Housing Support Supplemental Services Enrollment Criteria and Forms

Revised: February 6, 2026

Minnesota Health Care Programs (MHCP) requires providers to enroll for the services they provide to MHCP members to receive reimbursement. Follow the instructions to enroll as a Housing Support Supplemental Services provider, to enroll a Housing Support practice location, or to add Housing Support Supplemental Services to an existing Home and Community-Based Services (HCBS) enrollment record.

How to Enroll

Review the MHCP Service Combinations for HCBS (DHS-8371) (PDF) for a list of different HCBS enrollment record types.

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

Online MPSE Portal

Use the Minnesota Provider Screening and Enrollment (MPSE) portal by following the Registration Instructions. Also, upload the following in the MPSE portal:

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

· Copy of the Housing Support Agreement with the lead agency (county or Tribe) to provide supplemental services signed by the lead agency.

· Copy of all applicable Vendor Profile Forms provided by the lead agency (county or Tribe) to show eligibility for the supplemental service rate.

or

Submit Forms via Fax

Complete the following documents for each location providing services and fax your materials to MHCP Provider Eligibility and Compliance at 651-431-7493.

· Housing Support Supplemental Services Provider Enrollment Application (DHS-5924) (PDF)

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

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

· Copy of the Housing Support Agreement with the lead agency (county or Tribe) to provide supplemental services signed by the lead agency.

· Copy of all applicable Vendor Profile Forms provided by the lead agency (county or Tribe) to show eligibility for the supplemental service rate.

· EFT Supplier ID Notification (DHS-3725) (PDF), if you wish to be paid through electronic funds transfer (EFT) (optional)

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

MHCP will process documents in the order received. Whether enrolling using the MPSE portal or by fax, allow 30 days for processing. MHCP will send a request for more information letter via U.S. mail (or in the provider’s MN–ITS mailbox, if one has been created) if more information is needed to complete the enrollment.

Enrolling a Housing Support Practice Location

Housing Support Supplemental Services providers must enroll each practice location where Housing Support Supplemental Services are provided. The practice location type is listed at the top of the Housing Support Agreement. A practice location is where services are provided at one of the following:

· Residential practice location or group setting: If supplemental services are provided to members in a Housing Support setting or program where all residents live in one residential setting, the practice location is the residential setting.

· Office practice location or community setting: If supplemental services are provided to members in a Housing Support setting or program where residents live in multiple, scattered-site locations, the practice location is the office setting from which employees are sent out to provide the services.

Add Housing Support Supplemental Services to an Existing HCBS Record

If you are an existing HCBS support services provider, follow the Steps to Add a New Service in MPSE.

If you are an existing provider, but do not have an HCBS Support Services (18-NR record), follow the Steps to Add a New Enrollment Record in MPSE.

If you choose the fax option to add Housing Support Supplemental Services to an existing HCBS enrollment record, complete and fax the following forms:

· Housing Support Supplemental Services Provider Enrollment Application (DHS-5924) (PDF)

· Copy of the current Housing Support Agreement with the lead agency to provide supplemental services signed by the lead agency.

· Copy of all applicable Vendor Profile Forms provided by the lead agency (county or tribe) to show eligibility for the supplemental service rate.

MHCP reviews requests to add to existing HCBS records and will determine the appropriate record to add Housing Support Supplemental Services or if a new enrollment is required. MHCP will process documents in the order received. Whether enrolling using the MPSE portal or by fax, allow 30 days for processing. MHCP will send a request for more information letter via U.S. mail (or in the provider’s MN–ITS mailbox, if one has been created) if more information is needed to complete the request.

Revalidation

MHCP is required to follow the Centers for Medicare & Medicaid Services (CMS) 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 in the How to Enroll section 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 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 the Provider Screening Requirements section in the MHCP Provider Manual for 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.

Review the Frequently Asked Questions for HCBS Revalidation available for providers.

Reporting Changes

The provider must notify MHCP any time a change occurs. Refer to Changes to Enrollment in the Enrollment with MHCP section of the MHCP Provider Manual for details.

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