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MHCP Provider Manual

2018 Manual Revisions

Updates cited below do not include minor grammatical or formatting changes that otherwise do not have bearing on the meaning of the policy contained herein. Refer to Provider Updates that may contain additional MHCP coverage policies or billing procedures. MHCP incorporates information from these updates into the Provider Manual on an ongoing basis. Sign up to get email notices of section changes.

December 31

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid – We posted the new EIDBI billing grid that is effective Jan. 1, 2019.

December 26

Provider Basics
Billing Policy (Overview)

· Paper Claim Submission Policies – Removed link to information about submitting paper authorizations since authorizations must be submitted to the review agents.

December 17

Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· EIDBI Billing Grid – Added information that details the number of hours a clinician can provide for individual intervention EIDBI services.

December 14

· MHCP Member Evidence of Coverage – We updated the list of services covered under substance use disorder services (formerly chemical dependency services).

December 10

Individualized Education Program (IEP) Services

· Speech and Language Pathology and Audiology Services – Clarified coverage for Speech Language Pathology and Audiology IEP evaluations, re-evaluations and assessments. Providers may bill for assessments that are health-related and conducted for the sole purpose of identifying the health needs of the child for the child’s IEP or IFSP even if the assessment does not result in an IEP.

December 7

Reproductive Health/OB-GYN

· Abortion Services – Under the billing section corrected abortion CPT code S0901 to S0191 (misoprostol).

December 6

Physician and Professional Services

· Physician and Professional Services – Updated with the correct reporting and discarding information of administered drugs with using the JW modifier under the Reporting the Discarded Portion of Administered Drugs section. Physician Services in Teaching Settings section added for teaching guidelines. "Recipient" was updated to "member" throughout this section.

EW and AC

· Elderly Waiver (EW) and Alternative Care (AC) Program – We added links to the Community-Based Services Manual (CBSM) for the following services in the Covered and Noncovered Services sections: Homemaker, Respite Care, and Specialized Equipment and Supplies. We revised the Residential Care Services subsection; this service was discontinued effective July 1, 2018, although claims from before this date may still be submitted if within the one-year claim submission for timely billing.

RSC-TCM

· Relocation Service Coordination—Targeted Case Management (RSC—TCM)

· In Covered Services, we added links to RSC-TCM and VADD-TCM sections of the Community-Based Services Manual (CBSM) and the MH-TCM section of the MHCP Provider Manual.

· Under Authorization Requirements, we clarified that for Waiver Transitional Services, a service provider may simultaneously provide waiver transitional services and RSC-TCM to an eligible member who meets the requirements and limitations for waiver transitional services.

· Under Billing, we deleted procedure code T1016 because it is no longer valid.

December 3

Clinic Services

· Clinic Services – Added description for CPT guidelines in the Billing for PHNC Services table.

November 30

Mental Health Services

· CTSS Children’s Day Treatment –We clarified content throughout, including the following:

· Added Eligible CTSS Children's Day Treatment Providers

· Added more information on Documentation Requirements

· Provided more detail for Noncovered Services

November 6

Equipment and Supplies

· Ambulatory Assist Equipment – Under Covered Services, Walkers we added the following:

· Bill Medicare first for replacement hand brakes for walkers if the brakes originally dispensed with the walker are in need of repair and need to be replaced. When dispensing a new walker with hand brakes, bill Medicare first for the walker. Bill MHCP for hand brakes as a replacement for the standard glide-type brakes, because Medicare does not pay for hand brakes.

October 31

Provider Basics
Enrollment with MHCP

· Home and Community Based Services (HCBS) Programs Provider Enrollment – Added to step 7:

· Clarification that providing a copy of general liability insurance certificate also applies to family supported living services or family supported living services with in-home respite services.

· A link to the Home and Community-Based Settings Applicant Assurance Statement.

October 30

Transportation Services

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates – Removed information regarding multiple rider proration. Proration ended July 1, 2017. Clarified who is responsible for obtaining the level of service (LOS) assessments.

October 25

Provider Basics

· Managed Care Organizations (MCOs) – Under MCO Covered Services added Mille Lacs and Pine county to list of counties that go through MNET. Also, added pregnant women as eligible to receive NEMT through MinnesotaCare.

Individualized Education Program (IEP) Services

· IEP Providers – Updated the DHS contact name for the Provider Contact List to Jenny Roth.

· Personal Care Assistance (PCA) Services – Corrected error in text under Other Health-Related Procedures and Tasks, second bullet, so it reads correctly as, "Assistance with self-administered medication, including reminders to take medication, bringing medication to the child or youth, and assistance with opening medication containers; including medications given through a nebulizer. A PCA must not determine the medication dose or time for medication."

October 23

Provider Basics

· Authorization – Added authorization requirements for Psychiatric Residential Treatment Facilities. Updated KEPRO's mailing address.

October 22

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – Under covered services removed information regarding multiple rides as proration for multiple riders ended July 1, 2017.

