MHCP provider news and updates

Effective Jan. 27, 2026, and in coordination with the U.S. Centers for Medicare & Medicaid Services (CMS), Minnesota has implemented a freeze on new provider enrollments for 13 Medicaid service categories identified as high risk for fraud. (Note: A freeze on enrollment of EIDBI providers previously went into effect on Nov. 1, 2025.) Importantly, this action does not affect member enrollment.

Refer to the Minnesota Department of Human Services freezes provider enrollment for 13 Medicaid services email we sent Jan. 30, 2026, to learn more about the enrollment freeze. (pub. 1/30/26)

Effective immediately, all provider types and services in the following list are designated as high risk and are subject to enhanced screening requirements:  

1. Adult Day Care
2. Adult Rehabilitative Mental Health Services 
3. Assertive Community Treatment 
4. Community First Services and Supports Agency and Personal Care Provider Organizations
5. Companion Care
6. Early Intensive Developmental and Behavioral Intervention Agencies
7. Individualized Home Supports
8. Integrated Community Supports
9. Intensive Residential Treatment
10. Night Supervision
11. Non-Emergency Medical Transportation
12. Peer Recovery
13. Recuperative Care

Providers enrolled in one of the provider types or services identified as high risk are required to complete an off-cycle revalidation as soon as possible. Beginning Jan. 23 through Jan. 28, 2026, Minnesota Health Care Programs (MHCP) will begin sending revalidation notices. Check your MN–ITS mailbox “PRVLTR” folder for a revalidation letter, which will include instructions for completing the process. Providers without an active MN–ITS mailbox will receive their notification by U.S. mail. 

We highly recommend you use the Minnesota Provider Screening and Enrollment (MPSE) portal to complete your revalidation. This will allow you to track the progress of your revalidation. Refer to the MPSE Portal Training webpage for resources on using MPSE and to find a link to attend a technical assistance session. 

If you have recently completed a revalidation request, you must also comply with this off-cycle revalidation to remain an MHCP provider. If you previously submitted your revalidation request and it is pending processing, MHCP will reach out to you via MN–ITS or U.S. mail.

An application fee is required for the off-cycle revalidation for institutional providers. Refer to the Application Fees section for more information. 

As a result of your provider or service type being designated as high risk, you must complete the following additional screening requirements:

1. Fingerprint-based criminal background studies are required for all direct and indirect owners with an ownership interest of 5% or more. Each owner must have a completed background study on file. There is a required background study fee of $44 to submit each background study. There is also a fingerprint fee, which will vary depending on where the fingerprinting is obtained. These fees are separate from the application fee. 
   
   
   • The following provider types must complete a fingerprint-based criminal background study through NETStudy 2.0 for every direct or indirect owner with an ownership interest of 5% or more prior to submitting a revalidation request. The fingerprint-based criminal background study must receive either an "eligible" or "set-aside" determination from MHCP to revalidate:
     
     
     • Adult Day Care
     • Community First Services and Supports Agency and Personal Care Provider Organizations
     • Companion Care
     • Early Intensive Developmental and Behavioral Intervention Agencies
     • Individualized Home Supports
     • Integrated Community Supports
     • Intensive Residential Treatment
     • Night Supervision
     • Non-Emergency Medical Transportation
     • Substance Used Disorder provider type delivering Peer Recovery
       
       
   • The following provider types or services will not have access to NETStudy 2.0 (we will provide more information soon regarding how to complete required background studies for these provider types):
     • Adult Rehabilitative Mental Health Services
     • Assertive Community Treatment
     • Peer Recovery – Recovery Community Organizations
     • Recuperative Care
       
       
2. Pass an unannounced site visit. Once we have reviewed all your enrollment documents, we will refer your agency for an unannounced site visit.

Your revalidation is not considered complete until you receive a “Revalidation Complete” letter.

Respond promptly to the revalidation request. Failure to comply will result in termination of your MHCP provider enrollment.

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have any questions about this message. (pub. 1/22/26)

Refer to the Jan. 30 message titled Minnesota Department of Human Services freezes provider enrollment for 13 Medicaid services for updated information. The Minnesota Department of Human Services will freeze new provider enrollments in 13 categories of Medicaid services at high risk for fraud. The department is working with the U.S. Centers for Medicare & Medicaid Services (CMS) to implement the freeze, at which point the state will no longer accept new applications from businesses seeking to provide these services.

A start date for the freeze is not yet determined. The pause is initially slated to last six months. 

CMS directed Minnesota to freeze new provider enrollments in 13 high-risk categories as a fraud-fighting measure. The Minnesota Department of Human Services had already announced two-year licensing freezes on home and community-based services and adult day programs, effectively limiting new provider enrollment in those services.

Currently enrolled providers can continue to serve clients in the service areas they are already approved to provide. This action does not freeze member enrollment.

To ensure Minnesotans can receive critical services everywhere they live, the department will issue exceptions to add new providers where capacity is needed. Exceptions will require written approval from CMS.

Additionally, we are working with CMS so we can develop the necessary operational processes and system updates, including determining how applications in queue will be handled. We will share more information as soon as it is available.

Read the Minnesota Department of Human Services to freeze provider enrollment for 13 Medicaid services news release for more information about this change. (pub. 1/8/26)

The Minnesota Department of Human Services anticipates releasing some payments related to claims we suspended for pre-payment review (in the Dec. 13 - Dec. 23 warrant cycle) earlier than originally communicated. We anticipate many of these payments will be made as part of the Jan. 13, 2026, warrant cycle. (pub. 1/7/26)

This message is to clarify the Dec. 24, 2025, Provider News message about the pre-payment review process mandated by Governor Walz to combat fraud and abuse.

We announced that all claims identified as high-risk services would appear as “suspended” on the Dec. 30, 2025, remittance advice.

