MMIS automated changes to service agreements

Page posted: 8/3/26

This page provides information about automated processes that affect service agreements.

Automated changes to existing line items for rate adjustments

MMIS runs an automation process when the Legislature approves rate adjustments for services (also known as a cost-of-living adjustment [COLA]). MMIS partially adjusts service agreement lines for many of these services automatically.

When there is an MMIS automation process, DHS sends an eList announcement with information about:

· Affected services.

· Rate change(s).

· Services and rates (if any) the lead agency must update manually on the service agreement (i.e., will not be part of the MMIS automation process).

· Date the automation process is expected to run in MMIS.

· When lead agencies can enter or make changes to service agreements.

To sign up for eList announcements, refer to CBSM – AASD eLists (aging programs) and CBSM – DSD eLists (disability programs).

Rates reports

After the automation process, counties and Tribal Nations should use the following Infopac reports to identify service agreements changed by this process:

· MW2083A: Procedure Code Rate Increase Report Long-Term Care (LTC) Waivers/Alternative Care (AC) Program.

· MW2083B: Procedure Code Rate Increase Developmental Disabilities (DD) Program.

· MW2083H: Procedure Code Rate Increase Report Essential Community Supports (ECS) Program (refer to note below).

Note: Report PWMW941A-R2083H for ECS service agreements includes people enrolled in a managed care organization (MCO). The MCO that is identified in the LTC screening document’s preadmission screening field and the REF PROV NBR field on the MMIS ASA1 screen will receive their own page of this report. The MCO must review the report and either:

· Contact the county/Tribal Nation that is contracted to enter/change service agreements to make the changes.

· Email dhs.mcoecs@state.mn.us with the service agreement number and instructions for changing each affected line item if there is no contracted county/Tribal Nation.

Automated changes to existing line items for provider enrollment changes

MMIS will automatically change saved service agreement line items when DHS Provider Eligibility and Compliance ends a category of service (COS) or specialty code, or when there is a missing license code for the line item’s provider.

The PCOS and PPGM screens in the provider subsystem show COS and specialty code information for providers. The PLIC screen in the provider subsystem shows licensing information for providers.

When a code ends or is missing on the provider’s record, MMIS will make the following changes to the service agreement line items:

· Pended or approved line items that end after the COS ending date: MMIS will add reason code 858 to the line and post exception code 412 for COS or exception code 413 for specialty codes.

· Approved line items that begin after the current date: MMIS will change the status to pend and add reason code 858, then post exception code 412 and/or exception code 413.

· Suspended line items that overlap with the COS ending date: MMIS will post exception code 412.

· Suspended line items that overlap with the specialty code ending date or span more than one specialty code span with gaps in between: MMIS will post exception code 413.

· Line items that do not have the correct license code or begin before the license code begin date: MMIS will post exception code 413.

· Line items with the correct license code but the license state field is not MN or XX: MMIS will post exception code 413.

Note: MMIS will not make changes to a line item if the provider number field is empty or if the line item is denied.

You cannot approve suspended or pended line item(s) until either:

· DHS Provider Eligibility and Compliance updates the provider’s record. Only the provider can contact DHS Provider Eligibility and Compliance to request a change to their record.

· You change the line item period so it does not overlap with the COS or specialty code end date or begin before the license code begin date.

Reason code 858

Reason code 858 will place the following message on the recipient and case manager letters:
“You receive this letter due to changes to the provider’s records for this service. Contact your case manager or MN Health Care Programs member helpdesk at 651 431 2670 or 1 800 657 3739 for more information.”

Reason code 858 will place the following message on the provider, billing agent or managed care organization letter:
“Providers must continue to be eligible for enrollment in order for authorizations to be valid. This service line item is not currently supported”.

Provider change reports

Report PWMW9332-R2086 Service Agreements for Providers with COS Codes and/or Specialty Codes Ended identifies when MMIS changes an approved, pended or partially suspended service agreement due to a COS, license or specialty code ending. It is a daily report on Infopac. For more information, refer to MMIS LTSS Manual – Use Infopac reports.

There are four versions of this report:

· PWMW9332-R2086A identifies the AC, Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Elderly Waiver (EW) program service agreements.

· PWMW9332-R2086B identifies the DD program service agreements.

· PWMW9332-R2086G identifies the Moving Home Minnesota (MHM) service agreements.

· PWMW9332-R2086H identifies the ECS program service agreements.

The data sorts by:

· Tribal agency when the SACTAD field is populated.

· Agency where the case manager is located if there is a case manager on the ASA1 screen.

· County of financial responsibility for BI, CAC and CADI service agreements.

· County of service for AC and EW service agreements.

Cases appear on the report with the case manager provider number listed on the service agreement.

Note: It is important to keep the case manager provider field updated on the ASA1 screen whenever there is a change in case manager so MMIS sends the report and service agreement letters to the correct person.

Lead agency staff should review this report on a daily basis to identify which service agreements must be changed.

Resolve exception code 412 for COS

To resolve exception code 412:

1. Place the cursor on the line item provider number on the ASA3 screen.

2. Press F4 to navigate to the provider subsystem.

3. Go to the PCOS screen and take the appropriate action:

· If the COS code is not listed on the PCOS screen, the provider is not authorized to provide the service. You can set the line item status to S (suspend), D (deny) or P (pend). Add reason code 858 to the line.

· If the COS code is listed on the PCOS screen but the line item period overlaps with the COS end date, the provider’s authorization to provide the service has ended. You can change the line item end date so it no longer overlaps with the COS end date to approve the line. You can also set the line item status to S (suspend) or P (pend).