· Nonemergency Medical Transportation (NEMT) Services (Overview) – Removed Multiple Rider information. Proration for multiple riders ended July 1, 2017.

· State-Administered NEMT – Removed reference to multiple riders under covered services. Proration for multiple riders ended July 1, 2017.

Individualized Education Program (IEP) Services

· In the Billing and Authorization Requirements section we added that for services provided on or after Nov. 1, 2018, schools must use modifier XE rather than 76 for each additional trip per day for special transportation, and modifier XP rather than 77 when two separate schools provide the same service on the same day for the same child.

October 19

Mental Health Services

· Telemedicine Delivery of Mental Health Services

· We added an Overview section to provide more information including a definition of telemedicine and when services can be provided by telemedicine.

· We updated the Eligible Providers section: Eligible providers are mental health professionals who are qualified under MN Statute 245.462 Subd. 18 or mental health practitioners working under the supervision of a mental health professional. To be eligible for reimbursement, providers must self-attest that they meet all of the conditions of the MHCP telemedicine policy by completing the Provider Assurance Statement for Telemedicine (DHS-6806) (PDF).

· We added a Covered Services section: MHCP covers medically necessary mental health services delivered by a healthcare provider via telemedicine. This includes coverage limitations of three services by telemedicine per calendar week per recipient.

· We updated the Noncovered Services section: The following services may not be conducted via telemedicine: Children's day treatment, Partial hospitalization programs, Mental health residential treatment services, Case management services delivered to children. See the individual mental health service provider manual page for other limitations

· In the Billing section we added to use the place of service code 02 to indicate the service was provided via telemedicine.

October 18

Equipment and Supplies

· Oxygen Contract Regions and Price Schedule – Updated contract to add dates of contract and date the contract is due to end.

October 9

Community Paramedic Services

· Community Paramedic Services

· Removed Emergency Medical Technician (EMT) under eligible provider section to clarify this manual section is specifically for community paramedics.

· Changed wording under eligible recipients to clarify the member only has to have one of the issues listed to receive services.

· Changed recipient to member throughout the page.

October 8

Equipment and Supplies

· Spirometers – MHCP used to cover spirometers for home monitoring of pulmonary function following lung or heart transplants, but now covers spirometers for home monitoring of respiratory or cardiovascular conditions. We updated text in several places in this section to reflect this.

October 5

Hospital Services

· Hospital Services

· Under Institution for Mental Disease (IMD) we added: Adults under age 65 and children under age 21 who are admitted to an IMD are not eligible for Medical Assistance (MA).

· Added a new section for Psychiatric Residential Treatment Facility (PRTF): A PRTF provides active treatment to children and youth under age 21 with complex mental health conditions. This is an inpatient level of care provided in a residential facility rather than a hospital. PRTFs deliver services under the direction of a physician, seven days per week, to residents and their families, which may include individual, family and group therapy. Children and youth under the age of 21 are eligible based on medical necessity. PRTFs are not subject to the IMD exclusion; they qualify as accredited, licensed inpatient psychiatric hospitals.

Home Care Services

· Home Care Services – Updated with the face-to-face visit requirement in the covered services section. Also added under Noncovered services information about the services not being covered without the required documentation.

· Home Care Nursing (HCN) Services – Class A licenses are no longer issued by the Minnesota Department of Health, as of 2014 the license required for providers is the Comprehensive Homecare License.

· Home Health Aide Services – We updated this section to comply with the requirement for Home Health Agencies to have a Comprehensive Home Care license for enrollment with MHCP.

· Skilled Nurse Visit (SNV) Services – Updating the manual page to reflect the correct type of licensure that is required for enrolling as a Home Health Agency.

Provider Basics

· Billing the Recipient – Revised criteria for billing a member for prescriptions.

Hearing Aid Services

· Hearing Aid Services Codes – Updated Hearing Aid Services Codes List to reflect added coverage for HCPCS V5020 - Conformity Evaluation, and also added instructions for requesting authorization of FM Systems V5281 and V5282.

· Cochlear Implants – Reactivated HCPCS code L8625 effective Jan 1, 2018. Updated descriptions for HCPCS codes L8618, L8624, and L8691

October 4

Hospital Services

· Inpatient Hospital Authorization – Added Psychiatric Residential Treatment Facility (PRTF) in Admissions Requiring Inpatient Hospital Authorization (IHA). Added definition of Psychiatric Residential Treatment Facility (PRTF).

October 3

Optical Services

· Optical Services – Authorization requirement removed for vision therapy or orthoptics and pleoptics.

· Removed language stating:

· 1) 92071 and 92072 include the supply of contact lens

· 2) Claims for contact lenses for the same date of service will be denied.

· Removed the two year stipulation regarding replacement eyeglasses. Replacement eyeglasses can be given when one of the listed medical necessities are met.

October 2

Provider Basics

· Enrollment with Minnesota Health Care Programs (MHCP) – Added transportation to provider list. Changed Optometrist to Optical and added all optical providers in this category.

