MHCP Provider Manual

Latest Manual Revisions

Revised: October 26, 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.

October 26, 2023

Provider Basics
Enroll with MHCP

· Certified Nurse Specialist Enrollment Criteria and Forms – The title was updated to Certified Nurse Specialist to be consistent with our Minnesota Provider Screening and Enrollment (MPSE) portal. We updated the names of the required provider agreements when enrolling.

· Dental Hygienist Group Enrollment Criteria and Forms

· We updated the manual page name to be consistent with the MPSE portal and our other enrollment pages.

· We updated the enrollment criteria to be consistent with enrollment procedures.

· Mental Health Group Enrollment Criteria and Forms – We updated the title to match the provider type name on the MHCP Enrollment Provider Manual and Minnesota Provider Screening and Enrollment (MPSE) portal.

October 25, 2023

Optical Services

· Optical Services – We have revised this manual section to clarify language and update formatting. There are no changes to policy or billing procedures.

October 24, 2023

Provider Basics
Enroll with MHCP

· Ambulatory Surgical Center Enrollment Criteria and Forms

· We updated the page title to Ambulatory Surgical Center Enrollment Criteria and Forms.

· Under, How to Enroll, Use the Online Minnesota Provider Screening and Enrollment Portal, we clarified language and updated links.

Member Evidence of Coverage

· MHCP Member Evidence of Coverage

· In the Retroactive Coverage section, we added the following text to be consistent with our Minnesota Health Care Programs (MHCP) Provider Manual.

"We cannot pay you back for medical bills that you paid. State and federal laws prevent us from paying directly. The provider has the option to do one of the following:

· Refund to you the full amount you paid and bill MHCP for the services.

· Keep your payment and choose not to bill MHCP for the services."

· In the Copays section, in the table, we changed “Non-routine dental" to “Nonpreventative dental."

October 20, 2023

Provider Basics
Enroll with MHCP

· Hearing Aid Dispenser Enrollment Criteria and Forms

· We updated the page title to Hearing Aid Dispenser.

· We updated provider agreement titles and links.

October 19, 2023

Provider Basics
Enroll with MHCP

· Individualized Education Program (IEP) Enrollment Criteria and Forms

· We updated the title to Individualized Education Program.

· Under How to Enroll, we updated with new provider agreements.

· Under Revalidation and Reporting Changes, we updated with links to resources.

October 18, 2023

Provider Basics
Enroll with MHCP

· Community Health Worker Enrollment Criteria and Forms – We updated the names and links to the required provider agreements for enrollment.

· Dentists and Dental Group Enrollment Criteria and Forms – We updated the names and links to the required provider agreements for enrollment.

October 17, 2023

Provider Basics
Enroll with MHCP

· Recovery Community Organizations (RCOs) Enrollment Criteria and Forms

· We updated the title of this page to Recovery Community Organizations Enrollment Criteria and Forms to be consistent with our other enrollment pages.

· Under the Online MPSE Portal and Submit Forms via Fax headings, we updated the names of the provider agreements that are required when enrolling.

October 16, 2023

Provider Basics
Enroll with MHCP

· Renal Dialysis Facility Enrollment Criteria and Forms – We updated this manual page name to be consistent with our other enrollment pages. We added information about how to enroll using the Minnesota Provider Screening and Enrollment (MPSE) portal. We updated the links to the provider agreements that providers are required to submit to enroll with Minnesota Health Care Programs.

October 13, 2023

Provider Basics
Enroll with MHCP

· Psychiatric Residential Treatment Facility (PRTF) Enrollment Criteria and Forms – We created a Psychiatric Residential Treatment Facility provider enrollment webpage to explain the Minnesota Health Care Programs provider enrollment process.

· Transportation Driver Enrollment Criteria and Forms – This is a new Minnesota Health Care Programs provider enrollment manual section for Transportation Driver providers.

October 12, 2023

Dental Services

· Dental Services – Under Covered Services, COVID-19 Testing by Dentists, we updated content to include what has been posted on Coronavirus (COVID-19). No policy changes are reflected in the changes.

Provider Basics
Enroll with MHCP

· Billing Entity for Physician Group Enrollment Criteria and Forms – We updated the link for MPSE Registration and Categories of Enrollers to MPSE Registration and Access to match the name of the landing page.

· Enrollment with Minnesota Health Care Programs (MHCP) – We removed an explanatory sentence for Home Care Nursing Agency Group to be consistent with the rest of the eligible provider types list.

October 10, 2023

Program HH (HIV/AIDS) Services

· Program HH (HIV/AIDS) Services

· Under Dental Benefit, Dental Benefit Covered Services, we updated the benefit set to align with the benefits for Children and Pregnant Women. This includes the following changes.

· We added CDT codes and service limits for diagnostic, diagnostic imaging, prevention, restorative, periodontics, removable prosthodontics and adjunctive general services.

· We removed content for oral surgery, orthodontics, Temporomandibular Joint (TMJ) Disorder and pain relief services.

· Under Dental, Dental Benefit Authorization Requirements, we removed the Non-Pregnant Adults Authorization Chart because it no longer applies to this program.

· Under Drug Benefit, Drug Benefit Billing, we added content that Program HH covers Cabenuva, Sunlenca and Trogarzo to align with how other MHCP programs cover these drugs.

· Under Medication Therapy Management Services, MTMS Covered Services, we updated that services provided by telephone should follow the MHCP Telehealth Services policy.

· We updated language for clarity.

October 6, 2023

Equipment & Supplies

· Incontinence Products – Under Covered Services, Coverage Criteria, we clarified what HCPCS codes are covered.

