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MHCP Provider Manual

2019 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, 2019

Equipment and Supplies

· Incontinence Products

· Under Coverage Criteria in Covered Services, we limit underpads to 200 per month unless prior authorization is obtained.

· Under Covered Services, we show tables for dates of service beginning Jan. 1, 2020 and dates of service before Jan. 1, 2020.

· Under Covered Services, we updated product combination tables to remove the word "primarily" for clarity.

· Under Covered Services, we added protective underwear or pull-on to the list of products in the second row of Table 4 and updated the codes.

· Under Noncovered Services, we added swim diapers.

December 26

Equipment and Supplies

· Ambulatory Assist Equipment

· Under Overview, we added information about canes, crutches and walkers to clarify ambulatory assist equipment.

· Under Eligible Recipients, we clarified wording that MHCP members who meet medical necessity criteria are eligible.

· Under Covered Services, we updated wording and added a section on crutch substitutes (E0118). We clarified that pediatric walkers should be billed with most appropriate HCPCS code. Reverse walkers do not have a specific code and should now be billed with E1399. We updated wording for gait trainer documentation requirements.

· Under Noncovered Services, we clarified standers in combination with a gait trainer are not covered. This is not a policy change, it has always been documented on the stander page.

· Under Authorization, we removed wording for authorization for walkers that exceed the fee schedule rate as it is no longer allowed to exceed the fee schedule rate.

· Under Billing, we explained to not use a miscellaneous code regardless of special features or weight capacity unless specifically listed in this policy.

December 23

Immunizations & Vaccinations

· Immunizations & Vaccinations – Incorrect ages were listed for influenza under Seasonal Influenza Vaccines.

December 20

Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· Under Overview, we clarified that services offer medically necessary treatment to people under the age of 21 on Medical Assistance (MA) with autism spectrum disorder (ASD) or related conditions.

· Under Responsibilities, we clarified that the provider has 15 business days to upload the requested information or make the requested changes if KEPRO pends the case in the Atrezzo portal and requests additional information.

December 18, 2019

Provider Basics

· Billing Policy (Overview)

· Under Free-Care Policy removed the following paragraph: For dates of service before Dec. 15, 2014, MHCP takes into account all resources available to recipients including free services. CMS' “free care" policy does not reimburse providers for service they give to Medicaid recipients if the same services are offered for free to non-Medicaid patients.

· Under Eligibility Requests and Responses: Removed the limit of 50 for verifying ID numbers or dates of service up to one year before date of inquiry.

· Under Void Claims: Changed “void Waiver and Alternative Care (AC) Services Claims" to Void (“Take-Back") Waiver and Alternative Care (AC) Services Claims for Fee-for-Service.

· Under Legal References: Changed Minnesota Statues, 2256B.0915, subd 3a(c) to 256S.18 (elderly waiver cost limits)

December 17

Renal Dialysis

· Renal Dialysis Overview

· Under Eligible Recipients we clarified that all MHCP members are eligible to received renal dialysis and related services for end stage renal disease.

· We also clarified under the subheading "Exceptions" that members who are eligible for only acute and maintenance dialysis do not need to apply for Medicare.

· Under Payment Limitations, we corrected "Epoetin" to "Erythropoietin."

December 11

Community Emergency Medical Technician (CEMT) Services

· Community Emergency Medical Technician (CEMT) Services – Added "Eight minutes of a unit must be used in order to bill the unit" under Billing section.

November 27, 2019

HCBS Waiver Services

· HCBS Waiver Services

· Updated the name Behavioral Support to Positive Support on the covered/noncovered services chart and moved the service name to go along with the alphabetical order.

· Added "X" to indicate Positive Support service is a covered service under the DD waiver program.

· Removed the following discontinued services from the covered/noncovered services chart: Supported Employment Services and Residential Care Service

November 26

Equipment and Supplies

· Gloves

· Under Overview, we clarified the definitions of non-sterile and sterile gloves.

· Under Covered Services, we moved wording from the Documentation section to the Coverage Criteria section and added clarifying language explaining conditions non-sterile and sterile gloves are covered.

· Under Noncovered Services, we clarified gloves used for routine hygiene and incontinence are not covered and that non-sterile or sterile gloves for members living in nursing facilities or intermediate care facilities are not covered but included in the per diem.

· Under Billing, we added language to use MN-ITS 837P or X12 Batch. We also clarified shipping and delivery costs are included in the MHCP maximum allowable payment.

· Incontinence Products

· Under Covered Services, we updated policy to state that any underpad product could be covered with medical necessity. Also, in Table, 1, Table 2, Table 3 and Table 4, quantity limits have been updated to reflect new product combinations and quantity limits.

· Under Noncovered Services, we removed small and chair-size underpads. They will be covered if medically necessary.

· Under Authorization, we updated to include need for modifier 76 to be used when authorization has been given for excess quantities.

· Under Billing and Documentation, we updated billing for T4535 to include modifiers U1 for light incontinence products, U2 for moderate and U3 for heavy. We also clarified that when billing one size apart, bill sizes on different dates but adhere to the quantity limits unless prior authorization is obtained.

November 22

Tribal and Federal Indian Health Services

· Tribal and Federal Indian Health Services – We updated the Examples of programs, facility type and applicable rate chart. Per the Health and Human Services Omnibus bill effective July 1, 2019, MHCP will no longer make IHS encounter payments for MinnesotaCare major programs FF (Parents) and LL (Citizen Kids).

November 15

Mental Health Services

· Explanation of Findings

· Under Overview, we added: The service is provided to members, the member’s family and caregivers or to others to help them better understand the member’s illness and provide professional insight needed to carry out a treatment plan.

· Under Eligible Providers we added a link to the Clinical Supervision of Outpatient Mental Health Services manual page.

· Under Covered Services we added: The mental health professional or mental health practitioner working as a clinical trainee providing the explanation of findings is required to obtain authorization from the client or the client's representative prior to release of information.

November 12

Mental Health Services

· Partial Hospitalization Program

· We clarified the Eligible Providers section to state providers must be a Medicare certified outpatient hospital facility or a community mental health center.

· Under Eligible Recipients, we added:

· Members must have the ability to participate in treatment

· Members must have completed a CASII and SDQ for children 6 years old and older

· Members must have completed an ECSII and SDQ for children 5 years old and younger

· Under Authorization Requirements, we removed Medicare guidelines requiring physician certification by the 18th day and we created an Authorization Requirements for Concurrent Services subsection from existing authorization requirements and new authorization requirements for provider partial hospitalization and residential crisis stabilization services.

· Under Billing, we added "Report the attending provider as the physician who has overall responsibility for the patient's medical care and treatment" and added a procedure code chart.

November 6

Immunizations & Vaccinations

· Immunizations & Vaccinations

· Created a separate section for information about the Department of Health's Minnesota Vaccine for Children (MnVFC) program.

· Added dental providers and community paramedics to Eligible Providers.

· Clarified information about pharmacies billing for vaccines under Pharmacies.

· Added section on Community Paramedics.

