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MHCP Provider Manual

2011 Manual Revisions

Updates cited below do not include minor grammatical or formatting changes that otherwise do not have bearing on the meaning of the policy contained herein. Refer to Provider Updates that may contain additional MHCP coverage policies or billing procedures. MHCP incorporates information from these updates into the Provider Manual on an ongoing basis. Sign up to get email notices of section changes.

12/23/2011

Addition(s)/Revision(s)

Chiropractic Services – Legislative changes effective 1/1/12 - restoring CMT from 12 to 24 annual units

Hospital Services – Added Evidence-based Childbirth Program Policy information

12/22/2011

Addition(s)/Revision(s)

Elderly Waiver (EW) and Alternative Care (AC) Program – Removed broken links

12/19/2011

Addition(s)/Revision(s)

Rehabilitative Services – Updated manual material to reflect January 1, 2012 legislative change eliminating SMT coverage for recipients 21 and older

12/14/2011

Addition(s)/Revision(s)

Physician and Professional Services – Added two sentences under smoking cessation -- states that smoking cessation products are subject to quantity limits consistent with the FDA-approved dose

12/13/2011

Addition(s)/Revision(s)

HCBS Waiver Services – Removed Nutritional Services section

Provider Basics

· Billing Policy

· Billing the Recipient – Added ARRA, end-date GAMC and CCDS copay, and 5% of gross income information

12/08/2011

Addition(s)/Revision(s)

Elderly Waiver (EW) and Alternative Care (AC) Program – Removed statement about requiring physician orders in the specialized supplies and equipment section

11/30/2011

Addition(s)/Revision(s)

Inpatient Hospital Authorization – Updated the medical review agent information

Physician and Professional Services – Clarified physician-administered drugs and text that the MHCP Prescription Drug PA Agent reviews requests for physician-administered drugs

11/29/2011

Addition(s)/Revision(s)

Reproductive Health/OB-GYN

· Hysterectomy – Clarified PA requirements for hysterectomies

11/22/2011

Addition(s)/Revision(s)

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP) – J0561 replaces both J0570 and J0580 for the injection of penicillin G benzathine under Secondary MFPP Services

11/16/2011

Addition(s)/Revision(s)

Laboratory/Pathology, Radiology & Diagnostic Services

· Radiology/Diagnostic Services – Clarified exception for the technical component when it is an emergency done in an ambulatory surgical center or in an outpatient setting

11/15/2011

Addition(s)/Revision(s)

Equipment & Supplies – New policy about coverage of miscellaneous products, removed obsolete references to modifier 22, added information about 13 month rental period

11/10/2011

Addition(s)/Revision(s)

Reproductive Health/OB-GYN

· Free-Standing Birth Center Services – Updated billing information with Revenue codes

11/08/2011

Addition(s)/Revision(s)

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/Pathology Services – Clarified specimen handling policy, changed blood collection policy, added genetic modifier requirement, added Oncotype Dx coverage criteria

11/04/2011

Addition(s)/Revision(s)

Authorization – Added hearing aids to fax numbers for the medical review agent

Health Care Homes (HCH) – Fixed link to HCH MN–ITS User Guide, added link to HCH public page and added Practice-specific Provider Alert reports

11/02/2011

Addition(s)/Revision(s)

Authorization – Changed name of medical review agent to Telligen and added more fax numbers

11/01/2011

Addition(s)/Revision(s)

Nursing Facilities – Removed MREP information

10/27/2011

Addition(s)/Revision(s)

Authorization – Added new information about authorization requirements when the recipient has TPL or Medicare

Equipment & Supplies

· Specialized Wound Treatment Technology – Added K0743 as covered negative pressure wound therapy device under Covered Services

Eyeglass and Vision Care Services – Updated HCPCS code under Hydrophilic contact lens

10/21/2011

Addition(s)/Revision(s)

Provider Basics

· Programs and Services – Updated information in programs BB, EH and deleted program GM information

