MHCP Provider News

Sept. 8, 2014 News

  • • The DHS Disability Services Division (DSD) presents the following VirtualPresence opportunity for Positive Support Community of Practice: Draft of New Rule Review. The session is Tuesday, Sept. 30, 2014, from 10 a.m. to noon. View the flier for registration and session details. (Added 9/16/14)
  • • An additional metro-area DHS Background Studies Informational meeting is scheduled for Monday, Oct. 20, 2014, at the Eagan Community Center, 1501 Central Parkway, Eagan from 1-3 p.m. DHS continues to hold informational meetings throughout the state to inform people about the background study changes that will be implemented in early 2015 and to gather feedback. During the meetings, participants are given an overview of the changes and are able to ask questions. No preregistration is needed to attend any of the informational meetings. The changes only affect entities that submit background study requests to DHS through NETStudy. (Revised 9/15/14)
  • • ​DHS proposes to adopt a rule that requires use of positive support strategies; establishes a process to phase out use of chemical restraints, mechanical restraints, manual restraints, time out, seclusion or any other aversive or deprivation procedure; and governs emergency use of manual restraint. The new rule will apply to home and community-based services licensed under Minnesota Statutes, Chapter 245D that are provided to people with a disability or people age 65 and older, and to services provided by all department-licensed facilities and programs to people with a developmental disability or a related condition. DHS will conduct informal public input sessions to solicit comment on the draft rule in September and October 2014. See schedule on the public input sessions Web page. A draft of the new rule and forms for submitting input will be available on the Possible Adoption of Rules Web page on or about Sept. 18, 2014.
  • • The DHS Disability Services Division (DSD) presents the following VirtualPresence opportunity for Positive Support Community of Practice: Valued Community Members, with guest speaker Dr. Angela Amado. The session is Tuesday, Sept. 16, 2014, from 10 a.m. to noon. View the flier for registration and session details.
  • • Refer to Retroactive Medical Assistance Eligibility for information about how MHCP is handling requests for retroactive eligibility determination from people who apply for health coverage through MNsure.
  • • Review recent Provider Updates:

  • MN–ITS

    Continue to refer to the 5010/D.0 Announcements page for additional information about MN–ITS functionality.

    Industry Initiatives

    This Industry Initiatives section gives you quick, easy access to current federal and state industry initiatives that potentially impact your business. Please review these pages on a regular basis. We will note changes to the right of the initiative as we update the pages.


    Review the updated 5010/D.0 page for announcements about both direct data entry (DDE) and batch transactions.

    Behavioral health home

    Review the Behavioral health home page.

    Electronic health records




    Integrated Health Partnerships demo


    Health care homes

    Refer to the Health Care Homes Eligible Providers section in the MHCP Provider Manual about notifying MHCP of your HCH certification.


    The Protecting Access to Medicare Act of 2014 (HR 4302) delayed implementation of ICD-10 until Oct. 1, 2015. Watch the ICD-10 page for updates.


    The Centers for Medicare and Medicaid Services (CMS) is reinstating Procedure to Procedure (PTP) NCCI edits that pair immunization administration codes (CPT 90460-90474) with the preventive medicine Evaluation and Management (E/M) service codes (99381-99397) to be effective April 1, 2014. The edits apply to claims with dates of service on or after Jan. 1, 2013, that are submitted on or after April 1, 2014. The edits may be bypassed if a PTP-associated modifier is correctly appended to the preventive medicine E/M code.


    Pay-for-Performance (P4P) program providers may earn up to two payments of $250 in 12 months for providing optimal diabetes and cardiovascular disease care to eligible fee-for-service (FFS) recipients.

    Rate Changes for September 1, 2014

    Effective Sept. 9, 2014, MHCP implemented the rate increases for dates of service on or after Sept. 1, 2014. MHCP will replace claims submitted Sept. 1 - Sept. 8, 2014. We will notify providers when we determine a replacement date.

