MHCP provider news and updates

We are delaying the EVV implementation date for personal care services providers. Dec. 1, 2021, is no longer the go-live date for personal care services providers to connect to the HHAeXchange system. We will be pushing the go-live date to a later time to ensure that providers have their questions answered and concerns addressed about implementation. We will communicate the new go-live date to you after it is determined via eList announcements, provider communications and updates to the Electronic visit verification webpage. Providers who have been identified as providing services that require use of EVV will find a memo with information about the delay in the PRVLTR folder of their MN–ITS mailbox. (pub. 10/27/21)

EIDBI provider agencies must use the Minnesota Department of Human Services (DHS) NETStudy 2.0 system beginning Nov. 10, 2021, to conduct background studies on all individuals who have direct contact with people who access services and their legal representatives. The changes apply to all employees hired by an EIDBI agency on or after July 1, 2021, including new hires.

Review the Background study changes for EIDBI providers DHS autism eList announcement for more information. (pub. 10/27/21)

WIC seeks your help in referring people to the program. WIC provides personalized nutrition education and counseling, breastfeeding support and nutritious foods, as well as information and referrals to other health and social services.

Complete the Minnesota WIC Referral Form to refer people to WIC. Local WIC staff will reach out to the person within a few days after you submit the referral form. (pub. 10/26/21)

Federally approved policy modifications to targeted case management (TCM) services to temporarily allow telephone and video-conferencing in place of in-person face-to-face contact during the COVID-19 pandemic have been extended until the end of the federal public health emergency. 

See the Coronavirus (COVID-19) section of the Minnesota Health Care Programs Provider Manual and Bulletin #21-69-04: DHS extends temporary changes to Targeted Case Management changes Face-to-face contact requirements for information and requirements about providing targeted case management services during the federal public health emergency.

The change was effective Mar. 19, 2020, and allows case managers to conduct targeted case management visits by phone or video with adults receiving services or their legal guardians, and with children receiving services and their parents or legal guardians. The change runs through the end of the public health emergency. 

The affected services include: 

• Child welfare targeted case management 
• Children’s mental health targeted case management 
• Adult mental health targeted case management 
• Vulnerable adult or adult with developmental disabilities (VA/DD) targeted case management

Tribal provider requirements
This change means that Indian Health Services (IHS), Sec. 638 Tribal providers, may receive the daily encounter payment when the contact between the case manager and the person receiving services happens by telephone instead of through an in-person face-to-face visit. Although the mode of how a service may be delivered is temporarily changing (for example, targeted case management services can be delivered via telephone temporarily), there are no changes to the payment methodology for the daily encounter payment. The same services and types of providers that are required to generate a daily encounter payment continue to be required when targeted case management services are delivered during the federal public health emergency. (pub. 10/22/21)

We have updated MMIS to pay a daily bundled rate to state plan certified CCBHCs for eligible fee-for-service claims effective Oct. 1, 2021.

This payment only applies to state plan certified CCBHCs. The payment policy for federal 223 Demonstration CCBHCs differs from state plan payment policy. CCBHCs participating in the federal 223 Demonstration will continue to be paid by a wrap-around process until they become state plan certified. 

Review the MHCP Provider Manual - Home for more information on billing policy. Review the Certified Community Behavioral Health Clinics webpage for more information on Minnesota’s integrated model of care. (pub. 10/22/21)

Key provisions passed during the 2021 Minnesota Legislative and Special Legislative Sessions can potentially assist with recruitment and retention of direct support professionals or reduce reliance on staff to provide supports.

Review the 2021 legislative changes that affect the direct care workforce shortage webpage to see these legislative updates. Additional information about the workforce shortage can be found on the new Direct care workforce shortage in Minnesota webpage. (pub. 10/22/21)

The Affordable Care Act Section E, Section 6401, created provisions to provider screening and other enrollment requirements under Medicare, Medicaid and CHIP to establish program integrity. The provisions include a new level of screening, application fees and an application and enforcement component.

New requirement
According to Minnesota Statute 256B.04, subdivision 21, if you have more than one business location that provides a service, you must follow the instructions for new enrollments and enroll each business location. This includes all satellite locations. These instructions are located within the Provider Screening Requirements section of the Minnesota Health Care Programs Provider Manual.

Reminders
MHCP continues to review enrollment records to identify providers due for required revalidation. MHCP will attempt to rely on Medicare enrollment information whenever possible.