October 2, 2023

Mental Health Services

· Partial Hospitalization Program – Under Authorization Requirements, we updated the number of progress notes required for authorization.

Provider Basics
Billing Policy Overview

· Billing the Member (Recipient) – In the Medical Assistance column of the Fee-for-Service Copays charts for 2024, 2023 and 2022, we clarified that copays do not apply to nonpreventive dental services.

October 1, 2023

Equipment and Supplies

· Nutritional Products and Related Supplies – Under Enteral Nutrition Coverage Criteria, Enteral Feeding Supply Kits, we added HCPCS B4148 as a covered code effective Oct. 1, 2023.

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September 29, 2023

COVID-19

· Coronavirus (COVID-19) – We added the end dates for policy modifications that ended with the end of the federal public health emergency. Some COVID-19 policy modifications will continue beyond the federal public health emergency. We added references to the specific Minnesota Health Care Programs Provider Manual pages where providers can find information about continuing COVID-19 services covered.

Dental Services

· Dental Benefits for Children and Pregnant Women – Under Covered Services, Preventive, CDT D1354, we removed “cannot be performed on the same date as D1206 or D9910" as part of its service limits.

September 28, 2023

Hearing Aid Services

· Hearing Aid Services

· Under Billing, Repair Claims, we updated the details needed for claim documentation.

· Under Billing, Hearing Aid Repairs - After Warranty, we updated policy to include the hearing aid HCPCS codes V5171, V5181, V5211, V5221, V5256, V5257, V5260 and V5261 and model number for remakes, replates or recasing, rather than using HCPCS code V5014.

Provider Basics
Program HH (HIV/AIDS) Services

· Program HH Dental Authorization Requirement Chart – We updated dental authorization criteria which includes the following changes:

· Removed the Limited Benefits Non-Pregnant Adults Authorization Chart and Endodontic and Periodontal Services text

· Added Maxillofacial Prosthetics content

September 25, 2023

Community Paramedic Services

· Community Paramedic Services – In the Covered Services section and in the Billing section, we removed text stating that community paramedic services are provided in the home as this is not a requirement in the Minnesota statute governing community paramedic services.

Provider Basics
Enroll with MHCP

· Enrollment with Minnesota Health Care Programs (MHCP) – We added a section for Enrollment for Managed Care Organization Providers. We moved the links to provider specific enrollment pages in the Eligible Providers section to the bottom of the page. We added the provider type number for each enrollment type linked in the Eligible Providers section. We revised language to clarify text throughout the page.

September 20, 2023

Individualized Education Program (IEP) Services

· IEP Personal Care Assistance (PCA) Services – Under Eligible Providers, People Eligible to Provide PCA Services, we removed “not be a person who receives PCA services.” This restriction no longer exists if the provider meets all the listed requirements.

· IEP Nursing Services – We updated language for clarity. No policy changes are reflected in our updates.

September 18, 2023

MHCP Member Evidence of Coverage

· MHCP Member Evidence of Coverage – Effective on or after Jan. 1, 2024, the Minnesota Legislature removed the copay and family deductible for all Medical Assistance members. Effective on or after Jan. 1, 2024, the Minnesota Legislature also changed several MinnesotaCare copay fees and removed the family deductible.

September 13, 2023

Equipment and Supplies

· Equipment and Supplies – Under Billing, we updated the process for billing prior authorization requests for manually priced HCPCS codes.

· Incontinence Products – Under Covered Services, Coverage Criteria, we added underpads can be covered for children under the age of 4 years for other diagnoses not related to incontinence.

September 8, 2023

Physician and Professional Services

· Gender-Affirming Surgery – We updated the gender-affirming surgery policy following feedback during Health Services Advisory Council meetings.

September 6, 2023

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

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

· Under Covered Services, we removed the family memory care component and renamed the two remaining components to Caregiver counseling and Caregiver training in the service table for family caregiver services.

· Under the Elderly Waiver Customized Living Services Rate Adjustment section, we added the minimum rate for 2024.

Provider Basics
Enroll with MHCP

· Certified Nurse Midwife Enrollment Criteria and Forms

· We updated the enrollment criteria.

· We removed the Nurse Licensure Compact information.

· Under How to Enroll, Use the Online Minnesota Provider Screening and Enrollment (MPSE) Portal and Complete the following documents and fax your materials to 651-431-7462,

· we linked to MCO In-Network Provider Agreement (DHS-8355).

· we added copy of current APRN CNM license from state of practice.

· we removed copy of registered nurse license from state of practice.

September 1, 2023

Behavioral Health Home Services

· Behavioral Health Home Services – Under Eligible Members, language has been updated on Behavioral Health Home (BHH) Services Rights, Responsibilities and Consent (DHS-4797B) to end the allowance of verbal consent that was allowed during the federal public health emergency.

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August 31, 2023

Physician and Professional Services

· Physician and Professional Services – In the Implantable Neurostimulators section, we added the new MHCP-covered service Hypoglossal Nerve Stimulation.

August 28, 2023

Provider Basics
Billing Policy Overview

· Billing the Member (Recipient) – Under Copays and Family Deductible, we added tables to reflect cost sharing for 2024.

Hospital Services

· Inpatient Hospital Services – Under Billing, we added a section about Medicare Part B coverage only for members with dual eligibility.

August 24, 2023

Provider Basics
Enroll with MHCP

· Certified Registered Nurse Anesthetist Enrollment Criteria and Forms

· We updated the requirements to enroll as a certified nurse anesthetist.

· We removed information about the Nurse Licensure Compact.