Renal Dialysis

· Renal Dialysis - Method 1 – Updated billing information

10/20/2011

Addition(s)/Revision(s)

Provider Basics

· Programs and Services

· Program HH (HIV/AIDS) Covered Services – Updated Nutrition Benefit information

10/12/2011

Addition(s)/Revision(s)

Provider Basics

· Provider Requirements – Added Licensed Professional Clinical Counselors (LPCCs) under Eligible Providers

10/07/2011

Addition(s)/Revision(s)

Equipment & Supplies

· Diabetic Equipment & Supplies – Removed text indicating authorization is required for code A9276

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory Authorization Code List – Updated PA list

10/06/2011

Addition(s)/Revision(s)

Physician and Professional Services – Clarified text about billing

Provider Basics

· Prepaid Minnesota Health Care Programs (PMHCP) – Added information about the 7/1/11 inpatient hospital carve-out for some MinnesotaCare enrollees

10/04/2011

Addition(s)/Revision(s)

Equipment & Supplies – Removed instructions for billing 2 respiratory suction pumps on the same date

Provider Basics

· Billing Policy

· Payment Methodology – Hospital – Added link to spreadsheet listing the fee for service inpatient hospital rates in effect for all hospitals as of 1/1/11

10/03/2011

Addition(s)/Revision(s)

Rehabilitative Services

· Service Thresholds - Occupational Therapy, Physical Therapy, Speech-Language Pathology – Deleted codes G0281 and G0282 for investigative services as identified in BCBS medical policy

09/30/2011

Addition(s)/Revision(s)

Provider Basics

· Provider Requirements

· Access Services – Clarified interpreter service billing

09/29/2011

Addition(s)/Revision(s)

Physician and Professional Services

· Pay-for-Performance Program – Clinical results for optimal care blood pressure was changed to < 140/90

09/28/2011

Addition(s)/Revision(s)

Elderly Waiver (EW) and Alternative Care (AC) Program

· Waiver and Alternative Care (AC) Programs – Service Credentials – Updated table

09/27/2011

Addition(s)/Revision(s)

Community Health Worker (CHW) – Updated to reflect new policies and procedures

Dental Services (Overview) – Updated circumstances when dentist may be involved with fabrication of an apnea appliance, authorization and billing information

Elderly Waiver (EW) and Alternative Care (AC) Program – Updated Chore section

Mental Health Services

· Adult Crisis Response Services – Revised authorization criteria section

· Mental Health Provider Travel Time – Text clarification and added legal reference

· Psychological Testing – Clarified distinction between clinical trainee and technicians

Nursing Facilities – Updated private room section

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP) – Updated contraceptive list

09/26/2011

Addition(s)/Revision(s)

Health Care Homes (HCH) – Clarification on effective date under Patient Care Management Tool

Physician and Professional Services – Removed GAMC reference in the MNT and DSMT sections

09/23/2011

Addition(s)/Revision(s)

Pharmacy Services – Updated all references to AWP and updated reimbursement information for clotting factors

09/20/2011

Addition(s)/Revision(s)

Elderly Waiver (EW) and Alternative Care (AC) Program – Updated Chore section

Pharmacy Services

· Drug Categories with Limited Coverage – Removed listing of benzonatate as a covered cough product

Provider Basics

· Programs and Services

· Program HH (HIV/AIDS) Covered Services – Updated information under Mental Health Benefit

09/15/2011

Addition(s)/Revision(s)

Equipment & Supplies

· Pneumatic Compression Devices – New policy for peripheral artery disease

09/12/2011

Addition(s)/Revision(s)

Hearing Aid Services

· Hearing Aid Services Codes – Moved analog an digitally programmable codes to "always requires auth" section -- no longer available on contract

Pharmacy Services Overview – New language for when a pharmacy may accept cash payment for prescriptions

08/31/2011

Addition(s)/Revision(s)

Medication Therapy Management Services (MTMS) – MTM service now allowed in recipient's home