MHCP Provider Eligibility and Compliance notifies providers when it is time to complete revalidation. All providers are required to complete revalidation at least one time every five years. Providers will receive a notice when it is time for revalidation and can expect to receive an initial revalidation notice as soon as 3 ½ years after the most recent revalidation or enrollment date.

Providers seeking certification or licensure may be reviewed before their pre-scheduled revalidation date.

Call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411 or TTY: 711 or 800-627-3529 for more information. (pub. 10/20/21)

Minnesota Health Care Programs (MHCP) will soon change to a 90-day retention history for all inbound and outbound batch transactions, including “Mailbox-Transaction Responses File Types.” We recommend MN–ITS users archive old batch files. We will post additional information in a Provider News message after we determine the effective date of the change. (pub. 10/20/21)

HHS Secretary Xavier Becerra again renewed the federal COVID-19 public health emergency effective Oct. 18, 2021. See the HSS’ Renewal of Determination That A Public Health Emergency Exists webpage to read the official declaration of this renewal. (pub. 10/18/21)

Minnesota Department of Human Services (DHS) is hosting several upcoming events related to autism services and supports. Registration for these events is required.

Connect with interpreters to understand their role in health care on Oct. 19, 2021
In this virtual event you will learn about the role of interpreters to facilitate communication in health care settings. Review the Connect with interpreters to understand their role in health care DSD eList announcement for registration and additional information.

Virtual job fair opportunity with EIDBI providers on Oct. 21, 2021
DHS is hosting a virtual job fair with employers from across Minnesota who provide services and supports to people with autism spectrum disorder (ASD) and related conditions.

Employers will be offering information on:

• Job opportunities
• Practicum and internship opportunities
• Career paths in the industry

Review the Virtual job fair opportunity on Oct. 21 with EIDBI providers DSD eList announcement for registration and additional information.

Learn about life experiences of young adults with autism Nov. 4, 2021
You will hear from youth and young adults with autism share their lived experiences in this virtual event. Panelists will talk about several topics and be available to answer questions. Review the Learn about life experiences of young adults with autism DSD eList announcement for registration and additional information.

Early Intensive Developmental and Behavioral Intervention (EIDBI) Beyond the Basics training Nov. 10, 2021
This training is for EIDBI providers and others interested in expanding their knowledge and understanding of EIDBI services for people younger than age 21 with autism spectrum disorder (ASD) or a related condition. Review the EIDBI Beyond the Basics training available in November DSD eList announcement for registration and additional information. (pub. 10/15/21)

New funding is available for health care providers affected by the COVID-19 pandemic. The U.S. Department of Health and Human Services (HHS), through the Health Resources & Services Administration (HRSA), made $25.5 billion available. This funding includes $8.5 billion in American Rescue Plan resources for providers who serve rural Medicaid, Children's Health Insurance Program (CHIP) or Medicare patients, and an additional $17 billion for Provider Relief Fund Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic. Applications are due Oct. 26, 2021. Review the HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding webpage for more information. Review the HRSA Future Payments webpage for application instructions and a schedule of technical assistance webinars to help you navigate the application portal. (pub. 10/4/21)

We are accepting applications through Oct. 31, 2021, from people who want to join the new Waiver Reimagine Advisory Committee (WRAC). The committee will provide input about the implementation of Waiver Reimagine during virtual meetings held every other month.

Review the full Request for applicants to join Waiver Reimagine Advisory Committee DSD eList announcement for more information. (pub. 9/29/21)

The 2021 Minnesota Legislature approved a minimum daily rate for individual licensed assisted living facilities that are designated as disproportionate share facilities. The facility must have at least 80% of the residents enrolled in the Elderly Waiver (EW) program on Oct. 1, 2021, to be designated as a disproportionate share facility.

Facilities can apply between October 1 - 31, 2021, to receive this designation and associated rate adjustments by submitting the Disproportionate Share Facility Application (DHS-8157-ENG) to Minnesota Department of Human Services (DHS). DHS will inform facilities of their application results and designate eligible facilities by Nov. 15, 2021.

Eligible facilities will receive a minimum daily rate of $119 for claims associated with EW participants who receive 24-hour customized living services at the facility between July 1, 2022, and Dec. 31, 2022, assuming the rate adjustment program receives federal approval.

