MHCP provider news and updates

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:  

• Adult companion
• Adult day and adult day bath
• Chore
• Home-delivered meals 
• Homemaker: assistance with personal cares, home management and cleaning
• Individual community living supports (ICLS) 
• Respite: in-home and out-of-home

Component rates increase for the following services under EW effective for start dates on or after Jan. 1, 2019:

• Customized living
• Foster care

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

(pub. 11/14/18)

Beginning December 3, 2018, the fee-for-service pharmacy program will limit the initial fill of an opiate prescription to no more than a seven days’ supply. Managed care plans within Minnesota Health Care Programs (MHCP) will implement this change no later than January 1, 2019. The new limit will apply to all claims where the member does not have a paid claim for the same drug, or a similar drug containing the same active ingredient(s), in the previous 90 days. A member that has a paid fee-for-service claim for the same drug, or a similar drug with the same active ingredient(s), within the previous 90 days will not be subject to the initial fill restriction.

Why the change?
MHCP is initiating this change as part of the Uniform Pharmacy Policy initiative. Curbing the escalating problem of prescription opioid abuse is a key priority of the Minnesota State Substance Abuse Strategy. Refer to Minnesota’s opioid prescribing guidelines for more information. (pub. 10/30/18)

Minnesota Health Care Programs (MHCP) provider training is offering free claims help sessions for Housing Support Supplemental Service providers only. These sessions are tailored to have hands-on help to enter claims into MN–ITS.

The sessions are provided in a computer lab with computers available for you to use. You may bring and use your own laptop, if you prefer. Sessions are limited to 16 participants and are in-person only; a webinar will not be offered. Sign up early to reserve a seat.

You can find the dates and times, learning objectives and prerequisites for these sessions on the MHCP enrolled providers training page. (pub. 10/30/18)

Minnesota Health Care Programs (MHCP) review agent, Keystone Peer Review Organization (KEPRO), has changed its mailing address. When sending documentation to KEPRO through the United States Postal Service (USPS) use the following address:

    KEPRO
    Attention: MN Medicaid
    2810 N Parham Rd. Suite 305
    Henrico, VA 23294

(pub. 10/23/18)

A year ago Minnesota’s first searchable online tool for statewide substance use disorder (SUD) services, Fast-Tracker, went live. Today 355 of a possible 480 licensed 245G, Rule 32, tribal and border state programs are voluntarily registered on Fast-Tracker. Individuals seeking help, family members, detox programs, assessors, care coordinators, physicians, and others, can find and quickly access statewide SUD service openings through this site. Feedback from tribes, counties, providers and other stakeholders is that they are using the site and are finding it very useful.

If your licensed program is not listed on Fast-Tracker, register today. It’s free and takes just 10 minutes. Call Linda at 651-426-6347 for information on how to register your program.

See the Fast-Tracker for Substance Use Disorder Update e-memo for more details. (pub. 10/18/18)

For Medical Assistance fee-for-service members: submit all PRTF referrals to the state medical review agent KEPRO, using the Psychiatric Residential Treatment Facility (PRTF) Eligibility for Admissions (DHS-7696) (PDF).

For members enrolled in a managed care organization (MCO): submit all PRTF referrals directly to the PRTF provider.

What has changed

• Previous protocol asked providers to work directly with PRTF providers before submitting the DHS-7696 to the medical review agent.
• Authorizations from KEPRO for admission to a PRTF are now valid for up to 180 days, rather than 30 days. Reviews resulting in the person being determined to meet medical necessity for PRTF will now remain valid until admission as long as the diagnostic assessment is current (within last 180 days) and the child or youth has no significant changes in symptoms or needs.

Email Dhs.prtf@state.mn.us with any questions. (pub. 10/17/18, rev. 10/30/18)

The Institute for Community Inclusion at the University of Massachusetts Boston is accepting applications for the Minnesota technical assistance project (MN-TAP). This project will help providers offer better support to people with intellectual and developmental disabilities as they get and succeed in competitive, integrated employment opportunities.

See Employment technical assistance opportunity for service providers for more information. (pub. 10/9/18, rev. 10/30/18)