who are 65 and older and are receiving PCA services through MCOs. The transition to FFS does not apply to people 65 and older in managed care. 

Changes to PCA payer do not affect other health care services.

Under this contract change, members will continue to be enrolled in the MCO they were enrolled in and the MCO will continue to pay for their other health care services.

The contract change does not apply to the two options for those 65 and over: Minnesota Senior Health Options (MSHO) or Minnesota Senior Care+ (MSC+). MSHO and MSC+ MCOs will continue to authorize and pay for PCA and HCN services. (pub. 2/6/2019)

Minnesota Health Care Programs (MHCP) has identified an APC overpayment error on procedure codes with status indicators Q1, Q2 or Q3 when multiple units were paid. Procedure codes with status indicators Q1, Q2 or Q3 are limited to a single unit based on Centers for Medicare & Medicaid Services (CMS) guidelines.

We are currently updating our system to meet these guidelines. After the system work is completed, we will identify overpaid claims within the last three years. MHCP will update providers with the remittance advice date of the reprocessed claim. (pub. 1/31/2019)

Minnesota Health Care Programs (MHCP) clarified DBT IOP Exclusionary Services in the DBT IOP section of the MHCP Provider Manual. Concurrent therapy is allowed only for family therapy. You must submit a justification and communication plan with authorization materials to provide concurrent family therapy and DBT services. DBT cannot be provided concurrently with outpatient individual or group psychotherapy, partial hospitalization or day treatment. This clarification assures the DBT therapist is leading the treatment of the individual and is adhering to the fidelity of the DBT Model. (pub. 1/31/19)

Minnesota is experiencing a significant shift in continuum of care for youth under 21 years old. See the medical necessity distinction memo to learn how we have differentiated between CRF and PRTF to fit within the continuum of care, with the goal of ensuring safe and effective treatment for Minnesota’s youth. See the Children’s Residential Facilities (CRF) and Psychiatric Residential Treatment Facilities (PRTF) webpages for more information about CRF and PRTF. (pub. 1/23/19)

The Behavioral Health Division will provide webinar and online on-demand training sessions during 2019.

See the Alcohol and Drug Abuse Learning Center webpage for training and registration information.

See the CCDTF training announcement e-memo for Substance Use Disorder (SUD) reform training and registration information. (pub. 1/23/19)

Effective Jan. 1, 2019, Minnesota Department of Human Services (DHS) will no longer be a third-party administrator (TPA) for SCHA health plan.

Providers who have current EW service agreements with SCHA managed by a county lead agency will have their agreements closed by a lead agency or case manager up to Dec. 31, 2018. These providers may continue to follow the fee-for-service billing process for dates of services through Dec. 31, 2018. 

For dates of service on or after Jan. 1, 2019, claims billed through the fee-for-service process will be denied. Providers will need to follow SCHA’s instructions, 2019 Changes Specific to Elderly Waiver Providers (PDF), for service authorization and billing for dates of service of Jan. 1, 2019, and after. 

This change does not affect tribal providers who have EW service agreements for persons enrolled with SCHA and whose case is managed by a tribal lead agency. These providers can continue to follow the fee-for-service process for service agreements and billing after Dec. 31, 2018. (pub. 12/7/18, rev. 1/18/19)

Comprehensive assessment, treatment coordination and peer support services can be provided to managed care members beginning Jan. 1, 2019. Your contract with managed care organizations (MCOs) must include the three new services before providing services to bill claims. You can submit claims for managed care members beginning Jan. 1, 2019.

Bill the new services using the following codes:

• Comprehensive Assessment: H0001 with no modifier code
• Treatment Coordination: 1016 with HN and U8 modifier
  Do not bill more than 8 units per client, per day. You must bill with U8 and HN modifiers.
• Peer Recovery Support Services: H0038 with U8 modifier
  Do not bill more than 8 units per client, per day. You must bill with the U8 modifier.