· Under How to Enroll, we linked to MCO In-Network Provider Agreement (DHS-8355) in the Use the Online Minnesota Provider Screening and Enrollment (MPSE) Portal and Complete the following documents and fax your materials to 651-431-7462 sections.

· We updated language and form titles for clarity.

August 21, 2023

Equipment and Supplies

· Mobility Devices – Under Noncovered Services, we clarified the definition of unbundling.

August 17, 2023

Provider Basics
Enroll with MHCP

· Audiologist Enrollment Criteria and Forms – Under How to Enroll, we linked to the Managed Care Organization In-network Provider Agreement (DHS-8355) in both the Online MPSE Portal and Submit Forms via Fax sections.

August 15, 2023

Provider Basics
Enroll with MHCP

· Chiropractor Enrollment Criteria and Forms – Under How to Enroll, we linked to the Managed Care Organization In-network Provider Agreement (DHS-8355) in the Online MPSE Portal, Submit Forms via Fax and Chiropractor Group sections.

Mental Health Services

· Diagnostic Assessment

· Under Eligible Members and Covered Services, Brief Diagnostic Assessment, we removed information stating the brief diagnostic assessment may only be used for a member six years old or older.

· Under Covered Services, Standard Diagnostic Assessment, we updated requirements per legislative changes.

August 14, 2023

Mental Health Services

· Adult Rehabilitative Mental Health Services (ARMHS)

· Under Eligible Members, we clarified eligible members must have a primary diagnosis of a mental illness determined by a diagnostic assessment.

· Under Covered Services, Best Practices for the ITP, we clarified best practices are not requirements, only recommendations.

· Under Covered Services, Community Interventions, we revised language of Community Interventions that do not qualify.

· Under Covered Services, we updated the Level of Care Assessment language to include Necessity of Care Service Recommendations or Referrals.

August 11, 2023

Transportation Services

· Nonemergency Medical Transportation (NEMT) Services (Overview) – Under Billing, Documentation Requirements, we updated the trip documentation requirements to include what is required to be entered on the trip log.

· State-Administered NEMT – Under Documentation, we updated the trip documentation requirements to include what is required to be entered on the trip log.

August 10, 2023

Rehabilitation Services

· Augmentative Communication Devices – Under Billing, we clarified that pricing documents must be submitted with the claim for HCPCS codes that require manual pricing.

Dental Services

· Dental Services – Under Covered Services, we changed the COVID-19 Testing and Vaccination header to COVID-19 Testing by Dentists. Additionally, we deleted text about dentists ordering and administering COVID-19 vaccines in accordance with Minnesota Statutes, 150A.055 (Administration of Vaccines).

August 8, 2023

Provider Basics
Enroll with MHCP

· Billing Entity for Physician Group Enrollment Criteria and Forms – Under How to Enroll, we linked to the Managed Care Organization In-network Provider Agreement (DHS-8355) in both the Online MPSE Portal and Submit Forms via Fax sections.

August 4, 2023

Provider Basics
Enroll with MHCP

· Certified Mental Health Rehabilitation Professional Enrollment Criteria and Forms – Under How to Enroll, we linked to the Managed Care Organization In-network Provider Agreement (DHS-8355) in both the Online MPSE Portal and Submit Forms via Fax sections.

August 3, 2023

Provider Basics
Enroll with MHCP

· Billing Entity for Mental Health Enrollment Criteria and Forms – Under How to Enroll, we linked to the Managed Care Organization In-network Provider Agreement (DHS-8355) in both the Online MPSE Portal and Submit Forms via Fax sections.

· Children’s Residential Treatment Enrollment Criteria & Forms – Under How to Enroll, we linked to the Managed Care Organization In-network Provider Agreement (DHS-8355) in both the Online MPSE Portal and Submit Forms via Fax sections.

· Community Mental Health Center Enrollment Criteria and Forms

· We moved Covered Services to the Community mental health center (CMHC) webpage.

· Under How to Enroll, we updated the list of forms that need to be submitted via MPSE or fax.

· Under Attestation, we updated requirements.

· Under Additional Resources, we updated Minnesota Statutes to include Mental Health Uniform Service Standards and removed two Minnesota Rules.

August 2, 2023

Provider Basics
Health Care Programs and Services

· MHCP Benefits at-a-glance – We removed School-Based Community Services from the MHCP Benefits at a glance table. Review specific services, for example, rehabilitation services, mental health services.

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July 31, 2023

Reproductive Health/OB-GYN -

· Obstetric Services and HIV Counseling – We updated language for clarity.

July 28, 2023

Provider Basics
Enroll with MHCP

· Ambulatory Surgical Center Enrollment Criteria

· Under How to Enroll, Use the Online Minnesota Provider Screening and Enrollment (MPSE) Portal, we linked to the MCO In-Network Provider Agreement DHS 8355. We also added the Confirmation of the MHCP provider screening fee payment or proof the fee was paid to another state or Medicare and Clinical Laboratory Improvement Amendments (CLIA) certification (if applicable) documents.

· Under How to Enroll, Fax Completed Forms to 651-431-7462, we linked to the MCO In-Network Provider Agreement DHS 8355.

· We updated language and form titles for clarity.

July 27, 2023

Provider Basics
Health Care Programs and Services

· MHCP Benefits at-a-glance – Added PCA services as a covered service under major program codes AC. Added School Based Community Services as covered under major program MA, NM, RM.

July 26, 2023

Home Care Services

· Home Care Nursing (HCN) Services – Under Eligible Providers, we corrected text to indicate what agencies can provide home care nursing services.

July 24, 2023

Provider Basics
Provider Requirements

· Risk Levels and Enrollment Verification Requirements – The risk level for Home Care Nurse has been lowered from moderate to limited risk.

