mn dhs provider change form
Restriction: In the case of a vendor, excluding or limiting the scope of the health services for which a vendor may receive a payment through a program for a reasonable time. Photocopying shall be done on the vendor's premises unless removal is specifically permitted by the vendor. Record retention after vendor withdrawal or termination. Suspending Payments: Stopping any or all program payments for health services billed by a provider pending resolution of the matter in dispute between the provider and DHS. VfsUU"@`c`@7&`k]8J$ "3` f Subp. Minnesota Rules 9505.0170 to 9505.0475 Medical Assistance Payments Minnesota Health Care Programs (MHCP) requires all enrolled providers to follow applicable state and federal regulations. Home health or personal care services providers. Policies and procedures. Minnesota Rules 9505.0315 Medical Transportation Minnesota Statutes 256B.02 Policy Prior Authorization Form for Psychiatric Residential Treatment Facilities (PRTF) Care Management Referral Form - PDF Housing Stabilization is a Home and Community Based Service (HCBS), and providers of Housing Stabilization must abide by the HCBS requirements. A vendor who commits any of the following acts may be convicted of a felony and fined up to $25,000 or imprisoned for up to five years, or both: Convicted: A judgment of conviction has been entered by a federal, state, or local court, regardless of whether an appeal from the judgment is pending, and includes a plea of guilty or nolo contendere. If a provider uses a billing agent or organization (person or entity that submits a claim or receives MHCP payment on behalf of a provider), the provider must also list the name and address of the billing agent on the enrollment application. If the ownership of a long-term care facility or vendor service changes, the transferor, unless otherwise provided by law or written agreement with the transferee, is responsible for maintaining, preserving, and making available to DHS on demand the health service and financial records related to services generated before the date of the transfer as required under subpart 1 and Minnesota Rules 9505.2185, subp. %PDF-1.6 % endstream endobj 1121 0 obj <>stream Remove an organization or close a location %PDF-1.6 % Universal Referral Form, Accident Reporting Form Ownership, Tax ID, and/or Legal Name change may require a new contract. They are also useful for those who are not proficient in graphic design, as they eliminate the need to start from scratch or hire a professional designer. For assistance, refer to the Instructions to Complete the PCA Technical Change Request (DHS-4074A), DHS-4074C. Genetic Testing Prior Authorization Form You must be an MHCP-enrolled provider AND registered to use MNITS to access the system. The notification must include the provider name, the National Provider Identifier (NPI) or Unique Minnesota Provider Identifier (UMPI), office address, and billing agent's name and address. If Provider Enrollment terminates a provider, the provider has a right to an administrative appeal at the Office of Administrative Hearings (OAH). 1341 0 obj <>stream Enrollees get health care services through a health plan. Documentation required for every child in family child care Documentation family child care license holders must maintain Additional family child care license holder forms and information Enroll with MHCP. Health Service Record: Electronically stored data, and written or diagrammed documentation of the nature, extent, and evidence of the medical necessity of a health service provided to a recipient by a vendor and billed to MHCP. endstream endobj 298 0 obj <>stream Partners and providers. FDR Compliance Program Requirements Table of Contents; Member Find of Covers (EOC) MN-ITS User Quick; Minnesota Provider Screening press Enrollment Manual (MPSE) Latest revisions at this Manual; Provider Basics; COVID-19; Sedative Services; . endstream endobj startxref %PDF-1.7 % Send the notice to: DHS MHCP Provider Enrollment DHS-4905C Extended Psychiatric Inpatient- Initial Review Notice of Admission Form for Withdrawal Management Acupuncture Prior Authorization Request Form(Effective 8-8-2022) !Q][>=)@`@NgsJ^~20Ozs6S$-=(U]KbMHa The latest edition provided by the Minnesota Department of Human Services; Compatible with most PDF-viewing applications. B) endstream endobj 302 0 obj <>/Subtype/Form/Type/XObject>>stream Notify MHCP Provider Enrollment in writing if you hire a billing agent after enrollment. Using printable templates can save time and effort, as they provide a basic structure and design that can be used as a starting point for creating professional-looking documents. Patient: Any