However, our system did not flag all impacted claims as “suspended.” Some claims will appear in “to be paid” status even though they are being held for pre-payment review. This only affects claims from the Dec. 13 to Dec. 23, 2025, warrant cycle. These claims will not appear on the remittance advice until they are released for payment or denial. You can submit a Request Claim Status in MN–ITS or batch and this will show the claim status category P1 and claim status 3 under claim information. 

We have updated our system to place all high-risk claims in “suspended” status going forward. 

“Suspended” status means DHS will review claims in the weeks after a warrant cycle ends. We will release proper payments after payment integrity is verified. 

Providers may experience a difference in how quickly they get reimbursed because of the pre-payment review process. For example, a provider may historically have received reimbursement about every 14 days, but the pre-payment review process may result in a longer timeframe. The review process may take up to the following mandated claim review timeframes before reimbursement is received.

• 30 days to pay or deny clean claims (without attachments)
• 90 days to pay or deny complex claims (replacement claims, Medicare crossovers, third-party liability claims, claims with information in the notes or comment fields, claims with attachments, and claims placed in a “suspended” status) 

Additionally, the DHS Commissioner has the legislative authority to suspend and perform a deeper analysis on any claims which may be potentially suspect for fraud, waste or abuse. 

Review the online pre-payment review FAQs, check your MN–ITS mailbox and sign up for email alerts for the most up-to-date information. (pub. 12/31/25)

We have clarified this message with a new message. Please refer to the All claims for high-risk services will be held for pre-payment review message we published on this webpage Dec. 31, 2025. The December 30, 2025, warrant cycle will show claims impacted by the pre-payment review process. These claims will appear in “suspended” status on the Provider Supplemental Data Remittance Advice (RA02). DHS will review claims suspended for pre-payment review in the weeks after a warrant cycle ends, and release proper payments as quickly as possible without jeopardizing efforts to mitigate fraud, waste and abuse. (pub. 12/24/25)

Minnesota Department of Human Services (DHS) is implementing a temporary licensing moratorium for adult day care. This moratorium will go into effect Feb. 1, 2026, and is anticipated to last 24 months, ending Jan. 31, 2028.

Under this moratorium, DHS will:

• Stop accepting new applications for adult day care licenses,
• Cancel all submitted license applications currently in the DHS Licensing Division’s queue.

Review the Temporary Licensing Moratorium for Adult Day Care bulletin for more information.

We want to clarify that this temporary moratorium is specifically regarding adult day care licenses and does not affect licensed providers who have already submitted enrollment applications to Minnesota Health Care Programs (MHCP) Provider Eligibility and Compliance. Adult Day Care providers may continue to enroll with Minnesota Health Care Programs and make changes to their current enrollments. Please understand we are currently experiencing a backlog of submissions.

Contact your adult day care licensor or call the DHS Licensing help desk at 651-431-6624 if you have any questions regarding this moratorium. (pub. 12/16/25)

Minnesota Department of Human Services (DHS) published a message on this webpage titled Temporary Home and Community-Based Services (HCBS) 245D licensing moratorium on Dec. 4, 2025. We want to clarify that this temporary moratorium is specifically about licensing for HCBS – 245D providers and does not affect licensed providers who have already submitted enrollment applications to Minnesota Health Care Programs (MHCP) Provider Eligibility and Compliance. Review the Licensing for HCBS – 245D providers webpage for more information. HCBS providers may continue to enroll with Minnesota Health Care Programs and make changes to their current enrollments. Please understand we are currently experiencing a backlog of submissions. 

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411, option 4, if you have questions about this message. (pub. 12/16/25)

The Minnesota Department of Human Services (DHS) is implementing a temporary 245D licensing moratorium for Home and Community-Based Services (HCBS). This moratorium will go into effect on January 1, 2026, with an anticipated duration of 24 months, ending December 31, 2027.

Under this moratorium, DHS will:

• Stop accepting new applications for 245D licenses
• Stop adding new service lines to currently licensed providers, and
• Cancel all submitted applications currently waiting to be approved.

Review the licensing for HCBS – 245D providers webpage for more information. We update this webpage regularly when new information becomes available.

If you have any questions regarding this moratorium, contact your 245D (HCBS) licensor or call the DHS Licensing help desk at 651-431-6624. (pub. 12/4/25)

The Minnesota Department of Human Services has created a frequently asked questions webpage about the new pre-payment review process that Governor Walz announced on Oct. 29, 2025. Please refer to the FAQ page for the most current information about pre-payment review, and submit additional questions through the email link at the bottom of the page. (pub. 11/6/25)

In a coordinated effort to reduce fraud, waste and abuse in Minnesota’s Medicaid program, Governor Tim Walz announced on Oct. 29 a new process for Minnesota Department of Human Services (DHS) to review claims for certain Medicaid benefits and services before they are paid. Read the news release on the governor’s office Press Releases webpage.

This new “pre-payment review” process will be overseen by a third-party vendor, Optum. For 14 specific services that have been identified as high risk, Optum will verify that billed services were necessary, correctly documented and provided before DHS makes payments.

Minnesota Health Care Programs has 30 days to pay or deny clean claims (without attachments), and 90 days to pay or deny complex claims (replacement claims, Medicare crossovers, third-party liability claims, claims with information in the notes or comment fields, or claims with attachments). The DHS Commissioner has the legislative authority to suspend and perform a deeper analysis on any claims which may be potentially suspect with regard to fraud, waste or abuse. There may be payment processing delays as we roll out this new pre-payment review process. We are working with Optum on a regular interval to review any suspended claims for these 14 Medicaid services and will continue to adjudicate claims timely and efficiently without compromising needed review. DHS is not holding all submitted claims for these 14 Medicaid services for 90 days. Some submitted claims could be suspended for up to 90 days and, of course, some of these claims may be denied.