For more information, visit the Elderly Waiver (EW) and Alternative Care (AC) Program section of the Minnesota Health Care Programs Provider Manual under billing or review the Elderly Waiver Customized Living Services Rate Adjustment Aging & Adult Services Division Community Supports for Seniors E-List message. (pub. 9/28/21)

Free-Standing Birth Center facility base rates have been updated retroactively to July 1, 2018, using a percentage of the statewide average hospital payment for an uncomplicated vaginal birth as stated in Minnesota Statute 256B.0625, subdivision 54. Review the following table for rate effective dates.

Free-standing Birth Center facility rates

Minnesota Health Care Programs will reprocess claims retroactive to July 1, 2018, on the Sept. 28, 2021, remittance advice. (pub. 9/28/21)

Minnesota Health Care Programs (MHCP) is aware of the SA line items in pended status for CLS line items attempted to be created by lead agencies. The SA line item goes into pended status when the provider listed on the SA line item has a license or credential end date occurring before the SA line end date. The pended status on the SA occurred due to the License requirement changes for customized living services provider reflected on the Home and Community-Based Services provider enrollment record. Contact the lead agency for SA corrections to the service line dates. Call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411 if your SA is in pended status due to your license or credentials and we will submit a case to Provider Eligibility and Compliance. (pub. 9/27/21)

The 2021 Minnesota Legislature authorized a number of rate and budget increases for home and community-based services. The following service rate and monthly budget increases are effective Oct. 1, 2021:

• 10.10% increase to Personal Care Assistant (PCA)
• 10.30% increase to PCA Complex
• 49.70% increase to PCA Supervision
• 3.16% increase to Elderly Waiver (EW), Alternative Care (AC), and EW and AC Consumer Directed Community Supports (CDCS) monthly case mix budget caps
• 1.58% increase to CDCS budgets under the Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI), and Developmental Disabilities (DD) waiver programs
• 10.10% increase to Consumer Support Grant budgets
• $42.00 for CDCS background checks 

The terms and conditions of the July 1, 2021, to June 30, 2023, SEIU collective bargaining agreement (CBA) go into effect Oct. 1, 2021. The rate increases related to the CBA fit within the 10.10% increase to PCA and are not calculated in addition to it.

New terms of the CBA include a new minimum wage and new paid time off (PTO) accrual rate for workers in the bargaining agreement. Effective Oct. 1, 2021, direct support workers providing PCA Choice, CDCS or CSG services must:

• be paid a minimum of $14.40 per hour
• accrue a minimum of one hour of PTO for every 30 hours worked

We will communicate more information about additional terms of the new CBA and provider responsibilities in a future communication sent to providers’ MN–ITS mailboxes.

Additional information and resources about these changes is available on the Long-term services and supports rates changes webpage.

Call the Minnesota Health Care Programs Provider Call Center at 651-431-2700 or 800-366-5411, option #4, for more information. (pub. 9/27/21)

HHAeXchange has dedicated the following phone number and email address to better support Minnesota’s providers with EVV implementation.

• Phone number: 855-573-1521
• Email: MNsupport@hhaexchange.com

(pub. 9/24/21)

The MHCP Uniform Preferred Drug List (PDL) is changing beginning Oct. 1, 2021. Two of the biggest changes include:

• Entresto and Eliquis changing from nonpreferred to preferred status on the Uniform PDL.
• Branded inhalers Proair HFA, Ventolin HFA and Advair Diskus continuing to have preferred status on the Uniform PDL. The generic versions of these inhalers are moving from preferred status to nonpreferred status.

Review all the changes on the Uniform PDL and preferred drug list changes (PDF). We have created the following resources to help you understand your role in keeping MHCP members on a nonpreferred drug or transitioning members to a preferred drug on or after Oct. 1, 2021:

• Frequently Asked Questions for Providers Regarding the Uniform PDL (PDF)
• Preferred Drug List Flow Diagram for Providers (PDF)
• Continuation of Therapy Prior Authorization Criteria (PDF)
• Nonpreferred Drug Prior Authorization Criteria (PDF)

If you have additional questions, contact:

• MHCP Provider Call Center (for members in fee-for-service Medicaid) at 651-431-2700 or 800-366-5411; or 
• Managed Care Organization (MCO) responsible for the MHCP member’s coverage (for members in Managed Care Medicaid or MinnesotaCare). See the following table for contact information.