adult resident, patient, recipient, or client receiving medical care from or through the provider. Advance Directive: A written instruction such as a living will or durable power of attorney for health care, recognized under state law and relating to the provision of care when the patient is incapacitated. Download a fillable version of Form DHS-3535A-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services. If the patient has an advance directive and has given the provider a copy, the provider must comply with the terms of the advance directive, to the extent allowed under state law. Refer to child protection programs and services for more information. Download a fillable version of Form DHS-3535A-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services. Consult with the appropriate professionals before taking any legal action. To protect private data and protected health information, lead agencies should contact the SASD Support Team using this secure form: Service Agreement and Screening Document (SASD) Support Team Portal, DHS-3754. This process is called a renewal. Minnesota Rules 9505.2195 Copying Records endstream endobj 1117 0 obj <>stream MHCP also excludes individuals and entities from participation in MHCP if they are on either the federal or state excluded provider list. (Minnesota Statute 256B.48, subd. Form DHS 3535 ENG Download Fillable PDF Or Fill Online Individual Practitioner Mhcp Provider Profile Change Form Minnesota Templateroller. The SASD Support Team makes every effort to process change requests and corrections within 10 business days. 294 0 obj <> endobj Medically Necessary or Medical Necessity: Terminating Participation or Termination: Rehabilitative and therapeutic service records. Forms for family child care Forms for licensed family child care providers This page has links to forms and documents for family child care providers. G!Qj)hLN';;i2Gt#&'' 0 Legal Disclaimer: The information provided on TemplateRoller.com is for general and educational purposes only and is not a substitute for professional advice. Posted 11.23.22. Uniform Re-Credentialing Application, Join Our Network . Payment for any covered service furnished to a recipient by a provider may not be made to or through a factor, either directly or indirectly. Change of Information TEMPORARY LICENSED AND LICENSED HOME CARE PROVIDERS . Free DHS Change Of Provider Form Mn Online 8 and 256B.0625. They typically come in popular file formats, such as PDF or Microsoft Word, and are available for free or for purchase from websites and software providers. The federal Health and Human ServicesOffice of Inspector General (OIG) has the authority to exclude individuals and entities from participation in Medicare, Medicaid and other federal health care programs. The SASD Support Team will make every effort to process screening document deletion requests on a weekly basis. Forms utilized for the following codes: H2012, H2017, H0034, 90882, and H0019. DHS-4159A Adult Mental Health Rehabilitative. Find DHS Forms Find a collection of the most popular forms across DHS: Immigration Forms, Travel Forms, Customs Forms, Training Forms, Additional Resources Immigration Forms Travel Forms Customs Forms Training Forms Additional Resources Keywords How Do I - At DHS How Do I? Records may be maintained electronically in an Electronic Health Records (EHR) system for all or part of the five-year record keeping period. Follow-up procedures must be in place to provide the information to the individual directly at the appropriate time. Medical transportation record must document: Medical supplies and equipment record must: Rehabilitative and therapeutic service records must comply with requirements listed in Rehabilitative Services. Hn0} If DHS permits use of installment payments, DHS shall assess interest on the funds, unless the overpayment occurred because of department error. Disclosure of Ownership Form MN Uniform Practitioner Change Form PCA . 0qPWp:dW5 ;6V]BpJ#@DE"?Fo=+57]>>=@^{"p5yM~'A}t`)6ts(T^ `p]~@5zPn/VO=RB;#Gkj@!bg~7s}f Provider Change Request. HS]O0}_qd_TILXv]@O.K{=p> X1R)MD*u 7p\y D2a\&bh1hq{.uNj`)9T@*pU&T!Bz $2ToWIGtfN.