DHS recognizes that payment delays have impacts on providers, and we are committed to processing claims as quickly as possible and within the mandated timelines. We appreciate your patience as we initiate and refine our new pre-payment review process. Please continue to provide services to MHCP members and submit your claims as you normally would. We are implementing this new process for fee-for-service claims only.

Pre-payment review will be an ongoing and permanent new business process for DHS as fee-for-service claims come in and before provider payments go out. Importantly, this new safeguard will be tied to services, not provider types. 

For reference, here are the 14 high-risk benefits and services with a link to their Provider Manual sections:

1. Adult Companion Services 
2. Adult Day Services
3. Adult Rehabilitative Mental Health Services 
4. Assertive Community Treatment 
5. Community First Services and Supports 
6. Early Intensive Developmental and Behavioral Intervention 
7. Housing Stabilization Services
8. Individualized Home Supports
9. Integrated Community Supports 
10. Intensive Residential Treatment Services
11. Night Supervision Services
12. Nonemergency Medical Transportation Services 
13. Recovery Peer Support 
14. Recuperative Care

Continue to submit claims for these services based on information outlined in our MHCP Provider Manual and Community-Based Services Manual. If you have questions, contact the Provider Resource Center. (pub. 10/29/25, rev. 10/31/25)

The department is launching a new e-newsletter for providers titled MHCP Provider Connect: A weekly roundup of news, updates and reminders to keep Minnesota Health Care Programs providers informed of developments at the Minnesota Department of Human Services. Our goal is help keep you aware of changes that impact your work and the communities we serve together. Sign up for email alerts on the Email Updates webpage to have these emails sent directly to your inbox. (pub. 1/15/26)

The 2025 Minnesota Legislature created new provisional licensing requirements that affect all enrolled EIDBI agencies. All EIDBI agencies currently enrolled with Minnesota Health Care Programs must apply for a provisional license by May 31, 2026. Agencies that have not submitted an application by this date must not operate and will be disenrolled from providing EIDBI services according to Minnesota Statutes 245A.142, subdivision 3. 

The Minnesota Department of Human Services (DHS) published a Pre-Licensing Application Checklist (DHS-8818) (PDF) that explains the information required for the provisional license application. The checklist will help EIDBI agencies prepare for completing the online provisional license application, which is expected to be available in January.  

Visit the EIDBI Provisional Licensure FAQ webpage or email the EIDBI licensing team at eidbi.licensing.dhs@state.mn.us if you have questions about a provisional license. (pub. 12/23/25)

We recommend providers check their MN–ITS mailbox regularly for important correspondence from Minnesota Health Care Programs (MHCP). MHCP delivers the following provider information electronically to each provider’s MN–ITS mailbox account. 

• Provider news and updates
• Enrollment letters
• Medical, dental and service authorization letters
• Remittance advices

Providers are required to verify member eligibility. Use MN–ITS or call the automated Eligibility Verification System at 651-431-2700 or 800-366-5411 option 1. Review the Verifying MHCP Eligibility in MN–ITS and Understanding Eligibility Results in MN–ITS videos for more information.

The Minnesota Department of Human Services is currently hosting monthly office hours for Community First Services and Supports (CFSS) providers. The February 16, 2026, session has been rescheduled to February 23, 2026. 

If you have already registered for the February 16 office hours, we updated the link to join to the new date and you do not need to take any action. 

These office hours sessions focus on questions about CFSS policies, enrollment and the transition from personal care assistance to CFSS. CFSS policy and enrollment staff will be on hand to answer questions during the office hours. 

Refer to the CFSS Provider Agency Office Hours registration page for additional dates and times and to register for a session. (pub. 2/2/26)

Minnesota Health Care Programs (MHCP) made the following two updates in the Minnesota Provider Screening and Enrollment (MPSE) portal that impact Early Intensive Developmental and Behavioral Intervention (EIDBI) agencies.

1. EIDBI Agency Licensing Requirement
We updated MPSE to comply with Minnesota statute that requires EIDBI organizations to provide a license number. Users must now enter licensing information on the Credentials page in MPSE.

EIDBI organizations must apply for a provisional license by May 31, 2026.

Temporary workaround:
Users should do the following to edit the Credentials page until you have an approved provisional license:

• Select Add a Credential.
• Choose EIDBI Agency License.
• Enter “99999” for the license number as a placeholder license number when prompted.
• Enter 01/01/2026 for the start date 

Agencies will need to repeat these steps until they have an approved license.

Users are required to update the Credentials page with their assigned license number after the provisional license is approved.

2. Site Visit Contact Information Requirement
An MHCP investigator must be able to contact someone from the EIDBI agency when the EIDBI agency is required to complete a site visit.

Users must now add site visit contact information on the Enrollment Record Information page. The contact information must include:

• Contact individual’s full name
• Phone number

This information is required to support site visit communication.

Refer to the EIDBI licensing webpage for information about EIDBI licensing requirements and required forms and documentation.

Revalidation Note
EIDBI agencies with requests in a “Pending Review” status waiting for processing in MPSE must change their original submission back to “Draft,” resubmit as a revalidation and include all changes to be processed together. Do the following to change the revalidation indicator on a request:

• While in the request (must be the assigned user and in EDIT mode), use the right-side navigation and click Request Information.
• Then change the revalidation indicator to YES. 

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 and request an MPSE walkthrough if you need assistance. (pub. 1/30/26)

Some chiropractic claims with dates of service before Jan. 1, 2026, are being incorrectly denied for age limit. The age limit for chiropractic services went into effect Jan. 1, 2026. We are working on correcting the issue and will publish a message on this webpage after we fix the issue and begin reprocessing claims. You can continue to submit claims even though it will be denied in error. No further action is required by providers. 

Call the Minnesota Health Care Programs Provider Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 1/30/26)

The Minnesota Department of Human Services has sent providers who attended the entire Dec. 17-19, 2025, Community First Services and Supports (CFSS) Steps for Success workshop 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 entire training should receive their certificate by the end of the business day Jan. 28, 2026. 