· Added “Immunizations administered concurrently with services for the treatment of emergency medical conditions" under Noncovered Services.

· Removed gender from HPV vaccine in Vaccines and Toxoids Quick Reference table.

· Updated statutes and links under Legal References.

October 31, 2019

Dental Services

· Advanced Dental Therapist (ADT) – Updated title of legal reference: Limited Authorization for Dental Hygienists to Collaborative Practice Dental Hygienists.

Ambulatory Surgical Centers

· Ambulatory Surgical Centers

· Clarified the description of Ambulatory Surgical Centers in Overview.

· Removed Provider Type Home Page Links.

· Clarified language under Eligible Recipients.

October 29

Equipment and Supplies

· Bath and Toilet Equipment

· In the Commodes section under Covered Services, we removed the authorization requirement.

· In the Rehab Shower and Toileting Systems section under Covered Services, we clarified E1399 may be used when the equipment will not be used for bath or shower.

· In the Bath Lift Equipment section under Covered Services, we eliminated the use of the U3 modifier for product-specific pricing.

· Under Billing, we eliminated the use of the U3 modifier for product-specific pricing for commodes.

October 28

Individualized Education Program (IEP) Services

· IEP Billing and Authorization Requirements

· Under IEP Procedure Codes, Modifiers and Units, removed the table for Health-related coding scheme for services prior to Nov. 1, 2018.

· Under Using a Date Span, deleted modifiers 76 and 77, which were replaced with modifiers XE and XP effective Nov. 1, 2018.

Equipment and Supplies

· Patient Lifts and Seat Lift Mechanisms

· Under Authorization, we removed the authorization requirement for electric patient lifts.

· Under Billing, we explained that electric patient lifts dispensed before July 1, 2019, are priced by report.

October 22

Provider Basics
Enroll with MHCP

· Enrollment with Minnesota Health Care Programs (MHCP) – Adding information about how to enroll with MHCP using the Minnesota Provider Screening and Enrollment (MPSE) portal.

October 21

Mental Health Services

· Children’s Mental Health Crisis Response Services

· Under Billing for Children's Crisis Response Services, we replaced code S9484 with H2011, added Service Descriptions, updated Units and added Additional Requirements to the Child Crisis Service Billing chart.

· Under Eligible Providers in the Enrollable Mental Health Agencies heading, we updated the requirements for MHCP Mental Health Practitioners.

Equipment and Supplies

· Transcutaneous Electrical Nerve Stimulator (TENS)

· Under Overview, we clarified a transcutaneous electrical nerve stimulator.

· Under Eligible Providers, we list Federally qualified health centers, Home health agencies, Hospitals, Indian Health Services, Medical Suppliers and Rural health clinics.

· Under Covered Services, we explained coverage for acute and chronic pain and we explained covered TENS supplies.

· Under Noncovered Services, we explained anything not listed under Covered Services is not covered.

· Under Authorization, we removed prior authorization for TENS units and explained authorization is required for conductive garments.

· Under Billing, we explained payments for rentals and Medicare deductibles.

October 18

Equipment and Supplies

· Diabetic Equipment & Supplies

· We introduced new policy regarding Adjunctive and Therapeutic Continuous Blood Glucose Monitoring (CGM) in this manual section.

· In the Continuous Blood Glucose Monitoring section under Covered Services, we differentiate between adjunctive and therapeutic CGM.

· We list the codes to be used for adjunctive CGM and therapeutic CGM.

· We clarify authorization is required for both adjunctive and therapeutic CGM equipment.

· We explain the difference between Class II and Class III therapeutic CGM devices.

· We list quantity limits for CGM equipment and supplies.

· In the Insulin Syringes section under Covered Services, we removed the authorization requirement and changed quantity limits for insulin syringes to 300 per month.

· Under Covered Services, we removed authorization requirements for reusable insulin pens.

· In the Ambulatory Insulin Infusion Pumps section under Covered Services, we removed the authorization requirement for ambulatory insulin infusion pumps.

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP) Procedure Codes – Reminder: The Minnesota Family Planning Procedure Codes lists four codes for the Zika virus detection and treatment: 87662, J1726, J7296, with J0565 requiring a prior authorization.

October 17

Pharmacy Services

· Pharmacy Services – Deleted "unless the pharmacy is using unit dose dispensing" under Pharmacy Service Limitations.

October 15

Pharmacy Services

· Point of Sale Diabetic Testing Supply Program

· Added new preferred blood glucose monitors and test strips and deleted NDC's that are no longer preferred.

· Changed the product limit of blood glucose testing strips from 200 to 100 per 30 days under Preferred Blood Glucose Testing Strips.

· Changed payment rate of the Wholesale Acquisition Cost (WAC) from plus 2% to minus 2% under Payment Rates.

October 14

Mental Health Services

· Adult Day Treatment – Under Eligible Providers, we added a link to the Adult Day Treatment Policy webpage.

October 9

Transportation Services

· Ambulance Transportation Services – Under Billing, we added a Supplemental Payments section explaining supplemental payments are made to statutorily eligible providers for providing services on a fee-for-service bases to Medical Assistance (MA) enrollees.

October 8

Mental Health Services

· Children’s Therapeutic Services and Supports (CTSS)

· Updated information to clarify that H2012 Behavioral Health Day Treatment is a CTSS service. Provider should continue to reference Children's Day Treatment page for guidance.

· In the Children's Therapeutic Services and Supports (CTSS) for children under 21 years old Billing Service grid, H2012 Behavioral Health Day Treatment has been added.

Anesthesia Services

· Anesthesia Services – Under Billing, a Supplemental Payments section was added; it explains supplemental payments are made to statutorily eligible providers who provide services on a fee-for-service bases to Medical Assistance (MA) enrollees.

October 4

Mental Health Services

· Children’s Therapeutic Services and Supports (CTSS)

· Under the CTSS Certification heading in Eligible Providers, we updated the link to provider assurance statement.

· Under the Recertification heading in Eligible Providers, we updated the link to the new recertification application.

· Under the Billing Services Table, H2012 was removed because the service is no longer a part of CTSS services.

Provider Basics
Billing Policy (Overview)

· A Supplemental Payments – Non-Hospital and Hospital section has been created under Billing Policy (Overview) in the Provider Basics section. It explains which service providers may receive supplemental payments, how supplemental payments are regulated and how they are calculated.

Provider Basics
Enroll with MHCP

· Home and Community Based Services (HCBS) Programs Provider Enrollment

· Removed step 1. "Determine which HCBS enrollment record type you are enrolling for by using the Service Combinations Allowed by MHCP for HCBS Waiver (DHS-7947) (PDF)" in both the Enrollment Criteria and Adding Services to Current Enrollment Record sections.

· Added language about submitting enrollment materials using the Minnesota Provider Screening and Enrollment (MPSE) portal.

Pharmacy Services

· The Unit Dose Dispensing section has been deleted.

October 2

Chiropractic Services

· Chiropractic Services

· In the Chiropractic Services chart under Billing, we updated descriptions of codes 98941 and 98942.

