MHCP provider news and updates

Minnesota Department of Human Services and its partners have developed a new training video about Minnesota Rules, 9544, commonly known as the Positive Supports Rule or the rule on positive support strategies and restrictive interventions. The 37-minute training video is optional and is intended for all service providers licensed under Minnesota Statutes, 245A, except:

• Providers licensed under Minnesota Statutes, 245D, who must follow additional guidelines. 
• Child care providers, who are exempt from these requirements under Minnesota Statutes, 245.8251, subdivision 1 and Minnesota Statutes, 142B.63.

You will find the Minnesota Rule 9544 Training video on YouTube. Email PositiveSupports@state.mn.us if you have comments or questions about the training. (pub. 2/27/25)

Minnesota Department of Human Services (DHS) will add the following recommended components of care to the Minnesota C&TC Schedule of Age-Related Screening Standards (DHS-3379) effective Oct. 1, 2025:

• Syphilis screening at least once for young adults 18 years and older, and
• Suicide risk screening beginning at age 12 years

The American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care Bright Futures Periodicity Schedule, U.S Preventive Services Task Force, Centers for Disease Control and Prevention, and the Minnesota Department of Health (MDH) recommend these updates. You are strongly encouraged to complete the recommended components as part of a C&TC visit. 

We will update the Minnesota C&TC Schedule of Age-Related Screening Standards (DHS-3379) and other relevant publications to reflect this change. MDH will post a new Syphilis Screening fact sheet and Suicide Risk Screening fact sheet on the MDH Child and Teen Checkups Fact Sheets webpage July 1, 2025, to allow time for clinics to become familiar with procedures and update protocols as needed before Oct. 1, 2025. (pub. 2/25/25)

Licensed behavior analysts (LBAs) can enroll as a qualified supervising professional (QSP) for Early Intensive Developmental and Behavioral Intervention (EIDBI) services effective Jan. 1, 2025. This update is intended to expand access to EIDBI services by allowing LBAs to oversee treatment for individuals with autism spectrum disorder and related conditions.

LBAs will be responsible as QSPs for developing and monitoring comprehensive treatment plans, supervising applied behavior analysis services, and ensuring high-quality, individualized care for members receiving EIDBI services. This update aligns with Minnesota’s commitment to increasing EIDBI provider capacity and improving access to early intervention services for children and families.

Providers who want to enroll as a QSP must complete the EIDBI Qualified Supervising Professionals Assurance Statement (DHS-7120C) (PDF) and submit proof of licensure. Agencies who want to affiliate the LBA as a QSP to their organization must complete the EIDBI Provider Agency Assurance Statement (DHS-7120B) (PDF).

 Review the EIDBI Provider Enrollment Criteria and Forms section of the Minnesota Health Care Programs Provider Manual for information about enrollment requirements and the application process. Review the QSP qualifications, roles and responsibilities section of the EIDBI policy manual for information about QSP qualifications and responsibilities (pub. 2/14/25)

With the MinnesotaCare expansion in effect as of January 1 (for more information, refer to DHS Bulletin 24-21-10 and the MinnesotaCare coverage expansion message published Nov. 19, 2024), new enrollees are now receiving MinnesotaCare coverage. Make sure to follow the correct steps to check eligibility. Some MinnesotaCare enrollees will be on fee-for-service rather than managed care plans, and do not have managed care ID cards.

Verify member eligibility using MN–ITS or by calling the automated Eligibility Verification System at 651-431-2700 or 800-366-5411 option 1. Please review the Verifying MHCP Eligibility in MN–ITS and Understanding Eligibility Results in MN–ITS videos for more information. (pub. 2/13/25)

Minnesota Health Care Programs (MHCP) covers the administration of the RSV vaccine ABRYSVO (CPT code 90678) for pregnant people effective Aug. 21, 2023. 

Before administering the RSV vaccine ABRYSVO, providers need to verify the pregnant member’s eligibility for major program and eligibility type by using the eligibility verification request feature in MN–ITS. The pregnant member must be eligible for one of the following listed major programs and one of the following listed eligibility types:  

• Major programs: EH, IM, MA, NM, KK or LL 
• Eligibility types: PC, PX, 2P, 2X, P1 or P2

Members must report any updated information to their county of residence.