Call the Minnesota Health Care Programs Provider Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 1/28/26)

The EIDBI provisional licensing application is now live in the Provider Hub. Review the Provider Hub message emailed to EIDBI agencies to learn about the Provider Hub and application, including help and resources to guide you through the application process. 

EIDBI provisional license applications are due in the Provider Hub by May 31, 2026. EIDBI agencies that have not submitted a provisional license application by May 31, 2026, will be disenrolled from Minnesota Health Care Programs for providing EIDBI services. (pub. 1/27/26)

The Minnesota Department of Human Services has identified transportation claims are incorrectly denying for the following procedure codes:

• A0170: Parking fees and tolls
• A0180: Lodging
• A0190: Meals

We are updating our system to correct this error. Providers do not need to take any action at this time. We will provide an update on this webpage about reprocessing claims when available. 

Contact the Minnesota Health Care Programs Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 1/27/26)

The Minnesota Department of Human Services is aware of internal systems issues causing certain CPT and HCPCS code claims to deny in error for Minnesota Health Care Programs (MHCP) enrolled Individualized Education Program (IEP) and school-based community services (SBCS) providers. We are working to resolve these issues.

We will automatically reprocess any claims previously denied due to these issues once the resolution is complete. You do not need to resubmit those claims.

You may continue to submit new claims as usual. While some claims may deny initially, we will also automatically reprocess those claims after the resolution is complete.

Contact the MHCP Provider Resource Center at the following phone numbers with questions about claims or billing: 

• Phone number for local callers: (651) 431 2700, option 3
• Phone number for toll free callers: (800) 366 5411, option 3
• Hours of operation: 8 a.m.– 4:15 p.m., Monday–Friday (closed from noon–12:45 p.m.)

(pub. 1/27/26) 

MHCP covers a variety of services delivered at home. Refer to the following:

• If you are an MHCP-enrolled provider of services eligible to be provided at home, you can bill for visits provided at place of service 12 even if you have not done so previously.
• MHCP-enrolled providers use place of service 12 when billing for a home visit. Place of service 12 is inclusive of any location, other than a hospital or other facility, where the patient receives care in a private residence.
• Providers do not need to document or provide information on the patient’s home address when billing for home visits. 
• All the required components of the billing code or service must be provided to bill. Not all visits are appropriate in place of service 12.

Special note about Evaluation and Management (E&M) services
E&M services can be provided for members at home for any reason. Home visit E&M codes are covered for new and existing patients. (pub. 1/27/26)

The Minnesota Department of Human Services has formally appealed and requested a hearing on the decision by the Trump Administration to withhold over $2 billion in annual Medicaid funding for Minnesota. 

It is important for everyone to know that there have been no changes to funding at this time. Providers should continue to bill as usual. You will continue to be paid for eligible services you provide Medicaid enrollees under state law.

Refer to the Federal Medicaid funding update to learn more. (pub. 1/23/26)

The Minnesota Department of Human Services has clarified billing expectations and eligible provider types for several CPT codes in the Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid. These updates provide EIDBI providers with additional guidance and do not represent new billing requirements.

The following lists the updates to the EIDBI billing grid:

• For CPT 97151 and T1024, we updated the language to clarify eligible provider types.
• For CPT 0373T, we clarified that the code can only be billed by one provider. This applies even when multiple providers deliver the service. The service must be delivered under the supervision of a Level I or Qualified Supervising Professional (QSP).
• For midpoint billing and daily limits: we clarified that providers may only bill for a unit when the service provided was for at least half of the unit time. We also clarified that daily limits represent the maximum allowable billing for one day, and all services must be medically necessary.
• For CPT 97155, we clarified that the authorized amounts providers request in the individual treatment plan (ITP) must generally be about 20% of total intervention time (97153, 97154, 0373T), unless specified otherwise.
• For provider specialty codes, we clarified when providers can use EIDBI provider specialty codes, which are programmed in MMIS during enrollment to designate provider levels. These codes are not modifiers and providers must not enter these codes on claims. EIDBI agencies may use the specialty codes to verify individual provider level and service eligibility within their records.

Review the updated billing grid to ensure compliance with current EIDBI billing requirements. For questions, contact the Minnesota Health Care Programs Provider Resource Center. (pub. 1/20/26)

Effective Feb. 2, 2026, MHCP will reimburse providers for Casgevy for transfusion-dependent beta-thalassemia, outside the APR-DRG, if the following criteria apply: 

• Casgevy is provided at an authorized treatment center.
• Casgevy is submitted on a professional claim.
• The individual receiving Casgevy is an MHCP member enrolled in fee-for-service.
• The MHCP member meets PA criteria for Casgevy. 
• The provider has an approved prior authorization (PA) for Casgevy for transfusion-dependent beta-thalassemia. 

Providers should submit prior authorization requests for Casgevy to Prime Therapeutics. Refer to Casgevy clinical PA criteria for additional details. 

Call the Provider Call Center (staffed by Prime Therapeutics) at 844-575-7887 with questions. (pub 1/15/26)

Effective Jan. 1, 2026, Minnesota Health Care Programs (MHCP) dental benefits will include the following updates.

• Obsoleted Current Dental Terminology (CDT) codes effective Jan. 1, 2026:
  • D1352 - Preventive resin restoration in a moderate to high caries risk patient (permanent tooth) 
  • D1705 - AstraZeneca COVID-19 vaccine administration (first dose) 
  • D1706 - AstraZeneca COVID-19 vaccine administration (second dose) 
  • D1707 - Janssen (Johnson & Johnson) COVID-19 vaccine administration  
  • D1712 - Janssen (Johnson & Johnson) COVID-19 vaccine administration (booster dose) 
  • D9248 - non-intravenous conscious sedation.