July 21, 2023

Provider Basics

· Managed Care Organizations (MCOs) – Under Eligible Providers we added new information about the 21st Century Cures Act.

July 18, 2023

Provider Basics
Enroll with MHCP

· Acupuncture Enrollment Criteria and Forms – Under How to Enroll, we linked to the Managed Care Organization In-network Provider Agreement (DHS-8355) in both the Online MPSE Portal and Submit Forms via Fax sections.

July 14, 2023

Provider Basics
Authorization

· Drug Authorizations

· We updated all references to the drug authorization request contractor to the current contractor Kepro.

· In the second bullet point, we updated the prescription drug prior authorization call center hours to 8 a.m. to 5:30 p.m. on Monday through Friday, except select holidays.

· We updated instructions on how to submit a medical drug authorization to reflect the current contractor, Kepro.

· Under Authorization with third-party liability, we removed the text about an electronic authorization request through PAXpress™ because it is no longer valid. Additionally, we removed text about allowing select prescriptions to be electronically processed at the point of sale because it is no longer valid.

Provider Basics
Enroll with MHCP

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Under Ongoing Reporting Requirements, we clarified information in the Change in Ownership section.

July 12, 2023

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/Pathology Services – Under Billing, Drug Testing, we updated urine drug testing frequency. We deleted a maximum of 15 tests in a 12-month period and replaced with Centers for Medicare & Medicaid Services frequency criteria.

July 10, 2023

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Children – Under Vaccines and Toxoids Available Through MnVFC, we added CPT code 90671 to the table. It has been covered but was not previously included in the table.

July 6, 2023

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Transportation Services – Under Documentation, we updated the trip documentation requirements to include what is required to be entered on the trip log.

July 1, 2023

Equipment and Supplies

· Incontinence Products – Under Covered Services, we changed the quantity limits for disposable briefs, diapers, underwear, pull-ons, liners, shields, guards, pads and garments (HCPCS T4521-T4535, T4538, T4533-T4544) will be covered up to 400 units per product or combination of products per month before authorization is required effective July 1, 2023. Quantity limits for underpads (T4541-T4542) will be covered up to 100 units per month before authorization is required.

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June 30, 2023

Mental Health Services

· Children’s Intensive Behavioral Health Services

· We changed the name of this section of the MHCP Provider Manual from Intensive Treatment in Foster Care Program to Children’s Intensive Behavioral Health Services.

· We updated text throughout the manual section to explain eligibility is expanding to include children living with parents.

· We updated text throughout to align with Uniform Service Standards.

· Under Eligible Providers, Provider Responsibilites, we added services must be delivered and documented for two hours per encounter. We also clarified the level of care screening tool to be used to determine if services are medically necessary.

· Under Eligible Members, we clarified language and added the eligibility expansion to those living with parents.

· Under Covered Services, we clarified information about receiving the daily encounter rate.

· Under Noncovered Services, we clarified mental health certified family peer specialist services are not a covered service.

June 29, 2023

Dental Services

· Dental Benefits for Non-Pregnant Adults – Under Covered Services, Periodontics, we clarified the service limits for CDT code D4910 Periodontal Maintenance. D4910 can be performed once every 91 days for 730 days following a submitted claim to the Minnesota Department of Human Services with a paid service line for CDT code D4341 or D4342. After 24 months, D4910 is not payable unless D4341 or D4342 are performed again under a new prior authorization.

June 28, 2023

Mental Health Services

· Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM) – Under Covered Services and Billing, we added Interactive Video information that is allowed to continue beyond the end of the federal public health emergency.

June 22, 2023

Reproductive Health/OB-GYN

· Obstetric Services and HIV Counseling – Under Billing, Breast Pumps, we changed instructions. Bill accessory kits for hospital grade breast pumps using HCPCS code A9999.

June 15, 2023

Equipment and Supplies

· Nebulizers – Under Covered Services, we clarified that prior authorization is required for quantities greater than one every five years for nebulizer HCPCS codes E0570, E0572, E0574 and E0585. For HCPCS code E0580, prior authorization is required for quantities greater than one every three years.

June 14, 2023

Member Evidence of Coverage (EOC)

· MHCP Member Evidence of Coverage

· We reorganized the layout of the Evidence of Coverage manual page for clarity.

· We update the MHCP Member ID card.

· We updated the copay fees in the Copays section under Billing.

· We grouped the services MHCP covers under Specific Health Care Services in the Covered Services section and the services MHCP does not cover under the Noncovered Services section.

June 7, 2023

Immunizations and Vaccinations

· Immunizations and Vaccinations

· Under Billing for Vaccines, Billing for Adult Vaccines, we added code 90673 and removed 60973 in the Use With column for CPT code G0008.

· Under Immunization and Vaccine Benefits Codes for Children, we clarified that all vaccines must be obtained through Minnesota Vaccines for Children.

June 6, 2023

Child Welfare Targeted Case Management (CW-TCM)

· Child Welfare Targeted Case Management (CW-TCM) – Under Covered Services and Billing, we added Interactive Video information that is allowed to continue beyond the end of the federal public health emergency.

Substance Use Disorder (SUD) Services

· Removed the Rule 25 Process section of the MHCP Provider Manual. The Rule 25 Process to receive funding and access to SUD services ended June 30, 2022. All fee-for-service claims with dates of service before July 1, 2022, that have service agreements that follow the timely billing rule officially ends June 30, 2023.