Providers should refer to the following for billing information: 

• For members 18 years old and younger: Billing for Child Vaccines in the Immunizations and Vaccinations section of the MHCP Provider Manual 
• For members 19 years old or older: Billing for Adult and Non MnVFC Vaccines in the Immunizations and Vaccinations section of the MHCP Provider Manual

Additionally, we reprocessed claims back to dates of service beginning Aug. 21, 2023. Reprocessed claims appeared on remittance advices for Dec. 3, 2024. 

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 2/12/25)

The Minnesota Department of Human Services will reprocess Equipment and Supplies claims for HCPCS code A4432 that were erroneously limited to three units. The reprocessed claims will be reflected on the Feb. 11, 2025, remittance advice.

Call the Minnesota Health Care Programs Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 2/4/25)

Minnesota Health Care Programs (MHCP) resolved the system issue for Substance Use Disorder services Individual (H2035) and Group (H2035 HQ) remittance advice remark code N362 on Jan. 14, 2025. Services provided on or after Jan. 14, 2025, that deny with code N362 are denying correctly and you will need authorization from the medical review agent. 

Refer to information under the Authorization heading in the Substance Use Disorder (SUD) Services section of the MHCP Provider Manual for information about the six hours a days and 30 hours a week limits for H2035 and H2035 HQ hours, and follow the authorization process when hours or units exceed the limit.

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have any questions about this message. Email questions about authorization to sud.direct.acccess.dhs@state.mn.us. (pub. 1/31/25)

A new Minnesota Department of Human Services (DHS) report – co-created with community leaders – offers reflection, guidance and recommendations for action to better use Medicaid to support the health and well-being of American Indian communities.

Pathways to Racial Equity in Medicaid: Improving the Health and Opportunity of American Indians in Minnesota (PDF) aims to address the ongoing health disparities experienced by American Indian communities in the state. Dr. Nathan Chomilo, Medicaid Medical Director, is the report’s lead author.

The report is the result of extensive community engagement, incorporating guidance from American Indian community members, Tribal leaders and health care providers. The findings underscore the urgent need for systemic changes in health care delivery to center Indigenous knowledge and practices. The report calls for a fundamental rethinking of how health is defined and how health systems operate, advocating for an approach that embraces holistic, culturally relevant practices rather than Western biomedical models. 

The report includes three main calls for action:

• Invest in traditional healing. To expand access to traditional healing services, the report proposes engaging with Tribal Nations and urban American Indian clinics to explore covering traditional healing practices through Medicaid. This could include applying for a federal waiver or incorporating traditional healing into Medicaid to address social drivers of health. 
• Reframe definitions of health and well-being. A collaborative effort with Tribal Nations and urban American Indian communities is vital to developing a shared definition of health and well-being that reflects Indigenous values and cultural practices. The report encourages DHS to work with federal partners to ensure that Medicaid rules and regulations support this vision. This aligns with the 2022 guidance from the White House on Indigenous knowledge.
• Establish a Pathways to American Indian and Tribal Health Integration (PATH-I) Team. Creating a dedicated PATH-I team at DHS would enhance community engagement and ensure that cultural competence is integrated across state agencies. The team would focus on ongoing dialogue with community members, share information about Medicaid resources, and improve coordination among state and local health systems.

DHS will begin to implement the report’s recommendations immediately, working closely with American Indian communities. The agency encourages community members, Tribal Nations, providers and community-based organizations to engage in ongoing dialogue. Refer to the Report looks at ways Medicaid can improve health equity for American Indian communities news release for more information. (pub. 1/28/25)

The Minnesota Department of Human Services (DHS) has published two new forms for requesting changes to Community First Services and Supports (CFSS) service authorizations. Effective immediately, counties, tribal nations and provider agencies must use these forms for all CFSS change requests for members using CFSS services not paid by a waiver, alternative care or managed care organization.  

• CFSS Request Form (DHS-6893I)
  Counties and tribal nations must use this form to request changes to the member’s CFSS services. 
• CFSS Technical Change Request (DHS-6893K)
  CFSS provider agencies, financial management services (FMS) providers and consultation services providers must use this form to request changes to the member’s CFSS services. 

PCA Services

The following forms are for members using personal care assistance (PCA) services not paid by a waiver, alternative care or managed care organization. For those members, counties, tribal nations and provider agencies must continue to use the following forms.

