What types of policy changes does Minnesota Medicaid (MHCP) issue?

Minnesota Medicaid (MHCP) regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Minnesota Medicaid (MHCP) update its policies?

Minnesota Medicaid (MHCP) typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Minnesota Medicaid (MHCP) policy changes are tracked here?

This page currently tracks 36 documented Minnesota Medicaid (MHCP) policy changes. New items are added as they are identified.

What should I do when Minnesota Medicaid (MHCP) changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Minnesota Medicaid (MHCP) Policy Changes & Prior Auth Updates

We track 36 documented policy changes from Minnesota Medicaid (MHCP) across MN. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Minnesota Medicaid (MHCP) notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Minnesota Medicaid (MHCP) updates automatically.

High impact
Changes to Substance Use Disorder (SUD) treatment services
Minnesota Medicaid (MHCP)·Effective Jul 1, 2026
Minnesota is implementing legislative changes to Substance Use Disorder (SUD) treatment services effective July 1, 2026. These changes include new service type descriptions, new billing codes, and new billing procedures for outpatient SUD providers. The changes are pending federal approval and require preparation time before implementation.
High impact
Provider signature requirements for HCBS members support plans
Minnesota Medicaid (MHCP)·Effective Aug 1, 2026
Minnesota DHS updated HCBS support plan signature requirements effective August 1, 2026, clarifying that all providers serving HCBS waiver members, Alternative Care (AC), and Essential Community Supports (ECS) members must sign and retain current copies of support plans. Failure to comply may result in claims nonpayment or payment takebacks.
Medium impact
Online payment processing fees effective July 1
Minnesota Medicaid (MHCP)·Effective Jul 1, 2026
Effective July 1, 2026, Minnesota Health Care Programs will charge processing fees for online payments: 2.15% for credit/debit card payments and a flat $1.00 fee per ACH transaction. Billing teams must communicate these fees to patients and update payment processing systems to transparently display fees before payment confirmation.
Medium impact
Adaptive transportation services policy updates effective July 1, 2026
Minnesota Medicaid (MHCP)·Effective Jul 1, 2026
Minnesota Department of Human Services renamed 'Special transportation' to 'Adaptive transportation services' effective July 1, 2026, with new requirements that the child's IEP/IFSP must document the need for adaptive transportation. CMS no longer recognizes aides or Personal Care Assistants (PCAs) as vehicle adaptations, requiring removal of this from eligible provider documentation. Billing teams must update systems, forms, and documentation requirements to reflect these changes.
Medium impact
Upcoming changes to Behavioral Health Fund application processing will benefit potential patients, place less burden on county and tribal staff
Minnesota Medicaid (MHCP)·Effective Jul 1, 2026
Effective July 1, 2026, the Minnesota Department of Human Services will assume responsibility for determining Behavioral Health Fund (BHF) eligibility from local counties and tribes. This change creates a single, statewide eligibility processing system, reducing variation in rules and access across jurisdictions. Billing teams should prepare for potential changes in how BHF eligibility is verified and documented.
Medium impact
New authorization requirements for manual irrigation systems and rectal catheters effective July 1
Minnesota Medicaid (MHCP)·Effective Jul 1, 2026
Effective July 1, 2026, Minnesota Health Care Programs (MHCP) is reducing prior authorization requirements for manual transanal irrigation systems (A4459) and rectal catheters (A4453). Prior auth is now required only for quantities exceeding coverage limits: one manual system per dispensing (up to 4 per year) and up to 31 rectal catheters per month. Electronic transanal irrigation systems (A4479) continue to require authorization always with specific clinical documentation.
Medium impact
Directed pharmacy dispensing payment update
Minnesota Medicaid (MHCP)·Effective Aug 1, 2026
Minnesota MCOs will provide a new $4.50 per-prescription directed dispensing payment to eligible outpatient pharmacies starting August 2026. Pharmacies must complete and submit the Directed Pharmacy Dispensing Payment Assurance Statement (DHS-8750) by July 24, 2026, to qualify. Eligibility requires MHCP provider enrollment, Minnesota location, independence from pharmacy benefit managers/health carriers, and either location in a medically underserved area OR no more than 13 Minnesota locations.