08/26/2011

Addition(s)/Revision(s)

Equipment & Supplies

· Standers – Clarified coverage of standers in nursing facilities

08/25/2011

Addition(s)/Revision(s)

Immunizations & Vaccinations – Updated flu vaccine information and made one code clarification for 90715

Pharmacy Services Overview – Updated the Table of Contents

08/24/2011

Addition(s)/Revision(s)

Dental Services

· Critical Access Dental Payment Program (CADPP) – 2011 Legislative changes to Critical Access Dental Payment Program

Pharmacy Services Overview – Clarified text for DAW requirements when a generic is preferred

08/23/2011

Addition(s)/Revision(s)

Provider Basics

· Authorization – Removed outdated fax number

Pharmacy Services Overview – Clarified the use of the Prescribing Provider NPI

08/18/2011

Addition(s)/Revision(s)

Child and Teen Checkups (C&TC) – Added AAP FVA links. Moved legal reference for Lead Screening under Legal References

08/17/2011

Addition(s)/Revision(s)

Physician and Professional Services

· Health Care Homes (HCH) – MN–ITS HCH Tier e-Tool function provider access added

08/15/2011

Addition(s)/Revision(s)

Mental Health Services

· Adult Day Treatment – Revised authorization section

08/12/2011

Addition(s)/Revision(s)

Pharmacy Services – Added text and links for Medical Supplies and Equipment and information about the new Authorization medical review agent

08/09/2011

Addition(s)/Revision(s)

Mental Health Services

· Dialectical Behavior Therapy (DBT) – Added modifier HN for clinical trainees delivering DBT

Provider Basics

· Billing Policy (Overview)

· Payment Methodology – Hospital – Updated with 2011 legislative changes

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP) – Deleted the word “Essure” in the MFPP Sterilization table for code 58565 and updated the Referral to Other Providers section

08/08/2011

Addition(s)/Revision(s)

Provider Basics

· Billing Policy (Overview)

· Out-of-State Providers – Updated for new medical review agent

Health Care Programs and Services Overview – Updated for Legislative prohibition on payments to providers outside the United States

08/05/2011

Addition(s)/Revision(s)

Equipment & Supplies

· Positive Airway Pressure – Updated to allow purchase of CPAP/BiPAP if primary insurance requires purchase

08/02/2011

Addition(s)/Revision(s)

Personal Care Assistance (PCA) Services – Added QP policies and the QA policy in the supervision and eligible providers sections

07/28/2011 – 08/02/2011

Addition(s)/Revision(s)

Equipment & Supplies

· All Equipment and Supplies sections (except for Ventilators) have been updated with new medical review agent information

07/28/2011

Addition(s)/Revision(s)

Chiropractic Services – Updated with new medical review agent information

Eyeglass and Vision Care Services – Updated with new medical review agent information

Hearing Aid Services – Updated with new medical review agent information

Transportation Services Overview

· Ambulance Transportation Services – Updated with new medical review agent information

07/26/2011

Addition(s)/Revision(s)

Free-Standing Birth Center Services – Clarified information for billing recipient transfers

Immunizations and Vaccinations – Clarified admin code requirements and pricing for admin

Provider Basics

· Programs and Services

· Program HH (HIV/AIDS) Covered Services – Updated for new medical review agent. Deleted information about Program HH mental health services requiring prior authorization

Transportation Services Overview – Updated with new medical review agent information

07/25/2011

Addition(s)/Revision(s)

EW and AC

· Waiver and Alternative Care (AC) Programs – Services (Technical Specifications) – Added Specialist Service

07/22/2011

Addition(s)/Revision(s)

EW and AC

· Waiver and Alternative Care (AC) Programs – Services (Service Credentials) – Added Specialist Service

Mental Health Services

· Psychotherapy – Rule 47 revisions, clarification of progress notes

07/15/2011

Addition(s)/Revision(s)

Authorization – Updated for new medical review agent, effective 7/1/2011; added additional fax number 1-866-465-8113