    For dates of service on and after Sept. 1, 2014, MHCP will increase the payment rate by 5% for the following services:

  • • Mental health services
  • • Occupational therapy
  • • Physical therapy
  • • Physician and professional services
  • • Speech language pathology
  • MHCP will increase rates by 3% for the following services:

  • • Ambulatory surgery centers facility fees
  • • Eyeglasses not subject to a volume purchase contract
  • • Hearing aids not subject to a volume purchase contract
  • • Hospice services
  • • Laboratory services
  • • Outpatient hospital facility fees
  • • Public health nursing services
  • • Renal dialysis services
  • The increased rates do not apply to payments made to:

  • • Assertive Community Treatment (ACT)
  • • Children’s Mental Health Residential Treatment
  • • County-based purchasing plans (CBPs)
  • • Crisis Residential
  • • Federally Qualified Health Centers (FQHC)
  • • Indian Health Service (IHS) providers
  • • Intensive Residential Treatment Services (IRTS)
  • • Managed care organizations (MCOs)
  • • Medical supplies and durable medical equipment not subject to a volume purchase contract
  • • Prosthetics and orthotics
  • • Rural Health Clinics (RHC)
  • • Youth Assertive Community Treatment (YACT)

  • These rate increases apply to MHCP fee for service (FFS) payments made to providers. Payments from MCOs to providers are based on the provider’s agreement or contract with the MCO.

    Refer to 2013 Legislative Changes for the original communication on these rate changes.

    Chemical Health

    Medicated Assisted Therapy (MAT) Services
    Effective Aug. 1, 2014, the primary care provider (PCP) must submit a medical referral form for recipients in the Minnesota Restricted Recipient Program (MRRP) and in need of Medicated Assisted Therapy (MAT) services. Verify eligibility and contact the PCP listed on the recipient’s response page. For more details about the eligibility verification process for an MRRP recipient seeking MAT services refer to CCDTF E-MEMO on the Alcohol and Drug Abuse home page.

    Continuing Care

    ​The 2014 Minnesota Legislature authorized a 5% rate increase for continuing care providers and other services that was effective July 1, 2014. The Continuing Care Administration (CCA) developed a Web page to answer questions about the rate adjustment, as well as the requirements associated with the increase.

    Visit the Continuing care provider rate and grant changes Web page for more information.

    DME Codes Capped Rental Payment

    The Centers for Medicare and Medicaid Services (CMS) reclassified 63 DME codes to the Capped Rental payment category effective April 1, 2014. A second modifier is required with modifier RR, such as KH, KI, and KJ. If these appropriate modifiers are not billed, the claim line will deny. MHCP will follow Medicare guidelines and will pay claims retroactively back to April 1, 2014.

    All Capped Rentals with a prior authorization (PA) and modifiers RR KJ that were overpaid due to bypass of a PA, will be reproccessed and paid correctly at the 75%. MHCP will make a mass adjustment in the next month.

    Refer to CMS MLNMatters for any questions.

    Hearing Aid Providers

    The volume purchase contract expired Aug. 31, 2014. MHCP allows a 30-day grace period for instruments purchased, but not delivered, before the contract expires. Hearing aids obtained from the 2013 contract must be dispensed before the end of the grace period, on or before Sept. 30, 2014, including those with approved authorizations. The 2014 Hearing Aid Volume Purchase Contract, effective Sept. 1, 2014, is now available online.


    MHCP will be changing the pricing for respite and inpatient services to Core Based Statistical Area (CBSA) location. Providers submitting claims with revenue codes 0655 or 0656 must have a value of 61 and the CBSA number as the amount.

    Hospital Presumptive Eligibility (HPE)

    Qualifed hospital staff began making eligibility determinations under the HPE program July 1, 2014. Access to the training, forms and other information about HPE is available on the HPE Web page.

    IMD Providers

    Tell people who reside in an IMD facility that they need to apply for MHCP coverage directly through their county. People who have already applied or already have MHCP coverage should not complete another application. MHCP is working to resolve a system issue to allow submission of these applications online through MNsure. Refer to the Provider Update, IMD Eligibility and Claims Payment (MHP-14-04) for complete information.