Contact the MCO if you have questions. (pub. 1/16/19)

Minnesota Department of Human Services (DHS) is updating programming to pay EIDBI service claims using new Current Procedural Terminology (CPT) billing codes that went into effect Jan. 1, 2019. All EIDBI claims are currently being suspended. We will pay all suspended claims once the programming is complete. Contact the Minnesota Health Care Programs (MHCP) Provider Call Center at 651-431-2700 or 800-366-5411 if suspended claims are causing a financial hardship for you or your EIDBI agency. See the EIDBI Benefit Provider Manual for more information on EIDBI billing processes and procedures. (pub. 1/15/19)

We updated all active service agreements for Minnesota Health Care Programs (MHCP) Medicaid fee-for-service members previously approved for EIDBI services for 2019. Check your MN–ITS account for updated service agreements and contact Keystone Peer Review Organization (KEPRO) at 866-433-3658 or 612-354-5589 or Minnesota Department of Human Services (DHS) at ASD.DHS@state.mn.us if you have questions. The service agreements were converted based on the services and intensity of what was requested on the member’s previously approved Individualized Treatment Plan (ITP). Because the new codes have different service limits, you may need to update the ITP and request additional units on the authorization for dates in 2019.

The ITP form will update to reflect the new codes and will be available soon. Continue requesting services as usual using the ITP form and KEPRO will convert the services to the new codes.

The codes will also update in the KEPRO Atrezzo provider portal. The update will be completed soon, and you will see the case updated with the new codes and units for 2019.

All EIDBI providers need to use the updated billing grid and request services with those parameters moving forward. The EIDBI provider manual and policy manual will update to reflect the new coding guidelines.

Providers should pay attention to the following items while submitting for authorization of EIDBI services:

• Remember to request ITP progress monitoring units on your service agreement. This will allow you to bill for updates to the ITP throughout the year. The new limit is up to 30 units on each service agreement.
• Complete ALL corrections using the correction function on the Comprehensive Multi-Disciplinary Evaluation (CMDE) and ITP forms. Re-submit the form with the corrections. KEPRO will no longer accept any handwritten corrections submitted on the forms.  
• If you have multiple centers or EIDBI locations, all your locations must be enrolled and have an EIDBI taxonomy code assigned to them to authorize and bill for members at those individual locations. Include the correct taxonomy code on the CMDE and ITP form.
• It is not necessary to submit the Explanation of Benefits (EOB) or Third Party Liability (TPL) to KEPRO when requesting authorization. EOB and TPL only need to be submitted when submitting claims to DHS.
• Always submit the ITP and CMDE forms to DHS prior to sending them to KEPRO. If additional information or a correction is requested, use the correction feature on the forms and resubmit the data.
• The H0032 code used for ITP development and progress monitoring has an encounter rate of $82.44. More than one provider may bill the service for the same person in a day and multiple providers can work on the ITP on the same day.

For questions, contact ASD.DHS@state.mn.us and see the Minnesota Provider Screening and Enrollment (MPSE) portal training page for MPSE training and registration information. (pub. 1/8/19)

An approved variance for provider-agency requirements for the EIDBI benefit allows eligible service providers in bordering states to provide EIDBI services to people eligible for Minnesota Health Care Programs (MHCP) benefits.

Providers from bordering states must meet all of the following requirements:

• Have a current provider license in Iowa, North Dakota, South Dakota or Wisconsin
• Have an office in the border state where they are currently licensed
• Meet all EIDBI and Minnesota Department of Human Services (DHS) provider enrollment requirements and enroll as an EIDBI provider
• Serve members of Minnesota Medicaid, MinnesotaCare or other eligible health plans based in Minnesota

(pub. 1/8/19)

The Internal Revenue Service (IRS) standard business mileage rate increased from 54.5 cents to 58 cents per mile Jan. 1, 2019. Minnesota Health Care Programs (MHCP) will reimburse 58 cents per loaded mile for NEMT volunteer driver (A0080) and foster parent (A0090 UC) appropriate and most-direct-route transports for dates of service beginning Jan. 1, 2019, through Dec. 31, 2019. (pub. 1/8/19)

The 2018 volume purchase hearing aid contract updated to new Centers for Medicare & Medicaid Services (CMS) HCPCS codes for contralateral routing hearing aid devices and systems effective January 1, 2019. See the 2018 volume purchase hearing aid contract (PDF) for more information.

