Updated Procedure for Notifying DHS of Fee-for-Service Medical Assistance Patients Residing in Institutions for Mental Disease for Substance Use Disorder Services

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Behavioral Health e-Memo

#19-104

09/11/19

Updated Procedure for Notifying DHS of Fee-for-Service Medical Assistance Patients Residing in Institutions for Mental Disease for Substance Use Disorder Services

The Department of Human Services (DHS) is implementing a procedure, effective Sept. 11, 2019, for notifying DHS of fee-for-service (FFS) Medical Assistance (MA) members residing in an Institution for Mental Disease (IMD) for Substance Use Disorder (SUD) services.

This procedure establishes a process for when a Service Agreement (SA) displays a 944 edit. This procedure will help providers to properly bill for services during the member’s stay.

Providers must notify the county of financial responsibility when a FFS MA member is admitted to their facility and again when the member is discharged. County and tribal workers responsible for entering Service Agreements must contact DHS staff to change the member’s major program eligibility span in MMIS. This procedure is limited to MA members who meet all of the following criteria:

  • Are enrolled in a fee-for-service Medical Assistance (major program MA in MMIS)
  • Are admitted to or discharged from an IMD for SUD services
  • Are under age 65; and
  • Are not enrolled in a Managed Care Organization (MCO).

For members that meet all the criteria listed, begin immediately using the following IMD notification process. Continue following existing procedures for all other MA members residing in non-SUD IMDs.

 Updated Notification Process for Residents of IMDs for SUD Services

Providers: Complete the County Notice of IMD Status form (DHS-4145) (PDF) when a fee-for-service Medical Assistance member is admitted or discharged from an IMD for SUD services and fax it to the county or tribe of financial responsibility who completes the Service Agreements for that agency.

Tribal Staff: Complete the County Notice of IMD Status form (DHS-4145) (PDF) when a fee-for-service Medical Assistance member is admitted or discharged from an IMD for SUD services and fax it to 651-431-7471.

County Staff: The person completing the Service Agreement will see a 944 edit and will leave the completed SA in “suspend” status. Then, notify DHS staff in one of the following ways.

1. If you have SIR access, complete the County Relations Resource Center (CRRC) web form (found in SIR) using the following information from the provider.

  • Name of the individual who was in the facility
  • The PMI number
  • The admission and discharge dates for the person from the Service Agreement
  • Name of the facility
  • The NPI number of the facility

2. If you do not have SIR access, fax the completed County Notice of IMD form from the provider to 651-431-7535. Include your email address in the comments section of the form if you want an encrypted email once DHS staff has completed the update.

DHS Staff: 

  • Update the member’s major program according to their admittance or discharge date.
  • Confirm the program change within 15 business days via the web form, or email the person who faxed the form if they provided an email address, once the update is complete.
  • Identify the financial worker or team associated with the health care case and send a SIR email informing them that the case was updated to major program IM.

County Staff:   

  • County staff responsible for entering Service Agreements will need to change the SA dates to record the member’s admittance and discharge date for the IMD for SUD services.
  • An authorization letter is then automatically generated from MMIS and placed in the MN–ITS mailbox for the provider and mailed to the member (if appropriate).
  • The person completing the SA must complete this process at both IMD admission and discharge to record the member’s dates of service.

DHS is sending a corresponding SIR message to all county and tribal financial workers describing their role in this updated IMD for SUD services notification process.

There may be changes to this process as we progress with the SUD reform. Please watch for future updates.

Email DHS.CCDTF@state.mn.us should any immediate need arise. Thank you all for your patience while determine a suitable process for everyone.


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