· If the COS code is listed on the PCOS screen but the COS ends before the beginning of the line item period, you can set the line item status to S (suspend), D (deny) or P (pend). Add reason code 858 to the line.

Resolve exception code 413 for specialty codes

To resolve exception code 413 for specialty codes:

1. Place the cursor on the line item provider number on the ASA3 screen.

2. Press F4 to navigate to the provider subsystem.

3. Go to the PPGM screen and take the appropriate action:

· If the specialty code is not listed on the PPG screen, the provider is not authorized to provide the service. You can set the line item status to S (suspend), D (deny) or P (pend). Add reason code 858 to the line.

· If the specialty code is listed on the PPGM screen but the line item period overlaps with the specialty end date, the provider’s authorization to provide the service has ended. You can change the line item end date so it no longer overlaps with the specialty code end date to approve the line. You can also set the line item status to S (suspend) or P (pend).

· If the specialty code is on the PPGM screen but ends before the line item begin date, you can set the line item status to S (suspend) or P (pend).

Resolve exception code 413 for license codes

To resolve exception code 413 for license codes:

1. Place the cursor on the line item provider number on the ASA3 screen.

2. Press F4 to navigate to the provider subsystem.

3. Go to the PLIC screen and take the appropriate action:

· If the correct license code is not listed on the PLIC screen, the provider is not authorized to provide the service. You can set the line item status to S (suspend), D (deny) or P (pend). Add reason code 858 to the line.

· If the license code is listed on the PLIC screen but the line item period is before the license begin date, the provider’s license was effective after the line item begin date. You can change the line item begin date to approve the line. You can also set the line item status to S (suspend) or P (pend).

· If the license code is listed on the PLIC screen but the line item period overlaps with a license end date, the provider’s authorization to provide the service has ended. You can change the line item end date so it no longer overlaps with the license code end date to approve the line. You can also set the line item status to S (suspend) or P (pend).

Case manager’s role

The case manager is responsible to:

· Keep the case manager provider field on the ASA1 screen updated whenever there is a change in case manager so MMIS sends the report and service agreement letters to the correct person. Cases appear on the report sorted by the case manager provider number listed on the service agreement.

· Arrange services with a different provider when provider records are not corrected with the COS, specialty or license code.

· Arrange alternative providers for services during gap periods between end dates and the date the COS, specialty or license code is active, approved or effective again.

· End service agreement line items so new line items can be added with new providers.

Note: Codes added back to the provider screen may have a gap between the date the code ended and when it is effective again. If the person needs the service during this non-coverage period, the case manager must end the line item before the code ending date, remove reason code 858 from the line item and add a new line item for a different provider beginning the day the code ended.

Customized living license requirements

As of Aug. 1, 2021, providers of customized living services (T2031), 24-hour customized living services (T2031 with modifier TG) and customized living 24-hour, corporate foster care under age 65 (T2031 with modifiers TG and U9) must be licensed with one of the following licenses.

T2031 TG and U9:

· Assisted living facility license (existing customized living settings) = AL

· Assisted living with dementia care facility license (existing CLS settings) = DE

· Assisted living facility license (new customized living setting age 55 or older) = L7

· Assisted living with dementia care facility license (new customized living setting age 55 and older) = L8

T2031 or T2031 TG:

· Assisted living facility license (existing customized living settings) = AL

· Comprehensive home care license that meets assisted living licensure exemption in Minn. Stat. §144G.08, subd. 7 and a signed Customized Living Services Service Provider – Exempt from Assisted Living Facility Licensure Assurance Statement, DHS-8116 (PDF) = CE

· Assisted living with dementia care facility license (existing CLS settings) = DE

· Assisted living facility license (new customized living setting age 55 years or older) = L7

· Assisted living with dementia care facility license (new customized living setting age 55 and older) = L8

· Comprehensive home care license that meets assisted living licensure exemption of Minn. Stat. §144G.08, subd. 7 (new customized living setting age 55 old and older) and a signed Customized Living Services Service Provider – Exempt from Assisted Living Facility Licensure Assurance Statement, DHS-8116 (PDF) = L9

Providers that do not meet these requirements will appear on Report PWMW9332-R2086.

DHS updated exception code 413 (specialty and/or license code is missing or invalid) to support these license changes. For these procedure codes and modifiers only, MMIS will post the exception code on new or existing BI, CADI and EW service agreements when the line item provider’s record does not include the correct previous and/or new license codes.

To ensure the provider has an appropriate license code:

1. Move the cursor to the provider number on the line item on the ASA3 screen.

2. Press F4 to open the provider subsystem.

3. Navigate to the PLIC screen.

4. Check for one of the new license codes listed above. The license line must have a state code of MN or XX.

5. Take the appropriate action:

· If no licenses are present or you are unable to adjust the line item period, change the line item status to P (pend).

· If the line item is approved and you cannot resolve the exception code, you will not be able to make changes to the service agreement until the provider’s record is updated.

DHS also updated exception code 801 (license code is missing) to support these licenses changes. For these procedure codes and modifiers only, the exception code will post on claims with dates of services Aug. 1, 2021, or later when the line item provider’s record does not include the correct previous and/or new license codes.

Additional resources

CBSM – AASD eLists (aging programs)
CBSM – DSD eLists (disability programs)
Customized Living Services Service Provider – Exempt from Assisted Living Facility Licensure Assurance Statement, DHS-8116 (PDF)
MMIS LTSS Manual – Use Infopac reports