MHCP covers the following home care services:
Eligible providers must be enrolled with MHCP and categorized as one or more of the following:
Providers are required to:
Multiple Providers of Services
Service authorization can be issued to more than one provider agency at the same time. Each provider agency receives a separate service authorization. Each provider agency may be able to bill for the same type of service on the same day. Each agency must have an approved line item on the service agreement:
Recipients are eligible under one of the following programs:
Select the service below to view the policy information about each service:
Services must be:
Coordination with other MA Services
Hospice with waiver and home care services
Home Care & Individualized Education Plans (IEP)
Covered IEP services include nursing services, personal care assistants (PCA), physical therapy, occupational therapy, speech language pathology, mental health services, special transportation, and assistive technology devices.
The child may also be receiving these services through MA and/or a home and community-based services waiver. When services are provided through the school, they are considered IEP services and billed as such. IEP services are not considered or billed as home care, therapy or waiver services.
Coordination of IEP services and home care services are assessed on a 24-hour non-school day. A parent/guardian may choose to use authorized home care or waiver services in the school rather than have the school bill for the education plan service:
For further information and details about IEP, refer to the IEP section.
There may be additional non-covered services outlined under each provider-type specific covered service page.
Prior authorization for home care services is required for:
**Authorization is required after 9 skilled nurse visits per recipient, per calendar year, except for AC and waivered service program recipients who always require authorization.
Submit Authorization Requests
Submit authorization requests for SNV, HHA, and HCN directly to MHCP following the directions below..
Before requesting an authorization:
Service Agreements (SA) may be either temporary (45 days), or long-term (up to 365 days or 366 days in a leap year). Approved home care authorization requests can begin the date the request is received unless the request meets an exception. MHCP must receive all the required information before authorization can be approved.
Exceptions to Prior Authorization
Authorization may be requested after a home care service is provided to a recipient only under the following conditions:
Explanation for requesting authorization after performing service
Procedure for SNV, HHA and HCN
Emergency Service Provision
The home care services were required to treat an emergency medical condition that, if not immediately treated, could cause a recipient serious physical or mental disability, continuation of severe pain, or death. You must be able to substantiate the emergency by documentation such as reports, notes, and admission or discharge history.
Request retroactive authorization within five working from starting the initial
Home care services were provided on or after the date on which the recipient’s eligibility began, but before the date the recipient was notified that their case opened.
Request authorization within 20 working days of the date the recipient was notified that the case was opened.
Third Party Payer
A third party payer for home care services denied or adjusted a payment.
Submit authorization requests to DHS within 20 working days of the notice of denial or adjustment. Include a copy of the third party payer’s notice with the request.
The local county agency or DHS made an error.
Submit the request within 20 working days and include a statement that specifies:
The professional nurse determines an immediate medical need for up to 40 skilled nursing or home health aide visits per calendar year. Exceptions to prior authorization requests are evaluated according to the same criteria applied to prior authorization requests.
MHCP cannot authorize Waiver or Alternative Care (AC) services requested by a home care provider. Refer to Elderly Waiver (EW) and Alternative Care (AC) Program chapter for more information about Waiver and AC programs.
Changes in medical status are either temporary for 45 days or less or long term for up to 365 days (366 days in leap years). These include, but are not limited to, a change in health or level of care, service addition, a change in physician orders, recent facility placement, or a change in primary caregiver’s availability. Documentation must support the requested change in service. Temporary authorizations can only be approved for 45 days or less. DHS cannot approve back-to-back temporary requests.
Review the Service Authorization immediately for content and comments. Line item dates may differ from header dates. If you have questions about this process, contact the Provider Call Center at (651) 431-2700 or 1-800-366-5411.
The Home Care Nurse (HCN) Care Plan is a written description of professional nursing services needed by the recipient as assessed to maintain and/or restore optimal health.
The orders or plan of care must:
MHCP pays for services after the recipient has used all other sources of payment. MHCP is the payer of last resort. The order of payers for an MHCP recipient is:
Providers must bill all third party payers, including Medicare, and receive payment to the fullest extent possible before billing DHS. MHCP becomes the payer only after all other pay options (other than an MA waiver program) have been exhausted. Services that could have been paid by Medicare, an HMO, or insurance plan if applicable rules were followed are not covered by MHCP.
Providers must be familiar with Medicare coverage for home care recipients. Bill Medicare when Medicare is liable for the service or, if not Medicare certified, refer the recipient to a Medicare certified provider of the recipient’s choice, and notify recipients when Medicare is no longer the liable payer for home care services.
Medicare Home Health Prospective Payment System (PPS)
If the service is covered by Medicare, then Medicare guidelines must be followed. This affects all dually eligible recipients (those covered under a Medicare home health plan of care and on Medical Assistance):
Home health services are paid on a cost basis. Therefore, the PPS rate assigned to the beneficiary includes all the above services. Home health agencies that do not have these services available need to hire staff and keep supplies on hand or contract services with other agencies.
Multiple Providers of Services
Each provider agency may be able to bill for the same type of service on the same day. Each agency must have an approved line item on the service agreement:
• Services must only be billed in consecutive date spans, to avoid duplicate billing
• 15-minute codes may be billed by more than one provider, per date of service
Information about the Waivered Services and the Alternative Care (AC) program can be found in HCBS Waivered Services and Elderly Waiver and Alternative Care.
Additional billing information and resources are available at the MHCP Provider Website.
MN Statute 256B.0625
MN Statute 256B.0651
MN Statute 256B.0653
MN Statute 256B.0654