MCO and Pharmacy contact phone numbers

(pub. 9/20/21)

Third dose for COVID-19 vaccines approved for certain immunocompromised individuals

The American Medical Association approved Current Procedural Terminology COVID-19 vaccine third dose codes 0003A for Pfizer and 0013A for Moderna for only certain immunocompromised individuals effective Aug. 12, 2021. The Centers for Disease Control and Prevention (CDC) has issued guidance on people recommended to receive a third dose of the COVID-19 vaccine. See the COVID-19 Vaccines for Moderately to Severely Immunocompromised People and How to Talk with Patients Who Are Immunocompromised CDC webpages. The CDC-recommended third dose of an mRNA COVID-19 vaccine is to be administered 28 or more days from administration of the second dose. However, the physician or other qualified health care professional should use clinical judgment to determine whether a third dose is appropriate for the patient.

Minnesota Health Care Programs (MHCP) will only reimburse for the administration of the vaccine. As a reminder, vaccines are exempt from cost-sharing. Use the following administration codes to report the administration of the third dose for only Pfizer and Moderna COVID-19 vaccines:

• Pfizer-Biontech
  • Administration code 0003A: ADM SARSCOV2 30MCG/0.3ML 3RD DOSE
• Moderna 
  • Administration code 0013A: ADM SARSCOV2 100MCG/0.5ML 3RD DOSE

You may now submit claims. MHCP will cover administration codes 0003A and 0013A retroactive to dates of service on or after Aug. 12, 2021. 

You can find the covered codes on the MHCP fee schedule webpage. The MHCP COVID-19 vaccine billing instructions are in the Coronavirus (COVID-19) Billing section of the MHCP Provider Manual. (pub. 9/10/21)

Minnesota Department of Human Services (DHS) will not look for new or adjusted claims from providers eligible for customized living rate add-on payments described in Bulletin #20-25-02: Customized living rate add-on payments for settings with confirmed cases of COVID-19 (PDF) effective Sept. 30, 2021.

DHS will make one final round of add-on payments after Sept. 30, 2021, based on any eligible fee-for-service claims submitted before Sept. 30, 2021. DHS has informed managed care organizations (MCOs) of its plan to end payment processing for this program. MCOs will determine when they will stop processing add-on payments for services they coordinate.

See the Payments end for COVID-19 customized living rate add-on eList announcement for more details. (pub. 9/7/21)

We revised language to clarify that the policy is in effect now and remains in effect; it does not begin Sept. 1, 2021. A temporary peacetime emergency waiver allowing the member’s verbal or electronic written approval of the ITP or change in the ITP for mental health services or assessments delivered through telehealth remains in effect Sept. 1, 2021, based on new legislation. You may document the member's verbal approval or electronic written approval of the treatment plan or change in the treatment plan instead of obtaining the member’s signature.

This is effective Sept. 1, 2021, for providers of the following services:

• Intensive Rehabilitative Mental Health Services
• Children’s Therapeutic Support Services
• Intensive Treatment Foster Care
• Adult Rehabilitative Mental Health Services 
• Adult Mental Health Mobile Crisis Services
• Children’s Mental Health Mobile Crisis Services
• Outpatient Mental Health

Call the Minnesota Health Care Programs Provider Call Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 8/25/21, rev. 8/26/21)

The Minnesota COVID-19 peacetime emergency ended July 1, 2021, and the Minnesota Department of Human Services will end one temporary peacetime emergency PCA program change and reinstate another based on new legislation.

Change that will expire
The remote qualified professional visits waiver was extended through Aug. 30, 2021, and then will expire. Follow the rules listed in the Qualified professional (QP) services PCA policy manual for these visits effective Aug. 31, 2021.

Change reinstated
Parents of minors and spouses may care for their family members and be paid for PCA services effective July 1, 2021. Parents and spouses must be enrolled with Minnesota Health Care Programs (MHCP) as an individual PCA.

Questions
Call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411, option #4, if you have questions about this message. (pub. 8/4/21)

We have revised this message to specify SUD Service providers.

SUD Service providers must request the spenddown amounts from their clients effective immediately. Minnesota Department of Human Services no longer had authority to pay spenddown amounts for SUD clients beginning Aug. 1, 2020. This change is effective for claims with a date of service on or after Aug. 1, 2020.

Refer to Spenddowns in the Billing the Member (Recipient) section of the Minnesota Health Care Programs (MHCP) Provider Manual for more information.