    Laboratory and Radiology Services

    Reference and outside lab services

    Implementation of the reference and outside lab services policy changes, originally scheduled for October 1, 2014, has been delayed. These changes will now be effective for dates of service on and after January 1, 2015.

    Certified professional midwives

    An update was made to allow certified professional midwives to order and refer radiology and laboratory services for dates of service on and after May 21, 2012. MHCP will reprocess claims denied in error. Any reprocessed claims will appear on your Sept. 9 Remittance Advice.

    Mental Health

    With the transition to DSM-5, MHCP requires all mental health providers to use the World Health Organization's Disability Assessment Schedule (WHODAS) when completing a Diagnostic Assessment for adults beginning Oct. 1, 2014. The WHODAS replaces the Global Assessment of Function (GAF). Providers may use either the 12-item or 36-item WHODAS. Refer to the following resources for the forms and more information:

    Outpatient Hospital

    Laboratory Tests
    As of Jan. 1, 2014, providers were instructed to bill separately billable laboratory tests using TOB 14X.

    On July 1, 2014, CMS made an operational change to their policy and are now instructing providers to bill separately billable lab tests using TOB 13X adding modifier L1 (separately payable lab test) to the procedure code for dates of service on or after Jan. 1, 2014.

    Claims using TOB 14X submitted before July 1, 2014, do not require replacement. Refer to MLN Matters® Number: SE1412 for more information.

    Non-patient Laboratory Specimen
    Since July 9, 2014, MHCP processed outpatient claims billed with type of bill 14X and dates of service on or after Jan. 1, 2014, following APC pricing. MHCP is currently working on programming that will allow these claims to be priced using the Clinical Laboratory Fee Schedule (CLFS).

    MHCP will identify and reprocess all claims that were priced incorrectly when the programming is complete. Watch for an updated message indicating the remittance advice payment date for the reprocessed claims.

    Rule Change - Definition of “Investigative”

    DHS proposes to repeal obsolete language from Minnesota Rule 9505.5005 which defines “investigative” for the purpose of health care program payment. The proposed change will remove a reference to the National Blue Cross and Blue Shield Association Medical Advisory Committee because the committee no longer exists. The department will publish the Notice of Intent to Repeal Obsolete Rule in the State Register on August 18, 2014; the comment period will remain open until October 20, 2014. See the Web page on the Proposed Repeal of Obsolete Rule for more information.

    Waiver and AC Program Providers

    245D Licensing standards videoconference

    The Disability Services Division (DSD) is presenting a videoconference opportunity for 245D Licensing Standards. The session is Tuesday, Oct. 7, 2014, from 10 a.m. to noon. View the VirtualPresence Announcement for registration and session details.

    Public comments on HCBS waiver programs

    The Disability Services Division (DSD) added a second 30-day public comment period beginning 8:00 a.m., Tuesday, Sept. 9, 2014, through 4:00 p.m., Thursday, Oct. 9, 2014, for direct and indirect support policy for HCBS waiver programs. Supported employment language was added to the policy. Review the new language on the DRAFT of the BI, CAC, CADI and DD waiver general process and procedures Web page. Submit comments no later than 4 p.m. on Thursday, Oct. 9, 2014, to After the public comment period, DHS will update the Community Based Services Manual (CBSM).

    Public comments on federal waiver plan

    The Disability Services Division (DSD) is seeking public comments on amendments to the federal waiver plan. The 30-day public comment period began 8:00 a.m., Friday, Aug. 29, 2014, and ends 4:00 p.m., Monday, Sept. 29, 2014. Areas included are Customized Living/24-Hour Customized Living, Respite, Consumer-Directed Community Supports (CDCS), Tribal Standards, Adult Day Care Bath, Transportation, Extended Private Duty Nursing, and Environmental Accessibility Adaptations. For more information, view the DSD announcement and the federal waiver amendments draft.

    Providers of vehicle modifications and installations (Environmental Accessibility Adaptation), check your MN–ITS mailbox PRVLTR file for detailed information.

    Submit comments on the amendments no later than 4 p.m. on Monday, Sept. 29, 2014, to

    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.

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