September 14

Pharmacy Services

· Pharmacy Early-Refill Overrides – We combined the controlled and noncontrolled override charts into this one section.

September 10

Dental Services

· Children and Pregnant Women

· Under Oral evaluations took out that prophylaxis can't be done on same day as comprehensive evaluation. This is not a policy change; this information was added inadvertently in the incorrect place.

· Under Orthodontics for children through age 20, added that MHCP covers orthodontic treatment that meets the specifications of utilization criteria for children through age 20.

September 7

Pharmacy Services

· Pharmacy Services – The criteria for refill-too-soon has changed. Added new situations to refill.

Equipment and Supplies

· Mobility Devices – Under Eligible Providers, we removed the requirement of billing K0462 with modifier RR.

September 6

Provider Basics

· Emergency Medical Assistance (EMA) – Added psychiatric residential treatment facility (PRTF) as an approved behavioral health emergency medical condition. Added a section under Requesting Renewal of a Care Plan Certification with provider requirements. Under Noncovered Services, added Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services in conjunction with care in a PRTF.

Provider Basics
Enroll with MHCP

· Home and Community Based Services (HCBS) Programs Provider Enrollment – Revised step 7, H, to include SLS to exception for requirement of general liability insurance.

HCBS Waiver Services

· HCBS Waiver Services – Updated the Covered and Noncovered Services chart by adding bullets for the three different type of Employment Services and linked to the CBSM pages. Also added link to direct Individualized Home Supports, Remote Support - Individualized Home Supports, and Remote Support - Supported Living Services for Adults in Own Home to their CBSM pages. Added an "X" for Personal Support to reflect the service is covered under BI, CAC, and CADI effective July 1, 2018. Added "X" for Adult Companion to reflect the service is covered under CAC waiver effective October 1, 2018.

September 5

Dental Services

· Non-Pregnant Adults – Under Covered Services, we made a correction that D0120 and D0150 can be done on the same day as a prophylaxis and D0140 cannot be done on the same day as a prophylaxis. Added D9239 to covered services.

Anesthesia Services

· Anesthesia Services – A CMS price change of $0.03 increased 2018 rates for modifiers QY, QK, QK GC, and QX. DHS reprocessed claims from Jan. 1, 2018, through July 20, 2018. The adjustments appeared on the August 21, 2018, remittance advice.

Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – DHS will now accept enrollment applications and claims for CMDE clinical trainees. Added language for providers to check the recipient's eligibility monthly prior to submitting for authorization. Added link to Authorization section under Provider Basics in the MHCP Provider Manual under Eligible Providers. Added update to billing for telemedicine services. Added links to new brochures under Additional Resources.

August 24

Mental Health Services

· Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM) – The MHCP Provider Manual pages for adult and children's mental health targeted case management (AMH-TCM and CMH-TCM) have merged to form one resource for mental health targeted case management information.

August 20

Individualized Education Program (IEP) Services

· Personal Care Assistance (PCA) Services – Moved information about the PCA knowledge of emergency procedures and documentation from plan of care to Required Training. Removed old plan of care text and revised to clarify what information is required in a PCA Plan of Care. Added information about the plan of care that may be in the IEP or IFSP or a separate document. Also included an example of the level of documentation needed for a PCA Plan of Care.

August 14

Community Health Worker (CHW)

· Community Health Worker (CHW) – Updated Billing section to include groups larger than 8.

July 27

Mental Health Services

· We added a new section for Psychiatric Residential Treatment Facilities (PRTF). PRTFs are a new, high intensity residential treatment benefit for recipients under 21 years old in need of, and appropriate for receiving mental health service from a PRTF.

Hospital Services

· Outpatient Hospital Services – Physician's order for observation must be part of the recipient's records. Deleted outdated information about the Pay-for-Performance program.

July 26

Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit grid – We added billing instructions for CMDE clinical trainee. Also added procedure code time instructions for billing 15 and 30 minute units.

July 25

Provider Basics
Billing Policy (Overview)

· Medicare and Other Insurance – Added explanation of calculation for claims for members who are dually eligible in the Medicare B Crossover Claim Payment section. Added directions for billing different procedure codes to MHCP than codes billed to the primary insurer.

July 23

Provider Basics
Programs and Services

· MHCP Benefits at-a-glance – Updated wording referencing transportation services for both non-ambulance and ambulance transports. Non-ambulance transports adjustment include removal of the references to "access/common carrier" and "STS" transport types which are no longer proper descriptions of the service coordinated by the local county/tribal local agencies or MHCP enrolled providers.

July 9

· Clinic Services – We made the following update to the MHCP Provider Manual Clinic Services section: on the "Billing for PHNC Services" table, we changed the billing unit for Nursing Care code S9123 from one hour to one visit and added guidance to use the U8 modifier when billing evidence-based home visits.

Mental Health Services

· Intensive Treatment in Foster Care – We updated the Billing section to advice providers to bill in MN–ITS using 837P claims.