[4y7n1MDP0j=g*E^ X2SYJsOJ=I!J]D]KRihmOS-f&nR#wa{:f$f? Please complete the entire form and allow 14 calendar days for decision. FDR Attestation Refer to these statutes for additional details of these provisions. Minnesota Rules 9505.2160 to 9505.2245 Surveillance and Integrity Review Program 177 0 obj <>/Filter/FlateDecode/ID[<63DF40A7DB4F1E41940627D0A3C8D7BD>]/Index[156 36]/Info 155 0 R/Length 105/Prev 166954/Root 157 0 R/Size 192/Type/XRef/W[1 3 1]>>stream Access to a recipient's health service records shall be for the purposes in Minnesota Rules 9505.2200, subp. Subp. Online Provider Claim Reconsideration Form Minnesota Rules 9505.2197 Vendors Responsibility for Electronic Records Transplant Notification Form 181 0 obj <>/Encrypt 99 0 R/Filter/FlateDecode/ID[<973475DCD01E27468E832F0EBF960599><8141ECAA30294243A46EC116901FC5AF>]/Index[98 252]/Info 97 0 R/Length 200/Prev 547887/Root 100 0 R/Size 350/Type/XRef/W[1 3 1]>>stream Factor: An individual or organization that advances money to a provider for their accounts receivable for an added fee or a deduction of the accounts receivable worth. Initial Credentialing Application MHCP participation remains in effect until any of the following occur: A provider who fails to comply with the terms of participation in the provider agreement or with requirements of the rules governing MHCP is subject to monetary recovery, Minnesota Rules, part 9505 program sanctions, or civil or criminal action. Prior Authorization Form for Early Intensive Developmental & Behavioral Intervention (EIDBI) Form DHS-3535A-ENG Organization - Mhcp Provider Profile Change Form - Minnesota, Form DHS-5259-ENG Disclosure of Ownership and Control Interest of an Entity - Minnesota, Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Form DHS-2128-ENG Renewal for People Receiving Long-Term Care Services - Minnesota, Form DHS-4266-ENG Interstate Compact on the Placement of Children Request - Minnesota, Form DHS-0188-ENG Post-placement Assessment and Report to Court - Minnesota, Form DHS-2834-ENG Pre-northstar Care for Children Difficulty of Care Assessment - Minnesota, Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service/Item - Minnesota, Form DHS-6532-ENG CDCs Community Support Plan - Rule 185 Compliant - Minnesota, Form DHS-4074A-ENG Personal Care Assistance (Pca) Technical Change Request - Minnesota. endstream endobj 99 0 obj <>>>/Filter/Standard/Length 128/O([4M\\8l\){La)/P -1036/R 4/StmF/StdCF/StrF/StdCF/U(Y6[;i~ )/V 4>> endobj 100 0 obj <>/Metadata 29 0 R/OCProperties<>/OCGs[183 0 R 184 0 R 185 0 R 186 0 R 187 0 R 188 0 R 189 0 R 190 0 R 191 0 R 192 0 R 193 0 R 194 0 R 195 0 R 196 0 R 197 0 R 198 0 R 199 0 R]>>/Outlines 57 0 R/Pages 96 0 R/StructTreeRoot 77 0 R/Type/Catalog/ViewerPreferences<>>> endobj 101 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/Tabs/W/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 102 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Most of the services are funded under one of Minnesota's Medicaid waiver programs. NovusMED User- Add, Remove, Change Title XVIII, section 1877(b) of the Social Security Act Beginning on August 1, 2018, the provider may have to call the Office of Medical Assistance Programs, Provider Enrollment at 1-800-537-8862 to request a paper application if the PDF version of the application is no longer posted on the DHS Provider Enrollment website. General Prior Authorization Request Form Many application forms are published in languages other than English and can be found through eDocs. Inpatient hospitals, nursing facilities, providers of home health and personal care services, hospice programs and managed care plans must maintain written policies and procedures as well as the following: Providers are encouraged to work with associations and advocacy groups to further educate the community on these issues. UCare Contract Intake Form MCHP may stop or withhold payments effective the date the sale or transfer takes place if the new entitys enrollment is not complete. NOMNC Valid Delivery Documentation Form 1), Payment agreements between nursing homes and providers of ancillary medical care: A nursing home is not eligible to receive MA payments unless it refrains from requiring any vendor of medical care who is reimbursed by MA under a separate fee schedule, to pay any portion of the provider's fee to the nursing home. Minnesota Rules 9505.0195, subp. Investigative Costs: Investigative costs are subject to the provisions of Minnesota Statutes 256B.064, subd. 0 Universal Health Plan/Home Health Agency Prior Authorization Request Form, Mental Health and Substance Use Disorder Services endstream endobj 297 0 obj <>stream endstream endobj 299 0 obj <>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 300 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream All requests sent to the SASD Support Team using DHS-3754 must include a contact name, email address, phone number, lead agency name, title, subject, description of the issue and Person Master Index (PMI) number. )SI{ 0BO|cEs}Oq""TV}c`u-hSwi8J", See the Enrollment with MHCP section for details about enrolling for each provider type. 0 Minnesota Uniform Form for Prescription Drug Prior Authorization (PA) Requests and Formulary Exceptions MHCP providers are also mandated by law to report suspected maltreatment, abuse or neglect of children. This page provides quick links for providers looking for information, including how to enroll with MHCP and what services are covered. The following are some commonly used forms for providers who work with UCare. Vendor: The meaning given to "vendor of medical care" in Minnesota Statute 256B.02, subd. DHS retains the right to pursue monetary recovery, or civil or criminal action against the seller or transferor. 