Call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 7/30/21, rev. 10/1/21)

On June 30, the Minnesota Legislature voted to end the state peacetime emergency effective Thursday, July 1, 2021, at 11:59 p.m. This will end the COVID-19 Peacetime Emergency authority the Department of Human Services (DHS) has under Executive Orders 20-11 and 20-12 to seek federal authority to change or waive federal requirements and to modify and waive certain statutes and rules related to DHS programs. We have used this authority to respond to the COVID-19 pandemic. We are quickly working to analyze the language in the 2021 HHS Omnibus bill that modified the transition timeline for a number of the COVID-19 “CV waivers and modifications” and also made several pandemic changes a part of permanent state law. We will be making updates to our DHS waivers and modifications webpage to reflect revised dates soon. Please watch DHS bulletins, manuals and other regular communication channels for program-specific guidance over the coming weeks. (pub. 7/2/21)

MHCP offers training for providers who provide services for members enrolled in MHCP. We have updated on-demand and online training opportunities on the MHCP provider training webpage.

On-demand videos
On-demand videos are arranged by category, including Minnesota Provider Screening and Enrollment Portal (MPSE), MN–ITS and Billing. Each video can be viewed in 10 minutes or less and provides instructions on a concept or technique.

Online training
Online training is arranged by content for all providers or specific providers. Training is led by an instructor who will help attendees navigate the Minnesota Department of Human Services website and locate and use MHCP provider information and other related webpages or internet-based applications such as MN–ITS. Due to COVID-19, all instructor-led training is online only. We will update you on this webpage when, and if, we will continue in-person training. We have recently updated the look of the provider-specific training webpages and added the 2021 training dates. (pub. 12/22/20)

Minnesota Health Care Programs (MHCP) offers free online training for MHCP-enrolled providers. Go to the MHCP provider training webpage to see the list of available training.

We have added new training sessions for the following service providers:

• Psychiatric Residential Treatment Facilities
• Waiver and Alternative Care

(pub. 6/22/21)

MHCP now offers online resources and MN–ITS training for the following providers:

• Intensive Residential Treatment Services
• Adult Residential Crisis Stabilization Services 
• Inpatient Hospital 

Visit the Intensive Residential Treatment Services (IRTS) and Adult Residential Crisis Stabilization Services (RCS) Resources and MN–ITS Training and Inpatient Hospital Resources and MN–ITS Training webpages for dates, registration and more information. (pub. 8/31/21)

We have made changes to the Waiver and AC Resources and MN–ITS training due to feedback we received from providers via the Minnesota Health Care Programs provider training surveys. Training will now be offered in two half-day sessions instead of one full-day session. This change will be effective starting August 2021. See the Waiver and AC Resources and MN–ITS Training webpage for more information. (pub. 6/23/21)

Minnesota Health Care Programs (MHCP) is offering free online Provider Basics Resources and MN–ITS training to all enrolled MHCP providers who bill fee-for-services claims. This training is being offered monthly beginning Mar. 10, 2021.

You will learn how to navigate the MHCP provider webpages and the MHCP provider manual, and how to use MN–ITS administration, mailbox and eligibility requests (270/271) features. Go to the Provider Basics webpage to register for this training.

Claim training is not provided in this training. See our MHCP provider training webpage to register for provider-specific claim training. (pub. 2/11/21)

Minnesota Health Care Programs (MHCP) offers free on-demand training videos arranged by category on the MHCP provider training webpage. Each video can be viewed in 10 minutes or less and provides instructions on a concept or technique.

New videos: 

• Guide to the MN-ITS Home Page – You will learn about the different resources found on the MN–ITS home page and how they can help you in your role at your organization.
• Functions and Features of the MN-ITS Claim Screens – We demonstrate the various navigation elements found on the MN–ITS claim screens in this video. We also explain the different resources located in the right navigation panel used when completing a claim.
• Sending an Attachment for a MN–ITS Claim – We explain when an attachment is required, how to determine what documentation is needed and demonstrate how to fill out and submit the Administrative Uniformity Committee (AUC) cover sheet.
• How to Read Your Remittance Advice – You will learn what a remittance advice is, how you receive it and the information it contains.
• Guide to the User Administration Section in MN–ITS – Primary Administrators will learn how to make changes to their organization’s MN–ITS account.

(pub. 10/26/21)

Minnesota Health Care Programs is providing free online training for our MPSE online portal.

We have added two new videos:

• Managing Existing Affiliations to an Individual Provider in MPSE
• Managing Existing Affiliations to a Direct Support Worker in MPSE

See the MPSE portal training webpage for registration, brief online tutorials to help prepare you for class and more information. (pub. 2/1/20, rev. 2/19/20)