July 2

Moving Home Minnesota

· Moving Home Minnesota Demonstration and Supplemental Services Table – Updated the row for Supported Employment Services with end date of 8/31/18, for the 15 minutes procedure code.

June 29

· Provider Requirements – Moved content specifically for enrolling as an MHCP provider out of this manual section to a new sections for each provider type. Refer to Enrollment with Minnesota Health Care Programs.

· Moved content about excluded providers and checking the federal and state exclusions lists to a new section: Excluded Provider Lists.

· Added a section about the requirements for Nondiscrimination. All MHCP enrolled providers must post a notice of nondiscrimination practices. This explains where to post the notice and what it must include.

· Revised language under Health Service Records for Specific Providers under Medical equipment and supplies about maintaining records to clarify that physician's order or prescription may be photocopy or fax image, electronic, or original "pen and ink" documents.

June 22

· Mental Health Services – We added a paragraph about the requirement of mental health services outcome reporting in the Mental Health Information System (MHIS) and the Children's Mental Health Outcome Reporting System.

June 19

Equipment and Supplies

· Mobility Devices – Under Eligible Providers, TPL and Medicare, we added that Medicare does not cover wheelchair transit systems or tie downs, transport brackets, or similar wheelchair accessories. Providers may bill MHCP directly for these accessories that are part of a covered wheelchair. Follow MHCP authorization requirements. When billing, include an attachment that clearly states "wheelchair transportation accessory not covered by Medicare." MHCP does not cover accessories that are modifications to a vehicle.

June 13

Equipment and Supplies

· Patient Lifts and Seat Lift Mechanisms – We added that rental or purchase of electric patient lifts (E0635) now require prior authorization.

June 6

Provider Basics
Programs and Services
Emergency Medical Assistance (EMA)

· Kidney Transplant Services – We clarified that the transplant facility must be Medicare-certified.

June 1

Equipment and Supplies

· Nutritional Products and Related Supplies – We updated language to comply with a 2016 legislative change that allows pricing by report for enteral nutritional products. Also, clarified what documentation is required for authorization of food thickeners.

May 31

Individualized Education Program (IEP) Services

· IEP Billing and Authorization Requirements – Clarified requirements to bill evaluations when providing the face-to-face assessment for an evaluation. Use place of service 02, and modifier GT in addition to the assigned U1 - U5 modifiers.

PCA Services

· Personal Care Assistance (PCA) Services – We removed language to clarify that PCA agencies do not require licensure through the Minnesota Department of Health.

May 30

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Providers enrolling at QSP, Level I and Level II will need to obtain an NPI number from the NPPES website. Also, added process for CMDE clinical trainees to enroll.

HCBS Waiver Services

· HCBS Waiver Services – We added employment services, individualized home supports, and remote support onto the Covered/Noncovered Services chart.

Mental Health

· Mental Health Medication Management – We are deleting this section because the information can be found in other sections of the MHCP Provider Manual. Specifically, you can find the information in the following sections: Mental Health Services; Evaluation and Management Services; and Physician Consultation, Evaluation and Management.

May 23

Equipment and Supplies

· Orthopedic and Therapeutic Footwear – We updated this section with the following:

· MHCP now covers three pairs of therapeutic inserts including codes A5512, A5513, K0903 in a calendar year without authorization. Two pairs of inserts under code A5510 are still covered without authorization. Authorization for therapeutic footwear is required only when a third pair or subsequent pair of therapeutic shoes, a third pair or subsequent pair of inserts under code A5510, or a fourth pair or subsequent pair of inserts (A5512, A5513, K0903) is required in any calendar year.

· MHCP covers two pairs of orthopedic shoes and two pairs of inserts in a calendar year without authorization. Authorization for orthopedic footwear is required only when a third pair or subsequent pair of orthopedic shoes or a third pair or subsequent pair of inserts is required in any calendar year.

Provider Basics

· Authorization – Authorization requests for EIDBI will follow the same rules for home care authorization requests, that is, EIDBI providers will no longer need to send primary insurance information to KEPRO to receive an authorization. Added individual treatment plan (ITP) progress monitoring under EIDBI as a service requiring KEPRO authorization.

May 22

Elderly Waiver (EW) and Alternative Care (AC)

· Elderly Waiver (EW) and Alternative Care (AC) Program – We added links to the Community-Based Services Manual (CBSM) for the following services in the Covered Services section: Customized Living, Nutrition Services and Personal Emergency Response Systems (PERS).

Provider Basics
Provider Requirements

· Access Services – Updated the Spoken Language Interpreters subsection to clarify this is referring to face-to-face spoken language interpreters who must be on the MDH Spoken Language Interpreter Roster.

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – In the Documentation section, added that documentation must include the provider's NPI or UMPI number. Deleted that information must be recorded on a trip sheet.

May 18

Housing Support Supplemental Services

· Housing Support Supplemental Services – We clarified that a copy of the signed Housing Support Agreement with the lead agency is a required form for enrollment with MHCP.