07/07/2011

Addition(s)/Revision(s)

Authorization

· Drug Authorizations – Updated for new medical review agent

· MHCP Pharmacy Quick Reference – Updated for new medical review agent

07/06/2011

Addition(s)/Revision(s)

Mental Health Services

· Diagnostic Assessment – Revised for Rule changes and added links to Minnesota Rules 9505.0370, 0371, and 0372

06/30/2011

Addition(s)/Revision(s)

Authorization – Updated for new medical review agent

Dental Services (Overview)

· Authorization Requirement Tables for Children and Pregnant Women – Updated authorization text

· Children and Pregnant Women – Updated Oral Surgery criteria

· Non-Pregnant Adults – Updated Oral Surgery criteria

Equipment & Supplies

· Ambulatory Assist Equipment – Updated for new medical review agent

· Bath and Toilet Equipment – Updated for new medical review agent

Provider Basics

· Programs and Services

· Program HH Dental Authorization Requirement Chart – Updated for new medical review agent

06/29/2011

Addition(s)/Revision(s)

Mental Health Services

· Partial Hospitalization Program – Added LOCUS information and added link to Minnesota Rules 9505.0370 to 9505.0372

06/28/2011

Addition(s)/Revision(s)

Mental Health Services

· Dialectical Behavior Therapy (DBT) – New section and added links to Minnesota Rules 9505.0370 and 0372

· Explanation of Findings – Updated to implement rule change and added links to Minnesota Rules 9505.0370 and 0372

· Mental Health Medication Management – Changed the Medication Management definition to comply with rule; added legal references; and added links to Minnesota Rules 9505.0370 and 0372

06/27/2011

Addition(s)/Revision(s)

Hearing Aid Services

· Hearing Aid Services Codes – Moved code V5120 for a body worn aid up by the other body worn aids

06/23/2011

Addition(s)/Revision(s)

Mental Health Services

· Intensive Residential Treatment Services (IRTS) – Updated section to match current rules and requirements

Rehabilitative Services – Added 59 modifier billing information

06/16/2011

Addition(s)/Revision(s)

Day Training and Habilitation (DT&H) – Changed appropriate references to ICF/DD

Elderly Waiver (EW) and Alternative Care (AC) Program

· Waiver and Alternative Care (AC) Programs – Services/Service Credentials (Provider Qualifications) – Changed appropriate references to ICF/DD

Individualized Education Program (IEP) Services – Changed appropriate references to ICF/DD

06/14/2011

Addition(s)/Revision(s)

Clinic Services

· Federally Qualified Health Center and Rural Health Clinics – Added Nurse Midwife to FQHC/RHC encounter generating list of professionals

06/08/2011

Addition(s)/Revision(s)

Dental Services (Overview)

· Authorization Requirement Tables for Children and Pregnant Women – Updated authorization text

06/07/2011

Addition(s)/Revision(s)

Health Care Programs and Services Overview – Added GAMC end date; added example when recipient is covered by two programs; clarified newborn coverage policy; clarified persons incarcerated policy

06/01/2011

Addition(s)/Revision(s)

Equipment & Supplies – Added language about new versus used equipment

Mental Health Services

· Diagnostic Assessment – Added text under the Billing section “due to complex needs as identified above”

05/31/2011

Addition(s)/Revision(s)

Equipment & Supplies

· Lower Limb Prosthetics – New sub section

Pharmacy Services – Corrected phone number to MHCP Provider Call Center

05/26/2011

Addition(s)/Revision(s)

Mental Health Services

· Diagnostic Assessment – Removed link and text to outdated “Who Can Do Mental Health Diagnostic Assessments and Psychotherapy?” chart

05/24/2011

Addition(s)/Revision(s)

Provider Basics

· Billing Policy (Overview) – Updated Void claim information to include claims over 3 years and terminated providers

05/16/2011

Addition(s)/Revision(s)

Chiropractic Services – Added authorization/documentation criteria

05/11/2011

Addition(s)/Revision(s)