· In the X-ray Code chart under Billing, we updated descriptions for codes 72020, 72040, 72050, 72052, 72070, 72074, 72080, 72100, 72110, 72114, 72120, 72170, 72190, 72200, 72202 and 72220. We removed codes 72010 Full Spine, 72069 Thoracolumbar, standing and 72090 Scoliosis Study. We added codes 72081 Entire thoracic and lumbar including skull, cervical and sacral spine, one view, 72082 Entire thoracic and lumbar including skull, cervical and sacral spine, 2 or 3 views, 72083 Entire thoracic and lumbar including skull, cervical and sacral spine, 4 or 5 views, and 72084 Entire thoracic and lumbar including skull, cervical and sacral spine, minimum 6 views.

Mental Health Services

· LOCUS – The link to the Mental Health Policy Manual has been removed.

Child and Teen Checkups (C&TC)

· Child and Teen Checkups (C&TC)

· We updated the anticipatory guidance age ranges in the Health Education and Anticipatory Guidance section under Covered Service - Medical Screenings.

· Under Resources, we updated the link to the C&TC County and Tribe Contact List.

September 30, 2019

Mental Health Services

· Inpatient Visits – Under Billing, we removed the procedures on how to bill for services with date of service before Jan. 1, 2013.

September 24

Provider Basics
Health Care Programs and Services

· MHCP Benefits at-a-glance – In the Minnesota Health Care Programs (MHCP) Benefits at-a-glance chart, we separated major program KK, LL into two columns: KK, LL (Ages 18 or younger) and KK, LL (Ages 19 or 20).

Equipment and Supplies

· Incontinence Products – Under Covered Services, we removed the requirement that underpads be on the MHCP Incontinence Product List. Under Billing and Documentation, we removed U1 and U2 modifiers for billing pads, liners and guards.

September 23

HCBS Waiver Services

· Billing for Waiver and Alternative Care (AC) Program – Added "Common carrier transportation as defined by Minnesota Rules, part 9505.0315, subpart 1, item B, or a publicly operated transit system provider are exempt from this clause." under Waiver Transportation Service additional documentation requirements to clarify an exemption from the preceding text.

September 18

Pharmacy Services

· Pharmacy Services – Deleted the paragraph with information about Phentermine under "Billing" in this section of the manual. Added information under "Payment for Prescribed Drugs" about the National Average Drug Acquisition cost. Added a definition of National Average Drug Acquisition Cost (NADAC) in the "Definitions" section.

September 17

Optical Services

· Optical Services – The explanation under Replacement eyeglasses, Repairs and Noncovered services was updated to more concisely reflect Minnesota Administrative Rule 9505.277. The changes were made to clarify the removal of the two year stipulation regarding replacement eyeglasses on October 3, 2018. Replacement eyeglasses will only be provided when medically necessary or a member's eyeglasses are misplaced, stolen or irreparably damaged.

Equipment and Supplies

· Incontinence Products

· Under Covered Services, we added the following:

· Youth and adult-sized disposable briefs, diapers, protective underwear or pull-ons, liners, shields, guards, pads, and underpads are covered if they are listed on the MHCP Incontinence Product List (PDF).

· Any pediatric-sized product may be covered.

· We updated the tables with product combinations and quantity limits. Product combinations more than one size apart are not permitted.

· Under Noncovered Services, the following products and services are now not covered:

· Resuable underpads

· Small or chair-sized disposable underpads

· Disposable protective underwear or pull-ons, and disposable liners, shields, guards, pads, or undergarments for children under age 4

· Disposable adult- or youth-sized briefs or diapers, protective underwear or pull-ons, liners, shields, guards, pads, or undergarments, or underpads that are not on the MHCP Incontinence Products List when authorization has not been obtained.

· Use of a diaper service for cloth diapers

· Under Authorization, the following changes have been made:

· Only disposable briefs and diapers for members under age 4 are now covered. The first 300 units per month are the patient's responsibility. MHCP will authorize only the quantity that exceeds 300 per month.

· If the member is using a combination of products, documentation must now show all quantities of all products required.

· Authorization is now required for incontinence products that are not on the MHCP Incontinence Products List.

· Under Billing and Documentation, the following changes have been made:

· A new physician's order is now required annually for all incontinence products, regardless of age.

· For code T4535, U1 modifier for moderate products and U2 for heavy products must be used.

· Claim lines for pediatric-sized disposable brief or diaper, or any pediatric-sized disposable protective underwear or pull-on without a product code will now be denied.

· Claim lines for adult- and youth-sized disposable briefs or diapers, disposable protective underwear or pull-ons, disposable liners, shields, guards, pads and undergarments, and disposable underpads must now have a product code that matches a product code from the MHCP Incontinence Products List. Claim lines without a product code that matches the MHCP Incontinence Products List will now be denied unless authorized.

· If authorization is required, the claim must match HCPCS code, modifiers and product code as noted on the authorization letter.

· Providers can now dispense no more than a one month supply.

September 16

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – Under Responsibilities under the Service Authorization heading, we updated:

· The process of how forms will be accessed. Forms that were formerly accessed using a secure log in will no longer require security. Forms will be accessed and then downloaded in a PDF format to upload into the KEPRO Atrezzo portal.

· EIDBI providers will no longer be required to complete the "A week in the Life" form.

· Letter notifications 60 days prior to the renewal date for the individual treatment plan and the comprehensive multi-disciplinary evaluation will no longer be sent.

Mental Health Services

· Adult Crisis Response Services

· Under Eligible Providers, we added a link with MCO contact information.

· Under Billing, we updated the billing code to H2011 from S9484 and changed the unit amount in the chart. We also removed code H0018 from the chart.

· We removed Crisis Stabilization language. This information has been moved to the Residential Crisis Stabilization page of the MHCP Provider Manual.

September 13

Pharmacy Services

· 340B Drug Pricing Program – Removed the MHCP Pharmacy 340B Claim Reimbursement Rates from the Pharmacy Claims Reimbursement section and updated the Medical Claims Reimbursement for Clinician-Administered Drugs section to reflect changes to the 340B program that were passed during the 2019 legislative session.

September 3

Dental Services

· Dental Services (Overview)

· Clarified Overview section.

· Update program title: Limited Authorization for Dental Hygienists to Collaborative Practice Dental Hygienists.

· Removed outdated effective dates under Billing teledentistry services.

· Added Medicare Coverage and Other Insurance Billing section under General Billing Guidelines with D7111 code.

· Updated title of legal reference: Limited Authorization for Dental Hygienists to Collaborative Practice Dental Hygienists.

August 30, 2019

Clinic Services
FQHC and Rural Health Clinics

· Federally Qualified Health Center and Rural Health Clinics – Updated the Billing section.

August 29

Dental Services
Allied Oral Health Professional (Overview)

· Dental Therapist (DT) – Updated title of legal references: Limited Authorization for Dental Hygienists to Collaborative Practice Dental Hygienists.

August 27

Acupuncture Services

· Acupuncture Services – Under Covered Services, we clarified that the provider must document the patient's medical history and exam related to the service provided.

