Beginning Jan. 1, 2019, all personal care assistance (PCA) and home care nursing (HCN) services for people under age 65 will be covered under fee-for-service (FFS). Members will continue to be enrolled in the MCO they were enrolled in, but managed care organization (MCO) contracts for Minnesota Health Care Programs (MHCP) members under age 65 will no longer cover PCA and HCN. MHCP will cover the services on a FFS basis beginning Jan. 1, 2019.
Counties or tribes are responsible for annual assessments for service agreements that ended on Dec. 31, 2018, and after. Provider agencies should submit a Referral for Reassessment for PCA Services (DHS-3244P) to the member’s tribe or county of residence 60 days before the end date of a service agreement.
MCOs are responsible for annual assessments for existing service agreements with an end date on or before Dec. 30, 2018. Follow the usual procedures for annual assessment requests from MCOs for service agreements that end on or before Dec. 30, 2018. If the MCO approved a service agreement based on its last assessment with an end date that is on or after Jan. 1, 2019, it will be valid for the length of the agreement.
PCA service agreements
If a PCA provider does not receive a service agreement to continue services before Dec. 31, 2018, fax the PCA Technical Change Request (DHS-4074A) and a copy of the MCO service agreement to the Disability Services Division (DSD) Resource Center at 651-431-7447. State in the “Additional Information” section “for MCO transition.”
Home care nursing service agreements
Home care nursing (HCN) service agreements will transition to the usual FFS process through the medical review agent, KEPRO, as described in the Authorization section of the MHCP Provider Manual. HCN providers will continue to assess for HCN services. If an HCN provider does not receive a service agreement to continue services by Dec. 31, 2018, submit the Home Care Technical Change Request (DHS-4074) and a copy of the MCO service agreement through MN–ITS or the KEPRO portal. State in the “Additional Information/Treatment Plan” section “for MCO transition.”
Changes do not affect other health care services
Under this contract change, members will continue to be enrolled in the MCO they were enrolled in and the MCO will continue to pay for their other health care services.
The contract change does not apply to the two options for seniors (age 65 and over): Minnesota Senior Health Options (MSHO) or Minnesota Senior Care+ (MSC+). MSHO and MSC+ MCOs will continue to authorize and pay for PCA and HCN services. (pub. 11/16/18)
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