Home Care Nurse Enrollment Criteria and Forms

Revised: December 29, 2023

Home care nurses (HCN) may enroll with Minnesota Health Care Programs (MHCP) as individuals or agencies.

· Individual Home Care Nurse Enrollment Criteria and Forms

· Home Care Nursing Agency Group Enrollment Criteria and Forms

· Revalidation

· Reporting Changes

Individual Home Care Nurse Enrollment Criteria and Forms

To enroll as an individual HCN with MHCP, you must meet one of the following requirements:

· Be a registered nurse (RN)

· Be a licensed practical nurse (LPN)

If the provider is licensed and resides in one state but practices in another, MHCP will accept the license only if both states participate in the Nurse Licensure Compact (NLC). Minnesota does not participate in the NLC. So, if the provider practices in Minnesota, the nurse must have a Minnesota RN license. For example, the provider resides and is licensed in South Dakota but practices in North Dakota. Both states participate in the NLC so the provider can enroll with MHCP. The provider must be licensed in the state of permanent residency.

Providers who wish to enroll or reenroll with MHCP can do so in one of the following ways:

· Register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your enrollment online using the MPSE portal. Also, upload the following in the MPSE portal:

· Fee-for-Service (FFS) only or Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF).

· Home Care Nurse - Individual LPN or RN Provider Assurance Statement (DHS-7099) (PDF)

· Copy of the RN or LPN license from state of practice

or

· Complete and fax the following enrollment forms and requirement documents to MHCP Provider Eligibility and Compliance at 651-431-7462.

· Individual Provider Enrollment Application (DHS-4016) (PDF)

· Fee-for-Service (FFS) only or Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF).

· Home Care Nurse - Individual LPN or RN Provider Assurance Statement (DHS-7099) (PDF)

· Include the EFT Supplier ID Notification (DHS-3725) (PDF) if the individual HCN is a pay-to provider

· Copy of the RN or LPN license from state of practice

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

We process forms in order of date received. Allow 30 days for processing whether enrolling using the MPSE portal or by fax. We will send a request for more information letter to your MN–ITS mailbox or through U.S. Postal Service if more information is needed to complete your enrollment.

Home Care Nursing Agency Group Enrollment Criteria and Forms

To enroll as an agency HCN provider with MHCP, the Home Care Nursing agency must have a comprehensive home care license.

MHCP provider screening fee payment confirmation or proof the fee was paid to another state or Medicare. Refer to the MHCP Provider Screening Requirements for information on application fees. You can pay the application fee using the MHCP Provider Screening Fee Collections System.

Agencies who wish to enroll or reenroll with MHCP can do so in one of the following ways:

· Register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your enrollment online using the MPSE portal. Also, upload the following in the MPSE portal:

· Fee-for-Service (FFS) only or Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF).

· Copy of the comprehensive home care license

or

· Complete and fax the following enrollment forms and required documents to MHCP Provider Eligibility and Compliance at 651-431-7462.

· Organization – Provider Enrollment Application (DHS-4016A) (PDF)

· Fee-for-Service (FFS) only or Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF).

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

· Include the EFT Supplier ID Notification (DHS-3725) (PDF) if the HCN group is a pay-to provider

· Copy of the comprehensive home care license

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

We process forms in order of date received. Allow 30 days for processing whether enrolling using the MPSE portal or by fax. We will send a request for more information letter to your MN–ITS mailbox or through U.S. Postal Service if more information is needed to complete your enrollment.

Revalidation

MHCP is required to follow the Centers for Medicare & Medicaid Services final federal provider screening regulations.

MHCP will notify you when you are due for revalidation. When you are notified, you must submit a revalidation request through the MPSE portal or fax all required forms and documents listed above to DHS.

We recommend using the MPSE portal and following the Revalidation Instructions in the MPSE user manual to revalidate your record. Log in to your MN–ITS account on the MN–ITS: Home webpage and choose the Minnesota Provider Screening and Enrollment (MPSE) portal link. If you have not registered your MN–ITS account, your login information is on your original welcome letter. Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you do not have your welcome letter.

Refer to Revalidation in Provider Screening Requirements under Provider Basics in the MHCP Provider Manual for important information, including timelines, about the revalidation process and impacts to your enrollment. Providers who do not meet the revalidation timelines will have their enrollment terminated.

Reporting Changes

Report any changes made on a provider record to MHCP Provider Eligibility and Compliance. Refer to Changes to Enrollment in Enrollment with MHCP under Provider Basics in the MHCP Provider Manual for details.

Legal References

Minnesota Statutes, 148.171 (Nurses; Definitions; Title)
Minnesota Rules, 9505.0360 (Home Care Nursing Services)
Minnesota Statutes, 256B.0654 (Home Care Nursing)
Code of Federal Regulations, title 42, section 440.80 (Private duty nursing services)