Speech-Language Pathologist Enrollment Criteria and Forms

Revised: February 9, 2023

To enroll as a speech-language pathologist (SLP) with Minnesota Health Care Programs (MHCP), the SLP must:

· Obtain a license from the Minnesota Department of Health (MDH).

· Maintain applicable state licensure requirements as listed in Minnesota Statutes 148.515 – 148.5175, or comply with state regulatory requirements in states that do not license.

· Comply with applicable state licensure requirements described in Minnesota Rules 9505.0195.

· Enroll with Medicare.

Enrollment Criteria

SLPs who wish to enroll with MHCP or make enrollment requests can do so in one of the following two ways.

· Register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your enrollment online using the MPSE portal. Also, upload the following in the MPSE portal:

· Copy of license as a Speech-Language Pathologist in the state of practice

· Provider Agreement (DHS-4138) (PDF)

or

· Complete the following documents required to enroll as an SLP and fax your materials to MHCP Provider Eligibility and Compliance at 651-431-7462.

· Individual – Provider Enrollment Application (DHS-4016) (PDF)

· Provider Agreement (DHS-4138) (PDF)

· Copy of license as a Speech-Language Pathologist in the state of practice

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

We process forms in order of date received. Whether enrolling 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 your MN–ITS mailbox or U.S. Postal Service explaining what you need to do to complete your enrollment.

Revalidation

MHCP is required to follow the Centers for Medicare & Medicaid Services (CMS) final federal provider screening regulations.

Refer to Revalidation in the Provider Screening Requirements section of the MHCP Provider Manual for more information about how to complete your revalidation.

Reporting Changes

Report any changes made on a provider record to MHCP Provider Eligibility and Compliance. Refer to Changes to Enrollment in the Enroll with MHCP section of the MHCP Provider Manual for details.

Additional Resources

Minnesota Statutes 148.511-148.5198 (Speech-Language Pathologists and Audiologists)
Minnesota Rules 9505.0390 (Rehabilitative and Therapeutic Services)
Minnesota Rules 9505.0391 (Therapists Eligible to Enroll as Providers)
Code of Federal Regulations, title 42, section 410.62 (Outpatient speech-language pathology services: Conditions and exclusions)