June 2, 2023

Provider Basics
Enroll with MHCP

· Targeted Case Management (TCM) Enrollment Criteria and Forms – We added an Interactive Video section. CMH-TCM, AMH-TCM, VA/DD-TCM and CW-TCM providers need to complete and submit the Targeted Case Management Provider Interactive Video Assurance Statement (DHS-8398) (PDF) to deliver and bill for TCM services using interactive video.

Telehealth Services

· Telehealth Services – Under the Overview and Covered Services headings, we extended the date of Audio-only communication between the health care provider and the patient to July 1, 2025.

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May 31, 2023

Hearing Aid Services

· Hearing Aid Services

· Under Covered Services, we added content for Bone-Anchored Hearing Aids and Cochlear Implants.

· Under Billing, Repair Claims, we made the following updates:

· Added that all repair claims must include the hearing aid(s) HCPCS code.

· Added that a manufacturer's pricing invoice for repair of non-contract hearing aids must be in the Claim Note field.

· Removed that the hearing aid volume purchase contract number must be in the Claim Note field.

· Under Billing, we added Hearing Aid Repairs - After Warranty information that includes provider type, HCPCS codes, description and instructions.

· Under Billing, we removed Code V5014. Refer to Hearing Aid Services Codes for updated information.

· We updated formatting and language for clarity.

May 30, 2023

Mental Health Services

· Children's Mental Health Clinical Care Consultation – Under the Documentation of Covered Services and Authorization Requirements headings, we updated for Uniform Service Standards.

May 26, 2023

Individualized Education Program (IEP) Services

· Rates and Payments – Under Remittance Advice (RA), we removed text about MinnesotaCare funds being included on the RA. We updated language for clarity.

Provider Basics
Enroll with MHCP

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – We clarified that the MHCP Individual Practitioner - Provider Enrollment Application (DHS-4016) and the MHCP Organization - Provider Enrollment Application (DHS-4016A) are not required when enrolling using the Minnesota Provider Screening and Enrollment (MPSE) portal.

May 24, 2023

Hearing Aid Services

· Bone-Anchored Hearing Aids (BAHA) – We added a new manual page for bone-anchored hearing aids (BAHA).

· Hearing Aid Services Codes

· We clarified billing information for HCPCS codes V5014 and V5267. We also added HCPCS code L8694 which has been covered, but was previously missing from the list.

· We added an Additional Resources section.

Acupuncture Services

· Acupuncture Services

· We updated formatting and language for clarity which included adding an Overview section and links to resources for more information.

· Under Authorization Requirements, we added that MHCP allows up to 20 units of acupuncture services per calendar year without authorization.

Individualized Education Program (IEP) Services

· Occupational Therapy (OT) Services – We corrected language about the licensing of occupational therapists. Occupational therapists are licensed by the Minnesota Board of Occupational Practice and not the Minnesota Department of Health as previously noted.

Provider Basics
Enroll with MHCP

· Independent Laboratory Enrollment Criteria and Forms – This is a new Minnesota Health Care Programs provider enrollment manual section for Independent Laboratory providers.

· Independent X-ray Enrollment Criteria and Forms – This is a new Minnesota Health Care Programs provider enrollment manual section for Independent X-ray providers.

· Substance Use Disorder (SUD) Services Enrollment Criteria and Forms – Under the 1115 SUD System Reform Federal Demonstration heading, we updated provider participation requirements to read "Implement the standards identified in the enrolled provider's 1115 Substance Use Disorder System Reform enrollment checklist (DHS -7325) (PDF)" and "To comply with the federal requirement for utilization reviews within the 1115 SUD System Reform Demonstration, providers must submit the following supporting clinical documentation to the medical review agent, Kepro:

· Provider questionnaire (embedded in Atrezzo)

· Comprehensive assessment

· Initial Services or Initial Treatment Plan with measurable goals

· Documentation of treatment services; Treatment Plan Review

· Discharge/Transition Plan

May 23, 2023

Substance Use Disorder (SUD) Services

· Telehealth Delivery of Substance Use Disorder Services – Under Billing, we added individual and group treatment services billing information.

RSC-TCM

· Relocation Service Coordination-Targeted Case Management (RSC-TCM) – Under Eligible Members, we removed Program EH. People eligible for EH are not and have never been eligible for any waiver services, including transition services.

May 18, 2023

Provider Basics
Enroll with MHCP

· We have added an Acupuncture Enrollment Criteria and Forms section to the MHCP Provider Manual.

May 17, 2023

School-Based Community Services (SBCS)

· School-Based Community Services (SBCS)

· Under Enrollment, we added that schools can add multiple school-based community services to one record.

· We updated language for clarity.

Hearing Aid Services

· Cochlear Implants

· We updated formatting and language for clarity which included adding sections for Overview, Eligible Providers, Eligible Members, Authorization and Billing.

· Under Billing, Procedure Codes, we added an Authorization Required column in the table. We also added information for HCPCS codes L8690, L8692, L8693 and L8694 to the table.

May 12, 2023

COVID-19

· Coronavirus (COVID-19) – In the Home Care and PCA Services section, under Family Member Providing PCA Services for MHCP-Enrolled Members, we extended the deadline for this waiver to November 11, 2023.

Mental Health Services

· Psychiatric Residential Treatment Facility (PRTF)

· Under Overview, we deleted outdated information.

· Under Continued Stay Requirements, we clarified language about additional days of treatment approval and when to submit an updated plan of care to Arkansas Foundation for Medical Care.

May 11, 2023

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Adults – Under Vaccines and Toxoids for Adults, we added CPT code 90677 - Pneumococcal conjugate vaccine, 20 valent (PCV20). This has been covered, but was previously missing from the list.