Clinic Services – Removed Federally Qualified Health Center and Rural Health Clinics information and made it its own section

04/25/2011

Addition(s)/Revision(s)

Provider Basics

· Provider Requirements

· Provider Screening Requirements – Made correction to referring/ordering providers

04/19/2011

Addition(s)/Revision(s)

Ambulatory Surgical Services – Updated information and formatting

Chiropractic Services – Corrected new threshold limit and removed GAMC reference

Transportation Services Overview

· Acceptable Ambulance Diagnosis Codes – Updated two diagnosis code list spans for the A0429 service code. Spans updated to 782.0 thru 782.5 and 796.2 thru 796.4

04/13/2011

Addition(s)/Revision(s)

Dental Services (Overview)

· Children and Pregnant Women – Changed appropriate references to ICF/DD and updated authorization links

04/12/2011

Addition(s)/Revision(s)

Physician and Professional Services

· Health Care Homes – Clarification made under Eligible Providers

Rehabilitative Services

· Augmentative Communication Devices – Removed GAMC/CCDS text

04/11/2011

Addition(s)/Revision(s)

Clinic Services – Updated chart under Billing for PHNC Services

Equipment & Supplies

· Bath and Toilet Equipment – Removed reference to modifier 22 and the effective date of 04/01/2010 for use of modifier U3 for clarification

04/08/2011

Addition(s)/Revision(s)

Mental Health Services

· Adult Rehabilitative Mental Health Services (ARMHS) – Added LOCUS and Functional Assessment information

Reproductive Health/OB-GYN

· Sterilization – Changed appropriate references to ICF/DD

04/07/2011

Addition(s)/Revision(s)

Pharmacy Services

· NCPDP Payer Sheets Guidelines – Added the Other Payer ID Qualifier 03 BIN for field 6C and added the clarification of NCPDP to the reject codes in for other coverage code 03 in field 6E

04/05/2011

Addition(s)/Revision(s)

Mental Health Services

· Adult Crisis Response Services – Corrected community intervention 90882 unit length

04/04/2011

Addition(s)/Revision(s)

Pharmacy Services Overview – Removed reference to CDMI as the prior authorization review agent for prescription drugs

04/01/2011

Addition(s)/Revision(s)

Day Training and Habilitation (DT&H) – Changed appropriate references to ICF/DD

03/31/2011

Addition(s)/Revision(s)

Nursing Facilities – Changed appropriate references to ICF/DD

03/24/2011

Addition(s)/Revision(s)

Hearing Aid Services – Added language to clarify requirements for replacing hearing instruments

03/23/2011

Addition(s)/Revision(s)

Child and Teen Checkups (C&TC) – Added disclaimer under Legal References

Equipment & Supplies

· Specialized Wound Treatment Technology – Added criteria for NPWT for acute wounds

Mental Health Services

· Assertive Community Treatment (ACT) – Added LOCUS and Functional Assessment information and links

03/21/2011

Addition(s)/Revision(s)

Reproductive Health/OB-GYN

· Obstetric Services – Added information on E0604, hospital grade breast pumps: 3 month rental limit & a PA required for an additional month

03/18/2011

Addition(s)/Revision(s)

Hospice Services – Deleted obsolete information; updated format and reference to DD

Transportation Services Overview

· Special Transportation Services (STS) – Made clarifications and added a link to STS Procedure Codes & Payment Rates

03/16/2011

Addition(s)/Revision(s)

Equipment & Supplies – Updated policy regarding MUEs for prosthetics and orthotics

Pharmacy Services

· NCPDP Payer Sheets Guideline – Updated/clarified qualifier information for pharmacy COB reporting

03/15/2011

Addition(s)/Revision(s)

Elderly Waiver (EW) and Alternative Care (AC) Program – Changed appropriate references to ICF/DD

Equipment & Supplies

· Positive Airway Pressure for Treatment of Obstructive Sleep Apnea – Added information about suggested methods of compliance for CPAP and BI-PAP equipment within the 3rd month

Home Care Services

· Skilled Nurse Visit (SNV) Services – Changed appropriate references to ICF/DD

Laboratory/Pathology, Radiology & Diagnostic Services

· Authorization Requirements: Imaging Services – Clarified that authorization for emergency services in an ambulatory surgical center (ASC) or outpatient hospital setting is no longer required.