***D1720 Influenza Vaccine Administration was being considered for coverage in MHCP. There has been a policy change; D1720 will not be included in the MHCP Dental Benefit at this time. 

• New CDT codes for MHCP coverage effective Jan. 1, 2026:
  • D6049 - Scaling and debridement of a single implant in the presence of peri-implantitis (without flap entry). Once per 180 days. Code conflicts with D6081, D1110, D4910, D4346
  • D6280 - Implant maintenance procedures when a full arch removable implant/abutment denture is removed and reinserted 
  • one unit per 180 days
  • D9224 - Administration of general anesthesia with advanced airway; first 15-minute increment 
  • D9225 - Administration of general anesthesia with advanced airway; each subsequent 15-minute increment
  • D9244 - In-office administration of minimal sedation; single drug, enteral
  • D9245 - Administration of moderate sedation; enteral
  • D9246 - Administration of moderate sedation; non-intravenous parenteral (e.g., Intra-muscular (IM) subcutaneous (SC), submucosal
  • D9247 - Administration of moderate sedation; non-intravenous parenteral, each subsequent 15-minute increment

Contact the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 1/15/26)

This notice is to remind EIDBI providers of the requirements related to background studies conducted through NETStudy 2.0.

Requirement for EIDBI agencies
Each EIDBI provider location must maintain its own unique NETStudy 2.0 Agency ID to ensure accurate tracking, compliance, and proper documentation of background studies (BGS) for that specific site and their employees. Agencies must also ensure that all currently enrolled Minnesota Health Care Programs (MHCP) individual EIDBI providers, as well as any new individual EIDBI providers, complete a NETStudy 2.0 background study.

EIDBI organizations currently enrolled with MHCP who do not have an Agency ID for each existing location must obtain an Agency ID by submitting a Request for Early Intensive Developmental and Behavioral Intervention (EIDBI NETStudy 2.0 Agency ID Number (DHS-3891A) to Minnesota Department of Human Services (DHS) either via MPSE or fax. DHS will request the Agency ID from NETStudy 2.0 on the agency’s behalf. NETStudy 2.0 will then email the agency at the email contact listed on the DHS-3891A with the agency ID and onboarding information. Agencies can then run BGS on all for each location as outlined in Minnesota Statutes, 245C.03.  

New EIDBI organizations should submit a DHS-3891A along with their enrollment request. DHS will request the Agency ID from NETStudy 2.0 on the agency’s behalf after the enrollment documents or request is reviewed and complete. Next, NETStudy 2.0 will send new agencies an agency ID along with onboarding information to the email contact they list on the DHS-3891A. At that time, BGS can be run on all owners and authorized persons. Agencies can then run BGS on all as outlined in Minnesota Statutes, 245C.03.

BGS numbers should be included for each disclosed individual on the Owners/Authorized Persons Background Studies page in the MPSE portal or added to the BGS number section on the Disclosure of Ownership and Control Interest of an Entity (DHS-5259).  

Requirement for Individual EIDBI providers
Effective Aug. 5, 2025, individual EIDBI providers must have a complete DHS background study (BGS) through NETStudy 2.0 for each EIDBI location with an “eligible” or “set-aside” result before they provide services. An EIDBI individual provider must complete a new fingerprint BGS any time the individual provider becomes affiliated with an EIDBI agency. A background study completed under one location does not automatically transfer to another. 

Newly enrolled individual EIDBI providers, as well as current providers affiliated with more than one EIDBI agency, cannot have an effective or affiliation date earlier than the background study completion date for that specific agency.

Existing enrolled individual EIDBI providers must have a complete BGS on file with NETStudy 2.0 or their record will be terminated.

Please review your agency’s current setup and ensure that both Agency IDs and required background studies are in place for all locations and individuals.

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 1/13/26)

Minnesota Health Care Programs updated rates for treatment coordination and residential SUD treatment services effective Jan. 1, 2026. The new rates are identified on the Substance Use Disorder Service Rate Grid with Dollar (DHS-7612) (PDF) to include both the rates for services provided on or after Jan. 1, 2026 (pages 1 through 6) and rates for services provided Jan. 1, 2025, through Dec. 31, 2025 (pages 7-12). The new base rates are:

• Treatment coordination $37.13 per 15-minute unit
• Residential treatment:
  • ASAM 3.5 High-Intensity Residential (daily skilled treatment services) $294.67 per day (H2036 TG)
  • ASAM 3.1 Low-Intensity Residential services (at least five skilled treatment service hours per week) $216.90 per day (H2036 UD)   
    • Regarding the rate change for ASAM 3.1, Minnesota Statutes, 254B.0505, subdivision 1 still requires a rate for medium intensity residential, also referred to as ASAM 3.1 low-intensity (at least 15 skilled treatment service hours per week). However, the rate for this level of care was not increased and will remain $171.11 per day (H2036 TF).  
    • ASAM 3.1 programs that provide at least 15 hours of services per week may choose to bill using the appropriate value 24 code/procedure codes associated with either a minimum of 5 hours per week or a minimum of 15 hours per week. Only claims submitted with codes for low intensity (at least five hours per week) will receive the new rate of $216.90 per day.

Call the Minnesota Health Care Programs Provider Resource Center at 651-431-2700 or 800-366-5411 if you have any questions about this message. Email questions about state plan amendments, SUD residential and outpatient rates to sud.direct.access.dhs@state.mn.us. (pub. 1/9/26)

Minnesota Health Care Program (MHCP) reimbursement rates for mental health services will increase by 3.01% according to the Medicare Economic Index (MEI) to reflect inflation effective for calendar year 2026. This rate reflects the change in the MEI from the midpoint of the 2025 rate year to the midpoint of the 2026 rate year and is based on the MEI forecast published by the Centers for Medicare & Medicaid Services in the fourth quarter of calendar year 2025. MHCP uses the MEI to account for changes in the cost of providing services, including wages, benefits, and overhead. The 3.01% MEI increase will apply to eligible mental health services identified in Minnesota Statutes, 256B.761 (e) for claims with dates of service in calendar year 2026. (pub. 1/9/26)

Community First Services and Supports (CFSS) agencies and financial management services (FMS) providers must enroll each CFSS direct support worker with Minnesota Health Care Programs (MHCP). This is required because direct support workers must be listed as the rendering provider on claims for covered personal care services.

