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MHCP Provider Update PCA-10-01

MHCP to Conduct Annual Provider Renewal for all PCA Provider Agencies

March 31, 2010
Revised May 27, 2010

The 2009 home care reform legislation requires that MHCP must review PCA agencies (including Medicare-certified/Class A-licensed agencies providing PCA services) once every year for continued enrollment. Starting in June 2010, MHCP will notify agencies of their annual provider agency renewal, including review requirements and a due date. Providers will have 30 days to submit required documentation to complete the annual review.

At a minimum, MHCP will require the following at each annual provider agency renewal:

• Copy of current fidelity bond

• Copy of current surety bond (see PCA Agency Surety Bond (DHS-6033) example)

• Proof of liability insurance coverage

• Proof of Worker’s Compensation coverage (except Class A-licensed/Medicare-certified agencies)

• Current PCA Agency Personnel List and Affiliation(s) (DHS-6041) (follow directions on the form)

• New Designation of Billing Person (DHS-6000), identifying the person within the agency responsible for billing the agency’s PCA services; designated billing person must attend the PCA Provider Agency Billing Lab

• New Disclosure of Ownership and Control Interest (DHS-5259), reporting all agency owners and managing employees

• New MHCP Provider Agreement (DHS-4138) and the appropriate addendums:

• New Provider Agreement Addendum – PCPO (DHS-4022A)

• New Provider Agreement Addendum – PCA Choice Provider (DHS-4022B)

• New PCA Agency Applicant Assurance Statement (DHS-6005), assuring the agency is following additional PCA program requirements required policies and procedures in place before the annual review

• New Qualified Professional (QP) Acknowledgement (DHS-4022C), identifying each individual the agency designates to provide QP services

• Written record of grievances received by your agency in the previous year and resolutions to those grievances

PCA provider agencies must also meet ongoing requirements of other state agencies for Minnesota businesses.

Notification

MHCP will notify you through the MN–ITS Mailbox, Miscellaneous Received folder, PRVLTR file of your agency’s annual provider agency renewal. Do not submit forms and documents until you receive this notification in your PRVLTR file. MHCP will also use PRVLTR to request additional information, as necessary, during the annual provider agency renewal process.

Annual Provider Agency Renewal Schedule

MHCP will use the annual provider agency renewal schedule below, based on when the first staff from your agency attended and successfully completed one of the following Steps for Success (SFS) trainings:

• Voluntary 3-day SFS training before July 2009 and the 1-day SFS Part II follow-up in late 2009

• Required 3-day SFS training October 2009 or later

If agency personnel attended training in:	Your Annual Provider Agency Renewal will be in:
August – October 2009	June and July 2010
November – December 2009	August 2010
January 2010	September 2010
February – March 2010	October 2010
April – May 2010	November 2010
June – July 2010	December 2010
August – September 2010	January 2011
October 2010	February 2011
November 2010	March 2011
December 2010	April 2011

In December 2010, MHCP will also begin annual reviews of PCA agencies whose staff did not attend a required SFS training.

Suspension/Termination

If a PCA provider agency does not comply with annual provider agency renewal requirements, MHCP will notify the agency that it will:

• Suspend or terminate the PCA provider agency

• Suspend or terminate the agency’s affiliated provider agencies doing PCA services

• Not approve service authorizations for service dates after the suspension/termination date

• Not pay claims for services provided after the suspension/termination date

• Prohibit the PCA provider agency and its affiliates from providing PCA services for two years

After termination, a PCA provider agency that chooses to re-enroll with MHCP:

• Must wait for two years before re-applying to become an MHCP provider (MHCP will not consider processing an agency’s re-enrollment request before the two-year period)

• Must meet all enrollment requirements

• Must attend and successfully complete all training requirements for PCA provider agencies

• Will be on probation for one year from the date of re-enrollment

MHCP will send counties a report identifying current service authorization/agreements (SA) for providers who are no longer approved to provide PCA services. MHCP will send SA letters to recipients and providers showing the changes to the authorizations.

Agency Training

By January 1, 2011, PCA agencies must have required that its employees attend and successfully complete the following as appropriate:

• Steps for Success for PCA Agencies training workshops

• PCA Provider Agency Billing Lab

When registering for the Steps for Success workshops, if an owner, managing employee or qualified professional name is not listed on the registration page, complete the appropriate enrollment form to add the person to the agency’s file, before registering the person for the appropriate workshop:

• Disclosure of Ownership and Control Interest

• Qualified Professional (QP) Acknowledgement

• Designation of Billing Person

Additional Resources

• MHCP Provider Manual

• PCA Portal PCA Policy Pages

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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