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:
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)
Minnesota Department of Human Services (DHS) seeks public comments about adding the Early Social Interaction (ESI) modality to the list of approved behavioral and developmental treatment modalities covered under the EIDBI benefit. See the Florida State University College of Medicine’s Early Social Interaction webpage for more information.
DHS and the EIDBI Advisory Council reviewed the ESI modality and determined it met all statutory requirements to be added to EIDBI policy. See the “Revising treatment modalities” section of the Treatment modalities webpage for more information. We want additional feedback from autism spectrum disorder (ASD) providers and stakeholders about the ESI modality. The public comment period ends at 4 p.m., Feb. 1, 2019.
How to submit comments
Email comments to ASD.DHS@state.mn.us. We will also accept comments via the U.S. Postal Service. Mail written comments to:
ATTN: EIDBI Policy Staff
Minnesota Department of Human Services
Disability Services Division
P.O. Box 64967
St. Paul, MN 55164-0967
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:
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:
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)
|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|
The Minnesota Departments of Education (MDE) and Human Services (DHS) will conduct a beginner’s training presentation for IEP services on Tuesday, Feb. 12, 2019. This training is for school districts’ IEP billing coordinators and billing administrators who are new to third-party billing. We will include an overview about the Individuals with Disabilities Education Act (IDEA), provider enrollment, child eligibility requirements for services, coverage criteria, billing requirements and rate calculation for IEP health-related services.
Time and location
Training will be in person and via webinar. All registered participants will receive a confirmation email. We will forward the webinar details to those who register for the webinar.
In-person training will be at the Minnesota Department of Education, 1500 Highway 36 W, Roseville, MN 55113.
Use the IEP Training Registration form to register for the training. Space is limited and seating is not guaranteed for those who do not register before the Jan. 25, 2019, deadline.
Please email Kristin.Smith@state.mn.us (DHS) if you need to cancel your reservation.
We will provide a continental breakfast and boxed lunch.
Beginning Jan. 1, 2019, all personal care assistance (PCA) and home care nursing (HCN) services for people under age 65 will be covered under fee-for-service (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 the services on a FFS basis beginning Jan. 1, 2019.
Counties or tribes are responsible for annual PCA assessments for service agreements that ended on Dec. 31, 2018, and after. Provider agencies should submit a Referral for Reassessment for PCA Services (DHS-3244P) to the member’s tribe or county of residence 60 days before the end date of a service agreement.
PCA service agreements
If a PCA provider does not receive a service agreement to continue services before Dec. 31, 2018, fax the PCA Technical Change Request (DHS-4074A) and a copy of the MCO service agreement to the Disability Services Division (DSD) Resource Center at 651-431-7447. State in the “Additional Information” section “for MCO transition.”
Home care nursing services
Home care nursing (HCN) authorization requests and service agreements will transition to the usual FFS process through the medical review agent, KEPRO, as described in the Authorization section of the MHCP Provider Manual. HCN providers will continue to assess for HCN services. If an HCN provider does not receive a service agreement to continue services by Dec. 31, 2018, submit the Home Care Technical Change Request (DHS-4074) and a copy of the MCO service agreement through MN–ITS or the KEPRO portal. State in the “Additional Information/Treatment Plan” section “for MCO transition.”
Changes 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 seniors (age 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. 11/14/18, rev. 12/21/18)
Minnesota Health Care Programs (MHCP) records for nonresidential substance use disorder (SUD) treatment providers now show specialty codes for comprehensive assessment, treatment coordination and peer recovery support services. Tribally licensed and 245G SUD providers seeking payment for services funded under the consolidated chemical dependency treatment fund will not need to submit a new assurance statement to add these services at this time.
However, if you have any changes to your ability to provide these services in the future, you will need to submit a new assurance statement to Provider Eligibility and Compliance.
Contact placing authorities (currently, counties and tribal placing authorities) to authorize service agreements with applicable treatment service codes.
Providers can begin to provide services of treatment coordination, peer support and comprehensive assessment as of Jan. 1, 2019. The earliest claims may be submitted for fee-for-services clients, for these services, will be Jan. 8, 2019.
Bill using the following codes and rates:
Send questions about service agreements to email@example.com. Call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411 for questions related to billing and enrollment. (pub. 12/18/18)
Federal law mandates providers use Category I Current Procedural Terminology (CPT) codes for EIDBI services beginning Jan. 1, 2019. Do not use category III CPT billing codes after Dec. 31, 2018. Minnesota Department of Human Services (DHS) is working to update our systems by Jan. 1, 2019.
