MHCP provider news and updates

We posted an announcement on this page on May 30, 2018, with details about a request for proposal to provide training for direct care and support workers. We have received a number of questions about the request and posted the responses to questions for request for proposals to provide training (PDF) for your review.

The deadline for submitting questions has now passed. The due date for proposals is June 19, 2018, at 4:00 p.m. (pub. 6/12/18)

The Minnesota Department of Human Services requests comments on draft forms related to the Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit. The forms explain the rights and basic responsibilities of people who receive EIDBI services and their legal representatives, as well as the responsibilities of EIDBI provider agencies. The 30-day public comment period began at 8:00 a.m., May 29, 2018, and closes at 4:00 p.m., Thursday, June 28, 2018. See the DSD eList announcement for more information. (pub. 6/12/18)

Medicare does not cover wheelchair transit systems or tie downs, transport brackets, or similar wheelchair accessories. Bill MHCP directly for these types of accessories that are part of a covered wheelchair. Follow MHCP authorization requirements. Include an attachment with the claim that clearly states "wheelchair transportation accessory not covered by Medicare." MHCP also does not cover accessories that are modifications to a vehicle. (pub. 6/5/18)

Effective July 1, 2018, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) will no longer be a required component for capturing functional status in the diagnostic assessments for adults in Minnesota Health Care Programs (MHCP). To align with the current Diagnostic and Statistical Manual (DSM), federal guidelines, and state regulations for functional impacts, providers must ensure symptom descriptions, at a minimum the frequency, intensity and impact, are integrated into the diagnostic assessment. Include this information in the clinical summary. The WHODAS 2.0 is still an acceptable method to capture functional status in a diagnostic assessment for adults. The functional status components required for children 0-5 years old (ECSII, SDQ) and 5-18 years old (CASII, SDQ) will remain the same. (pub. 5/30/18)

DHS seeks proposals for a qualified contractor to provide training for direct care and support workers in the following programs:

• PCA Choice
• Consumer directed community supports (CDCS)
• Consumer Support Grant (CSG) 

The training will focus on two topics:

• Independent living
• Managing stress and challenges of paid caregiving 

The contractor chosen will develop and deliver curriculum. 

Providers are welcome to submit a proposal and to share this information with other potential contractors. 

View the request for proposal on the grants and RFPs webpage.

Deadline for submission
Proposals are due by 4:00 p.m. on June 19, 2018. We must have proposals in hand (not postmarked) by 4:00 p.m. on June 19, 2018, to be considered. DHS will not consider late proposals and will return unopened proposals to the sender. We will not accept proposals that are faxed or emailed. (pub. 5/30/18)

DHS has contracted with medical review agent, KEPRO to perform quarterly retrospective reviews. Benefit policy staff chooses four topics per quarter and randomly selects claims for review that meet the topic selection criteria.

You may receive a letter by fax from KEPRO requesting medical records. This letter will have details about the specific record requested, as well as a due date for submitting the information. Provide the requested records through KEPRO’s Atrezzo provider portal. Contact KEPRO with questions related to record submission at mnatrezzoregistration@kepro.com.

Ensure that your contact information, including fax number, is current in the MHCP provider enrollment file. If needed, call the MHCP Provider Call Center to update your provider file at 651-431-2700 or 800-366-5411. (pub. 5/30/18)

The MHCP Provider Directory site changed to a new look on Wednesday, May 16, 2018. It includes a link to MinnesotaHelp.Info, where we will list additional home and community-based services and providers. Most providers will be listed in one of the directories. If you or your agency are not listed in either the MHCP Provider Directory or in MinnesotaHelp.info, please call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411. A representative will get your information and forward it to the appropriate area to review for including in one of the lists. (pub. 5/16/18)

Eleven children’s mental health residential treatment facilities were reclassified as Institutions for Mental Diseases (IMD) effective May 1, 2018. Children’s IMD residential treatment program are facilities with over 16 beds. IMD status does not affect a member’s access to service, eligibility for continuing treatment, or the reimbursement process.

What this change means for counties and tribes

• Counties and tribes continue screening to establish medical necessity for residential level of care before placement, except in emergency placement (Minnesota Statutes 245.4885).
• County workers will receive the County Notice of IMD Status (DHS-4145) (PDF) from the IMD facility and will change the eligibility code to program IM.
• Counties and tribes continue to submit claims to DHS for services they provide to children eligible for Medical Assistance (MA). We will continue to reimburse them for the MA-covered treatment the facility provides. 

What this change means for IMDs providing children’s residential mental health services

• For a facility reclassified as IMD, MHCP provider enrollment will change the facility type to IMD.
• The facility is responsible for determining that the appropriate county, tribe, or managed care organization has been involved with the level-of-care determination.
• For MA members with fee-for-service coverage, the IMD facility completes the DHS-4145 and faxes it to the county. The county will change the eligibility code. (For managed care members, no change is needed.)
• The IMD facility continues to invoice the counties and tribes for services provided.

