MHCP Provider Manual

Latest Manual Revisions

Revised: January 27, 2023

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.

January 27, 2023

Provider Basics
Enroll with MHCP

· Dental Therapist (DT), Advanced Dental Therapist (ADT), and Collaborative Practice Dental Hygienist (CPDH) Enrollment Criteria and Forms – Updated to clarify the enrollment process for these provider types.

January 25, 2023

Certified Community Behavioral Health Clinic (CCBHC)

· Certified Community Behavioral Health Clinic (CCBHC) – We updated this manual section to reflect current Uniform Service Standards.

EW and AC

· Elderly Waiver (EW) and Alternative Care (AC) Program – Under the Elderly Waiver Customized Living Services Rate Adjustment section, we added a table for the minimum rate amount.

Mental Health Services

· Partial Hospitalization Program

· Under Eligible Providers, we updated to meet statutory requirements.

· Under Eligible Members, we removed SDQ as a screening tool for children and adolescents.

· Under Authorization Requirements, we removed SDQ.

Provider Basics
Enroll with MHCP

· Nursing Facility Enrollment Criteria and Forms

· We added a section on Conditions of Enrollment and provided legal citations for the authority on the requirements of participation with Minnesota Health Care Programs.

· We added a reference and link for Swing Bed Hospital Services for providers who want to enroll as swing bed services providers.

January 24, 2023

HCBS Waiver Services

· HCBS Waiver Services – In the table in the Covered and Noncovered Services section, we updated Integrated community supports to be covered under BI, CAC, CADI and DD.

Provider Basics
Enroll with MHCP

· Chiropractor Enrollment Criteria and Forms – Group enrollment criteria is being changed to: To enroll as a chiropractic group, the chiropractic group must be composed of at least one enrolled chiropractor.

January 23, 2023

Reproductive Health/OB-GYN

· Obstetric Services and HIV Counseling – Under Breast Pumps, we changed that E0602, manual breast pumps, and E0603, personal electric breast pumps, are covered one per pregnancy.

January 20, 2023

Mental Health Services

· Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM)

· Under Mental Health Targeted Case Management: Core Service Components and Process, Assessment, we removed the Completing LOCUS assessment to determine resources and resource intensity needs requirement.

· Under Documentation, Client file, Documenting clinical supervision, we removed the Complete or cosign all members' level of care assessments LOCUS (adult MH-TCM only) requirement.

January 18, 2023

Provider Basics
Billing Policy

· Billing the Member (Recipient) – Under Noncovered Services, we clarified the definition of a noncovered service.

· Payment Methodology - Non-Hospital – Under Legislative Changes Related to Rates, we updated dental information according to Minnesota Statutes 256B.76 and Minnesota Rules 9505.0445.

January 13, 2023

Provider Basics
Enroll with MHCP

· Intensive Residential Treatment Services Enrollment Criteria and Forms – Under How to Enroll, we added MPSE information and updated the list of required documents.

· Licensed Professional Clinical Counselor Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions.

· Occupational Therapist Enrollment Criteria and Forms – Under Enrollment Criteria, we have updated enrollment instructions to include the Minnesota Provider Screening and Enrollment portal.

January 12, 2023

Provider Basics
Enroll with MHCP

· Billing Entity for Mental Health Enrollment Criteria and Forms – Under Enrollment Criteria, we updated information to include Minnesota Provider Screening and Enrollment instructions. We also explained children’s therapeutic services and supports (CTSS) and adult rehabilitative mental health services (ARHMS) providers must submit proof of fee payment and a copy of the CTSS or ARMHS certification letter.

Anesthesia Services

· Anesthesia Services – We added a table for the 2023 Anesthesia Rates in the section MHCP Anesthesia Payment Formulas.

Member Evidence of Coverage (EOC)

· MHCP Member Evidence of Coverage – Made small revision to the Child and Teen Checkups verbiage under the Covered Services heading.

January 11, 2023

Reproductive Health/OB-GYN

· In the Minnesota Family Planning Program (MFPP) section of the MHCP Provider Manual, under Covered Services section, under Contraceptive and Medication Supplies, we removed the MFPP Contraceptive and Medication Supplies Table. We replaced it with the DHS NDC Search tool with instructions for use.

January 10, 2023

Provider Basics
Enroll with MHCP

· Rural Health Clinic Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions.

January 9, 2023

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP)

· In the Covered Services section, under Contraceptive and Medication Supplies, we removed the MFPP Contraceptive and Medication Supplies Table and replaced it with the DHS NDC Search tool with instructions for use.

· In the Legal References section, we removed the Section 1902(a)(32) of the Social Security Act reference and replaced it with the Code of Federal Regulations, title 42, section 435.214 reference.

Authorization

· MHCP Pharmacy Quick Reference

· We deleted the IFMC Medical Review Agent section because it is no longer valid.

· In the MHCP Provider Resource Center section, we deleted the check status of a medical supply authorization text because they do not check authorization requests.

· Additionally, updated the language for clarity.

Provider Basics
Enroll with MHCP

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Under Ongoing Reporting Requirements, we added a Changes in Ownership section, which includes a link to the Provider Entity Sale or Transfer Addendum (DHS-5550).

Substance Use Disorder (SUD) Services

· Substance Use Disorder (SUD) Services – Under Covered Services, we replaced smoking cessation with Tobacco Use Disorder cessation.

January 6, 2023

Provider Basics
Enroll with MHCP

· Regional Treatment Center Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions.

January 5, 2023

Provider Basics
Enroll with MHCP

· Public Health Clinic Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions.

Mental Health Services

· Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP)

· Under Eligible Members, we updated adolescent eligibility criteria.

· We updated assessment requirements and ITP requirements per legislation.

· We also updated this section to reflect Uniform Service Standards.

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information – In the Personal and Volunteer Driver Mileage table, we updated 2023 IRS Mileage reimbursement rates. Rates have been increased to $0.65 per mile for codes A0090 UC Modifier for Licensed Foster Parent and A0080 Volunteer Driver.

January 4, 2023

Equipment and Supplies

· Electrical Stimulation Devices – Under Covered Services, we deleted Implanted Neurostimulator Devices L8680 and L8686 and moved it to the Physician and Professional Services section of the MHCP Provider Manual.

Physician and Professional Services

· Physician and Professional Services

· We added the section Implantable Neurostimulators to clarify that the surgery CPT code 64568 requires prior authorization for the insertion of a cranial nerve neurostimulator electrode and generator. Claims for the devices will not pay unless there is an approved prior authorization for the procedure.

· Devices:

· L8680: Implantable neurostimulator, electrode, each

· L8686: Implantable neurostumulator pulse generator, single array, nonrechargable, includes extension

Provider Basics
Enroll with MHCP

· Podiatrist Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions. We also added that a copy of the podiatry license must be submitted when enrolling.

· Optometrist Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions. We also added that a copy of the optometry license must be submitted when enrolling.

January 3, 2023

Reproductive Health/OB-GYN

· Abortion Services

· Under Eligible Members, we updated to include MinnesotaCare members.

· Under Legal References, we removed Minnesota Rules 9505.0235 (Abortion Services).

· Additionally, we updated the language for clarity.

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Previous Revisions

2022 Manual Revisions
2021 Manual Revisions
2020 Manual Revisions
2019 Manual Revisions
2018 Manual Revisions
2017 Manual Revisions
2016 Manual Revisions
2015 Manual Revisions
2014 Manual Revisions
2013 Manual Revisions
2012 Manual Revisions
2011 Manual Revisions