Before enrolling a direct support worker, CFSS agencies and FMS providers must ensure the workers:

• Meet the PCA/CFSS worker criteria, requirements and responsibilities.
• Successfully complete the Individual PCA and CFSS training requirements. 
  • A certificate dated after April 15, 2020, meets training requirements for both personal care assistance (PCA) and CFSS.
  • PCA workers with certificates dated before April 15, 2020, must complete new training before providing CFSS services.
• Complete a background study through NETStudy 2.0 using the facility ID assigned to the agency at the time of enrollment with MHCP. 

CFSS agencies and FMS providers are responsible for keeping all enrollment information updated for direct support workers. The most effective way to report changes, end an affiliation or update information for an enrollment application is by submitting an affiliation request through MPSE. Agencies also have the option to fax the Individual DSW Change Request (DHS-5716) (PDF).

Review the Direct Support Worker Individual Enrollment Criteria and Forms section of the MHCP Provider Manual for more information about enrolling a direct support worker. 

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 1/9/26)

The Minnesota Department of Human Services (DHS) is conducting a survey during the month of January 2026 to collect feedback on how the direct care staffing shortage impacts people who receive supports. The survey is open to members who were eligible to receive a government-funded direct care service in Minnesota between Jan. 1, 2025, and Dec. 31, 2025. The survey is optional and those who complete the survey will remain anonymous. 

We request providers share this survey with members and their direct support workers to assist members (if needed) with taking the survey. Refer to the Minnesota direct care staffing shortage impact annual survey eList announcement to access the survey and for more information. (pub. 1/8/26)

The Department of Human Services (DHS) is hosting a webinar about the new Elderly Waiver (EW) hospital high-needs budget exception. Providers will learn about when and how to request the exception using a new EW budget exception form. 

After the webinar, providers will be able to:

• Define EW and the two types of EW budget exceptions 
• Understand EW eligibility criteria, available services and budgets 
• Know how to request a budget exception from the EW lead agency

The webinar will be held on Feb. 5, 2026, from noon to 1 p.m. Go to Elderly Waiver Hospital High Needs Exception - Webinar for Providers to register for the webinar.

Email dhs.aasd.hcbs@state.mn.us with any questions you have about this message. (pub. 1/5/26)

Minnesota Health Care Program (MHCP) will no longer cover chiropractic services for members 21 years old and older beginning Jan. 1, 2026. 

One evaluation and up to 24 visits per year (no more than six per month) are allowed for members under 21 years old. You must request authorization from the medical review agent to provide and be paid for services that exceed these service limits. 

Refer to the Chiropractic Services section of the MHCP Provider Manual for more information or call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 12/31/25)

Medica AccessAbility Solution® Enhanced, the integrated Medicare/Medicaid product offered through Medica, will no longer be a health plan option for Special Needs BasicCare (SNBC) members in any county starting Jan. 1, 2026.

Medica’s Non-Integrated AccessAbility Solution® remains unaffected by this change and will continue operating in 2026.

Approximately 1,800 Medica AccessAbility Solution® Enhanced SNBC members will transition to receiving their health care services through Medical Assistance fee for service beginning Jan. 1, 2026. Many of these members already have authorizations with Medica, and the Minnesota Department of Human Services (DHS) will honor most of those existing authorizations.

DHS asks providers to help members transitioning from Medica AccessAbility Solution® Enhanced by submitting Medicaid authorization requests to DHS’s authorization agents so these members may continue receiving services. 

What do providers need to do for members transitioning to fee-for-service?
Members who have approved authorizations with Medica AccessAbility Solution® Enhanced for services on or after Jan. 1, 2026, will need new authorizations from Minnesota Health Care Programs (MHCP). 

MHCP-enrolled providers should submit authorization requests to DHS’s designated agents.

 Submit authorization requests for Medicaid medical, home health care, and dental services to Acentra Health via their Atrezzo provider portal. Providers must include a copy of the approval notice for Medicaid paid services previously authorized under Medica AccessAbility Solution® Enhanced. 

Providers with questions about non-Medicare Part D covered drugs should contact the Prime call center at 844-575-7887. (pub. 12/31/25)

The Minnesota Legislature passed a provision during the 2025 Minnesota Legislative Session that requires MHCP providers with electronic medical records to allow SMRT access to and use of those records to support more efficient disability determinations. 

Key statute details 

• Minnesota Statutes, 256.01, subdivision 29 established the requirement effective May 24, 2025. 
• MHCP providers are required to accept electronically signed authorizations submitted by SMRT to release medical records.

We mailed providers a letter via the U.S. Postal Service regarding this statutory requirement. The requirement builds on existing requirements found in the Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF), requiring providers to: 

“Comply with all federal and state statutes and rules relating to the delivery of services to individuals and to the submission of claims for such services.”

The existing language in the DHS-4138 provider agreement allows the SMRT to obtain access to electronic health records without requiring a separate contract with individual MHCP providers. 

Attestation for use of records with valid authorization 
SMRT seeks data according to the valid authorization where the member has specifically requested the disclosure of all health information to SMRT. A valid authorization does not require an attestation under Code of Federal Regulations, title 45, section 164.509. Refer to Code of Federal Regulations, title 45, section 164.509. A valid authorization is sufficient on its own for providers to disclose health information to the State Medical Review Team.

Your next steps 
Ensure your organization’s electronic medical record system supports secure access for SMRT when requested.
Be prepared to accept electronically signed authorizations from SMRT for the release of medical records.
Review your processes to ensure compliance with this statutory requirement.

