Day Training and Habilitation for ICF/DD Enrollment Criteria and Forms

Revised: April 20, 2021

Effective Jan. 11, 2021, as part of the Waiver Reimagine project, Minnesota Health Care Programs (MHCP) is streamlining Day Training and Habilitation services (DT&H), covered under the Developmental Disability (DD) Waiver program, to transition to Day Support services. MHCP will complete the transition of DT&H services to Day Support services by Jan. 11, 2022. To enroll for Day Support services, see Home and Community-Based Services (HCBS) Programs Provider Enrollment.

DT&H services can only be provided to people living in Intermediate Care Facilities for People with Developmental Disabilities (ICF/DD residences) after Jan. 11, 2021.

How to Enroll

DT&H Providers who wish to enroll with MHCP to provide DT&H services to people living in ICF/DD must follow these steps.

1. Obtain a DT&H day services Need Determination Authorization letter from the Department of Human Services - Disability Services Division (DHS-DSD) approving the county or tribal lead agency and the DT&H day services provider’s DT&H needs determination application request. For more information, contact your local county agency or tribe (DHS-0005) (PDF)

2. Pay the application fee if you use a Federal Tax Identification Number (FEIN) or attach proof that you paid the fee to either Medicare or another state for the same location and to enroll to provide the same services. Use the MHCP Provider Screening Fee Collections System to pay the fee online. You must pay the fee before applying to MHCP.

3. Either register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your enrollment online using the MPSE portal,

or

Complete the following documents required to enroll as a DT&H provider for ICF/DD and fax to MHCP Provider Eligibility and Compliance at 651-431-7493.

· Day Training and Habilitation ICF/DD – Provider Enrollment Application (DHS-8121) (PDF)

· MHCP Provider Agreement (DHS-4138) (PDF)

· Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF)

· EFT Vendor Number Notification (DHS-3725) (PDF), if you wish to be paid through electronic funds transfer (EFT) (optional). See number 4 of Enrollment Process in the MHCP Provider Manual.

· Copy of your general liability insurance certificate naming “DHS Provider Eligibility and Compliance” as a certificate holder on the document, with the following address listed: PO Box 64987, St. Paul, MN 55164-0987.

Proof showing you are qualified to provide the services, including but not limited to:

· Need Determination Authorization letter from Disability Services Division (referenced in step 1)

· Rates agreement as approved by Disability Services Division

· ICF/DD Training and Habilitation Agreement (DHS-4224) (PDF) two-party agreement between DT&H and Intermediate Care Facilities/Developmental Disabilities (ICF/DD)

· Day Training and Habilitation Service Agreement (DHS-2638) (PDF) three-party agreement between DT&H, ICF/DD and the County

· Assignment of Payment for Day Training and Habilitation Services (DHS-4223) (PDF)

· A copy of the contract from the lead agency (for contracted case management services only)

· If you have further questions regarding the licensing standards of Minn. Stat. 245D services call DHS licensing help desk at 651-431-6624. The help desk is staffed Monday through Friday 8:00am to 4:00pm

· Review and keep a copy of the MHCP Data Privacy Notice (DHS-6287) (PDF).

Revalidation

MHCP is required to follow the Centers for Medicare and Medicaid Services (CMS) final federal provider screening regulations.

Refer to Revalidation in the Provider Screening Requirements section of the MHCP Provider Manual for more information about how to complete your revalidation.

Reporting Changes

You must notify MHCP any time a change occurs. Report any changes made on a provider record to MHCP Provider Eligibility and Compliance. Refer to Changes to Enrollment in the Enroll with MHCP section of the MHCP Provider Manual for details.

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

Additional Resources

Minnesota Statutes, 252.41 (Definitions)
Minnesota Rules, 9525.1210 (Definitions)
Code of Federal Regulations, title 42, section 440.60 (Medical or other remedial care provided by licensed practitioners)