August 26

Chiropractic Services

· Chiropractic Services – Under Noncovered Services, we added Diagnosis for acute and chronic pain to clarify it's a noncovered service.

August 21

Provider Basics
Enroll with MHCP

· Home and Community Based Services (HCBS) Programs Provider Enrollment

· Added step 1 under "Enrollment Criteria" to review the Services Combinations Allowed by MHCP for HCBS Waiver (DHS-7947) (PDF).

· Added under letter L., links to applicant assurance statements: Individualized Home Supports Provider Applicant Assurance Statement (DHS-3747) (PDF), Positive Supports Provider Assurance Statement (DHS-7807) (PDF), and Remote Support-Supported Living Services Provider Applicant Assurance Statement (DHS-7706) (PDF).

· Clarified Background Studies sub-section and removed residential care services as one of the bullets since it is no longer a service.

· Removed the "Processing Timelines, Approval," and "Pended and Denial" sub-sections as this information is already contained in the "Enroll With MHCP" section of the MHCP Manual under "Provider Basics."

HCBS Waiver Services

· Billing for Waiver and Alternative Care (AC) Program – Added the new HCBS documentation requirements passed during the 2019 legislative session in the Home and Community-Based Services (HCBS) Provider Service Documentation Requirements sub-section. Clarified the process of submitting claims in the Submitting Claims sub-section.

Individualized Education Program (IEP) Services

· Updated the Mental Health Services section for CTSS services in a school setting:

· In the Overview section, clarified the definition of CTSS mental health services.

· Clarified the options for CTSS certification.

· In CTSS certification, there's a new CTSS Provider Application and Assurance Statement for the initial application process. In addition, there's a new Intent to Bill for IEP Mental Health Evaluation form for providers who only provide IEP evaluation.

· In the “Evaluations, Reevaluations and Assessments" section, under “Diagnostic Assessments," added a link to the Diagnostic Assessment manual page and added additional DA requirements for CTSS services.

· Added a link to Covered and Noncovered IEP Health-Related Services and allow to Bill IEP evaluations if the evaluation results in the child receiving services or continuing to receive services, or the time spent performing the evaluation even if the service does not result in an IEP.

· Added a link to Minnesota Statues 256B.0943

August 15

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory and Pathology Services – We removed the Authorization Requirements section including the link to the Laboratory Authorization Code List because prior authorization requirement is no longer required for those codes.

August 13

MHCP Member Evidence of Coverage

· MHCP Member Evidence of Coverage – We added an updated version of the MHCP Member ID card and revised MinnesotaCare copay amounts.

August 12

Laboratory/Pathology, Radiology & Diagnostic Services

· We have deleted the Laboratory Authorization Code List from the MHCP Provider Manual. Prior authorization is no longer required for those laboratory procedure codes.

August 9

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – Under Legal References, we added a link to the state plan amendment for Intervention observation and direction to allow a same level provider to observe and direct a same level provider.

Hospital Services

· Inpatient Hospital Services – Clarification to billing for inpatient stays that exceed 180 days has been added.

August 2

Substance Use Disorder Services (SUD)

· Substance Use Disorder Services (SUD) – Under Billing, we added a Billing Freestanding and Residential Program Room-and-board charges for MCO Enrollees subsection that addresses Value Code 24 and rate codes.

August 1

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Under EIDBI Provider Agencies, we clarified the requirement to add QSP to the Ownership and controlling interest form that is a part of enrollment.

Mental Health Services

· Intensive Treatment in Foster Care

· Under Eligible Providers, we added county-operated entities, practice certifications and core services to be delivered.

· Under Provider Responsibilities, we updated service assessment and delivery requirements.

· Under ITFC Certification, we updated certification requirements, removed outdated training information and added orientation and site visits.

· Under Recertification, we updated recertification requirements.

· Under Eligible Members, we updated the age range for eligible members and the diagnostic assessment.

July 22, 2019

Dental Services

· Collaborative Practice Dental Hygienists – Updated title of legal reference: Limited Authorization for Dental Hygienists to Collaborative Practice Dental Hygienists. Updated references to limited authorization dental hygienists to the new terminology: collaborative practice dental hygienists.

July 19

Pharmacy Services

· Pharmacy Services – Deleted (the laws of another state or Canada) under Eligible Providers.

Dental Services

· Allied Oral Health Professional (Overview) – Updated title of legal reference: Limited Authorization for Dental Hygienists to Collaborative Practice Dental Hygienists.

July 18

Provider Basics

· Authorization – Clarified log-in information for accessing the CMDE Medical Necessity Summary Information (DHS-7108) (PDF) and the Individual Treatment Plan and Progress Monitoring (DHS-7109) (PDF) under Early Intensive Developmental and Behavioral Intervention (EIDBI) Authorization Requests.

July 17, 2019

Dental Services

· Critical Access Dental Payment Program (CADPP) – Under the heading "CADPP Dental Practice Designation Request" removed the following text: "DHS does require annual submission of critical access dental encounters from the previous year using the CADPP Encounter Data Request form (DHS-7602) (PDF). Submit the CADPP encounter annually on October 1. DHS will use the data to determine if your status as a CAD provider will continue."

July 12

Provider Basics
Enroll with MHCP

· Rehabilitation Billing Entity Enrollment Criteria and Forms:

· Changed manual page title from "Billing Entity for Physical Rehabilitation Enrollment Criteria and Forms" to "Rehabilitation Billing Entity Enrollment Criteria and Forms"

· Modified first sentence of text to read: " To enroll as a rehabilitation billing entity with Minnesota Health care programs . . ."

· Removed "Chiropractor" from the bulleted list of eligible providers

July 8, 2019

Mental Health Services

· Psychiatric Residential Treatment Facility (PRTF) – Under Services Outside of the Per Diem, we clarified definitions of services outside the per diem and allowable services. Under Authorization Requirements, we have changed authorization periods for new admissions and concurrent reviews in the Referring Provider Responsibility, PRTF Responsibilities and Continued Stay sections. We have added a Third Party Liability and Emergency Medical Assistance section and a Transitions in Coverage section.

July 1

Certified Community Behavioral Health Clinic (CCBHC)

· The Certified Community Behavioral Health Clinic (CCBHC) manual is revised and updated to remove mention of end dates for the federal demonstration.

June 21, 2019

Provider Basics
Enroll with MHCP

· We have created and launched a separate Recovery Community Organizations provider manual webpage to specify enrollment and eligibility requirements following the Minnesota Substance Use Disorder reform enacted by the legislature.

June 19

Individualized Education Program (IEP) Services

· Individual Education Program (IEP) Services Providers – Under the IEP Provider Contact List, we updated the name of the contact person to Kristin Smith for schools to contact to update or change their contact information.

Mental Health Services

· In the Mental Health Diagnostic Code Ranges chart, we removed the F10-F19 code range because those codes are no longer available for use by providers billing for ongoing mental health services.

