MHCP Provider News

Oct. 20, 2014 News


  • • The Disability Services Division (DSD) will present a VirtualPresence session about system changes related to waiver rates and positive supports. The session is Tuesday, Oct. 28, 2014, from 10 a.m. to noon. View the flyer for registration and session details. If you have questions, please send an email message to DSD Learn. (Added 10/24/14)
  • • The Continuing Care Administration issued a Memo announcing that home and community-based services Waiver, Alternative Care, Home Care, and Intermediate Care Facilities for Persons with Developmental Disabilities providers can now access the Web-based Quality Improvement Tool. This is the tool through which providers need to submit a quality improvement project by December 31, 2014, to maintain their full 5% July 1, 2014, rate increase.  More information is available on the CCA Rate web page.
  • • DHS and its partners created the Developing Positive Support Transition Plans (DHS-6810C) as a guide to help expanded support teams develop positive support transition plans in compliance with Minn. Stat. §245D.06, subd. 8. Please review this document to understand the requirements related to developing your positive support transition plan.
  • • Submit the Request for the Authorization of the Emergency Use of Procedures (DHS-6810D) by Oct. 22, 2014, to guarantee panel review. Read more information on DSD announcement web page.
  • • MHCP will start collecting fees before enrollment, reenrollment or revalidation to comply with federal requirements for provider screening:
  • • For new applications received on and after October 1, 2014
  • • At the time a provider is reenrolling
  • • Before completing revalidation
  • Providers can now access the MHCP Provider Screening Fee Collection System to make payments. Refer to the Provider Screening Requirements section of the MHCP Provider Manual to review the provider types that are subject to the application fees.

  • • ​DHS proposes to adopt a rule that requires use of positive support strategies; establishes prohibitions on the 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. See the Possible Adoption of Rules Web page for a draft of the new rule and forms for submitting input .
  • • 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

    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.

    5010/D.0

    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

     

    e-Prescribing

     

    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.

    ICD-10

    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.

    NCCI

     

    Pay-for-performance

    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 that were submitted Sept. 1 - Sept. 8, 2014. These claims will appear on the Oct. 7, 2014, warrant.

    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.

    Audiology

    Audiology Services Billed on an 837I Outpatient Claim
    MHCP is working on a system change for payment of audiology services billed on the 837I outpatient claim. Effective for dates of service on or after Oct. 1, 2014, audiology services billed on the 837I will be considered an outpatient service and subject to follow Outpatient Prospective Payment Systems (OPPS) payment methodology.

    MHCP will retroactively reprocess claims after the system change is completed. MHCP will update this message with the remittance advice date for the reprocessed claims when we determine that date.

    Chemical Health

    The MinnesotaCare 2% tax add-on will no longer apply to chemical health claims processed on and after July 23, 2014. The 2% tax applied to some chemical health claims before July 23, 2014, based on the revenue code. Services that are reimbursed by the CCDTF, which also includes MCO reimbursement for R&B, are exempt per Minnesota Statute 295.53, subd. 1 (7).

    Day Training and Habilitation

    Legislation passed in 2014 expands eligibility for people to receive partial-day day training and habilitation (DT&H). People who had DT&H authorized during the 2013 calendar year with any unit value (15-minute, daily or partial-day) are eligible to receive partial day DT& H as of Nov. 1, 2014.

    FQHCs

    On Oct. 1, 2014, CMS established five specific payment codes (G-codes) for use by FQHCs when submitting claims to Medicare under its Prospective Payment System (PPS). Do not use these new G-codes when billing for MHCP covered services. Continue to bill using the appropriate CPT, HCPC and CDT codes for MHCP-covered services.

    In-Reach Service Coordination

    MHCP enrolled community-based providers may now work with their local hospitals that provide In-reach Service Coordination (IRSC) to also provide IRSC services. All qualified community-based providers who want to participate in the IRSC program must first submit a completed Community-based Providers IRSC Applicant Assurance Statement. Refer to the Hospital In-reach Service Coordination (IRSC) section in the provider manual for more information.