Pharmacy Services

· Pharmacy Non-Controlled Substance Overrides – Changed appropriate references to ICF/DD

Relocation Service Coordination—Targeted Case Management (RSC—TCM) – Changed appropriate references to ICF/DD

Transportation Services Overview – Changed appropriate references to ICF/DD

· Access Transportation Services (ATS) – Changed appropriate references to ICF/DD

03/14/2011

Addition(s)/Revision(s)

HCBS-Waiver-Services – Changed appropriate references to ICF/DD

· Service Credentials (Provider Qualifications) – Updated table

Pharmacy Services

· Pharmacy Controlled Substance Overrides – Changed appropriate references to ICF/DD

03/10/2011

Addition(s)/Revision(s)

Laboratory/Pathology, Radiology & Diagnostic Services

· Radiology/Diagnostic Services – Changed effective dates for services under Authorization Requirements

03/08/2011

Addition(s)/Revision(s)

Billing Policy

· Payment Methodology - Non-Hospital – Updated the vaccines rate methodology

03/07/2011

Addition(s)/Revision(s)

Billing Policy

· Payment Methodology - Non-Hospital – Changed appropriate references to ICF/DD

Prepaid Minnesota Health Care Programs (PMHCP) – Changed appropriate references to ICF/DD

03/04/2011

Addition(s)/Revision(s)

Laboratory/Pathology, Radiology & Diagnostic Services

· Radiology/Diagnostic Services – Providers performing certain imaging services will receive an immediate approved authorization response if the ordering/referring provider completed clinical decision support through a DHS approved vendor (Nuance) or if age, diagnosis and medical history are met. All other providers will answer medical criteria questions related to the requested procedure and based on their response may receive an immediate approved authorization.

03/03/2011

Addition(s)/Revision(s)

HCBS Waiver Services – Added the new specialized supplies and equipment policy, oral and enteral nutritional products and responsibilities to the specialized supplies and equipment section

ICF/DD – Changed appropriate references to ICF/DD; deleted obsolete language

03/01/2011

Addition(s)/Revision(s)

Billing Policy

· How to Read Your PDF RA – Corrected supplemental data information

Health Care Programs and Services

· MHCP Benefits At-a-glance – Changed appropriate references to ICF/DD

Rehabilitative Services – Changed appropriate references to ICF/DD

Transportation Services

· Ambulance Transportation Services – Changed appropriate references to ICF/DD

02/25/2011

Addition(s)/Revision(s)

Provider Requirements – Changed appropriate references to ICF/DD; deleted Rule 101 information (now separate page); added link to Billing Organization Responsibilities

· Access Services – Added clarifier 'if provider cannot communicate with recipient' and for IEP providers to bill interpreter services per IEP section

· Provider Participation Requirements – Rule 101 – Consolidated Rule 101 information

02/23/2011

Addition(s)/Revision(s)

Equipment & Supplies – Changed appropriate references to ICF/DD, deleted obsolete language

· Gloves – Changed appropriate references to ICF/DD

· Mobility Devices – Changed appropriate references to ICF/DD, deleted obsolete language

· Patient Lifts and Seat Lift Mechanisms – Changed appropriate references to ICF/DD

Mental Health Services – Overview – Updated Mental Health continuum graphic

Rehabilitative Services

· Service Thresholds (OT, PT, Speech-Language Pathology) – Updated threshold descriptions (units vs. treatment sessions) and changed threshold for biofeedback codes

02/22/2011

Addition(s)/Revision(s)