June 18

Mental Health Services

· Certified Peer Specialist Services – Under Eligible Providers Qualifications, we updated the Certified Peer Specialist criteria to remove the high school diploma requirement. We removed the language that stated a Level II Certified Peer Specialist must complete 76 hours training and the certification information. Please see review the Certified Peer Specialist Policy page for certification requirements.

June 13

Mental Health Services

· Diagnostic Assessment (DA) Report Components

· We revised WHODAS 2.0 information under Functional Status of the DA to explain capturing the member's functional status within the DA is required. Providers must ensure symptom descriptions (at a minimum include the frequency, intensity and impact) are integrated into the diagnostic assessment and that it be included in the clinical summary.

· Additionally, we explained WHODAS 2.0 is still an acceptable method to capture functional status in a diagnostic assessment for adults. The functional status components required for children under 5 years old (ECSII, SDQ) and 5-18 years old (CASII, SDQ) remain the same.

June 12

Mental Health Services

· Intensive Residential Treatment Services (IRTS)

· Under the Eligible IRTS Providers section we removed: Have a contract with the host county agency, which approves the IRTS service. We Added: A statement of Need provided by the local mental health authority or a Need Determination from the DHS Commissioner.

· Under the Covered Services section we removed: Educating about mental illness and treatment including characteristic symptoms and early warning signs of relapse, managing stress and developing relapse prevention plans, developing coping skills and strategies for coping with symptoms, developing social skills to improve effectiveness in interactions across a range of settings and situations, and identifying therapeutic and rehabilitative approaches available to recipients, such as DBT or treatment for OCD

Child and Teen Checkups (C&TC)

· Child and Teen Checkups (C&TC)

· Under Resources, we deleted obsolete resource: DHS C&TC Materials and Ordering Information (DHS-4212A) (PDF)

· Under Oral Health, we changed the word exam to screening under primary care provider requirements.

Provider Basics
Billing Policy

· Payment Methodology – Non-Hospital - Under Payment Methodology - Non-hospital, we added a reference to the 23.7% mental health add-on in the legislative increases section.

June 10

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid – We updated the billing grid to clarify parameters surrounding the new programming and coding for the EIDBI benefit. We removed modifiers and clarified telemedicine language. We also indicated which services can be provided via telemedicine.

June 5

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· Under the table of contents section, we added a link to new EIDBI 101 training.

· Under the Managed Care Organizations section, we added a link to MCO contact information.

· Under the Process heading in the Service Authorization section, we changed the rule to require the ITP to be signed on the same day or after the CDME is signed.

June 3

Mental Health Services

· We updated the Mental Health Diagnostic Code Ranges chart to include allowable unspecified codes and R-Codes.

May 31, 2019

Mental Health Services

· Assertive Community Treatment (ACT) – Under Eligible Providers, we added a link to the Mental Health Certified Peer Specialist MHCP Provider Manual page.

May 24

Mental Health Services

· Certified Family Peer Specialist

· We have updated the eligibility and covered services to more clearly align with the scope of CFPS services.

· Under the Overview section, we added the need for CFPS must be identified in the individualized treatment plan.

· Under Eligible Providers, we removed providers must have a high school diploma or its equivalent.

· Under Eligible Providers Certification, we explained a Certified Family Peer Specialist must complete the Minnesota-specific training, approved by the Department of Human Services, to become certified and must renew or recertify every two years.

· Under Eligible Recipients, we updated the requirements for eligibility to include what services the recipient's child or youth must receive.

· Under Covered Services, we added Collaboration with others providing care or support to family, Establish and lead parent support groups, Support parental self-advocacy skills, including accompanying parents to IEP and treatment planning meetings, and community events, and Non adversarial advocacy.

· We deleted the Place of Service section from this manual page.

May 23, 2019

Hospital Services

· In the Hospital Services section, we changed the definition for Institution for Mental Disease (IMD) from:

A hospital, nursing facility or other institution with more than 16 beds that is primarily engaged in providing diagnosis, treatments or care of persons with mental diseases, including medical attention, nursing care and related services. Adults under age 65 and children under age 21 who are admitted to an IMD are not eligible for Medical Assistance (MA).

to:

A hospital, nursing facility or other institution with more than 16 beds that is primarily engaged in providing diagnosis, treatments or care of persons with mental diseases. This includes treatment for mental health and substance use disorders.

May 22

Individualized Education Program (IEP) Services

· IEP Personal Care Assistance (PCA) Services – Updated text to clarify what should be documented on the Activities Checklist and moved that section below Plan of Care.

May 16

Optical Services

· Optical Services – Under Eyeglasses, the following requirement was added: For initial eyeglasses to be medically necessary, there must be a correction of .50 diopters or greater in either sphere or cylinder power in either eye. Diopter is the unit of refracting power of the lens.

May 15

Elderly Waiver (EW) and Alternative Care (AC) Program

· Elderly Waiver (EW) and Alternative Care (AC) Program – Policy information for Case Management, Case Management Aide and AC Conversion Case Management is now in the Community Based Services Manual (CBSM). We added links to direct viewers to the specific CBSM pages.

May 13

Equipment and Supplies

· Airway Clearance Devices – Under Eligible Recipients, we removed the table of major programs. Under Covered Services, we defined neuromuscular diseases for high-frequency chest wall oscillation (HFCWO) air-pulse generator systems.

May 9

HCBS Waiver Services

· Billing for Waiver and Alternative Care (AC) Program

· Under Billing Procedure Codes, we added an explanation on billing hourly procedure code.

· Under the subsection Billing and Absences from a Residential Setting for AC and EW, we removed the Process and Procedure and Rates for Elderly Waiver (EW) information.

· We updated language in the Members Enrolled in Minnesota Senior Health Option (MSHO) and Minnesota Senior Care Plus (MSC+) subsection for changes to EW services provided to members who have South Country Health Alliance (SCHA).

Substance Use Disorder Services (SUD)

· Substance Use Disorder Services (SUD) – Under Covered Services, we clarified encounter payments are not available for self-administered medication.

Tribal and Federal Indian Health Services

· Tribal and Federal Indian Health Services – Under Payment Requirements, we clarified that the encounter rate does not pay for self-administered medication therapy, or major programs IM and HH.

Dental Services

· Dental Benefits for Non-Pregnant Adults – Under prosthodontics we made the clarification D5520, D5640, and D5650 limited to five per 180 days.

May 8

Personal Care Assistance (PCA) Services

· Personal Care Assistance (PCA) Services – Updated the billing procedures for the Enhanced Rate on the billing grid.

May 7

Clinic Services

· Federally Qualified Health Center and Rural Health Clinics

· In the billing subsection:

· We added instructions about service dates beginning July 1, 2019, for FQHCs to submit claims for MCO enrollees directly to MHCP.

· We added under Dentures, partials and root canals that when a root canal cannot be completed in one visit to used code D5899 and enter "additional visit requiring professional" as the description for the first visit and bill the appropriate code for the second visit.

· We deleted the subsection and table about global procedure service date for services rendered before January 1, 2015.

