Recuperative Care Enrollment Criteria and Forms

Revised: September 9, 2025

How to Enroll

Recuperative Care providers who wish to enroll with MHCP or make enrollment requests must follow these steps:

1. Complete the Pre-Enrollment Risk Assessment (PERA). You can start the Recuperative Care enrollment process after you have received a copy of the PERA approval letter.

We are finalizing the PERA process and will link to the assessment when it is available online.

2. Pay the application fee

Online MPSE Portal

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:

· Fee-for-Service (FFS) Only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or the MCO In-Network Provider Agreement (DHS-8355) (PDF)

· Recuperative Care Provider Assurance Statement (DHS-8486) (PDF)

· Recuperative Care – Health Services Provider Acknowledgment (DHS-8562) (PDF)

Note: If you list an individual on this form, they must be enrolled with MHCP and disclosed in the Owners and Authorized Persons section of the MPSE portal.

· Copy of the PERA approval letter (upload to the notes section of MPSE)

· Recuperative Care Surety Bond (DHS-8748) (PDF) (upload to the notes section of MPSE)

· Proof that a fee was paid to Minnesota Department of Human Services, another state Medicaid agency, or Medicare

or

Complete and Submit Forms by Fax

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

· Organization – Provider Enrollment Application (DHS-4016A) (PDF)

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

· Fee-for-Service (FFS) Only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or the MCO In-Network Provider Agreement (DHS-8355) (PDF)

· Recuperative Care Provider Assurance Statement (DHS-8486) (PDF)

· Recuperative Care – Health Services Provider Acknowledgment (DHS-8562) (PDF)

Note: If you list an individual on this form, they must be enrolled with MHCP and disclosed on the Disclosure of Ownership and Control Interest (DHS-5259).

· Copy of the PERA approval letter

· Recuperative Care Surety Bond (DHS-8748) (PDF)

· Proof that a fee was paid to Minnesota DHS, another state Medicaid agency, or Medicare

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

We process forms in order of date received. Allow 30 days for processing whether enrolling using the MPSE portal or by fax. We will send a request for more information letter through the U.S. Postal Service (or your MN−ITS mailbox, if you have an account) if we need more information 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 to the Minnesota Department of Human Services.

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

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

Legal References

Minnesota Statutes, 256B.0701 (Recuperative Care Services)