416 0 obj <>stream Requirements for Providers. BG[uA;{JFj_.zjqu)Q Renewing MA eligibility. Effective April 4, 2022, when a member is approved through a Provider Change Request, the eligibility start date with the new provider is the . What Is Form DHS-3535-ENG? DD Screening Document Codebook Minnesota Statutes 256B.064 Sanctions; Monetary Recovery A vendor shall grant DHS access during the vendor's regular business hours to examine health service and financial records related to a health service billed to a program. hbbd```b``"H&;f &g/@$X!0 6lr(t sA. Minnesota Statutes 62D.04, subd. PCA UMPI Term Form There is currently a shortage of EIDBI providers, which might delay or prevent people's ability to access and receive EIDBI services. MN Uniform Facility Credentialing Application Third Party Payer: The term defined in Minnesota Rules 9505.0015, subp. endstream endobj 1119 0 obj <>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 1120 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Health Service Records: In addition to those listed here, there may be other record obligations located throughout this manual specific to vendors of a particular service. TemplateRoller.com will not be liable for loss or damage of any kind incurred as a result of using the information provided on the site. This website or its third-party tools use cookies, which are necessary to its functioning and required to achieve the purposes illustrated in the cookie policy. When that is not possible, the SASD Support Team will gather the information, research the issue and respond with an answer as soon as possible. If a new owner agrees to keep the NPI established for an entity (provider), as of the effective date of the sale or transfer of the provider the following apply: Advance notification to MHCP Provider Enrollment is critical for providers of home care and waivered services due to the impact of a provider number change on service agreements through which they bill. Documentation: Health service records must be developed and maintained as a condition of payment by MHCP. Statute references (with links to the Revisor's website) occur throughout this application (e.g., 144A.472). Records must contain the following information when applicable: These vendors must follow additional requirements in their health service records: Pharmacy service record must comply with Minnesota Rules relating to pharmacy licensing and operations and electronic data processing of pharmacy records. This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. Minnesota Statutes 145C Health Care Directives Out-of-state providers must comply with all terms of this section and follow laws of the state in which the provider is located. An US federal government form is a file that is filled out to demand or supply information from the United States Government. 1194 0 obj <>/Filter/FlateDecode/ID[<548F396191910F45BC1DEA5275CB9D4C>]/Index[1114 138]/Info 1113 0 R/Length 149/Prev 834614/Root 1115 0 R/Size 1252/Type/XRef/W[1 3 1]>>stream 10 states in part: "A provider shall not place restrictions or criteria on the services it will make available, the type of health conditions it will accept, or the persons it will accept for care or treatment, unless the provider applies those restrictions or criteria to all individuals seeking the provider's services. The intent of an advance directive is to enhance a patient's control over medical treatment decisions. DHS-4074A-ENG 3-17 MINNESOTA HEALTH CARE PROGRAMS (MHCP) Personal Care Assistance (PCA) Technical Change Request Complete and fax this form to 651-431-7447 to request a technical change to an existing approved PCA service authorization (SA) for your agency. Under Minnesota law all enrolled providers are required to report all suspected maltreatment including abuse, neglect or financial exploitation of a vulnerable adult to the common entry point following the requirements in Minnesota Statutes 626.557, subd. Provider Notification/Change/Update/Termination Third-Party Agreement, UCare Continuity of Care Document "CYhpEObbG`aH??iQSj*{rfLbEdv va[?UZ.Nna!gI\ ,X]5 Use this form to notify MDH. Abuse: In the case of a vendor, a pattern of practice inconsistent with sound fiscal, business, or health service practices, and that results in unnecessary costs to MHCP or in reimbursement for services not medically necessary, or that fail to meet professionally recognized standards for health services. Substance Use Disorder Treatment Outpatient, Pharmacy F"' f?