Certified Nurse Midwife Enrollment Criteria and Forms

Revised: September 6, 2023

To enroll as a certified nurse midwife (CNM) with Minnesota Health Care Programs (MHCP), a CNM must be:

· Certified by the American Midwifery Certification Board (AMCB)

· Licensed in their state of practice as an Advanced Practice Registered Nurse (APRN) CNM

Nurse practitioners at a Public Health Service (PHS) Indian Hospital may have current registered nurse (RN) licensure from any state.

How to Enroll

Providers who wish to enroll with MHCP can do so in one of the following two ways.

· Use the Online Minnesota Provider Screening and Enrollment (MPSE) Portal.

· Register to access the MPSE portal by using the instructions under the Registration and Categories of Enrollers section in the MPSE Enrollment Manual

· Complete your enrollment online using the MPSE portal. If enrolling through the MPSE portal, you will be required to upload a:

· Copy of current APRN CNM license from state of practice

· Copy of current certification from the AMCB

· Completed, signed and initialed copy of the Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF)

or

· Complete the following documents and fax your materials to 651-431-7462.

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

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

· Copy of APRN CNM license from state of practice

· Copy of certification from the AMCB

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

We process forms in order of date received. Whether enrolling using the MPSE portal or by fax, allow 30 days for processing. If we need more information to complete your enrollment, we will send a request for more information letter through U.S. Postal Service (or in your MN–ITS mailbox, if you have an account) telling you what you need to do to complete your enrollment.

Revalidation

MHCP is required to follow the Centers for Medicare & Medicaid Services 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

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.

Legal References

Minnesota Statutes, 9505.0320 (Nurse Midwife Services)
Code of Federal Regulations, title 42, section 405.2401 (Rural health clinic and federally qualified health center services, Scope and definitions)