Essential Community Supports (ECS)

Revised: March 1, 2022

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Authorization Requirements

· Billing

· Legal References

Overview

The Essential Community Supports (ECS) program provides community-based supports for members who do not meet nursing facility level of care (NF LOC) criteria. Services support members with an assessed need for one of the ECS services to maintain their community living.

Eligible Providers

Providers eligible to provide, bill and be reimbursed by Minnesota Health Care Programs (MHCP) for providing Essential Community Supports (ECS) services must:

· Be an enrolled MHCP provider and continuously maintain qualifications to provide ECS services

· Be selected by the service member, or case management or service coordinator of the lead agency (county or tribe or managed care organization (MCO))

· Have a DHS-approved service authorization (SA) to provide services for the member

Follow the instructions on the Home and Community-Based Services Programs Provider Enrollment section to enroll to become an ECS services provider.

Note: If you are currently enrolled to provide any of the ECS services, other than Community Living Assistance (CLA), through an HCBS waiver program, you are already enrolled to provide these same services for people through the ECS program.

Eligible Members

Review Essential Community Supports (ECS) in the Community-Based Services Manual for member eligibility criteria.

Covered Services

Review Essential Community Supports (ECS) in the Community-Based Services Manual for a list of covered services.

Authorization Requirements

ECS services require approval from a case manager or service coordinator in the form of a completed service agreement (SA). The SA allows the provider to bill MHCP and receive payment after services are provided. MHCP will pay only services approved on the SA. The case manager or service coordinator enters the SA into the Minnesota Department of Human Services (DHS) MMIS system. You must ensure that the SA is accurate when you receive the authorization letter.

Each line item on the SA lists the following:

· MHCP-enrolled provider who is authorized to provide the needed services

· Rate of payment for the service

· Number of units authorized

· Date or date span of authorization of service;

· The authorized procedure codes

Billing

Refer to the Billing Policy Overview for more information about MHCP billing guidelines.

Submit claims as follows for all ECS services, including CLA:

· Bill MHCP directly for services incurred for fee-for-service MHCP and MCO members

· Enter service agreement type

· Use the 837P format

· Use the HCPC codes approved on the service agreement

· For Community Living Assistance Services only, use HCPC codes H2015 and H2016

Submitting Claims for ECS Services:

· Use MN–ITS Direct Data Entry (DDE) or your own X12 compliance software (batch billing system)

· Use the Professional (837P) claim bill only for services already provided

· Bill only for services that are approved on the service agreement

· Enter a diagnosis code. You must use the most current, most specific diagnosis code when submitting claims. MHCP will display the diagnosis code of the member in the service agreement letter.

· Use the information listed on your service agreement

· Use date spans only when you have provided services for all dates in the span

Managed Care Enrollees

· MCOs with no lead agency delegates using MMIS must send service agreements to DHS; DHS staff will enter them into MMIS

· Bill MHCP directly for services you provide for members on a prepaid health plan

Legal References

Minnesota Statutes, section 256B.0922