May 6

Provider Basics
Enroll with MHCP

· Speech-Language Pathologist Enrollment Criteria and Forms – We changed the first paragraph to read:

· Obtain a license from the Minnesota Department of Health (MDH).

· Maintain applicable state licensure requirements as listed in Minnesota Statutes, 148.515 to 148.5175, or comply with state regulatory requirements in states that do not license.

· Comply with applicable state licensure requirements described in Minnesota Rules, 9505.0195.

· Enroll with Medicare

· Under Enrollment Criteria section, we removed American Speech Language Hearing Association (ASHA) certification, and replaced with “Copy of license as a Speech-Language Pathologist in the state of practice."

May 2

Mental Health Services

· We have created a new MHCP provider manual page for Adult Mental Health Residential Crisis Stabilization Services (RCS). This information was previously included on the Adult Crisis Response Services page.

April 29, 2019

Pharmacy Services

· Medicare – We removed Barbiturates from Medicare Part D Excluded drug categories.

April 26

Rehabilitation Services

· Rehabilitation Services

· Licensing Information under Speech-language pathologists - we replaced the following statement:

Maintains applicable state licensure requirements or is in compliance with state regulatory requirements in states that do not license

with

Maintains applicable state licensure requirements found in Minnesota Statutes, 148.515 to 148.5175 or is in compliance with state regulatory requirements in states that do not license.

· We deleted the following bullet related to licensing requirements:

· Has a Certificate of Clinical Competence in speech-language pathology (CCC-SLP) from the American Speech-Language-Hearing Association (ASHA), or is completing the clinical fellowship year required for certification as a speech-language pathologist

MHCP Member Evidence of Coverage

· MHCP Member Evidence of Coverage

· The excess skin excision that was a noncovered services have been removed under the Bariatric* (weight loss surgery) services section.

· Child and Teen Checkups age-related visits updated to match the periodicity schedule.

Mental Health Services

· Neuropsychological Services – Under the Billing section we removed procedure codes 96118, 96119, 96120 and added procedure codes 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.

April 24

Mental Health Services

· Mental Health Services – Under Eligible Providers, we updated the procedure for MHCP Provider Enrollment under the Medicare Enrollment Denials heading.

April 22

Mental Health Services

· Children’s Therapeutic Services and Supports (CTSS)

· In Covered Services under the Criteria for Concurrent Care in Partial Hospitalization and Other Group Settings section, we deleted the group home and added Psychiatric Residential Treatment Facility according to statue change in 2017.

· Under Authorization, we added Service Plan Development to list of services that needed to be authorized and the calendar year of 24 sessions per calendar year

· Under Eligible Providers in the CTSS Certification section, we added a link to the new initial certification application DHS 3610-ENG.

· In the billing table, we changed codes H0031 and H0032 from 15-minute unit to session. We removed the UD modifier for these two procedure codes. We added the unit limit of 24 sessions to H0032. We also changed Family Psychotherapy units from session to 50 minutes according to CPT changes.

April 17

Programs and Services

· Emergency Medical Assistance

· Clarified the types of supporting clinical information that must be attached to the request form to complete the Emergency Medical Assistance Care Plan Certification Request.

· Updated the list of services not covered by EMA in the Noncovered Services section.

· Listed some of the prescriptions related to conditions and types of drugs that are not covered under EMA.

April 12

Rehabilitation Services

· Rehabilitation Services

· The wording in Record of Service section was changed from evidence of documented progress every 30 days to at least every 10th treatment day to follow Medicare's 10th day treatment progress note requirement. This evaluation counts as the first treatment day.

· Under Definitions for Practitioner of the healing arts: added the wording “For rehabilitation services these are": a physician, physician assistant, nurse practitioner, podiatrist, dentist, clinical nurse specialist, and certified midwife.

April 11

Mental Health Services

· Psychological Testing

· Under Covered Services, we added copy explaining how written reports documenting test results must be signed, filed and released.

· We also explained how the administration, scoring and interpretation of the psychological tests must be done under the clinical supervision of a licensed psychologist when performed by a technician, psychometrist, or psychological assistant or as part of a computer-assisted psychological testing program.

· Under Billing, we updated the Psychological testing table to reflect 2019 CPT code changes. We removed procedure codes 96101, 96102, 96103 and added procedure codes 96130, 96131, 96136, 96137, 96318, 96139 and 96146.

April 9

Mental Health Services

· Adult Rehabilitative Mental Health Services (ARMHS) – In the Adult Rehabilitation Mental Health Services (ARMHS) Benefits chart, we updated procedure codes H0031 and H0032 as per session with a maximum unit of one.

April 5

Equipment and Supplies

· Nutritional Products and Related Supplies – We updated the link for the DMECS Product Classification List.

Provider Basics
Enroll with MHCP

· Speech-Language Pathologist Enrollment Criteria and Forms – We added new information to explain that a speech-language pathologist must maintain state licensure and either obtaining a Certificate of Clinical Competence or be working toward completion of a year of clinical fellowship.

· Moving Home Minnesota (MHM) Provider Enrollment – Updated DHS-6638 form name and changed fax number to 651-431-7493. Moved the MHCP Data Privacy Notice to step 3 under New Enrollment for providers to reference when needed. Added a Training section onto this page under Processing Timelines.

· Physical Therapist Enrollment Criteria and Forms – We added new information to explain that a physical therapist must maintain state licensure, meet education requirements, and pass a state-approved examination for physical therapists.

April 3

Provider Basics
Enroll with MHCP

· Audiologist Enrollment Criteria and Forms – Added details about requirement to either hold a Certificate of Clinical Compliance in Audiology (CCC-A) or meet clinical practicum standards.

April 2

Rehabilitative Service

· Rehabilitative Service Codes for OT, PT, and SLP (occupational and physical therapy, and speech-language pathology) – Deleted CPT 96111 for developmental testing, and replaced with CPT 96112 Development test first 60 minutes, and 96113 Development test administration additional 30 minutes.

April 1

Moving Home Minnesota (MHM)

· Moving Home Minnesota Supported Employment Services (MHM SES) – Added information under a few of the sections throughout this page about changes to Supported Employment Services (SES) ending effective July 1, 2018 and being replaced by Employment Services. Also removed requirements for SES enrollment because this service is no longer a service providers can enroll to provide anymore.

Provider Basics
Enroll with MHCP

· Substance Use Disorder (SUD) Services Enrollment Criteria and Forms – We updated the Chemical health enrollment page to reflect the Substance Use Disorder reform as per 2017 MN legislation enactment. In this manual:

· We updated the organization or program assurance statement link and enrollment requirements

· We listed the enrollment criteria for professional or individual providers and updated assurance statement link

· We changed the term "chemical health/dependency" to Substance Use Disorder services enrollment page

March 22, 2019

Equipment and Supplies

· Equipment and Supplies

· Under Eligible Members, the major programs table has been removed. Refer to the Programs and Services and the Benefits at a Glance links for more information on eligible MHCP members.