Counties and tribal nations must use the PCA Request Form (DHS-4292) to request changes to the member’s PCA services. This includes requesting changes to a six-month PCA service authorization.

PCA provider agencies must continue to use the PCA Technical Change Request (DHS-4074A) to request changes to the member’s PCA services. This includes requesting changes to a six-month PCA service authorization.

Please note:  Effective Feb. 1, 2025, DHS will not process forms with incomplete or inaccurate information entered in required fields. (pub. 1/28/25) 

Minnesota Health Care Programs (MHCP) has discovered a systems issue that is impacting county and tribal agencies and transportation brokers claims. The service lines are denying for mileage with procedure codes S0215 and T2003. The A0100 (base rate) service lines are paying.

Providers should not submit claims for Modes 3-4 transportation services at this time. This critical issue is being worked on and we will publish another provider news when corrected and announce that we have reprocessed the denied claims.

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 1/24/25)

Minnesota Health Care Programs (MHCP) will update the billing information for oral, hormonal emergency, and non-hormonal emergency contraceptives referenced in Family Planning and Minnesota Family Planning Program services on March 1, 2025. 

Providers should know the following:

• Now until March 1, 2025: Providers can continue to bill for contraceptives as they have been.
• Starting March 1, 2025: Family Planning and Minnesota Family Planning Program under Reproductive Health/OB-GYN in the MHCP Provider Manual will reflect the updated billing and coding guidance. Providers should follow the updated guidance for submitting claims. We will deny claims if you bill the incorrect code for a service. 

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 1/23/25)

We revised this message to reflect that reprocessed claims will appear on the Feb. 7, 2025, remittance advice. 

Minnesota Health Care Programs (MHCP) has corrected a systems issue causing the denial of dental claims for CDT code D1351 (sealants), for dates of service beginning Jan. 1, 2024. The denial was for age restriction.  

Reprocessed claims will appear on your remittance advice for Feb. 7, 2025.

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 1/23/25, rev. 1/27/25)

The Minnesota Department of Human Services (DHS) has sent providers who attended the Community First Services and Supports (CFSS) Steps for Success workshop on Dec. 11-13, 2024, their certificates of completion. 

DHS sent the certificates to the email address used to register for the December CFSS Steps for Success workshop. Providers who completed the training should have received their certificate by the end of the business day Jan. 17, 2025. 

Call the Minnesota Health Care Programs Provider Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 1/23/25)

Members who currently use personal care assistance (PCA) or consumer support grant (CSG) services will receive up to six months of PCA or CSG services while they transition to Community First Services and Supports (CFSS). The Minnesota Department of Human Services (DHS) extended the services from three to six months to avoid gaps in service.

PCA providers will not need to request a reassessment at the end of the three- or six-month PCA service agreement. The reassessment previously completed will still be current.  The member will transition to CFSS and the CFSS provider agency will request a reassessment 60 days before the end of the CFSS service agreement. The CFSS provider agency will request the reassessment by completing the Referral for Reassessment for PCA/CFSS Services (DHS-6893B).

PCA providers should establish a process to track the PCA service agreements and follow up with members and lead agencies to determine if services will continue, and they will transition to CFSS. Review the AASD and DSD eList announcement for additional information. (pub. 1/21/25)

Community First Services and Supports (CFSS) policy staff will hold bi-weekly office hours for CFSS provider agencies and personal care assistance (PCA) agency providers transitioning to CFSS. The office hours will focus on understanding CFSS program requirements and the information in Department of Human Services CFSS manuals. Note, this meeting is in addition to the CFSS provider questions and answers sessions. 

CFSS policy staff office hours will be held from 11 a.m. to noon on:

• Tuesday, March 11, 2025
• Tuesday, March 25, 2025

There is no fee to join the CFSS policy office hours. Click on registration for CFSS provider agency office hours to attend. (pub. 1/21/25)

Minnesota Health Care Programs (MHCP) has created a frequently asked questions resource about the Recuperative Care program. We recommend reviewing Recuperative Care Program Frequently Asked Questions (PDF) if you are considering enrolling with MHCP as a recuperative care provider. 

