Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment

Revised: 06-05-2013

New Enrollment

To enroll to provide HCBS waiver and/or AC programs services follow the steps below:

1.	Use the Waiver and Alternative Care (AC) Programs Service Request Form (DHS-6638) to report the service(s) you planto provide and report your qualifications to provide the service(s)
2.	Verify to ensure all employees are not on the Office of Inspector General (OIG) Exclusion list. Keep this for your own records.
3.	Contract with the lead agency to provide services for recipients on Elderly Waiver, HCBS Waiver and AC programs.
4.	Ensure your agency initiates background studies for all direct care staff as required.
5.	Complete and fax the following forms to MHCP Provider Enrollment at (651) 431-7462: • Home and Community-Based Services (HCBS) Waiver and Alternative Care (AC) Programs – Provider Enrollment Application (DHS-4015) • MHCP Provider Agreement (DHS-4138) • Disclosure of Ownership and Control Interest (DHS-5259) • Waiver and Alternative Care (AC) Programs Service Request Form (DHS-6638) • Establish your Direct Deposit/Electronic Funds Transfer • Proof showing you are qualified to provide the services including but not limited to: • A copy of the contract from the lead agency • Copies of licenses/certifications/registrations when appropriate • The HCBS/AC Lead Agency Provider Enrollment Request Form (DHS-6383) when appropriate • Assurant statements as appropriate (see the Waiver and Alternative Care (AC) Programs Service Request Form (DHS-6638) to determine which services require an assurance statements and a link to the appropriate assurance statement for that service)

Housing with Services/Specialized Services Locations

HCBS waiver and AC provider locations with registration for either Housing with Services (HWS) or Specialized Services must complete steps 1-4 above for each HWS or specialized services location.

Provider Record Review

MHCP requires any providers who want to continue to provide waiver services and receive reimbursement for these services on or after 1/1/2014 to complete a record review.

During the review process, providers complete and submit the forms listed below to report the services they are currently providing or want to continue to provide and submit the approved service credentials as proof they are qualified to provide the service.

Record Review Documentation To complete the record review, complete and fax the following forms to MHCP Provider Enrollment at (651) 431-7462:

Lead agencies The lead agencies (county/tribal human services) have the following exceptions when completing the record review: Use “Public 5” to report:

Counties and tribes do not need to list the county board members yet do need to list the managing employees involved when completing the review for the human services offices. Managing employees are limited to the services the county is enrolling.

MHCP will continue to process record review documentation throughout 2013 and post the date for documentation they are processing on the Waiver/AC Provider Home Page.

Processing Timelines

MHCP processes new enrollment requests in the order received. MHCP processes the request and provides a response within 30 business days. Responses include: pending for more information, approval and denials. You must wait until Provider Enrollment processes the information to determine if it is complete or filled out correctly.

If MHCP approves the initial enrollment request, the provider applicant will receive a confirmation (Welcome) letter, including information about registering for MN–ITS. All HCBS waiver and AC programs providers must register and use MN–ITS for receiving mail and submitting all transactions electronically with MHCP.

Add Services

To add additional waiver/AC programs services to your current waiver enrollment record:

1.	Use the Waiver and Alternative Care (AC) Programs Service Request Form (DHS-6638) to report the service(s) you want to provide and report your qualifications to provide the service(s)
2.	Communicate with the lead agency to ensure your contracts include the new service
3.	Complete and fax the following forms to MHCP Provider at (651) 431-7462: • requesting MHCP to add the service(s) to your file • Proof showing you are qualified to provide the services • Assurant statements as appropriate (see the Waiver and Alternative Care (AC) Programs Service Request Form (DHS-6638) to determine which services require an assurance statements and a link to the appropriate assurance statement for that service)

MHCP will process all requests in the order received and provide a response within 30 business days.

Ongoing Reporting Requirements

MHCP requires waiver and AC programs service providers to notify MHCP any time a change occurs. Report any changes by completing the appropriate forms below and faxing to MHCP Provider Enrollment at (651) 431-7462:

MHCP will process the change information and notify the agency if any further documentation is necessary to continue or maintain enrollment with MHCP in relation to the changes.

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