May 16

Mental Health Services

· Intensive Residential Treatment Services (IRTS) – We added information to the Billing section advising providers not to bill for the date of discharge.

Provider Basics
Programs and Services

· Health Care Programs and Services Overview – Added information about how spenddowns work when a member eligible for Medical Assistance is enrolled in a managed care plan.

May 15

Essential Community Supports (ECS)

· Essential Community Supports (ECS) – Updated the link for Community Living Assistance (CLA) in the Overview and Covered Services sections to direct users to that information in the Community-Based Services Manual (CBSM).

· The policy content for Community Living Assistance (CLA) has moved to the Community-Based Services Manual (CBSM). Refer to the CBSM for CLA information.

May 11

Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – We made changes to clarify a person's eligibility for the EIDBI benefit, and to direct new providers to contact KEPRO to alert them of their NPI. Also made an update because EIDBI providers no longer need to submit other insurance information to KEPRO when asking for a service authorization.

May 10

Housing Support Supplemental Services

· Housing Support Supplemental Services – Updated this manual section title from Group-Residential-Housing-(GRH)-Supplemental-Services to Housing Support Supplemental Services. The text was clarified through-out manual. New section was added for approved supplemental service diagnosis codes to be used on all claims submission.

May 9

Individualized Education Program (IEP) Services

· Record Keeping and Documentation – We added information to clarify co-treatment of OT, PT and SLP services. Also clarified co-treatment for PCA service or nursing service when it is necessary to have two providers assist with the same service.

Physician and Professional Services

· Physician and Professional Services:

· Deleted reference to Pay-for-Performance program; this program has ended

· Billing Telemedicine Services: Deleted GT as a modifier when billing for telemedicine services; GT is no longer required as of April 1, 2018. Clarified that place of service 02 certifies that you are providing services to a patient via audio and visual telecommunications.

· Updated the definition of Advanced Practice Registered Nurse (APRN) according to Minnesota Statutes.

· Under Physician Assistants, deleted nurse practitioners as noncovered – nurse practitioners are allowed as assistants at surgery.

· Added correctional facility-based office as an originating site for Telemedicine

May 8

Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit grid – As of April 1, 2018, providers will no longer need a GT modifier on claims when billing for telehealth services. Providers will bill telehealth services using place of service (POS) 02 on the claim lines.

May 1

· Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project – We added the CCBHC provider webpage link in the Overview section.

Transportation Services

· Nonemergency Medical Transportation (NEMT) Services (Overview) – We made updates to better differentiate modes of transportation. Also, removed MnDOT variance since MnDOT no longer offers variances and updated documentation requirement information for transports.

April 30

Mental Health Services

· Adult Rehabilitative Mental Health Services (ARMHS) – We updated the Eligible Providers section to omit the word "professional" because not all providers listed qualify as mental health professionals.

Provider Basics
Billing Policy (Overview)

· Payment Methodology – Non-Hospital – We revised the following subsections:

· Updated information under Rate Variations and Legislative Changes for the legislative ratable add-ons July 2015 through January 2018

· Added and clarified under Equipment and Supplies about the following:

· 50th percentile of the usual and customary charges submitted for the code for the previous two calendar years minus 20 percent, plus current calendar year Medicare inflation factors for the medical supply or equipment

· Prosthetics and orthotics payment information

· Enteral products information

· Revised the Mental health subsection to clarify the payment methodology for mental health services.

April 27

Transportation Services

· Protected Transportation Services – Deleted outdated information under Eligible Recipients regarding recipients enrolled in Medica. Added that a licensed health care practitioner can identify a recipient in need of a protected transport.

April 26

Rehabilitative Services

· Rehabilitative Services Procedure Codes – We updated CPT therapy codes revised for Jan. 1, 2018.

Transportation Services

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates – For clarification and consistency, changed explanation of modifier to "origination and destination identifier" in the table. This is just a name change; it does not change the actual modifier used.

· Made minor clarifications in the description column.

· Added a link to the assisted transport (mode 4) billing information.

April 24

Individualized Education Program (IEP) Services

· IEP Providers – Added email link for new contact person, Janelle Beeken, for the Provider Contact list.

· MHCP Eligible Children – Removed Major Program LL from list of programs that cover IEP services.

April 18

· Nursing Facilities – We made several clarifications in the section.

· A new information was added about the case mix file. Under Billing Guidelines, added new paragraph titled Exceptions for Prepaid Health Plans. In Rehabilitative Services, removed following paragraph:

· Note: The provider that bills for and receives payment for services is responsible for the accuracy of the claims and for maintaining patient records that fully disclose the extent of the benefits provided. Also, if Medicare requires the nursing facility to do the billing for Medicare covered rehabilitative services for dually eligible recipients; you must follow Medicare's requirements until Medicare benefits are exhausted.

· Under Billing Guidelines, added link to MN–ITS User Manual for instructions on completing Long Term Care claims.

Transportation Services

· Access Services Ancillary to Transportation – Updated the list of MNET counties for NEMT and ancillary service coordination.