Refer to the Recuperative Care Enrollment Criteria and Forms section under Provider Basics in the MHCP Provider Manual for complete enrollment information. Refer to Recuperative Care in MHCP Provider Manual for complete policy information. 

Call the MHCP Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 1/17/25)

With the transition of outpatient pharmacy claims processing to Prime Therapeutics, the Minnesota Department of Human Services now accepts point-of-sale (NCPDP D.0) pharmacy claims for pen needles and insulin syringes. 

Point-of-sale claims for pen needles and insulin syringes will process at the same payment rate as professional claims submitted for these medical supplies using HCPCS codes. Point-of-sale claims are processed using the NDC of the product being dispensed. Providers may look up covered NDCs utilizing the Drug Lookup tool online at https://minnesota.primetherapeutics.com/drug-lookup. 

Providers may also continue to submit professional claims for pen needles and insulin syringes using HCPCS codes and are not required to submit these claims as point-of-sale pharmacy claims. (pub. 1/16/25)

Personal care assistance (PCA) agency owners and managing employees who have a Steps for Success certificate dated June 26-28, 2024, or before must take CFSS transition training for PCA agency owners/managers/QPs. 

If you received your certificate on June 26-28, 2024, or earlier, it may have Community First Services and Supports (CFSS) in the certificate number or title. You still need to take the transition test. 

Only Steps for Success certificates dated September 2024 and later meets the requirements for CFSS enrollment. If your Steps for Success certificate is dated September 2024 or later, you do not have to take the transition test. 

For instruction on how to add training certificates to your enrollment record using the Minnesota Provider Screening and Enrollment (MPSE) portal, join the MPSE questions and answers session held Wednesdays from 1-2 p.m.

For questions about the transition from PCA to CFSS, join the CFSS questions and answers session held Thursdays from 11 a.m. to noon. (pub. 1/16/25) 

Minnesota Health Care Programs (MHCP) covers mechanical stretching devices for eligible medical assistance (MA) or MinnesotaCare members effective Jan. 9, 2025. Members must either be:

• suffering from joint stiffness and not responding to physical or occupational therapy during the subacute injury or postoperative period; or 
• have a documented history of motion stiffness. 

Mechanical stretching devices are used for the treatment of joint contractures in the extremities and are intended to restore range of motion. MHCP covers dynamic splinting systems for ankles, elbows, fingers, forearms, knees, shoulders, toes, and wrists. 

Authorization is always required. MHCP does not cover static progressive stretch (SPS) or patient-actuated serial stretch (PASS) devices. 

Refer to the Mechanical Stretching Devices section of the MHCP Provider Manual for policy and billing information. Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 1/16/25)

The 21st Century Cures Act requires all Medicaid managed care in-network providers be screened and enrolled in Minnesota Health Care Programs (MHCP) by the Minnesota Department of Human Services (DHS). MHCP began enrolling contracted managed care organization (MCO) providers July 17, 2023.

MCO in-network providers must enroll each location that provides services to MHCP members. DHS has extended the enrollment deadline for existing contracted MCO providers from Dec. 31, 2024, to April 30, 2025. The following MCO in-network provider types who already have an existing contract with an MCO must be enrolled in MHCP by April 30, 2025.  

• Community Mental Health Center − provider type 10 
• Rehab Agency − provider type 11 
• Day Treatment − provider type 46
• Home Care Nursing Organization − provider type 64-O
• Medical Transportation − provider type 82

Existing MCO in-network providers who fail to comply with the federal enrollment mandate will be removed from the managed care MHCP provider network and will no longer be eligible to receive payments for services provided to MHCP members. 

To ensure you meet the enrollment deadline, submit your DHS enrollment application as soon as possible. Actively enrolled fee-for-service providers who have an existing contract with an MCO will not need to go through the screening and enrollment process again.

Refer to the Eligible Providers section of the Enrollment with MHCP Provider Manual page for a list of provider types that can enroll and instructions for how to enroll. Refer to the Minnesota Provider Screening and Enrollment (MPSE) portal training webpage for training on how to use the MPSE portal to enroll. Refer to the Enrollment process for MCO network providers section on the Enroll with MHCP webpage for additional information. Contact the MHCP Provider Resource Center with any additional questions. (pub. 1/15/25)

Due to new legislative updates and revalidations, the MHCP Provider Resource Center is experiencing high call volume. You may experience a longer wait time or you will have to call back at a different time. 