· For Sharps Disposal Containers under Miscellaneous Products, we added a sentence stating that pricing attachments must be submitted for all claims. We also clarified how claims must be billed for members with Medicare.

· Under Covered Services and Billing Policy, the Medicare Pricing, Data Analysis and Coding (PDAC) Palmetto GBA Durable Medical Equipment Coding System link has been updated.

March 21

Child and Teen Checkups (C&TC)

· Child and Teen Checkups (C&TC) – Under Resources, we have updated the Minnesota Department of Health (MDH) C&TC resource links to the MDH C&TC website, the MDH Preventive Health Care for Children, Teens and Young Adults website and the C&TC Fact Sheets. Additionally, MDH links to pages on those websites were updated throughout this manual section.

March 20

Provider Basics

· Authorization – Under Home Care Authorization Requests, we deleted "private duty nursing services" and changed it to "home care nursing services."

March 19

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid – In the billing grid, we removed the HK modifier for CMDE services.

March 14

Provider Basics

· Kidney Transplant Services – We updated Emergency Medical Assistance (EMA) Kidney transplant EMA Care Plan Certification (CPC) Request requirements for the EMA Care Plan Certification (CPC) and Inpatient Hospital Authorization (IHA).

· Added new a section "Outpatient Prescription Drugs that Do Not Require a Separate Authorization"

· Deleted from the "Prior Authorization " section these requirement:

· Clarified the instructions on what is required when submitting a request for inpatient hospital authorization for kidney transplant to KEPRO.

March 12

Moving Home Minnesota (MHM)

· Moving Home Minnesota Demonstration and Supplemental Services table (PDF) – Added rate change effective 3/1/19 on page 3 for Comprehensive Community Supports service with procedure code H2015 U6 to $17.17.

March 11

Mental Health Services

· General MHCP Non-Enrollable Mental Health Provider Requirements – Under Mental Health Practitioners, we updated the requirements for MHCP Mental Health Practitioners that changed effective May 12, 2018, according to Minnesota Statutes 2016, Section 245.462 Subdivision 17. We changed the number of hours of supervised experience, degree requirement, and work experience requirements.

February 27, 2019

Provider Basics
Enroll with MHCP

· Dental Therapist (DT), Advanced Dental Therapist (ADT), and Collaborative Practice Dental Hygienist (CPDH) Enrollment Criteria and Forms – Requirements for dental therapist (DT), advanced dental therapist (ADT), and collaborative practice dental hygienist (CPDH) to become enrolled providers with Minnesota Health Care Programs (MHCP).

February 20

Provider Basics
Enroll with MHCP

· We deleted the Licensed Psychological Practitioners (LPP) enrollment information. MHCP does not enroll LPPs.

Dental Services

· Dental Services (Overview) – We added information about state owned and operated dental clinics billing all claims directly to MHCP beginning January 1, 2019, under General Billing Guidelines.

February 13

Equipment and Supplies

· Positive Airway Pressure for Treatment of Obstructive Sleep Apnea – Under Covered Services in the first and second paragraphs, we replaced "made consistent progress" with "demonstrated use of" and defined compliance during the additional eight-week period.

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid – We removed the Level III providers row for Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification.

Rehabilitation Services

· Rehabilitation Services

· Revised "Therapy Students Providing Care" section to clarify when services provided by therapy students can be billed

· Added a section called "Eligible Ordering and Referring Providers"

· Corrected Physical Therapy provider titles

· Added a statement indicating Speech Language Pathologist Assistants are not eligible for Minnesota Health Care Programs enrollment or payment

· Clarified definition of "Practitioner of the Healing Arts" to remove oral surgeon and optometrist and add physician, clinical nurse specialist and certified nurse midwife

February 8, 2019

Provider Basics
Enroll with MHCP

· Occupational Therapist Enrollment Criteria and Forms – Added new section for providers enrolling as occupational therapists.

February 5

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid:

· We added service hour limits to the Person or Service Limits column of CMDE: Behavior identification assessment for the following providers:

· CMDE provider

· CMDE Clinical Trainee

· We added multiple provider billing information to the Person or Service Limits column of the ITP Development and Monitoring for the following providers:

· QSP

· Level I

· Level II

· We added that the Coordinated Care Conference cannot be billed with other EIDBI services, except the ITP to the Person or Service Limits column of the Coordinated Care Conference: Medical Team Conference for the following providers

· CMDE provider

· QSP

· Level I

· Level II

· We removed the Level III provider Family/Caregiver Training and Counseling - Group: Multiple family group adaptive behavior treatment guidance row.

February 1

Mental Health Services

· Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) – We clarified exclusionary services under the Authorization section. Concurrent therapy is only allowed for family therapy, which includes justification and communication submitted with authorization materials. DBT is not allowed to be provided concurrently with outpatient psychotherapy or group psychotherapy, partial hospitalization or day treatment. This clarification assures the DBT therapist is leading the treatment of the individual and is adhering to the fidelity of the DBT model.

Laboratory/Pathology, Radiology & Diagnostic Services

· Radiology/Diagnostic Services

· We added details for payment changes for computed radiography technology with modifier FY in the Billing section.

· We deleted Stereotactic Radiosurgery Planning and Delivery because this service ended.

Hearing Aid Services

· Hearing Aid Services Codes

· We added code V5030 and description Monaural, body worn, air conduction to the Hearing Aid Services Codes table

· We added code V5040 and description Monaural, body worn, bone conduction to the Hearing Aid Services Codes table

· We updated the description in the Hearing Aid Services Codes table for code V5070 to Hearing aid in glasses, air conduction

· We updated the description in the Hearing Aid Services Codes table for code V5080 to Hearing aid in glasses, bone conduction

· We updated the description in the Hearing Aid Services Codes table for code V5190 to Hearing aid, contralateral routing, monaural, glasses

· We updated the description in the Hearing Aid Services Codes table for code V5230 to Hearing aid, contralateral routing system, binaural, glasses

· We updated the notes in the Hearing Aid Services Codes table for codes V5170 CROS, ITE; V5180 CROS, BTE; V5210 BiCROS, ITE; V5220 BiCROS, BTE to V5170, V5180, V5210 and V5220 will end December 31, 2019. When billing repairs with a HCPCS code, use the same code that was billed when the aid was purchased.

