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)
Effective Jan. 1, 2019, Minnesota Department of Human Services (DHS) will no longer be a third-party administrator (TPA) for South Country Health Alliance (SCHA) health plan.
Providers who have current Elderly Waiver service agreements with SCHA will have those agreements closed by a lead agency or case manager no later than Dec. 31, 2018. Elderly Waiver 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. (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)
The Minnesota Department of Human Services (DHS) will host an information session Tuesday, Dec. 18, 2018, for EIDBI and comprehensive multi-disciplinary evaluation (CMDE) providers. We will cover updates to the billing codes and procedures.
Attend the session in person at the Elmer L. Andersen Human Services Building, Room 2360, 540 Cedar St., St. Paul 55101 or by webinar. See the information session announcement page to register and for more information. (pub. 11/27/18)
Effective Jan. 1, 2019, the service rate limits for the following Elderly Waiver (EW), Alternative Care (AC) and Essential Community Supports (ECS) program services will increase:
Component rates increase for the following services under EW effective for start dates on or after Jan. 1, 2019:
Component rate increases take effect on Jan. 1, 2019, but are applied on a rolling basis throughout the year. The rate increase is applied when a lead agency submits a new Residential Services Tool workbook because of an assessment or reassessment, a change in provider, or a change in the support plan driven by a change in the person’s needs or circumstances. Click “Tools” on the bottom of the Elderly Waiver Residential Services web page to download a workbook.
Monthly budget limits increase for the EW, AC and ECS programs effective Jan. 1, 2019. This includes Consumer Directed Community Supports (CDCS) and customized living and 24-hour customized living.
See DHS Bulletin MN Legislature authorizes rate and budget increases for Elderly Waiver, Alternative Care and Essential Community Supports (18-25-06) for rate and budget limit increases on or after Jan. 1, 2019. (pub. 11/19/18)
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 MCO they were enrolled in, but managed care organization (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 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.
MCOs are responsible for annual assessments for existing service agreements with an end date on or before Dec. 30, 2018. Follow the usual procedures for annual assessment requests from MCOs for service agreements that end on or before Dec. 30, 2018. If the MCO approved a service agreement based on its last assessment with an end date that is on or after Jan. 1, 2019, it will be valid for the length of the 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 service agreements
Home care nursing (HCN) 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. 11/16/18)
Minnesota Health Care Programs (MHCP) added six products to the Incontinence Products List to replace their equivalent discontinued products. MHCP has not removed the discontinued products from the list in case a supplier has these in stock and is still dispensing them to members.
Incontinence Product List Changes
|Replacement Product||Product Code||Discontinued Product||Product Code|
|Attends Extended Wear Briefs, Medium||DDEW20||Attends Overnight Briefs, Medium||BRNT20|
|Attends Extended Wear Briefs, Large||DDEW30||Attends Overnight Briefs, Large||BRNT30|
|Attends Extended Wear Briefs, Extra Large||DDEW40||Attends Overnight Briefs, Extra Large||BRNT40|
|TENA Complete +Care Briefs, Medium||69960||TENA Classic Briefs, Medium||67720|
|TENA Complete +Care Briefs, Large||69970||TENA Classic Briefs, Large||67740|
|TENA Complete +Care Briefs, Extra Large||69980||TENA Classic Briefs, Extra Large||67750|