MHCP Provider News

July 25, 2016


  • • See grants and requests for proposal (RFPs) for current grants available or RFPs in which you may be interested.
  • Review recent Provider Updates

    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.


    MN–ITS

    Announcements and availability: Watch the 5010/D.0 Announcements page for information about MN–ITS functionality, technical information, scheduled downtimes and other notifications.

    Electronic Health Records (EHR)

    Refer to the Minnesota Electronic Health Records Incentive Program (MEIP) web pages for complete information about EHR.

    County and Tribal Human Services

    My Move Plan Summary: To help with the process of moving, DHS created the My Move Plan Summary (DHS-3936-ENG (PDF) to support people with disabilities, including people with mental illness and people who use long-term supports and services. The summary is a written agreement that:

  • • Helps to clarify roles expectations before, during and after the move and
  • • Helps make the move successful by clearly communicating all key elements of the plan.

  • For more information view the Disability Services Division e-list announcement posted on July 14, 2016, Lead agencies should start using the My Move Plan Summary (DHS-3936).

    Day Training & Habilitation (DT&H)

    DHS replaced the previous Day Training and Habilitation (DT&H) Application for Need Determination of Services (DHS-4960) with two new DT&H day service determination-of-need applications on Feb. 1, 2016.

  • • Use the Determination of Need Application for Expansion of DT&H Services, DHS-4960A (PDF), when requesting to develop a new DT&H day services site or to increase or expand DT&H day services.
  • • Use the Determination of Need Application for Proprietary Changes, Reductions and Closures, DHS-4960B (PDF), when requesting to move, reduce or close DT&H day services.

  • For more information, refer to the Community Based Services Manual (CBSM) Day training and habilitation (DT&H) needs determination page.

    Emergency Medical Assistance

    Emergency Medical Assistance (EMA) covers kidney transplant services effective for dates of service on and after July 1, 2016. Refer to the Emergency Medical Assistance section of the MHCP Provider Manual for information and coverage criteria.

    Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)

    Supplemental payment settlement deadline: The deadline for federally qualified health centers (FQHC) and rural health clinics (RHC) supplemental payment settlement is December 31, 2016. Submit your detailed requests and supporting claims data immediately for all dates of service through December 31, 2014. We must have your detailed request and supporting claims data by the deadline or we will consider all supplemental payments settled.

    DHS will calculate the proposed managed care supplemental payments and pay clinics monthly for services provided before January 1, 2015. Clinics must conduct a timely review of the payment calculation data in order to finalize all supplemental payments. Report any issues arising from a clinic's review to DHS by January 1, 2017.(Minnesota Session Laws 2014, Chap 312, Art. 24, Sec. 35(i))

    Group Residential Housing Supplemental Services

    MHCP enrollment: Most providers of group residential housing (GRH) need to enroll as an MHCP provider to receive supplemental services payments from MHCP. GRH supplemental service rate payments are any payments MHCP makes to GRH providers in excess of the maximum room and board rate of $891.

    If you are a GRH provider and you are not sure if this change applies to you, here is how you can tell: Add the amount that a resident pays you each month for room and board to the amount you receive from the state for GRH for that resident. If those two amounts together are $891 or less, then you are only receiving GRH base-rate room and board payments. If you are only receiving GRH base-rate room and board payments for all GRH residents in your setting, you are not receiving GRH supplemental service rate payments and do not need to enroll.

    If you determine that your total GRH payment is more than $891 per month for one or more of your residents, then you will need to enroll with MHCP to continue receiving supplemental service payments. Beginning January 1, 2017, you will bill GRH supplemental services through MHCP. Complete your enrollment as soon as possible. All parts of your enrollment must be completed no later than December 31, 2016.

    Before you enroll, you must watch the recorded webinar. A link to the webinar is on the GRH Supplemental Services training web page. After watching the recorded webinar, complete the Group Residential Housing (GRH) Supplemental Services – Provider Enrollment Application (DHS-5924) (PDF) and fax all required forms to MHCP Provider Enrollment. If you have any questions about GRH supplemental services, call the MHCP Provider Call Center at 651-431-2700 or 800-627-3529.

    Hospital

    Managed care for inpatient hospitalization: Effective June 1, 2016, if a member changes health plans or changes from fee-for-service (FFS) to a health plan while he or she is in the hospital, the effective date of the health plan enrollment is no longer dependent on inpatient admit or discharge dates. The previous health plan or FFS in effect at the time of admission remains financially responsible for the inpatient hospital services for that hospital stay and any related professional and ancillary services until discharge from the hospital. The new health plan will be responsible for the services that are not related to the inpatient hospital stay beginning on the effective date of the enrollment. The same policy applies when a member changes from a health plan to FFS.

    Individualized Education Program (IEP)

    The issue with the rates system for claims with the GT modifier that caused claims to deny for “rate record not found” has been corrected.

    You may start billing once Provider Enrollment approves your Provider Assurance Statement for Telemedicine (DHS-6806) (PDF). If you have not yet done so, fax the completed form to Provider Enrollment for approval.

    Medical Supply

    Changes to Enteral Nutrition Codes B4149 – B4155: Effective for dates of service on and after July 1, 2015, all enteral nutritional products will be priced by report with product-specific pricing due to 2016 legislative changes. Enter the product name on the claim line or that claim line will be denied. We encourage providers to replace enteral nutrition claims now. You can replace claims through September 30, 2016. Beginning October 1, 2016, MHCP will replace any remaining enteral nutrition claims that you have not replaced. At that time, we will deny and take payment back for any replaced claims that do not have the product name.