· We added code V5171, description Contralateral routing device, monaural, in the ear (ITE) and notes in the Hearing Aid Services Codes table

· We added code V5172, description Contralateral routing device, monaural, in the canal (ITC)* and notes in the Hearing Aid Services Codes table

· We added code V5181, description Contralateral routing device, monaural, behind the ear (BTE) and notes in the Hearing Aid Services Codes table

· We added code V5211, description Contralateral routing system, binaural, ITE/ITE and notes in the Hearing Aid Services Codes table

· We added code V5212, description Contralateral routing system, binaural, ITE/ITC* and notes in the Hearing Aid Services Codes table

· We added code V5213, description Contralateral routing system, binaural, ITE/BTE and notes in the Hearing Aid Services Codes table

· We added code V5214, description Contralateral routing system, binaural, ITC/ITC* and notes in the Hearing Aid Services Codes table

· We added code V5215, description Contralateral routing system, binaural, ITC/BTE* and notes in the Hearing Aid Services Codes table

· We added code V5221, description Contralateral routing system, binaural, BTE/BTE and notes in the Hearing Aid Services Codes table

· We updated the description in the Hearing Aid Services Codes table for code V5200 to Dispensing fee, contralateral, monaural

· We updated the description in the Hearing Aid Services Codes table for code V5240 to Dispensing fee, contralateral routing system, binaural

· We updated the description in the Hearing Aid Services Codes table for code V5267 to Hearing aid supplies and accessories, not otherwise specified (use for rechargeable batteries, telecoils, tubes, ear hooks, receivers and other accessories); and we updated notes to Attachment with description required; include manufacturer's invoice or retail cost (MSRP) of the supply or accessory. Do not include service or labor charges when using this code.

· We updated notes in the Hearing Aid Services Codes table for code V5299 Miscellaneous hearing aid servicing to Attachment with description required to identify the service (labor only). Use for: ear wax removal and cleaning not associated with a hearing aid check; Hearing aid maintenance: ear hook, receiver and tube changes, etc. Use for other services that do not have a more specific HCPCS code.

· We corrected notes in the Hearing Aid Services Codes table for V5011 Hearing aid checks or reprogramming performed by a hearing aid dispenser. Cannot be billed with 92592 and 92593. Refer to the Audiology Service Thresholds when service is performed by an audiologist to Claims with DOS 90 days after the dispensing date will deny.

January 29, 2019

Transportation Services

· Ancillary Services Claim and Rate Information for Counties and Tribes

· We removed ATS transport from the second bullet point under Claim Information

· We removed the ICD-9 code under Claim Information

· We removed Modifier as a required entry for claim submission under Claim Information

Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project

· Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project

· We have updated the H0032 code in the Integrated Treatment Plan table under the Billing section to no longer include the UD modifier.

· We have updated the H0031 code in the Functional Assessment table under the Billing section to no longer include the UD modifier.

Provider Basics

· Billing the Recipient – Added text in Noncovered Services to further define services not covered:

· It is never covered by MHCP; or

· It is being provided by a provider that is out of network and a single case agreement has not been established

Also added text for a member to pay for a noncovered prescription if an Advance Member Notice has been completed.

January 25

Anesthesia Services

· Anesthesia Services – We added the 2019 rate table.

Provider Basics

· Billing the Recipient – We updated the copay and deductible information for 2019.

Substance Use Disorder Services (SUD)

· Substance Use Disorder Services (SUD)

· We corrected the outpatient individual (nonresidential) treatment Service Limitations column to three units per day in the Revenue and Procedure Codes table under the Billing section.

· We corrected the outpatient group (nonresidential) treatment Service Limitations column to 10 units per day in the Revenue and Procedure Codes table under the Billing section.

January 24

Early Intensive Development and Behavioral Intervention (EIDBI) Benefit

· Early Intensive Development and Behavioral Intervention (EIDBI) Benefit

· We clarified qualifying health programs in the fourth bullet point in the Eligible People section.

· We removed 60-day temporary increase language in Services that Require Authorization under the Service Authorization section

· We updated language in Services that Do Not Require Authorization under the Service Authorization section

· We added a link to the 2018 billing grid in the Billing section.

· We deleted "Only bill codes for 'the first 30 minutes' one time per day, per clinician level modifier" under Submitting Claims in the Billing section.

· We added a link to updated state plan amendment in the Legal References section.

January 15

Child and Teen Checkups (C&TC)

· Child and Teen Checkups (C&TC)

· We added to the Covered Services - Medical screenings subsection that fluoride varnish application is limited to four per 365 days.

· Under Immunizations and Vaccinations, Oral health, we added "or no later than 12 months of age" to the fluoride varnish application statement and under FVA primary provider billing that FVA is limited to four per 365 days.

· Under Covered Services - Dental Screening, we made the following changes:

· We changed clinical oral examination to "Clinical open mouth assessment"

· We deleted information about assessments or screening to clarify the medical provider role and expectations for dental screening as part of the full comprehensive C&TC exam.

Equipment and Supplies

· Equipment and Supplies – We added the requirement of following Minnesota Rules for electronically maintained records under Dispensing Orders and Detailed Written Orders.

Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project

· Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project

· We added a section detailing comprehensive evaluation updates and assessment components.

· We added a section explaining Outpatient (ambulatory) Withdrawal Management - level 2 (2-WM) eligibility and covered services.

· We revised the billing section to include comprehensive evaluation updates and Outpatient Withdrawal Management services. The procedure codes H0031 & H0032 have changed to per session codes with a max of one session per day.

January 14

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information – Updated mileage rates for Volunteer Driver (A0080) and Licensed Foster Parent (A0090 UC) to the 2019 IRS Standard Rate of $0,58 per loaded mile by the most direct route.

Substance Use Disorder Services (SUD)

· Rule 25 Service Access

· Revision to this Rule 25 manual section helps to delineate between the two ways individuals may access services through June 30, 2020. The Rule 25 process will end on July 1, 2020. We did not make any major changes, but moved billing information to the main substance use disorder (SUD) manual section.

· We are not changing the language for Rule 25 to substance use disorder (SUD); we will continue to follow the terminology as it is in the statutes governing Rule 25. That is, we refer to "CD" rather than SUD in this section. See statues: https://www.revisor.mn.gov/statutes/2016/cite/254A.19

January 11

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – Beginning Jan. 1, 2019, Medical Transportation Management's Minnesota Nonemergency Transportation (MTM-MNET) will coordinate nonemergency medical transportation (NEMT) and ancillary services for Aitkin, Carlton, Lake, and St. Louis counties, in addition to the 13 counties they already coordinate for.

January 9

Mental Health Services

· Intensive Treatment in Foster Care – We corrected the number of units of service from 78 to 72 under Authorization for ITFC services. Authorization is required after 72 units of service.

January 4

Substance Use Disorder Services (SUD)

· We revised this Substance Use Disorder (SUD) (formerly Alcohol and Drug Abuse) provider manual section to meet statutory requirements to comply with SUD reform that was passed by the Minnesota legislature during the 2017 session. According to the legislative changes, we updated this section with new billing codes, service types, billing policy and other information regarding new services.

January 3

Provider Basics
Enroll with MHCP

· Billing Entity for Mental Health Enrollment Criteria and Forms – Under Enrollment Criteria we clarified that to enroll as a billing entity for mental health with Minnesota Health Care Programs (MHCP), the entity must have at least one of the listed providers in the group. This previously stated to have two. We added:

· Licensed professional clinical counselor (LPCC)

· Psychiatric nurse practitioner (NP)

· Psychiatry or osteopathic physician

· Mental health rehabilitative professional

· Tribal certified professionals

January 2

Provider Basics

· Provider Screening Requirements – We updated the provider manual to reflect the new provider screening and enrollment fee amount of $586.00, effective January 1, 2019.

Previous Revisions

2018 Manual 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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