• Public forum on Reform 2020 implementation: If you are interested in Reform 2020, which involves waiver changes to Minnesota’s Medical Assistance and Medicaid programs, please share your thoughts at a public forum. View information on the Dec. 18 Public forum on Reform 2020 implementation. (Added 11/25/15)
• Legislative changes to rates: We have completed system work to implement the following legislative changes effective for dates of service on and after July 1, 2015:
• On Sept. 10, 2015, we began applying the 90 percent rate increase to claims for outpatient hospital medical supplies, durable medical equipment, and prosthetics and orthotics (not subject to volume contracts) to a hospital that meets criteria specified in Minnesota Statutes 62Q.19, Subd. 1 (a) (4). This increase does not apply to Medicare crossover claims.
• On Sept. 9, 2015, we began applying the 3 percent rate increase to claims for medical supplies, durable medical equipment, prosthetics and orthotics. We have replaced claims for services affected by these rate changes on your Oct. 20, 2015, remittance advice.
We also identified some claims for medical supplies, durable medical equipment, prosthetics and orthotics that incorrectly received the 3 percent increase for dates of service before July 1, 2015. These reprocessed claims will be on your Nov. 3, 2015, remittance advice.
• Revalidation letters: All PCA agencies have received revalidation letters in their provider MN–ITS mailboxes. You must complete revalidation to maintain your status as an enrolled provider with MHCP. MHCP is offering several optional PCA revalidation workshops to help providers fill out the revalidation forms correctly.
• Quality Improvement Tool: Long-term services and supports providers must submit quality improvement projects to DHS by Dec. 31, 2015, to receive the full July 2015, 1 percent rate increase. For more information on the process and how to submit your plan, see the 2015 Quality Improvement Tool announcement (PDF). For more information on the 2015 quality-improvement requirements, see the DHS long-term services and supports rates changes page.
Training and VideoPresence Opportunities
• Refer to the Provider Training page for information about new and ongoing training or to the list below for details on additional training sessions on special topics.
Announcements and availability
Watch the 5010/D.0 Announcements page for information about MN–ITS functionality, technical information, scheduled downtimes and other notifications.
All MHCP health care transactions for dates of service on or after Oct. 1, 2015, must include ICD-10 diagnosis codes for reporting a diagnosis. However, you must continue to submit ICD-9 codes for dates of service before Oct. 1, 2015. MHCP will deny claims for the following:
• A claim will be denied if you report ICD-9 codes for dates of service, or dates of discharge, on or after Oct. 1, 2015.
• A claim will be denied if you report ICD-10 codes for dates of service, or dates of discharge, before Oct. 1, 2015.
Some providers may experience difficulty submitting claims with ICD-10 codes through their organization’s systems. If you have difficulty with your billing system, you may submit claims with ICD-10 codes through MN–ITS. Refer to the following for more information:
MEIP webinar series
DHS is hosting a Minnesota electronic health record incentive program (MEIP) webinar series in December 2015. Professionals and hospitals must register for the webinar. The same presentation will be held multiple times over a two-week period. To learn more, see the MEIP webinar schedule and registration information.
Early Intensive Developmental Behavioral Intervention (EIDBI)
DHS is offering a webinar training session on billing for EIDBI services for anyone who has applied to become an EIDBI provider or is already enrolled as an EIDBI provider. Refer to the EIDBI Training page for more information. (Added 11/18/15)
Individualized Education Program (IEP)
IEP providers will receive revalidation letters in November 2015 and will be subject to the application fees. For more information, please review the Provider Screening Requirements section of the MHCP Provider Manual.
EpiPen and EpiPen Jr.
Effective Oct. 29, 2015, EpiPen and EpiPen Jr. no longer require prior authorization for fee-for-service Minnesota Health Care Programs (MHCP). MHCP made this change as a result of Sanofi's voluntary recall of all Auvi-Q injectors currently on the market.
Waiver and AC Program Providers
Transition plan for home and community-based settings
On Jan. 8, 2015, Minnesota developed a statewide transition plan (PDF) to address new rules that govern home and community-based services funded through the Medical Assistance program. The Centers for Medicare & Medicaid Services (CMS) issued the new rules in January 2014. On Oct. 8, 2015, CMS replied and asked for revisions to the proposed plan (PDF). CMS specifically asked DHS to clarify the following items:
• The public comment process
• Settings identification
• Assessment processes and outcomes
• Ongoing monitoring
• Remedial actions
• The heightened scrutiny process
• Relocation of people who currently receive Medicaid HCBS.
DHS is revising the transition plan in response to the CMS review. We will resubmit the transition plan to CMS within 75 days of a required call with CMS, which is scheduled for Nov. 30, 2015. We will notify you of a 30-day public comment period after the CMS call before we resubmit the plan to CMS. For more information, see the Transition plan for home and community-based settings page.
Help understanding the Disability Waiver Rate System
DHS has created new training videos for understanding the Disability Waiver Rate System (DWRS) and the Rate Management System (RMS). These videos are available to providers and lead agencies. Please see the RMS User Manual Training Modules page for a full list of videos.
Rates Management System (RMS) update
DHS will update the Rates Management System (RMS) on Dec. 18, 2015. The new release will include updates to the banding file, which will affect 2016 rate calculations. Banding is the period when changes to rates for existing authorizations and existing providers are limited. For additional information about what must be done before and after the update occurs, view the December update to the Rate Management System.
Changes to Disability Waiver Rate System frameworks
Beginning Jan. 1, 2016, DHS will implement the following two changes in the Disability Waiver Rates System:
• The first will account for regional differences in waiver-service costs
• The second will authorize a transportation framework for full-day DT&H services
DHS will integrate both changes with the Rate Management System (RMS). Implementation will occur on a rolling basis as service authorizations either renew or change.