May 9, 2023

COVID-19

· Coronavirus (COVID-19) – Under Covered Services Changes and Modifications, COVID-19 Testing, we explained testing for uninsured and new Medical Assistance group (Major Program TT) ends at the end of the federal public health emergency May 11, 2023.

May 4, 2023

Substance Use Disorder (SUD) Services

· Substance Use Disorder (SUD) Services

· Under Eligible Providers, we clarified language in the 1115 Substance Use Disorder System Reform Demonstration subsection.

· Under Covered Services, 1115 Substance Use Disorder System Reform Demonstration, we updated to "All SUD services provided by MHCP-enrolled 1115 SUD System Reform Demonstration providers must meet the standards for each level of care provided as published in the 1115 Level of Care Requirements (DHS-7326) (PDF). The levels of care that a provider is eligible to provide will be deterimined upon review and approval of the provider's 1115 Substance Use Disorder System Reform Enrollment Checklist (DHS-7325) (PDF). Refer to the 1115 SUD System Reform Demonstration webpage for more information."

· Under Covered Services, in the Residential subheading of 1115 Substance Use Disorder System Reform Demonstration, we updated the 15 percent rate enhancement to 25 percent, and the effective date from July 22, 2020, to Jan. 1 2022.

· Under Covered Services, in the Outpatient subheading of 1115 Substance Use Disorder System Reform Demonstration, we updated the 10 percent rate enhancement to 20 percent, and the effective date from Jan. 1, 2021, to Jan. 1, 2022.

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – Under Billing, we updated information about billing when a member has commercial insurance.

May 2, 2023

Provider Basics
Provider Requirements

· Access Services – Under Billing Language Interpreter Services, we added CDT code D9990 for Dental Services providers billing for sign and spoken interpreter services. Dental Services providers bill one unit per visit on a 837D claim format. This became effective on January 1, 2023.

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April 27, 2023

Dental Services

· Dental Benefits for Children and Pregnant Women – Under Diagnostic, Clinic Oral Evaluations, we updated the services limits for CDT codes D0120, D1040, D1050, D0160 and D0180 with additional excluded CDT codes.

April 6, 2023

Dental Services

· Dental Benefits for Children and Pregnant Women – Under Diagnostic, Diagnostic Imaging, we added the service limit information of one series per calendar year for CDT Code D0373.

Provider Basics
Enroll with MHCP

· Hearing Aid Services Enrollment Criteria and Forms – We added a new manual page for Hearing Aid Services.

April 5, 2023

Equipment and Supplies

· Allergen-Reducing Products for Children – Under Eligible Providers, we added public health clinics.

Provider Basics
Enroll with MHCP

· Physician Assistant Enrollment Criteria and Forms – We added a new manual page for Physician Assistant.

April 4, 2023

Mental Health Services

· Children's Therapeutic Services and Supports (CTSS)

· Under Eligible Providers, Provider Responsibilities, we added Uniform Service Standards (USS) information about treatment plans.

· Under Covered Services, we added USS information to the Psychotherapy, Mental Health Behavioral Aide (MHBA), MHBA Supervision and Direct Observation Requirements, Direction to a Mental Health Behavioral Aide, Service Plan Development, and Individual treatment plan and treatment plan review subsections.

· Under Covered Services, Skills Training, we explained skills training facilitates the acquisition of behavioral, functional or psychological skills medically necessary to rehabilitate the child to an age-appropriate developmental trajectory that has been disrupted by a diagnosed mental health disorder.

· Under Covered Services, Service Plan Development, we explain how a mental health service plan must be performed and documented; that development, review and revision consists of drafting and communicating face to face or electronically; that service plan development is covered only if a treatment plan is completed for the child; and how an individual treatment plan review must be conducted.

· Under Documentation, we added USS information to the Documenting approval and Progress notes subsections.

April 3, 2023

Mental Health Services

· CTSS Children’s Day Treatment

· Under Eligible Providers, we replaced Clinical Supervision information with Treatment Supervision information.

· Under Eligible Members, we added that members must be eligible for up to five days of treatment based on the hospital's medical history and presentation examination of the member.

· Under Covered Services, we updated information about program availability frequency, day treatment group size and individual treatment plan description.

· Under Documentation Standards, we updated to reflect the Mental Health Uniform Service Standards Act and added Documenting approval and Progress notes sections.

________________________________________________________________________________

March 27, 2023

Equipment and Supplies

· Diabetic Equipment and Supplies – Under the Point of Sale Diabetic Testing Supply program and Noncovered Services headings, we explained therapeutic continuous glucose monitors are covered as HCPCS codes A4239 and E2103 only in the point of sale diabetic testing supply program effective Jan. 1, 2023. We removed therapeutic continuous glucose monitor codes K0553 and K0554 as they are no longer covered.

Provider Basics
Enroll with MHCP

· Community Health Worker Enrollment Criteria and Forms – We updated the list of schools in Community Health Worker Criteria and Forms to reflect the Minnesota Department of Health list of schools that offer the Community Health Worker (CHW) certificate program.

March 24, 2023

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/ Pathology Services – Under Legal References, we removed a link to a reference that is no longer appropriate.

March 23, 2023

Physician and Professional Services

· Physician and Professional Services

· We added a bookmark link to the section for Weight Loss Services.

· In the Eligible Asthma Services Providers section, we clarified the sentence: "Local public health workers are not enrolled in MHCP and cannot bill for the home assessment."

· In the Medical Nutritional Therapy (MNT) section, we moved the section on Weight Loss Services to follow the Medical Nutritional Therapy section.

March 20, 2023

Mental Health Services

· Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) – We removed LOCUS requirements as LOCUS is not required for Dialectical Behavior Therapy providers.

· Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS) – Under Billing, we added a link to the 2023 IRMHS rates table and the billing code for travel.

March 17, 2023

Dental Services

· Provider Participation Requirements – Rule 101

· We added the following text in the Dental providers section under MHCP Casleoad Limits:

· Dental practices located outside of the seven-county metro area who want to be paid for other state-sponsored health care programs are not subject to the required 10 percent annual active case load. In this section, we also added link for providers to complete their enrollment online using our online enrollment application: Minnesota Provider Screening and Enrollment (MPSE) Portal

· We updated the Minnesota Rules citation in the Legal References section.

March 16, 2023

COVID-19

· Coronavirus (COVID-19) – In the Vaccines section, under COVID-19 Vaccine and Administration Codes, we updated administration code 0164A reporting for vaccine code 91316 to show 91316 is Moderna vaccine.

March 15, 2023

Individualized Education Program (IEP) Services

· Personal Care Assistance (PCA) Services

· We updated language and formatting throughout the page for clarity which included adding a Table of Contents with hyperlinks and renaming some section headers.

· In the Eligible Providers section, under Required PCA Training, we replaced the Individual Personal Care Assistant Training link with a link to the Personal Care Assistant (PCA) and Community First Services and Supports (CFSS) Training and Test.

· In the Supervision section, under QP Qualifications, we updated the links for the audiologist and occupational therapist.

March 8, 2023

Officer-Involved Community-Based Care Coordination

· Officer-Involved Community-Based Care Coordination – Under Billing, we removed reimbursement rate information. Rate information is included in the Minnesota Health Care Programs Fee Schedule.

Relocation Service Coordination-Targeted Case Management (RSC-TCM)

· Relocation Service Coordination-Targeted Case Management (RSC-TCM)

· Under Eligible Providers, we added a paragraph about enrollment and a link to the Targeted Case Management (TCM) Enrollment Criteria and Forms section of the MHCP Provider Manual. We also separated RSC-TCM eligible institutions into its own subsection.

· Under Eligible Providers, the Provider Certification Application Process subsection, we updated the information where applications may be sent.

March 7, 2023

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/ Pathology Services – Under Genetic Testing, Rapid Whole Genome Sequencing, we updated Rapid Whole Genome Sequencing criteria to:

· All of the following must be met:

· Critically ill infant or child in the intensive care unit (ICU) with no unifying diagnosis.

· Clinical circumstances present the need for rapid testing in time-sensitive cases as a last resort to guide clinical decision making in treatment or management of patient’s genetic condition.

· Test must be ordered by the infant’s treating physician and prior to ordering testing, infant must be evaluated by a medical geneticist or other physician subspecialist with expertise in the conditions or genetic disorder for which the testing is being considered.

AND

· One of the following is met:

· Critically ill infant or child with a history of multiple hospitalizations or readmissions within 30 days of discharge for an unexplained condition which no diagnosis has been reached despite extensive workup and previous testing in the identification of rare genetic disease variant; or

· Clinical presentation does not fit a well-defined gene analysis test that is available or previous extensive workup and testing has failed to receive a diagnosis

March 6, 2023

Mental Health Services

· Psychotherapy – Under Billing in the Mental health psychotherapy benefits for children and adults table, we added that you can now bill two units of 90837 for prolonged psychotherapy services face to face with the member for 91 minutes or more.

March 3, 2023

Dental Services

· Dental Benefits for Children and Pregnant Women – We added the following new procedure codes under Diagnostic Imaging in the Diagnostic section.

· D0372 - Intraoral tomosynthesis - comprehensive series of radiographic images

· D0373 - Intraoral tomosynthesis - bitewing radiographic image

· D0374 - Intraoral tomosynthesis - periapical radiograpic image

March 2, 2023

COVID-19

· Coronavirus (COVID-19) – In the Home Care and PCA Services section, in Family Members Providing Services for MHCP-Enrolled Members, we added the end date for this policy modification of May 11, 2023, which is the end of the federal public health emergency.

Dental Services

· Dental Benefits for Non-Pregnant Adults – We added the following new procedure codes under Diagnostic Imaging in the Diagnostic section.

· D0372 - Intraoral tomosynthesis - comprehensive series of radiographic images

· D0373 - Intraoral tomosynthesis bitewing radiographic image

· D0374 - Intraoral tomosynthesis - periapical radiograpic image

________________________________________________________________________________

February 24, 2023

Dental Services

· Authorization Requirement Tables for Non-Pregnant Adults

· Under Prophylaxis, we updated the vendor link to the Kepro/MHCP website for submitting authorization requests. We also replaced Authorization Request: D1110 Multiple Prophylaxis (DHS-7979)(PDF) with the Authorization Request on the Kepro/MHCP website.

· Under Oral Surgery–Removal of Impacted Teeth, we updated the vendor link to the Kepro/MHCP website for submitting authorization requests. We also listed the Oral and Maxillofacial Surgery Medical Necessity Questionnaire and updated periodontal details.

Mental Health Services

· Mental Health Provider Travel Time – Under Billing, we added a hyperlink to MN–ITS 837P.

February 23, 2023

Behavioral Health Home Services

· Behavioral Health Home Services

· Under Billing, we clarified claims submitted by a mental health billing entity must include the rendering NPI of the MHCP-enrolled team member.

· Under Managed Care, we clarified Behavior Health Home (BHH) services providers need to contact the individual's MCO to determine what the MCO requires on the claim for BHH services.

February 22, 2023

Dental Services

· Authorization Requirement Tables for Children and Pregnant Women

· Under Endodontics, we clarified that endodontic endosseous implant treatment requires prior authorization.