Refer to Children's mental health news for more details and the list of children's IMD facilities. (pub. 5/16/18)

Beginning August 20, 2018, the maximum opioid dose will decrease from the current 120 morphine equivalents per day (MED) to 90 MED. This limit will apply to Minnesota Health Care Programs (MHCP) for both managed care plans and fee-for-service. The prior authorization (PA) vendor may grant exceptions in clinically appropriate circumstances, such as cancer-related pain, palliative or hospice care, or documented medical necessity. To request an exception, submit a PA request to Health Information Designs (HID) at 866-205-2818 or fax a completed PA request to 866-648-4574.

Work with patients to reduce daily opioid doses
To minimize disruption for the MHCP members you serve, work with your patients who have current doses at the 120 MED maximum and reduce their daily opioid doses to the new 90 MED maximum before August 20, 2018. This will not affect those prescriptions that already have an existing prior authorization for a higher daily morphine equivalent dose.

Why the change?
MHCP is initiating this change as part of the Uniform Formulary Policy initiative. Curbing the escalating problem of prescription opioid abuse is a key priority of the Minnesota State Substance Abuse Strategy.  

High doses of opiates are linked to an increase in morbidity and mortality. The goal of this and other changes is to ensure safe and effective use of opiates in managing pain when pharmacotherapy is deemed medically necessary. Refer to the Minnesota’s opioid prescribing guidelines for more information. (pub. 5/15/18)

A system update caused institutional Medicare crossover claims to deny lines with adjustment code CO-A1, M51 remark in error. The denied claims were on your May 1, 2018, remittance advice. We will reprocess claims that are not yet replaced. These claims will be replaced with batch number 4 18129 00 901 on the May 15, 2018, remittance advice. (pub. 5/15/18)

Claims billed for Children’s Therapeutic Services and Supports (CTSS) procedure code H2014 from April 13 to April 26, 2018, were incorrectly denied. MHCP will reprocess these denied claims. The reprocessed claims will be on your May 15, 2018, remittance advice. (pub. 5/15/18)

Multiple assistive listening device (ALD) components billed together on the same claim will deny due to NCCI edits. When requesting authorization for a complete ALD system, select one of the following appropriate bundled codes:

• V5281 – Assistive listening device, personal FM/DM system, monaural (one receiver, transmitter, microphone), any type
• V5282 – Assistive listening device, personal FM/DM system, binaural (two receivers, transmitter, microphone), any type

On separate documentation list the individual contracted ALD components, both HCPCS codes and descriptions (either transmitter, microphone or receiver(s)) and include model numbers and individual prices as listed on the contract.

On the Authorization Form (DHS-4695) (PDF), list one of the two system HCPCS codes: V5281 or V5282, with the NU modifier and a description of “Bundled ALD.” Do not enter a model number or a bundled price; they are not listed on the contract.

Submitting the claim
Include the approved authorization number and bill one claim line using HCPCS V5281 or V5282, and enter "bundled ALD" in the model number field. No attachment or other documentation is necessary when you submit the claim. (pub. 5/15/18; rev. 6/12/18)

The Minnesota Department of Human Services (DHS) is surveying providers of personal care assistance, home health services, and home and community-based services to learn more about existing use of electronic visit verification (EVV) in Minnesota. The 21st Century Cures Act requires states to electronically verify personal care services, including home and community-based services that provide support for activities of daily living or instrumental activities of daily living by January 1, 2019. By January 1, 2023, states must electronically verify home health services. You can learn more about the EVV requirement in the recent legislative report: Legislative Report: Electronic Visit Verification System, January 2018. If you are a provider of these services, look for a letter in the PRVLTR folder in your MN–ITS mailbox that has a link to the survey. (pub. 5/15/18)

The Minnesota Department of Human Services will add three employment services to our home and community-based services (HCBS) waivers starting July 1, 2018. The new services will be added to the Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Developmental Disabilities (DD) waivers. They will replace Supported Employment Services and the community-based work component of the Day Training and Habilitation (DT&H) and Prevocational Services.

We will provide more details to you through your MN–ITS mailbox and other announcements as we get closer to the effective date. Check your MN–ITS mailbox regularly and sign up for DSD eLists so you do not miss any important information. In the meantime, visit the Employment First webpage for current information and regular updates. (pub. 5/15/18)

We revised language and updated links in the C&TC Schedule of Age-Related Screening Standards (Periodicity Schedule) (DHS-3379) (PDF). Printed copies are available to order on the DHS Bulk Order Website.

Revisions include the following:

• Screening Schedule: We added this sentence to clarify – “If a child misses a screening visit or a required screening component was not offered at a previous visit, the missing screening components should be performed at the earliest possible time.”
• Changes on this updated C&TC Periodicity Schedule (compared to 2016):
  • Human immunodeficiency virus (HIV) screening lab test – We revised this paragraph to clarify requirements.
  • Dyslipidemia screening –  We added a link to the Dyslipidemia Risk Assessment C&TC Fact Sheet
  • Oral health – We revised the language to state that for children 6 years and older, fluoride varnish may be applied based on their risk factors for dental caries.
• Clarifications, Health history: We added this language to clarify: “This may include housing stability, food security, home or community safety, adverse childhood experiences. No specific form or questionnaire is required.”

(pub. 4/25/18; rev. 5/15/18)