You may also refer to the following webpages:

• MHCP billing resources webpage for billing resources 
• MHCP provider training webpage for free training sessions for specific provider types and services

We will offer free question and answer sessions for the MPSE Portal beginning Feb. 7, 2024. Refer to the Minnesota Provider Screening and Enrollment (MPSE) portal training webpage for more information about the sessions. (pub. 1/29/24)

The Minnesota Department of Human Services will be offering weekly questions and answers sessions for the MPSE Portal. Questions and answers sessions take place every Wednesday from 1 to 2 p.m. starting on Feb. 7, 2024. These sessions are free and no registration is required.

MPSE questions and answers sessions will be held virtually using the Microsoft Teams platform, but attendees do not need to have Microsoft Teams installed. Participants can use the browser version. Find the link to join the questions and answers session on the MPSE portal training webpage.

Who should attend?

• Owners of MHCP-enrolled organizations.
• Individual providers who maintain their own MHCP enrollment records.
• Employees of MHCP-enrolled organizations who maintain provider enrollment records. 
• Employees of MHCP-enrolled organizations who process affiliations or do credentialing.
• Employees of MHCP-enrolled organizations responsible for MHCP compliance. 
• Individuals or organizations interested in becoming an MHCP provider for the first time.
• Anyone interested in learning more about the MPSE portal.

(pub. 3/18/24)

MHCP offers training for providers who provide services for members enrolled in MHCP. We have updated on-demand and online training opportunities on the MHCP provider training webpage.

On-demand videos
On-demand videos are arranged by category, including Minnesota Provider Screening and Enrollment Portal (MPSE), MN–ITS and Billing. Each video can be viewed in 10 minutes or less and provides instructions on a concept or technique.

Online training
Online training is arranged by content for all providers or specific providers. Training is led by an instructor who will help attendees navigate the Minnesota Department of Human Services website and locate and use MHCP provider information and other related webpages or internet-based applications such as MN–ITS. All instructor-led training is online only. (pub. 11/22/22)

Minnesota Health Care Programs (MHCP) offers free online training for MHCP-enrolled providers. Go to the MHCP provider training to review the list of available training. We have scheduled 2025 training sessions for the following:

• Child and Teens Checkups
• Community Mental Health Workers
• Consultation Services
• Dental Services
• Doula
• Early Intensive Developmental and Behavioral Intervention
• Federally Qualified Health Centers and Rural Health Clinics
• Financial Management Services
• Housing Stabilization Services
• Housing Support Supplemental Services
• Individualized Education Program Services
• Mental Health
• Nursing Facilities
• Personal Care Assistance/Community First Services and Supports agencies
• Psychiatric Residential Treatment Facilities
• Substance Use Disorder
• Waiver and Alternative Care

(pub. 12/31/24)

Minnesota Health Care Programs (MHCP) is offering free online Provider Basics Resources and MN–ITS training to all enrolled MHCP providers who bill fee-for-services claims. This training is being offered monthly beginning Mar. 10, 2021.

You will learn how to navigate the MHCP provider webpages and the MHCP provider manual, and how to use MN–ITS administration, mailbox and eligibility requests (270/271) features. Go to the Provider Basics webpage to register for this training.

Claim training is not provided in this training. Refer to the MHCP provider training webpage to register for provider-specific claim training. (pub. 2/11/21)

Minnesota Health Care Programs (MHCP) offers free on-demand training videos arranged by category on the MHCP provider training webpage. Each video can be viewed in about 10 minutes and provides instructions on a concept or technique. The following new videos are available:

• Request for More Information (RFMI) – This video shows a provider how to find an RFMI in their MN–ITS mailbox and in the Minnesota Provider Screening and Enrollment (MPSE) portal.
• Managing Electronic Funds Transfer in the Minnesota Provider Screening and Enrollment Portal – This video shows a provider how to set up electronic funds transfer in the MPSE portal.

(pub. 2/11/25))

Minnesota Health Care Programs provides free online training for our MPSE online portal. We have scheduled training sessions for 2025. Visit the MPSE portal training webpage to review the schedule, register for a training session, view brief online tutorials to help prepare you for class and more information. (pub. 12/17/24)