Who to contact
Call the State Medical Review Team at 651-431-2493 if you have questions or want more information about the statute or implementation process. (pub. 12/30/25)

Minnesota Health Care Programs is reducing the critical access mental health rate add-on according to the following schedule passed by the legislature: 

• For services provided on or after Jan. 1, 2026, the rate add-on is reduced to 5.92 percent. 
• For services provided on or after Jan. 1, 2027, the rate add-on is zero percent. 

Refer to Minnesota Statutes, 256B.763, subdivision 2, to review the legislation. 

Refer to information under the Critical Access Mental Health Rate Increase Elimination heading on the Service rates information webpage for more information about the critical access mental health rate. (pub. 12/30/25)

MHCP supports telehealth as a safe and effective way for its members to get care. Members can get many health care services from home via telehealth using their phone or computer. Telehealth meets the same standards as in-person services when clinically appropriate and helps reduce barriers like travel, clinic access, and safety concerns. MHCP covers and reimburses eligible telehealth services for members in managed care and fee-for-service programs.

Providers delivering services by telehealth are held to the same standards of care and professional conduct as in-person services. 

Refer to the Telehealth Services section of the MHCP Provider Manual or the Fee-for-service coverage for Medical Assistance and MinnesotaCare webpage for more information. (pub. 12/30/25)

New tiered minimum wages for Personal Care Assistance (PCA) Choice and Community First Services and Supports (CFSS) budget model workers are planned for 2026. These new tiered wages will start on January 1, 2026, or within 30 days after federal approval, whichever happens later.

Minnesota has not received federal approval yet. Because of this, PCA Choice agencies and financial management services (FMS) providers are not required to pay the new tiered schedule 2 wages until we receive federal approval. 

We will post a Provider News update when we receive federal approval. (pub. 12/30/25)

Minnesota Health Care Programs (MHCP) updated the enteral nutrition lists for certain products that have multiple flavors. We added new products covered by MHCP, removed discontinued products or products no longer covered by MHCP, updated names of some covered products, and updated and removed 4-digit codes assigned by MHCP. Review product names on the lists to ensure you are accurately billing the correct product. 

Use the updated 4-digit codes beginning March 1, 2026. Do not use discontinued 4-digit codes for claims with dates of service on or after March 1, 2026. Providers are not required to use these 4-digit codes, but the codes used for authorization requests and billing claims must match the codes on the lists. 

Review the Enteral Nutrition Price List B4149-B4155 (PDF) and Enteral Nutrition Price List B4157-B4162 (PDF) documents for information on 4-digit assigned MHCP codes. Review the Nutritional Products section of the MHCP Provider Manual for policy information for enteral nutrition. Contact the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 12/30/25)

Minnesota Department of Human Services (DHS) will require observation and direction (that is, CPT code 97155) authorization requests to include individual clinical justification that demonstrates medical necessity for EIDBI services requested on or after Jan. 1, 2026. We are working to clarify the expectations that observation and direction must be individualized and tied to the person’s documented clinical need to ensure consistent application across the program. These clarifications align with new clinical supervision standards we announced in a July 29, 2025, eList announcement and that are outlined in Minnesota Statutes, 256B.0949.

EIDBI provider actions
Observation and direction services may not receive authorization approval if requirements are not followed.

EIDBI providers must:

• Meet supervision requirements in Minnesota Statutes 256B.0949, subdivision 15-16 and ensure the qualified supervising professional (QSP) provides the minimum required oversight.
• Ensure observation and direction services requested in the individual treatment plan (ITP) reflect the person’s specific clinical need. Refer to the How to complete ITP and Progress Monitoring, DHS-7109 webpage for more information and instructions.
• Request observation and direction services in proportion to direct treatment (that is, CPT code 97153 and 97154) and document medical necessity in the ITP.
• Align observation and direction use with national guidance (that is, Council of Autism Service Providers [CASP], ABA Coding Coalition), which recommends 20% of the person’s direct treatment hours.
• Use the ITP to explain the need for observation and direction service authorization. If observation and direction services exceed 20% of direct treatment hours, the medical review agent may request unit reductions or additional documentation. 
• Use observation and direction as a supervisory, supportive service that supplements direct treatment, as indicated in the Observation and direction EIDBI Benefit Policy Manual.

EIDBI providers must NOT:

• Provide observation and direction without prior authorization.
• Request observation and direction services equal to or greater than direct treatment hours.
• Assume the QSP must deliver all observation and direction services. Other qualified staff may provide observation and direction when clinically necessary.
• Use observation and direction as a substitute for direct treatment, to mirror treatment intensity, default authorization or routine agency practice without individual consideration.

Service authorization
DHS, its medical review agent and managed care organizations are actively working to consistently enforce the observation and direction requirements. This is part of a broader effort to establish consistent and equitable service limits. This approach aligns with Minnesota’s EIDBI program with national best practices and ensure high-quality, person-centered care across services.

More information
Email ASD.DHS@state.mn.us if you have questions about this message. (pub. 12/23/25)

We have revised this message by removing the reference to QSPs attesting to being an agency employee by submitting DHS-7120C. All QSP EIDBI providers must be EIDBI agency employees effective Jan. 1, 2026. QSPs can no longer be independent contractors according to Minnesota Statutes, 256B.0949, subdivision 2.

An employee is a person who is employed temporarily, part time or full time by the agency that submits claims or bills for the work, services, supervision or treatment performed by the person. This does not include:

• Independent contractors (for example, workers who file tax form 1099), billing agencies or consultants who do not provide EIDBI services.
• People who perform work, provide services, supervise or provide treatment for fewer than 80 hours in a 12-month period.