Billing Policy

· Payment Methodology - Non-Hospital – Updated anesthesia payment methodology

Transportation Services

· Access Transportation Services – Removed older date references in the Overview section

02/18/2011

Addition(s)/Revision(s)

Rehabilitative Services – Added clarification of professional documentation guideline under Documentation Requirements

02/17/2011

Addition(s)/Revision(s)

Hearing Aid Services Codes Table– Added criteria for hearing aid repair authorization required for repair costs over $400

02/15/2011

Addition(s)/Revision(s)

Elderly Waiver (EW) and Alternative Care (AC) Program– Changed code X5467 to T2029 under Specialized Supplies and Equipment

Equipment & Supplies

· Pneumatic Compression Devices – Clarified that E0675 is not covered under Non-Covered Services

02/10/2011

Addition(s)/Revision(s)

Community Health Worker – Added MH professionals to the list of eligible providers

Equipment & Supplies

· Diabetic Equipment & Supplies – Added blood glucose monitors might need diagnosis under Covered Services

· Pneumatic Compression Devices – Added E0656, E0657 are not reimbursed separately from the compressor under Non-Covered Services

02/09/2011

Addition(s)/Revision(s)

Hospital Services – Added clarification notes to the MHCP Coverage Ended During Inpatient Stay subsection

02/08/2011

Addition(s)/Revision(s)

Personal Care Assistance (PCA) Services – Added PCA Portal policies under PCA Agency enrollment section

02/02/2011

Addition(s)/Revision(s)

Health Care Programs and Services – Added subsection Emergency Medical Assistance (EMA) Service Limitations

· MHCP Benefits At-a-glance – Updated

Hospital Services – Added MHCP Coverage Ended During Inpatient Stay under Inpatient Billing sub section

Provider Manual Table of Contents – Added EMA Service Limitations under Programs and Services

Provider Requirements – Removed Access Services information

01/31/2011

Addition(s)/Revision(s)

Child and Teen Checkups (C&TC) – Corrected title for Screening for Autism in Toddlers, Developmental Health and Mental Health

01/27/2011

Addition(s)/Revision(s)

Provider Requirements

· Access Services – New subsection; updated information about modifiers for interpreter services; added legislative requirement that interpreters must be on MDH Roster list

Hearing Aid Services – Clarified text for policy surrounding hearing aid replacement when lost or broken and authorization requirements for lost or damaged hearing aids

01/25/2011

Addition(s)/Revision(s)

Transportation Services (Overview) – Clarified information regarding STS. Deleted verbiage referencing Local Trade Area

01/24/2011

Addition(s)/Revision(s)

Rehabilitative Services

· Service Thresholds (Occupational Therapy, Physical Therapy, Speech-Language Pathology) – Added modifiers to sections of the rehab threshold chart

01/20/2011

Addition(s)/Revision(s)

Billing Policy

· Medicare and Other Insurance – Clarified providers must verify if a policy is a Medicare replacement policy; and insurance includes long term care insurance

Physician and Professional Services

· Primary Care Coordination (PCC) – Added the word rendered under Eligible Providers

01/19/2011

Addition(s)/Revision(s)

Equipment & Supplies – Added link to Breast Pumps to the Table of Contents

01/18/2011

Addition(s)/Revision(s)

Anesthesia Services – Updated with the new 2011 anesthesia formulas

Immunizations & Vaccinations – Updated recipient eligibility; clarified coverage, including vaccines/toxoids and administration charts

Rehabilitative Services

· Augmentative Communication Devices – Added clarifying language about repairs on devices that have been modified by the recipient

01/12/2011

Addition(s)/Revision(s)

Reproductive Health/OB-GYN – Change title of Birth Center Services section to Free-Standing Birth Center Services

01/11/2011

Addition(s)/Revision(s)

Personal Care Assistance (PCA) Services – Added text from the assurance statement to the PCA about non-compete clause use for individual PCAs who have left the agency

Rehabilitative Services

· Orthotic Procedures – Updated chart with new L-codes