    Mental Health Services

    DSM-5 and ICD-9
    Effective Oct. 1, 2014, the Diagnostic and Statistical Manual of Mental Disorders (DSM) transitioned to DSM-5.The DSM-5 reports both ICD-9 and ICD-10 codes related to each diagnostic criteria. Implementation of ICD-10 is delayed until Oct. 1, 2015. Continue to submit ICD-9 codes on all claims submitted to MHCP until ICD-10 codes are required. Use DSM-5 diagnostic criteria for all mental health services completed after Oct. 1, 2014.

    Adult Diagnostic Assessments
    As a result of DSM-5 implementation, MHCP requires that Diagnostic Assessments (DAs) for adult recipients include the World Health Organization's Disability Assessment Schedule (WHODAS), effective Oct. 1, 2014. This does not apply to DAs for children recipients. Providers may use either the 12-item or 36-item WHODAS. Do not include the Global Assessment of Function (GAF) score in DAs completed after Oct. 1 ,2014. Refer to the following resources for the assessments, copyright information, user agreement, language translations and any other WHODAS questions:

  • • Assessments:
  • • Guidance:
  • • Legal References:

  • Adult Mental Health Authorizations
    Refer to Provider Update, Adult Mental Health Authorization Requests (MHS-14-02) for instructions on submitting detailed authorization requests and documentation for adult recipients of mental health services. These instructions support and clarify information in the MHCP Provider Manual and the Mental Health Policy Manual.

  • • MHCP will provide similar reference resources for the Children’s Mental Health Authorization Request soon.
  • PCA

    Information requests
    On Friday, Oct. 3, 2014, provider agencies and fiscal support entities (FSE) that provide direct support services to people who participate in the PCA Choice, Consumer Directed Community Supports (CDCS) and Consumer Support Grant (CSG) programs received two information requests in their MN–ITS mailboxes. Both of these requests are required. They must be completed and returned to DHS by Nov. 2, 2014.

  • • One request is a spreadsheet asking for employment information about workers.
  • • The other request is a survey of the provider agency’s wage and benefit information.

  • DHS will provide this information to the Minnesota Management & Budget office, which is negotiating the contract with the Service Employees International Union (SEIU). The state and SEIU began contract negotiations on Sept. 25, 2014, for workers who provide direct support to people who participate in the PCA Choice, CDCS and CSG programs.

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

    Radiology Services

    DHS has reprocessed claims with CPT code 72100, submitted between Feb. 15, 2014, and June 21, 2014, that were denied with Claim Adjustment Reason Code CO 11, "The diagnosis is inconsistent with the procedure." Reprocessed claims are on your Sept. 11, 2014, Remittance Advice.

    Hospital and Rural Health Clinics

    Same-day Outpatient Hospital Lab Service and Rural Health Clinic Encounters
    Federal regulations require certain labs to be performed on site when the provider is a Rural Health Clinic (RHC). Minnesota Health Care Programs (MCHP) pays RHCs an all-inclusive rate that covers the specified lab services and all other services provided by the RHC. MHCP will deny as a duplicate service specific lab services provided by a hospital provider on the same day as an RHC visit. Bill all services provided by an RHC to MHCP using the RHC’s NPI, including those services provided by an RHC professional at other locations. Refer to 42 CFR Part 491.9(c)(2) for more information.

    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 Aug. 18, 2014; the comment period will remain open until Oct. 20, 2014. See the Web page on the Proposed Repeal of Obsolete Rule for more information.

    Waiver and AC Program Providers

    The Minnesota Department of Human Services’ Aging Services and Disability Services divisions present the following VirtualPresence opportunity for the HCBS Performance-based Incentive Payment Program (HCBS PIPP) on Tuesday, Oct. 21, 2014, from 10:30 to 11:30 a.m. View the flyer for registration and session details. If you have questions, please email DSD Learn.

    New method for staffing hours delayed
    Implementation of the new method to calculate residential staffing hours was scheduled for Oct. 20, 2014; however, DHS will delay the implementation for approximately six months.

    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 1-800-366-5411.

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