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services

· Clarified that fee for service recipients have to contact their county of residence for policies and procedures regarding NEMT modes 1 - 4.

· Moved mode 4 - assisted transport information from state-administered NEMT page to the local county or tribal agency NEMT page

· Added Pine County to the list of counties contracted with MNET.

· Removed information about MnDOT variances; MnDOT no longer issues variances

· Added information about recipients residing in a nursing facility

· Added trip documentation requirements

· Removed rate information. This information is in the Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information section

· State-Administered NEMT – Removed references to mode 4 unassisted transportation and moved them to the county tribe transportation page as mode 4 is administered by the counties and tribes not the state.

April 4

Equipment and Supplies

· Urological and Bowel Supplies – We changed the name of this section to Urological and Bowel Supplies and added coverage information for the anal irrigation system and accessory unit.

· We added information under Indwelling Catheters or Insertion Trays about documentation of medical necessity (such as recurrent encrustation, inability to pass a straight catheter, or sensitivity to latex) for a specialty catheter (A4340) or a silicone catheter (A4312, A4315, A4344) that is now required.

· We clarified that authorization is always required for code A4459 and accessory units under code A9999 and to use modifier NU when billing these codes.

March 28

Equipment and Supplies

· In the Mobility Devices section, under Wheelchairs in Long Term Care Facilities, we deleted the requirement that documentation must demonstrate absence of a progressive condition.

March 27

Provider Basics

· Authorization – Deleted the "MHCP" section on this page that listed forms specific to program HH and home care. You can find the following forms on the Program HH (HIV/AIDS) Covered Services section of the Provider Manual:

· Nutritional Supplemental Authorization Request Form - Program HH (DHS-5849) (PDF)

· Greater Minnesota Meal Program Referral Form-Program HH (DHS-6348) (PDF)

· Medication Therapy Management Services (MTMS) Authorization Form (DHS-6246) (PDF)

You can find the Service Agreement Quick Reference Guide through the link in several places where it is most appropriate within the Provider Manual.

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information

· Under Personal and Volunteer Driver Mileage clarified that reimbursement is up to 100 percent of the IRS business deduction rate in place on date of service.

· Under Rural Urban Community Area (RUCA) clarified that if the claim service line has 51 or more miles on it RUCA would not apply.

March 21

Child and Teen Checkups (C&TC) – We made the following revisions and updates in this section:

· Identified the six screening components from the Oct. 1, 2017, C&TC Periodicity Schedule that are not required to be implemented until March 1, 2018. These components are:

1. Weight for length percentile, under physical growth and measurement component

2. Social determinants of health, under the health history component

3. Human immunodeficiency virus (HIV) screening lab test

4. Near visual accuity (plus lens) screen ng beginning at age 5, under vision screening component

5. Addition of 6000Hz at 20 dB screening for age 11 and over, under hearing screening component

6. Dyslipidemia risk assessment for children at ages indicated on the Periodicity Schedule

· Changed that C&TC program staff provide outreach communications and assistance to families of children younger than age 20, to families of children younger than age 11 requiring further evaluation, diagnosis and treatment for a condition identified during the C&TC screening visit.

· Added a new Laboratory Tests or Risk Assessment subsection with billing information details about documenting in the medical record the required lab test results or the reason a required lab test was not done.

· Added a Hematocrit or hemoglobin subsection.

· Clarified language in the Sexually transmitted infection (STI) risk assessment and human immunodeficiency virus (HIV) screening lab test subsection regarding confidentiality and documentation of this required screening component, including the reason, if the HIV blood test was not done.

· Under Screening exceptions, claim guideline exceptions table, we made the following changes in the Exception Reason and Situations:

· From "Condition already identified," deleted the exception for an adolescent already diagnosed with HIV from

· From "Screening recently provided" :

· Deleted lead screening was performed at a different agency

· Clarified hearing or vision screening

· Deleted HIV screening performed at a different agency

· Added information about mental health screening recently performed

· From "Parent or young adult," deleted HIV screening offered but youth declined the test

· In Two-character HIPAA-Compliant Referral Condition Codes and Definitions we removed "not including dental referrals" from the ST (new diagnosis or treatment service requested) instructions.

Hospital Services

· Hospital In-reach Service Coordination (IRSC) – We deleted the subsection "Past Timely Filing." IRSC claims are to be submitted within the same timelines as any other claim type. For information on timely filing of a claim see Provider Basics, Billing (Overview), Timely Filing section.

March 20

Optical Services – Changed the name of the eyeglasses and vision services section in the provider manual to Optical Services.

March 19

Hospital Services

· Critical Access Hospital (CAH) Services – We removed the Critical Access Hospital Rates - Fee-for-Service form (DHS-3786) and added a link to the payment methodology for critical access hospitals webpage for rate information.

March 16

Physician and Professional Services

· We deleted the Pay-for-Performance Program (p4p) section from the MHCP Provider Manual. This program has not been active since 2011.