#Dqc"f!b\ 1H6"=|3y^\0i^MA%t4]wGvnjjXgnrY_jupx9_vww7O%zLNi;n=m#nqlvn>;ZiYwvJ{xJt36@ U 4kXf MinnesotaCare is funded by a state tax on Minnesota hospitals and health care providers, Basic Health Program funding and enrollee premiums and cost sharing. HQK0+.y+B")RaO m!n[d]{1|9s}Z2t6BIe)U$}C`u! (DHS) Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) . 0qPWp:dW5 ;6V]BpJ#@DE"?Fo=+57]>>=@^{"p5yM~'A}t`)6ts(T^ `p]~@5zPn/VO=RB;#Gkj@!bg~7s}f hZnGF"@^A3]9141sXoB56eg|l-5BM!dh"@5O[ >{t[tnCK&~h[Zd$cl 0k h| %d"@$4HOirh2-@B h&f@sSBs2904hfb<4MmF8`r)A BSBf[h0K 4S0EAs`HF[#=jK=&Z#0@Zu-fDdg?QH(S+lx2@-N Minnesota Statutes 256B.0655 Authorization and Review of Home Care Services Change or update your facility profile(tax ID, legal name, ownership, address, phone, NPI) Health Ride Provider Profile Form They are customizable, allowing users to make modifications to the text, colors, and layout, and they can be saved and reused for future use. MHCP funds paid for health care not documented in the health service record are subject to monetary recovery. W-9, Manage Your Information - Add/Change/Term UCare Individual & Family Plans Prescribing Privileges for PCP Partners DSD MMIS Reference Guide Minnesota Rules 9505.0225 Request to Recipient to Pay Care Management Referral Form - Word endstream endobj 1118 0 obj <>stream Financial records, including written and electronically stored data, of a vendor who receives payment for a recipient's services under MHCP must contain: Subpart 1. 42 CFR 431.107 Required provider agreement As of today, no separate filing guidelines for the form are provided by the issuing department. Pre-Determination Request Form 349 0 obj <>stream Department access to records. The following are some commonly used forms for providers who work with UCare. Referrals are made both to the Medicaid Fraud Control Unit (MFCU), and to the civil section of the AG's office. Federal anti-fraud and abuse provisions prohibit certain types of business transactions or arrangements. Subp. Designated providers are required to complete the Designated Provider section of DHS-3161 and fax the completed form to the county indicated on the form. Lead agencies must manually route to the OVR LOC 580 queue whenever the automatic routing fails. DHS Household CountyLink Get Manuals Home Bulletins . Minnesota Statutes 609.52, subd. %%EOF Minnesota Rules 9505.0195 Provider Participation St. Paul, MN 55164-0987 Add a facility or location 'u s1 ^ Durable Medical Equipment/Supply Prior Authorization Form Yes No Birth Notification Form for Prepaid Medical Assistance Plan and MinnesotaCare member 1114 0 obj <> endobj 4+t?1zxn nmZn5&xUAX5N(;a,r}=YUUA?z r[ $ If the enrollee does not respond with a health plan choice or a request to opt out, they will be defaulted into a plan. Record retention in contested cases. In conclusion, printable templates offer a quick and easy solution for producing high-quality documents and forms. If you have Medical Assistance (MA) or MinnesotaCare, the Department of Human Services (DHS) must review your eligibility once a year to see whether you are still eligible. Minnesota Statutes 256B.27 MA; Cost Reports Fraud: Acts which constitute a crime against any program, or attempts or conspiracies to commit those crimes including the following: Health Plan: A managed care organization that contracts with DHS to provide health services to recipients under a prepaid contract. Service authorization and billing 'u s1 ^ j7v@i\yU-hB{n/x"ji7v2[Xf*Z&l>n+x^_?Fa.&& 3, in the fourth and fifth years after the date of billing. Program overviews. A vendor who withdraws or is terminated from a program must retain or make available to DHS on demand the health service and financial records as required under subpart 1. 