· Under Oral and Maxillofacial Surgery, we updated the vendor link to the Kepro/MHCP website for submitting authorization requests. We also listed the Oral and Maxillofacial Surgery Medical Necessity Questionnaire.

· Under Orthodontics, we updated the vendor link to the Kepro/MHCP website for submitting authorization requests. We also added the Orthodontia Medical Necessity Questionnaire.

February 16, 2023

Officer-Involved Community-Based Care Coordination Services

· Officer-Involved Community-Based Care Coordination Services – Under Eligible Providers, we deleted Counties are required to pay the nonfederal share (50% of the estimated total cost) of the service at initial enrollment as well as on an ongoing basis.

February 15, 2023

COVID-19

· Coronavirus (COVID-19)

· In the Eligible Providers section, under Providers Eligible to Administer COVID-19 Vaccines, we added that students in a healthcare profession but not enrolled in MHCP are approved to administer COVID-19 vaccines.

· In the Vaccines section, under COVID-19 Vaccine and Administration Codes, we updated ages to the following CPT vaccine codes.

· 91301: Moderna vaccine, updated to 12 years and older

· 91304: Novavax vaccine, updated to 12 years and older

· In the Vaccines section, under COVID-19 Vaccine and Administration Codes, we added the following CPT vaccine codes.

· 91314: Moderna vaccine, 6 years - 11 years

· 91315: Pfizer-BioNTech vaccine, 5 years - 11 years

· 91316: Moderna vaccine, 6 months - 5 years

· 91317: Pfizer-BioNTech vaccine, 6 months - 4 years

· In the Vaccines section, under COVID-19 Vaccine and Administration Codes, we updated the use with and effective date information for the following CPT administration code.

· 0041A: Novavax, added Report 0044A for the booster dose with the effective date of Oct. 19, 2022.

· In the Vaccines section, under COVID-19 Vaccine and Administration Codes, we added the following CPT administration codes.

· 0144A: Moderna, administration of single booster dose

· 0154A: Pfizer-BioNTech, administration of single booster dose

· 0164A: Pfizer-BioNTech, administration of single booster dose

· 0173A: Pfizer-BioNTech, administration of third dose

· Additionally, we updated language for clarity.

Mental Health Services

· Mental Health Services - Level of Care Assessment and Necessity of Care Recommendation or Referral

· Under Eligible Providers, we removed Adult Mental Health Targeted Case Management information.

· Under Legal References, we deleted a link to Minnesota Statutes 256B.0625.

Physician and Professional Services

· Physician and Professional Services

· In the Eligible Asthma Services Providers section, we added a list of the providers who can bill for a home assessment.

· In the Billing for Asthma Services section, we clarified the billing text.

February 14, 2023

Provider Basics
Enroll with MHCP

· Individual PCA or DSW Enrollment Criteria and Forms

· In the section, How to Enroll, we clarified the two options to enroll as using the MPSE online portal or submitting required documents by fax.

· We clarified the text in the Background Study section.

· We clarified the text in the Reinstating an inactive affiliation section.

· We added a section for Revalidation.

· We updated the section on Reporting Changes.

· Rehabilitation Agency Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment portal instructions.

February 10, 2023

Equipment and Supplies

· Mobility Devices – Under Covered Services, we added the Backup Manual Wheelchairs section. Also also updated requirements for ultra-lightweght, lightweight and tilt-in-space wheelchairs in the Manual Wheelchairs section.

Nursing Facilities

· Nursing Facilities

· We have reorganized the content of this manual page for clarity.

· We added an Overview section to explain Minnesota Health Care Programs (MHCP) role in providing nursing facility services.

· We organized content into Covered Services and Noncovered Services sections to clarify the services that MHCP covers and does not cover.

· We added a section for Medicare and Other Insurance.

· We have moved the Swing Bed Hospital Services section to a separate Swing Bed Hospital Services manual page.

· We moved the Conditions of Participation section to the Nursing Facility Enrollment Criteria and Forms manual page.

· In the Billing section, under Resident Classification System, we included links to the Minnesota Case Mix Review Program and Case Mix Information published on the Minnesota Department of Health website.

· We removed outdated legal references in the Legal References section.

Provider Basics
Enroll with MHCP

· Rehabilitation Billing Entity Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment portal instructions.

February 9, 2023

Provider Basics
Enroll with MHCP

· Licensed marriage and family therapist (LMFT) Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment portal instructions.

· Physical Therapist Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment portal instructions.

· Speech-Language Pathologist Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment portal instructions.

February 8, 2023

Mental Health Services

· Psychotherapy

· Under Authorization, we explained providers do not need to submit authorization requests for the following psychotherapy services that exceed unit or hour limits beginning Jan. 1, 2023, through Dec. 31, 2024:

· 26 hours psychotherapy (with patient) (including biofeedback) per calendar year, cumulative

· 26 units of family psychotherapy (with patient or family member or both), per calendar year, cumulative

· 10 sessions of multiple family group psychotherapy per calendar year

· 52 sessions of group psychotherapy per calendar year, cumulative

· Under Billing, we deleted CPT Code 99354 from the Mental health psychotherapy benefits for children and adults table as it has been discontinued.

Transportation Services

· Nonemergency Medical Transportation (NEMT) Services (Overview) – In the Noncovered Services section, under Excluded Costs Related to Transportation, we added information about not billing members for wait time.

February 6, 2023

Provider Basics
Enroll with MHCP

· We have removed the County-contracted Mental Health Rehabilitation Enrollment Criteria and Forms page because we do not currently accept enrollment.

________________________________________________________________________________

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.

____________________________________________

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