March 8

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Grid – We added that EIDBI providers who are billing for telemedicine services are to continue using the GT modifier, as well as selecting POS (place of service) 02 to their claim lines.

Medication Therapy Management Services (MTMS)

· Medication Therapy Management Services (MTMS) – Added the provider must submit the Provider Assurance Statement for Telemedicine before billing MHCP.

Mental Health Services

· Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) – We updated the following information:

· Treatment plan must include measurable goals for stage one DBT treatment and must be updated every 90 days.

· A one-time authorization for up to an additional 78 units for prolonged exposure protocol has been added to the billing table.

March 7

Mental Health Services

· Adult Rehabilitative Mental Health Services (ARMHS) – We added a link to the ARMHS policy page in the Eligible Provider section.

March 3

· Acupuncture Services – Effective January 1, 2018, the 20 allowed acupuncture units will be based on a calendar year, rather than on an annual basis.

February 28

Hearing Aid Services

· Hearing Aid Services Codes

· Updated code descriptions of the following:

· V5100, V5110, V5267, V5274, V5011

· Renamed the last column to "Notes" to include general additional information about some codes and made these revisions:

· Deleted obsolete information

· Listed specific items that require authorization

· Added the following:

· V5274 requires a description; use only when a more appropriate code is not available

· Contracted CROS/BiCROS systems include a compatible hearing aid

· Authorization and billing information about certain assistive listening devices/FM systems and components

· Limits on standard batteries

· V5267 must be used for rechargeable batteries

· Details for use of repair code V5014

February 13

Physician and Professional Services – Clarified in NDC Reporting of Outpatient Physician-Administered Compound Drug subsection that multiple service lines are necessary.

Added public health nursing organization to eligible providers for telemedicine.

Under Transplant Services:

· Clarified eligible providers and moved stem cell information to the Stem Cell Transplant Coverage subsection.

· In Eligible Recipients, clarified that people enrolled in emergency Medical Assistance are eligible for kidney transplants when the transplant is approved thorough an EMA Care Plan Certification, but EMA does not cover any other organ transplants.

· Clarified other transplant coverage as required to be performed in a Medicare certified transplant facility.

February 12

Equipment and Supplies

· Hospital Beds – Changed "safety beds" to "enclosed beds."

February 9

Dental Services

· Children and Pregnant Women – Services performed in a school or Head Start program are considered house calls. House calls or extended-care facility calls can only be billed for on-sight delivery of covered services.

· Non-Pregnant Adults – Under Covered Services, the following codes were discontinued and replaced with new codes effective January 1, 2018:

· D5510 (replaced with D5511 and D5512)

· D5610 (replaced with D5611 and D5612)

· D5620 (replaced with D5621 and D5622)

February 7

Provider Basics
Programs and Services

· Health Care Programs and Services Overview

· Revised program descriptions in the major program codes chart to reflect current coverage groups in each program.

· Revised description of automatic newborn coverage to indicate the exact programs the policy applies to.

· Revised description of spenddowns to indicate the exact programs the policy applies to.

February 6

Anesthesia Services – Added the 2018 anesthesia rates chart.

February 2

Individualized Education Program (IEP) Services

· Record Keeping and Documentation – We clarified under the Service Time and Encounters section that when two providers are working with the same child at the same time, report only the face-to-face time providing services to the child. Overlapping time or waiting while the other provider is working with the child is considered indirect time.

February 1

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information – We updated the local agency volunteer and licensed foster parent rates for 2018.

January 2018

01-31-2018
Addition(s)/Revisions

Individualized Education Program (IEP) Services

· IEP Rates and Payments – We removed information about coverage for IEP evaluations, re-evaluations and assessments under the Reporting Cost Data – District Responsibilities section, and inserted a link to that information under Covered and Noncovered Services in the IEP Services Manual.

01-30-2018
Addition(s)/Revisions

Provider Basics
Billing Policy (Overview)

· Billing the Recipient – Added table for 2018 copays and family deductible and updated throughout that the family deductible increased to $3.15 effective Jan. 1, 2018.

Equipment and Supplies

· Under Covered Services, we added information on the 21st Century Cures Act effective January 1, 2018, regarding the Medicare upper payment limit for MHCP durable medical equipment.

· Under Miscellaneous Products, Sharps Disposal Containers, we added that an attachment is required for Medicare claims.

· Under Billing and Documentation, Add-ons and Upgrades, current language stated the provider cannot bill the member for the difference of the covered equipment and the upgraded equipment. We clarified that the provider cannot bill the member or accept payment on behalf of the member for the difference between the covered equipment and the upgraded equipment.

· Hospital Beds

· Under Fixed height manual hospital beds, protection from serious injury has been added as a criteria for coverage.

· Under Bariatric, extra-duty, extra wide hospital beds, the following language has been added:

· Coverage may be considered for members with daily seizure activity, uncontrolled movement disorder, or a medically necessary condition putting the member at significant risk for injury in a standard bed. Requests for a manual, semi-electric, or total electric bed must meet the criteria for the type of hospital bed requested.