    Rate Changes to Ventilator Codes E0465 and E0466: Effective for dates of services on or after January 1, 2016, ventilators billed with HCPCS codes E0465 and E0466 will be reimbursed at the Medicare fee schedule rate to comply with state law passed by the 2016 legislature. The Medicare fee schedule rate for E0465 and E0466 is $1,055.23. The interim rates that were previously assigned will be rescinded. We will reprocess and pay at the Medicare fee schedule rate all previous paid claims with dates of services on or after January 1, 2016.

    Electric Patient Lifts Code E0635: Effective for dates of service on and after July 1, 2015, electric patient lifts will be priced by report due to 2016 legislative changes. Attach pricing documentation with claim submission and discontinue use of modifier U3. Follow this procedure with new and replaced claims.

    DME Items Reclassified to Capped Rental (CR) Category: Effective July 1, 2016, the following HCPCS codes will be classified to the capped rental DME payment category: E0197, E0140, E0149, E0985, E1020, E1028, E2228, E2368, E2369, E2370, E2375, K0015, K0070, AND E0955. When billing these codes for rental, add one of the K modifiers as follows: KH modifier for the first month of rental; KI for the second and third months; and KJ for months 4–13.

    Mental Health

    Functional assessment vocational domain: We revised the vocational domain of the functional assessment to reflect informed choice guidelines of the Minnesota Olmstead Plan. This update is in effect as of June 30, 2016, and is in the Functional Assessment section of the MHCP Provider Manual.

    Under “Vocational,” we added “Jobs, Careers.” This refers to the person’s participation in purposeful activity, which may include competitive, sustained employment or meaningful work. This work may be full-time or part-time employment or volunteer work on a regular or periodic basis. It may also be production of a product or provision of a service through engagement in a structured activity, which can be either externally directed by other(s) or self-directed. To create a person-centered planning approach, we also included a section, “Consider the following questions.”

    Billing Change for Procedure Code H2015 with or without modifiers: Providers who bill procedure code H2015 with or without modifier(s) must bill each date of service on a separate line on the claim beginning July 1, 2016. If you bill with a date span, your claim will deny.

    You may use H2015 with or without modifier(s) for the following services:

  • • Housing Access Coordination service (BI, CAC, CADI and DD)
  • • Comprehensive Community Support Services (MHM)
  • • Community Living Assistance, in person and remote service (ECS)
  • Comprehensive Community Support Services (Crisis Assistance) for CTSS

  • Center for Victims of Torture—Rate Negotiation for Targeted Case Management: The Center for Victims of Torture (CVT) cannot negotiate different rates for Mental Health Targeted Case Management (MH TCM) with different counties. County-negotiated rates cannot be more than the rate the provider charges for the same service to other payers. Before CVT provides services, they must receive agreement from the county that is financially responsible for the person receiving services. Refer to the Mental Health Update sent June 7, 2016.

    Transportation

    We updated the Transportation sections of the MHCP Provider Manual to reflect the July 1, 2016, legislative changes for nonemergency medical transportation (NEMT). You can see or print a copy of training on the changes or view a recording of the presentation on the Nonemergency Medical Transportation (NEMT) Training web page.

    Vision

    Effective September 1, 2016, the contractor for the volume-purchase eyeglass contract will change. Classic Optical will begin contacting vision providers the week of July 25 with introductory materials.

    Waiver and Alternative Care (AC) Programs

    Public comment on use of monitoring technology: DHS seeks public comments on a new policy for the use of monitoring technology with people who receive services through the Waiver and AC Programs. Review a draft of the proposed monitoring technology policy, and then email comments to DSD.PublicComments@state.mn.us. The comment period ends at 4 p.m. Tuesday, August 23, 2016.

    Billing Change for Procedure Code H2015 with or without modifiers: Providers who bill procedure code H2015 with or without modifier(s) must bill each date of service on a separate line on the claim beginning July 1, 2016. If you bill with a date span, your claim will deny.

    You may use H2015 with or without modifier(s) for the following services:

  • • Housing Access Coordination service (BI, CAC, CADI and DD)
  • • Comprehensive Community Support Services (MHM)
  • • Community Living Assistance, in person and remote service (ECS)
  • • Comprehensive Community Support Services (Crisis Assistance) for CTSS

  • Crisis respite allowed on BI and CADI Waivers: Beginning July 1, 2016, crisis respite is allowed on the BI and CADI waivers. If you are currently enrolled as a waiver provider with Minnesota Health Care Programs (MHCP), have the credentials and would like to add this service to your record, complete the HCBS Programs Service Request Form (DHS-6638) (PDF) and fax it to MHCP provider enrollment.  

    Training and VideoPresence Opportunities

    Information about most new and ongoing training is on the Provider Training page. Any information listed in this section is for additional training sessions on special topics.

    Grants and RFPs

    See the Grants and requests for proposals web page for more information.

    Related Links

    Visit our Provider website for more comprehensive information, including these pages:

  • Latest Manual Revisions
  • • Previously published Provider News items
  • Provider Updates (we also place newly published Provider Updates in your MN–ITS Mailbox, as appropriate)

  • This page includes news and resources for providers enrolled to serve Minnesota Health Care Programs (MHCP) recipients. Get notices of Provider News through our free Provider Email Lists.

    If you have questions about this information, call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411.

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