New Codes for Contralateral Routing Hearing Devices

New Code	Contralateral Routing Technology	Old Code
V5171	Hearing aid, contralateral routing device, monaural, in the ear	V5170
V5181	Hearing aid, contralateral routing device, monaural, behind the ear	V5180
V5221	Hearing aid, contralateral routing system, binaural, behind the ear/behind the ear	V5220

Use the new codes for prior authorization and claims submitted on or after Jan. 1, 2019. Refer to New and Revised Codes for Contralateral Routing Hearing Devices on the American Speech-Language-Hearing Association’s website for more information. (pub. 1/8/19)

MPSE portal training is scheduled for 2019. The MPSE portal is the new online process providers will use to submit and manage their enrollment with Minnesota Health Care Programs (MHCP). See the MPSE portal training page to register and for the webinar information. (pub. 12/31/18)

The Centers for Medicare & Medicaid Services (CMS) mandates changes to mental health procedure codes beginning Jan. 1, 2019.

Do not use the following codes in 2019: 96101, 96102, 96103, 96118, 96119 and 96120. See the chart for new 2019 codes and changes.

2019 Neuropsychological CPT Code Changes

Service Description	2018 Procedure code	2018 unit allowed	2019 Procedure code	2019 unit allowed
Neurobehavioral status exam both face-to-face time with the patient and time interpreting test results and preparing the report by physician or other qualified health care professional. First hour.	96116	1 hour	96116 (same as 2018)	1 hour
Each additional hour	None	None	96121	1 hour
Neuropsychological testing evaluation services including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and reporting, and interactive feedback to the patient, family member(s) or caregiver(s) by physician or other qualified health care professional. First hour.	96118	1 hour	96132	1 hour
Each additional hour	None	None	96133	1 hour
Neuropsychological test administration and scoring of two or more tests, any method, by physician or other qualified health care professional. First 30 minutes.	None	None	96136	30 minutes
Each additional 30 minutes	None	None	96137	30 minutes
Neuropsychological test administration and scoring of two or more tests, any method, by a technician. First 30 minutes.	96119	1 hour	96138	30 minutes
Each additional 30 minutes	None	None	96139	30 minutes
Neuropsychological test administration, with single automated, standardized instrument via electronic platform with automated results only.	96120	1 session	96146	1 session

2019 Psychological CPT Code Changes

Service Description:	2018 Procedure code	2018 unit allowed	2019 Procedure code	2019 unit allowed
Psychological testing evaluation services including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and reporting, and interactive feedback to the patient, family members(s) or caregiver(s) by physician or other qualified health care professional. First hour.	96101	1 hour	96130	1 hour
Each additional hour	None	None	96131	1 hour
Psychological Test administration and scoring of two or more tests by physician or other qualified health care professional. First 30 minutes.	None	None	96136	30 minutes
Each additional 30 minutes	None	None	96137	30 minutes
Psychological test administration and scoring of two or more tests, any method, by technician. First 30 minutes.	96102	1 hour	96138	30 minutes
Each additional 30 minutes	None	None	96139	30 minutes
Psychological test administration, with single automated, standardized instrument via electronic platform with automated results only.	96103	1 session	96146	1 session

(pub. 12/28/18)

The Centers for Medicare & Medicaid Services (CMS) has established a Medically Unlikely Edits (MUEs) of one unit for HCPC codes H0031 (mental health assessment by non-physician) and H0032 (mental health service plan development by non-physician) beginning Jan. 1, 2019. MUEs prevent payment for an inappropriate quantity of the same service on a single day. Currently, more than one unit is allowed for each of these codes when the UD modifier is included. The UD modifier will no longer be required and only one unit of each of these services will be allowed per day for Managed Care Organizations (MCOs) and fee-for-service claims beginning Jan. 1, 2019. Minnesota Health Care Programs (MHCP) will deny a claim line that includes more than one unit. MHCP will determine a per-session rate for H0031 and H0032 and will reprocess paid claims with dates of service beginning Jan. 1, 2019, once a new rate is established. (pub. 12/28/18, rev. 1/8/19)

Beginning Jan. 1, 2019, Medical Transportation Management’s Minnesota Nonemergency Transportation (MTM/MNet) will coordinate local agency NEMT (modes 1 – 4) and related ancillary services for Aitkin, Carlton, Lake and St. Louis counties through a host county contract with St. Louis county. Minnesota Health Care Programs (MHCP) fee-for-service (FFS) members and transportation providers who want to receive or provide local agency NEMT including personal mileage (mode 1), volunteer driver (mode 2), unassisted (mode 3) and assisted (mode 4) transports and related ancillary services in these four counties must contact MTM/MNet at 844-399-9466 instead of the county beginning Jan. 1, 2019. (pub. 12/26/18)