DHS and Keystone Peer Review Organization (KEPRO), the state medical review agent, are coordinating to ensure current authorizations are transitioned to the new codes without requiring additional steps from providers. We have also notified managed care organizations (MCOs) and they are working to update their systems accordingly.
We encourage all providers to attend the informational billing meeting via webinar or in person Tuesday, Dec. 18 at 2:00 p.m. at Elmer L. Andersen Human Services Building, Room 2370, 540 Cedar St., St. Paul 55101. See the information announcement page for registration and additional information. If you registered for the EIDBI webinar, you will receive an invitation by noon Monday, Dec. 17.
DHS will host a billing lab webinar on Wednesday, Dec. 19 from 9:00 a.m. until 3:00 p.m. See the Training on EIDBI billing page for registration and additional information.
An EIDBI technical assistance call is scheduled for 2:00 p.m. Wednesday, Dec. 19. We will review the new codes and answer any questions providers have. See the Technical assistance announcement page for registration and more information.
Watch for additional provider news updates over the next several weeks.
Direct billing and claims questions to the Provider Call Center at 651-431-2700 or 800-366-5411.
Direct policy and other general questions to ASD.DHS@state.mn.us (pub. 12/14/18)
Minnesota Department of Human Services (DHS) invites current and potential EIDBI providers to attend provider input sessions during 2019. We encourage all providers to attend. We will discuss policies and proposed changes, provide updates and gather provider feedback.
Providers can attend in person or via webinar. All input sessions will be held at Elmer L. Andersen Human Services Building, Room 2370, 540 Cedar St., St. Paul 55101. See the session announcement page for registration and additional information.
2019 Provider Input Sessions
Effective for dates of service on or after Jan. 1, 2019, SUD residential and inpatient hospital providers must include date of discharge on the final treatment claim along with the appropriate patient status code. The date of discharge or transfer is not reimbursable by Minnesota Health Care Programs (MHCP), but must be included on the claim for proper billing.
See the claim date span memo for more information. (pub. 12/13/18)
Centers for Medicare & Medicaid Services (CMS) published a new ZIP code list used for calculating RUCA for dates of service (DOS) Jan. 1, 2019, through Dec. 31, 2019. See ambulance services center and open the “Zip Code to Carrier Locality File – Revised 11/14/2018” listed under the Coding/Billing/Payment section of Important Links. Open the Excel worksheet “ZIP5_JAN2019” to review the Minnesota (MN) ZIP codes. (pub. 12/11/18)
The Youth ACT certification application is now available online for providers who want to provide Youth ACT services. See the certification application to apply.
See the Youth ACT page for more information about the service. (pub. 12/11/18)
If you are a Minnesota Health Care Programs (MHCP) provider of SUD outpatient services, contact the MCOs to contract with or amend managed care contracts to include:
Providers who do not have contracts in place for Medical Assistance (MA) or MinnesotaCare members risk not receiving reimbursement for services. MCOs are responsible for establishing their own provider networks and are not required to contract with all SUD providers. (pub. 12/10/18)
Licensed community providers can deliver eligible services to members who reside in PRTF. Services must be coordinated with the PRTF provider and identified in the individual plan of care. PRTF arranged and concurrent services are billed by the licensed professional using (837P) professional claims with the place of service (POS) code 56.
Arranged Services – Professional services not covered in the per diem arranged by and provided at the facility by a licensed professional.
Concurrent Services – Limited services provided by another provider that supports continuity of care and successful discharge from a PRTF.
Refer to the Minnesota Health Care Programs (MHCP) Provider Manual psychiatric residential treatment facility (PRTF) section for more information about arranged and concurrent services not covered in the per diem. (pub. 12/7/18)
Minnesota Health Care Programs (MHCP) will reprocess all enhanced rate PCA claims submitted for members after the July 1, 2018, PCA enhanced rate launch.
MHCP identified some payment errors with enhanced rate claims and, after reviewing our processing system, made changes to ensure proper payments to providers who serve members eligible for the enhanced rate.
All reprocessed claims will appear on the warrant received the week of Dec. 10, 2018. This does not include claims for MCOs. (pub. 12/7/18)