· Under Pediatric hospital beds, pediatric-sized hospital beds have been defined with footboard and side rails up to 24 inches above the spring.

· Bed Enclosure and enclosed beds have been replaced with Safety Beds. The requirement of unrestricted mobility resulting in documented injuries sustained as a result of wandering unsupervised has been removed and replaced with unrestricted mobility demonstrates significant risk for serious injury, not just possibility of injury.

· Under Authorization, documentation requirements for requests for bariatric/heavy duty hospital beds, has been added for members with daily seizures, uncontrolled movement disorder, or a medically necessary condition.

· Seasonal Affective Disorder (SAD) Lights – We clarified that therapeutic light boxes are covered when referred by an MHCP enrolled mental health practitioner. When billing with an approved authorization, enter the physician as the ordering provider.

01-26-2018
Addition(s)/Revisions

Behavioral Health Home Services – We added updates to billing requirement and guidance on billing for other MA-covered services.

Individualized Education Program (IEP) Services

· Record Keeping and Documentation – We added clarification to the start and end times requirement that will be implemented starting February 1, 2018.

Provider Requirements

· Access Services – Under Eligible Providers, we deleted community health workers in the subsection "Ineligible for interpreter services." Interpreter services are now available when receiving community health worker services.

01-25-2018
Addition(s)/Revisions

Hospital Services

· Critical Access Hospital (CAH) Services - We updated the Critical Access Hospital (CAH) manual page with new rebase rate information for CAH services. The updates are made in the following sections:

· Payments beginning with your fiscal year ending in 2017

· Cost-based inpatient payment methodology for CAH

Individualized Education Program (IEP) Services

· Personal Care Assistance (PCA) Services – We clarified and added information about the use of start and end times for PCA services in school and how to document information for time studies.

· Rates and Payments – We added clarification of the new start and end time requirements.

01-23-2018
Addition(s)/Revisions

HCBS Waiver Services – We updated the Covered and Noncovered Services grid to reflect the added services to BI, CAC, CAD, and DD waivers:

· Case management aide (DD)

· Crisis respite (CAC)

· Night supervision (CAC and DD)

· Specialist services (BI, CAC and CADI)

01-19-2018
Addition(s)/Revisions

Community Health Worker (CHW) – Added registered nurse to the list of providers that can supervise a CHW and added language to allow CHWs to enroll using an NPI if they have one under Covered Services.

Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Added updates to Telemedicine section to include enrollment for the mental health practitioner to provide the service. Added section for the mental health professional supervisor to enroll in order to supervise a clinical trainee completing the CMDE. Clarified language related to enrollment for the provider agency.

Mental Health Services

· Psychotherapy – Under the Billing section we added effective Jan. 1, 2018, psychotherapy add-on code 99354 will be allowed for billing with code 90847 family psychotherapy. Use prolonged service code 99354 with 90847 to report Family Psychotherapy face-to-face with recipient present of 80 minutes or longer. 99354 will count towards the cumulative calendar year threshold of 26 sessions. We also updated individual psychotherapy code description to match CPT 2017 description and with patient or family present was removed.

01-12-2018
Addition(s)/Revisions

Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – We made the following changes to the section:

· Updated link to EIDBI state plan under Legal References.

· Added clarification on the authorization requirements for the initial ITP, CMDE and coordinated care conference under the Service Authorization section.

· Added language under Billing that DHS will not accept claims for services rendered by a clinical trainee at this time but enrollment applications will be accepted.

· Updated requirement for Level III providers to include their UMPI number for all services rendered on the claim under the Submitting Claims section.

· Added information about providers being required to have a MN-ITS username and password to log in to CMDE and ITP forms under the Submitting Claims section.

Equipment and Supplies

· Oxygen Contract Regions and Price Schedule (PDF) – Updated pricing for the 2018 oxygen contract.

Immunizations & Vaccinations – We added effective for service dates on or after January 1, 2018, the base rate for vaccine administration is the lower of the provider's submitted charge or the Resource Base Relative Value Scale (RBRVS) rate under the Administering Vaccines – Billing and Payments section.

01-10-2018
Addition(s)/Revisions

Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Grid – We added that all service limits apply to the recipient. Also, we revised language under ITP to be one initial ITP every three years without authorization.

01-04-2018
Addition(s)/Revisions

Moving Home Minnesota (MHM) – We updated the Disability Linkage name to Disability Hub MN under MHM Recipient Enrollment.

01-02-2018
Addition(s)/Revisions

Equipment and Supplies

· Oxygen Equipment – Removed authorization requirements for oxygen equipment. Added new coverage policy for portable concentrators, home liquefier systems, home compressor systems, and portable equipment for recipients with stationary concentrators.

Previous Revisions

2017 Manual Revisions
2016 Manual Revisions
2015 Manual Revisions
2014 Manual Revisions
2013 Manual Revisions
2012 Manual Revisions
2011 Manual Revisions

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