MHCP Provider News

Nov. 17, 2014 News


  • • The Disability Services Division (DSD) presents the following VirtualPresence opportunity for HCBS PIPP: Strategies for Successful Change in Quality Improvement Projects on Tuesday, Dec. 2, 2014, from 10:00 a.m. - 11:00 a.m. Please view the flyer for registration and session details (PDF). If you have questions, please email DSD Learn. (Added 11/19/14)
  • • As part of its commitment to more person-centered supports, DHS has contracted with the Institute on Community Integration at the University of Minnesota to offer a year-long training and technical assistance program. The intent of this program is to help agencies implement organizational changes for more person-centered supports. Review the Summary of Opportunity for details. The anticipated start date is April 2015. Applications are open to lead agencies (counties and tribes) and provider agencies. The application deadline is Jan. 30, 2015. For questions email Anne Roehl at vand0202@umn.edu.
  • • DHS is working closely with Minnesota Management & Budget (MMB), the Minnesota Department of Health (MDH) and the Department of Public Safety on preparedness planning for a possible case of the Ebola virus in our state. No cases of Ebola have been found in Minnesota. We posted a memo about reporting requirements and protective recommendations on our website. Refer to the memo to human services providers for more information.
  • • MHCP incorrectly calculated reimbursement amounts for some claims submitted Sept. 8 through Oct. 27, 2014, when Medicare applied coinsurance or a deductible to the service. We will identify all of the affected claims and replacement claims will appear on the Nov. 18, 2014, remittance advice.
  • • The DHS Disability Services Division (DSD) is sponsoring three one-day classroom sessions conducted by the University of Minnesota’s Institute for Community Integration. Being Person-Centered: An Introduction, will be offered on Nov. 19, 20 and 24, 2014, from 9 a.m. to 4 p.m. View the training announcement for registration and session details. Email DSD Learn if you have questions.
  • • 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 Dec. 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.
  • • ​Review recent Provider Updates:

  • MN–ITS

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

    Holiday hours and claims submissions
    The Provider Call Center will be closed several days during the upcoming holiday season. MN–ITS will be available, but staff will not be available on these days to help answer claims submission questions. Cut-off dates and scheduled days closed are:

  • • Nov. 27 and 28
  • • Dec. 25
  • • Jan. 1, 2015

  • MHCP recommends that you do not wait until the cut-off date to submit claims. Cut-off dates that coincide with holidays are Nov. 27 and Dec. 25. Submit claims early so staff is available to answer any questions you may have.

    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.

    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.

    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.

    Doula Services

    As of July 1, 2014, MHCP covers fee-for-service (FFS) doula services. Managed Care Organizations (MCOs) cover doula services as of Sept. 25, 2014, the date the Centers for Medicare and Medicaid Services (CMS) approved the state plan amendment.

    We updated the MHCP Provider Manual to include a section for Doula Services. Refer to this section for additional coverage information.

    In-Reach Service Coordination (IRSC)

    IRSC coverage
    MHCP covers fee-for-service IRSC services on and after Jan. 1, 2013. Participating managed care organizations (MCOs) will cover the services on and after Oct. 10, 2014.

    Children with Severe Emotional Disturbance (SED)
    Recipients under the age of 21 diagnosed with SED are eligible for IRSC services if they meet one of the following criteria:

  • • Visited a hospital emergency department two or more times in the previous consecutive three months
  • • Were admitted to an inpatient psychiatric unit two or more times in the previous consecutive four months
  • • Are being discharged from either an emergency department or an inpatient psychiatric unit to a shelter

  • IRSC program services
    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

    DSM5 and WHODAS Frequently Asked Questions (FAQS)
    The Adult and Children’s Mental Health Divisions have published frequently asked questions and responses about the DSM5 and ICD-10 transition and the WHODAS assessment. Refer to the FAQs for more information:


    Psychiatric Consultations to Primary Care Providers
    Effective for dates of service on or after July 1, 2013, the following provider types, in addition to psychiatrists, are eligible to provide psychiatric consultations to primary care providers:

  • • Licensed psychologist
  • • Nurse practitioner
  • • Clinical nurse specialist

  • On Aug. 6, 2014, Minnesota Health Care Programs (MHCP) completed systems work to accept claims from these providers for this service. If you are one of the affected providers, you may now submit claims for psychiatric consultations for the eligible dates of service. Refer to Psychiatric Consultations to Primary Care Providers for more information.

    Submit claims with dates of service from July 2013 through Oct. 2013 with a copy of this letter as a claim attachment. You must submit claims for these dates of service within 60 days from the date on the letter. MHCP will override the timely filing limit of 12 months from the date of service only if you meet these conditions.

    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:

  • 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.

    Nursing Facility

    Effective Jan. 1, 2015, nursing facilities will be required to submit a request for a refund of the spenddown amount withheld by DHS for clients in a managed care plan. Providers have no later than one year from the date of service or six months from the warrant date to request the refund.

    PCA

    Memo on ebola virus preparedness
    DHS is working closely with Minnesota Management & Budget (MMB), the Minnesota Department of Health (MDH) and the Department of Public Safety on preparedness planning for a possible case of the Ebola virus in our state. No cases of Ebola have been found in Minnesota. We posted a memo about reporting requirements and protective recommendations on our website. Refer to the memo to personal care attendants and home care workers for more information.

    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). 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.

    Supplemental Recovery Program

    In 2013, legislation required DHS to implement the supplemental recovery program. This program requires the State to identify third party carriers and recover third party liability (TPL) on the State’s behalf eight months after the Managed Care Organization (MCO) has paid a claim. The State contracted with Health Management Systems, Inc. (HMS) as the vendor to recover the TPL associated with the MCOs’ claims. HMS also does this for fee-for-service claims. HMS earns a percentage-based fee for TPL recoveries. HMS researches TPL, reports it to DHS, and bills previously unbilled third party liabilities.

    The TPL information reported becomes part of the DHS TPL file and is reported to MCOs. This information is available in MN–ITS for all providers. Providers must bill TPL before submitting claims to DHS or an MCO. If TPL data is inaccurate, report it as described in the Medicare and Other Insurance section of the Provider Manual. All providers must cooperate with DHS and MCO requirements.

    Waiver and AC Program Providers

    VirtualPresence Session Announcement
    (Added 11/25/14)

    The Disability Services Division (DSD) presents the following VideoPresence opportunity: How Adult Day Programs Can Institute Quality Improvement Measures to Reduce Hospital Readmissions on Monday, Dec. 1, 2014, from 11 a.m. to 12:30 p.m. Please view the flyer for registration and session details. If you have questions, email DSD Learn.

    Identification of 245D HCBS Providers
    Program directors: The Disability Services Division (DSD) needs to identify providers licensed under 245D who have immediate capacity to:

  • • Provide residential and home-based services to people with highly complex behavioral or medical support needs. Review the full DSD announcement.
  • • Provide consultation on person-centered planning and positive supports. The consultations will be with other 245D-licensed providers who serve people with highly complex behavioral or medical support needs. Review the full DSD announcement.

  • DHS will make a list of these providers available to lead agencies to use for making referrals. Review each of the DSD announcements to see a full description of the DHS request and how to submit your information.

    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.

    Sign up to receive Provider Updates and other MHCP notices in your email account.


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