Targeted Case Management (TCM) Enrollment Criteria and Forms

Revised: February 10, 2025

The local county or tribal agency approves targeted case managers (individuals or agencies), but counties and tribes cannot activate a case manager’s Minnesota Health Care Programs (MHCP) enrollment. Only MHCP can change an approved county case manager’s status to active. MHCP enrolls the following types of targeted case managers:

· Adult Mental Health

· Children’s Mental Health

· Child Welfare

· Relocation Services Coordination (RSC)

· Vulnerable Adult/Developmental Disability (VA/DD)

How to Enroll

Providers who want to enroll or reenroll, or providers required to revalidate with MHCP, can do so in one of the following two ways.

Online MPSE Portal

Register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your enrollment online using by using the instructions under the Registration and Access section in the MPSE Enrollment Manual.

If enrolling through the MPSE Portal, you will be required to upload a 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).

You may add targeted case management services to multiple different enrollment record types using the MPSE portal. The following chart shows which targeted case management (TCM) services are allowable on each enrollment record type.

Allowable TCM services for enrollment record types

Enrollment record type	Adult Mental Health TCM	Children’s Mental Health TCM	Child Welfare TCM	RSC TCM	VA/DD TCM
Community Mental Health Center - 10	Yes	Yes	Yes	No	No
HCBS Case Management - 18	No	No	No	Yes	Yes
Targeted Case Management - 44	Yes	Yes	Yes	No	No
County Human Services Agency - 45	Yes	Yes	Yes	Yes	Yes
Indian Health Services - 51	Yes	Yes	Yes	No	No
Community Health Clinic - 58	Yes	Yes	Yes	No	No
Public Health Nursing Organization - 61	No	No	No	Yes	Yes

or

Submit Forms via Fax

Fax the following documents to MHCP Provider Eligibility and Compliance at 651-431-7462.

· Organization – Provider Enrollment Application (DHS-4016A) (PDF) (for agencies and groups)

· Home and Community Based Services (HCBS) - Provider Enrollment Application (DHS-4015) (PDF) (for RSC and VA/DD only)

· 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)

· Disclosure of Ownership and Control Interest (DHS-5259) (PDF) (for agencies and groups)

· EFT Supplier ID Notification (DHS-3725) (PDF)

· 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.

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

MHCP processes forms in date order received. Whether enrolling, reenrolling, or revalidating 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 via U.S. Postal Service (or your MN–ITS mailbox, if you have an account) explaining what you need to do to complete your enrollment or revalidation.

Interactive Video

The following MHCP-enrolled TCM providers may deliver TCM through interactive video:

· Child Welfare Targeted Case Management

· Children’s Mental Health Targeted Case Management

· Adult Mental Health Targeted Case Management

· Vulnerable Adult/Developmental Disability Targeted Case Management

Organizational providers who want to deliver and bill for TCM services using interactive video must assure they meet the requirements of the interactive video policy and attest to the safety and effectiveness of interactive video for the person served, according to Minnesota Statutes, 256B.0625, subdivision 20b. Complete and submit the Targeted Case Management Provider Interactive Video Assurance Statement (DHS-8398) (PDF) to DHS through the MPSE portal or by fax to add interactive video services to your current enrollment record.

Revalidation

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

Notify MHCP any time a change is made on a provider record. Refer to Changes to Enrollment in the Enrollment with Minnesota Health Care Programs (MHCP) section of the MHCP Provider Manual for details.

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

Additional Resources

Minnesota Statutes, 256B.0621 (Covered Services: Targeted case management)
Minnesota Statutes, 245.462 (Definitions; Case management service provider)
Minnesota Statutes, 245.4711 (Case Management Services)
Minnesota Statutes, 256B.0625, subdivision 20b, (Targeted case management through interactive video)