4. These templates can be used for a variety of purposes, such as creating invoices, resumes, business cards, and more. Minnesota Rules 9505.0140 Payment for Access to Medically Necessary Services Provider Directory & Subdirectory Questionnaire Form Details: Released on January 1, 2012; Lead agencies must allow all PCA/CFSS services agreements with edits that require DHS-level review to route to DHS for processing. Title XI, section 1128(b) (formerly Title XIX, section 1909) of the Social Security Act CBSM MMIS exception codes (formerly called MMIS edits) The Department of Revenue establishes the rate under Minnesota Statute 270.75. ? mF* N The Change Report Form for the Supplemental Nutrition Assistance Program (DHS-2402B) (PDF) may only be given to Change Reporting units for SNAP. endstream endobj 105 0 obj <>/Subtype/Form/Type/XObject>>stream PCA UMPI Change Form Housing Stabilization Services is a Minnesota Medical Assistance benefit to help people with disabilities, including mental illness and substance use disorder, and seniors find and keep housing. Last Updated: 10/26/2022 Was this page helpful? We would like to show you a description here but the site won't allow us. Note: As of November 2022, the SASD Support Team is the new name for the DSD Resource Center. Minnesota Rules 9505.2160 to 9505.2245 (enacted June 10, 1991; amended March 18, 1995) establish a program of surveillance, integrity, review and control. All information is provided in good faith, however, we make no representation or warranty of any kind regarding its accuracy, validity, reliability, or completeness. They are typically utilized for things like requesting passports, visas, or social security numbers. %PDF-1.7 % Restricted Recipient Program Intake Form If you want to know more or withdraw your consent to all or some of the cookies, please refer to the cookie policy. . Other forms for Pharmacy are available based by product, please see thespecific pharmacy pagefor the exact forms. According to federal law, the following providers must give written information on state laws regarding the patient's right to make decisions and the provider's policies concerning implementation of those rights at the following times: If a patient is incapacitated at one of the above times, and if the provider issues materials about policies and procedures to families, surrogates, or other concerned persons, the provider must include in those materials the information about advance directives. Additional forms, information and instruction may be found on the individual pages related to relevant topics. DHS 4159 (CTSS) Children's Therapeutic Services and Supports Authorization Form-Posted 2.23.23. .D"NlI0kb`%*@Hnf`bd|r(A0@ '" HS]O0}_qd_TILXv]@O.K{=p> X1R)MD*u 7p\y D2a\&bh1hq{.uNj`)9T@*pU&T!Bz $2ToWIGtfN.[4y7n1MDP0j=g*E^ X2SYJsOJ=I!J]D]KRihmOS-f&nR#wa{:f$f? MNITS MNITS is the DHS billing system for providers enrolled in Minnesota Health Care Programs (MHCP). Minnesota Health Care Programs (MHCP) MA Home Care Technical Change Request Complete and fax this form to 6514317447 to request a technical change to an existing approved home care (nonPCA) service authorization for your agency. Information about the monitoring of recipient use of health services is found in Health Care Programs and Services. Review the Housing Stabilization Services Enrollment Criteria and Forms section of the DHS Provider Manual for enrollment criteria and instructions on how to enroll with DHS. %PDF-1.7 % Whether for personal or business use, they provide a cost-effective and convenient option for those who need to create and print multiple copies of similar documents. Paper applications will continue to be accepted for processing. Health Connect 360 Referral Form Commonly used application forms and application information for human services programs are listed below. CountyLink Other manuals Complex Case Management Referral Form - PDF Minnesota Provider Screening and Enrollment Manual (MPSE), Certified Community Behavioral Health Clinic (CCBHC), Community Emergency Medical Technician (CEMT) Services, Allied Oral Health Professional (Overview), Early Intensive Developmental and Behavioral Intervention (EIDBI), Inpatient Hospitalization for Detoxification Guidelines, Lab/Pathology, Radiology & Diagnostic Services, Adult and Children's Crisis Response Services, Adult Residential Crisis Stabilization Services (RCS), Health Behavioral Assessment/Intervention, Physician Consultation, Evaluation and Management, Psychiatric Consultations to Primary Care Providers, Psychiatric Residential Treatment Facility (PRTF), Telehealth Delivery of Mental Health Services, Moving Home Minnesota (MHM) Provider Enrollment, Officer-Involved Community-Based Care Coordination Services, Breast and Cervical Cancer (BRCA) Genetic Testing and Presumptive Elegibility Services, Screening, Brief Intervention, and Referral to Treatment (SBIRT), Telehealth Delivery of Substance Use Disorder Services, Access Services Ancillary to Transportation, Local County or Tribal Agency NEMT Services, Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information, State-Administered Transportation Procedure Codes, Modifiers and Payment Rates, Tribal and Federal Indian Health Services. chuck schumer office staff, should i live in chicago or new york quiz,
