As the state continues to battle both substantiated and alleged claims of Medicaid fraud, DHS has announced a freeze on new provider enrollments in 13 categories of Medicaid-funded services as part of efforts to strengthen program integrity and address Medicaid fraud.

This enrollment freeze comes on the heels of a prior decision to subject some claims to further review by Optum before processing payments to providers.

High Risk for Fraud

The 13 categories deemed high risk for fraud in this action are: adult companion services, adult day services, adult rehabilitative mental health services, assertive community treatment, community first services and supports, early intensive developmental and behavioral intervention, individualized home supports, integrated community supports, intensive residential treatment services, night supervision services, nonemergency medical transportation services, peer recovery support services and recuperative care.

Provider enrollment is the process for providers and billing organizations doing business with Minnesota Health Care Programs (MHCP) to receive payment for services provided to MHCP members. For LeadingAge Minnesota members, this freeze primarily affects Adult Day Services Providers.

Providers currently in the enrollment pipeline awaiting approval will be affected as well as those who may be awaiting approval of a new license.

Providers Awaiting Approval

For providers awaiting approval, the effective date will be critical, as it will determine whether waiver-funded services may begin before the freeze takes effect or must be delayed until it is lifted. LeadingAge Minnesota recognizes the operational and financial uncertainty this creates. DHS has not yet issued guidance on how pending applications will be handled. LeadingAge Minnesota is monitoring the situation and seeking clarification on next steps.

Currently Licensed Providers

In addition, all currently licensed providers in the 13 designated programs will be subject to revalidation of their enrollment as a MHCP provider. Normally, revalidation is planned to occur every five years and is required to maintain program eligibility. DHS has not yet released timelines or procedural details for the upcoming revalidation cycle, though it is anticipated that an accelerated timeline will be applied for the programs identified. LeadingAge Minnesota will communicate requirements, deadlines, and resources once formal guidance is issued.

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

Next Steps

Providers are encouraged to watch for further communications and prepare for revalidation by ensuring licensing, ownership, compliance, and enrollment information is accurate and up to date.

Did you know DHS has a new weekly newsletter for MHCP providers? To sign up for MHCP news, updates and reminders, click here.

What This Means for Providers

• Providers with pending enrollment applications may experience delays in approval and Medicaid billing until the freeze is lifted or DHS provides further direction.
• Adult Day Services providers awaiting licensure should closely monitor communications regarding application status, as the license effective date may determine whether waivered services can begin prior to the freeze.
• All currently enrolled providers should plan to complete revalidation when required and begin preparing now by reviewing ownership, licensing, compliance, and enrollment information for accuracy. Watch your MN-ITS Mailbox for communications from DHS.
• Operational and financial planning may need to account for potential delays in service start dates, reimbursement, or expansion plans tied to Medicaid-funded services.

LeadingAge Minnesota will continue to advocate for clarity on behalf of members and will share timely updates as DHS releases additional guidance.