Next steps
Review your agency staffing model to ensure you comply with this requirement. Refer to the QSP qualifications, roles and responsibilities webpage for more information. (pub. 12/23/25, rev. 1/7/26)

Minnesota Department of Human Services (DHS) is aware that some CFSS service providers are experiencing a claims processing issue. Claim adjustment reason code CO 273 is appearing on some remittance advices. Claims with this adjustment code indicate the authorization has been exceeded, resulting in a denial or partial payment.

DHS has identified the issue impacting fee-for-service agreements in both the CFSS budget model and agency model. The issue occurs even when authorizations for these claims still show available funds or units on the service lines for the procedure codes being billed. We are working to resolve this issue. We will update providers when we have more information to share.

Contact the Minnesota Health Care Programs Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 12/23/25)

Minnesota Department of Human Services (DHS) received questions about Medica acquiring certain UCare contracts and assets, and what that means for both providers and members. The following clarifies the impacts of the acquisition. 

• Not Impacted: UCare Minnesota’s Prepaid Medical Assistance Program (PMAP), MinnesotaCare, Minnesota Senior Care Plus (MSC+) and Non-Integrated Special Needs BasicCare (SNBC) products are not impacted by this change. As of January 1, 2026, these products will continue under the UCare name and members will continue to have access to the same UCare network of providers. Medica commits to providing advance notice of any future changes. Members who are currently enrolled in these UCare products do not need to do anything at this time.
  
  
• Impacted: UCare’s Minnesota Senior Health Options (MSHO) and Integrated Special Needs BasicCare (I-SNBC) products will end December 31, 2025. For the remainder of 2025, there are no changes to benefits, coverage, contracts or network status for these members. For coverage in 2026, there is a path forward for these members to continue to be covered and receive care. UCare sent notification to all members that were impacted by this change. These dual (Medicare and Medical Assistance) enrollees will have a special election period available to select a new Medicare health plan. CMS will assign a new Prescription Drug Plan for enrollees that do not make a new Medicare selection effective January 1, 2026. Additionally, DHS will systematically move enrollees from UCare MSHO to UCare MSC+ and from UCare Integrated SNBC to UCare Non-Integrated-SNBC effective January 1, 2026. Medica also issued a notice to its provider network on Dec. 8, 2025, of these changes and this process for ensuring continuity of care for impacted members.

For the remainder of 2025 and beginning January 1, 2026, UCare members can continue to see their same providers. Medica is working quickly to welcome these new members and ensure their networks remain in place. Medica has committed to providing advanced notice to providers of any changes. UCare providers with questions about their contract with UCare should contact the Provider Assistance Center. UCare will keep its current Customer Service and Provider Assistance centers open from 8 a.m. – 5 p.m., Monday - Friday. You may call the centers at the following numbers:

• Members: 612-676-3200 or toll free at 800-203-7225
• Providers: 612-676-3300 or toll free at 888-531-1493 

Medica has also provided a toll-free number for providers or members to call with questions related to MSHO or coverage options: 888-925-0747. Providers are also encouraged to visit Medica.com/Providers for the latest information and updates related to its transaction with UCare.

DHS is working to establish a new Annual Health Plan Selection (AHPS) timeline and mailing schedule. We will share that information as soon as it is available. (pub 12/18/25)

Minnesota Department of Human Services (DHS) will increase the service limit for psychological testing services from 8 hours (16 half-hour units) per member per calendar year to 10 hours (20 half-hour units) per member per calendar year effective Jan. 1, 2026.  

 You must request authorization from the medical review agent to provide and be paid for services delivered to a member for hours that exceed the 10-hour service limit. 

We will publish an updated Psychological Testing section of the MHCP Provider Manual with the new service limit and authorization information on Jan. 1, 2026. (pub. 12/18/25)

Minnesota Health Care Programs (MHCP) has opened registration for the 2026 dates for the Community First Services and Supports (CFSS) Steps for Success workshops. The three-day workshop sessions will be held: 

• March 25-27, 2026 
• June 24-26, 2026 
• September 23-25, 2026 
• December 2-4, 2026 

After a workshop session fills, MHCP will remove it as a selection from the online registration system. We will close unfilled workshop sessions at 8 a.m. seven business days before the workshop begins. The workshop will continue to be online-only and sessions will begin promptly at 8:30 a.m. and end at 4:30 p.m. 

If you have any questions, call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411. (pub. 11/26/25)

On July 4, 2025, President Trump signed the Federal Reconciliation Bill (H.R.1) into law. This new law brings changes to Medicaid, a federal health insurance program called Medical Assistance in Minnesota. All states must implement the changes in the law, which include additional requirements for eligibility. 

Nothing has changed yet. The first changes won’t take effect until fall 2026. This gives Minnesota Department of Human Services time to review the details, get more information from the federal government, and communicate the changes clearly to Minnesotans. 

We recently published our What the new federal budget law means for Medicaid webpage with resources and information: a timeline, details about the coming changes and how they may affect the people you serve, and a partner toolkit to help communicate clearly and accurately to impacted Medical Assistance enrollees. 

We will add more content as we get more guidance from the federal government, so check the webpage often. (pub. 10/21/25) 

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 webpage to review the list of available training. (rev. 3/3/25)

Minnesota Health Care Programs (MHCP) offers free online training for MHCP-enrolled providers. Go to the MHCP provider training webpage to review the list of available training. We have scheduled 2026 training sessions for the following:

• Child and Teen Checkups
• Community Health Worker
• Consultation Services
• Dental Services
• Doula
• Early Intensive Developmental and Behavioral Intervention
• Federally Qualified Health Center and Rural Health Clinic
• Financial Management Services
• Home Care Services
• Housing Support Supplemental Services
• Individualized Education Program
• Mental Health
• Nursing Facility
• Personal Care Assistance/Community First Services and Supports Agency
• Psychiatric Residential Treatment Facility
• Recuperative Care
• Substance Use Disorder
• Waiver and Alternative Care
  (rev. 1/13/26)

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. (pub. 6/3/25)