Community First Services and Supports (CFSS) Provider Agency Enrollment Criteria & Forms

Posted: September 19, 2024

· How to Enroll

· Revalidation

· Reporting Changes

How to Enroll

Each provider agency must complete a Community First Services and Supports (CFSS) enrollment application to provide CFSS services. Each additional business site or location must apply. Your initial CFSS application to enroll with Minnesota Health Care Programs (MHCP) must include all items listed in this section.

Owners and managing employees (directly or indirectly involved in the day-to-day operations of the CFSS business) are required to attend a CFSS Steps for Success workshop before completing the enrollment process. If you have a training certificate that says “PCA Steps for Success,” you must take the CFSS Steps for Success transitional training.

CFSS provider agencies must follow these steps:

· Attend the CFSS Steps for Success training or CFSS transitional training if the provider has already taken PCA Steps for Success training.

· Pay the application fee.

· Register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your enrollment online using the MPSE portal,

or

Complete the following forms and fax to Provider Eligibility and Compliance at 651-431-7465 along with any other required documents.

· CFSS Agency Enrollment Application (DHS-8160) (PDF)

· Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF)

· MHCP Provider Agreement (DHS-4138) (PDF)

· CFSS Agency Agreement Addendum (DHS-8160A) (PDF)

· CFSS Agency Assurance Statement (DHS-8560) (PDF)

· Designation of Billing Person for CFSS (DHS-8559) (PDF)

· Copy of CFSS Steps for Success training certificate for owners and managing employees

· Copy of certificate of registration with the Office of the Secretary of State of Minnesota

· Copy of certificate of liability insurance. Copy of your general liability insurance certificate naming “DHS-PE” as a certificate holder on the document, with the following address listed: PO Box 64987, St. Paul, MN 55164-0987

· Copy of Workers’ Compensation insurance

· Copy of fidelity bond in the amount of 20,000

· Copy of the Community First Services and Supports (CFSS) Surety Bond (DHS-8558) (PDF). The surety bond must be in the amount of $50,000 for first time enrolling providers.

Note: Medicare-certified home health agencies who wish to provide CFSS, follow the enrollment steps in Home Health Enrollment Criteria and Forms.

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 U.S. mail (or in your MN–ITS mailbox, if you have an account) telling you 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.

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 under How to Enroll to Provider Eligibility and Compliance at 651-431-7462.

We recommend using the MPSE portal and following the instructions in the Revalidation section of 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 the Provider Screening Requirements section of the MHCP Provider Manual for more information about how to complete your revalidation.

Reporting Changes

You must 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.

You must also meet ongoing requirements of other state agencies for Minnesota businesses.