Medium impact
Single pharmacy benefit manager update
Minnesota Medicaid (MHCP)·Effective Jan 1, 2028
Minnesota Department of Human Services has contracted with Prime Therapeutics as the single pharmacy benefit manager (sPBM) to administer outpatient pharmacy benefits for Minnesota Health Care Programs members in managed care plans, effective January 1, 2028. Billing teams must prepare for a transition in how pharmacy claims are processed and routed for these plans, separate from the existing fee-for-service program.
High impact
CMS Managed Care Plan audit and record requests for EIDBI and peer recovery services providers
Minnesota Medicaid (MHCP)·Effective Jun 12, 2026
The Minnesota Department of Human Services is conducting a CMS Managed Care Plan audit of EIDBI and peer recovery services providers. CoventBridge Group is the authorized vendor requesting medical and administrative records on behalf of CMS. Healthcare practices must comply with all record requests and meet specified deadlines provided by CoventBridge Group.
High impact
Early Intensive Developmental and Behavioral Intervention (EIDBI) claim denials for services billed with CPT code H0046 UB resolved
Minnesota Medicaid (MHCP)·Effective May 20, 2026
Minnesota Health Care Programs (MHCP) has resolved a system issue that incorrectly denied EIDBI claims billed with CPT code H0046 UB for dates of service from Dec. 16, 2025 through Jan. 27, 2026. Affected providers can either allow DHS to reprocess claims automatically or submit manual rebills. Billing teams should identify impacted claims and take action to recover denied revenue.
High impact
Update on H0032 and H0046 reimbursement rates for EIDBI services
Minnesota Medicaid (MHCP)·Effective Apr 29, 2026
Minnesota Health Care Programs (MHCP) corrected an underpayment issue affecting EIDBI service codes H0046 UB (Travel Time) and H0032 UB (Individual Treatment Planning and Progress Monitoring) for claims billed March 25–April 28, 2026. Reimbursement rates are now correct as of April 29, 2026. Providers with impacted claims can request DHS reprocessing or submit replacement claims.
High impact
2026 Mental Health Codes and Maximum Adjusted Fee For Service (FFS) Rate by Date of Rate Change grid published
Minnesota Medicaid (MHCP)·Effective Feb 1, 2026
Minnesota Department of Human Services published updated Mental Health Codes and Maximum Adjusted Fee-for-Service (FFS) rates effective February 1, 2026. Billing teams must review the new rate grid and Page 1 guidance to understand when services qualify for adjusted reimbursement rates, as this supersedes previous mental health rate schedules.
High impact
Jan. 1, 2026, PCA and CFSS reimbursement rates and wage floor retroactive payment requirements
Minnesota Medicaid (MHCP)·Effective Jan 1, 2026
Minnesota DHS has implemented new tiered minimum wage floors for Personal Care Assistance (PCA) and Community First Services and Supports (CFSS) direct support workers, effective Jan. 1, 2026, with retroactive payment requirements. Providers must pay workers the enhanced minimum wages for all hours worked from Jan. 1, 2026 forward, and must make retroactive payments for hours already worked. New wage floor tiers were distributed to PCA Choice and FMS providers on May 28, 2026.
High impact
System issue affecting certain Early Intensive Developmental and Behavioral Intervention (EIDBI) claims resolved
Minnesota Medicaid (MHCP)·Effective Jan 1, 2025
Minnesota Health Care Programs (MHCP) has resolved a system issue that incorrectly denied certain EIDBI claims with an invalid Place of Service 11 edit. Affected claims billed with specific CPT and HCPCS codes with modifier UB for dates of service from January 1, 2025 through May 6, 2026 can now be reprocessed by DHS or resubmitted by providers.
High impact
Potential scam related to revalidation
Minnesota Medicaid (MHCP)·Identified May 22, 2026
The Minnesota Department of Human Services has issued a fraud alert regarding unauthorized phone calls impersonating DHS staff requesting enrollment and private health information under the guise of revalidation. Billing and administrative staff must immediately educate themselves and providers on this scam, verify caller identity through official channels (651-431-2700), and never provide sensitive information over unsolicited calls. Legitimate revalidation requests will be in writing and will not solicit patient/recipient data over the phone.
High impact
Use modifiers with physical therapy (PT) and occupational therapy (OT) authorizations
Minnesota Medicaid (MHCP)·Identified May 5, 2026
Minnesota Health Care Programs (MHCP) now requires specific modifiers on all physical therapy (PT) and occupational therapy (OT) authorizations and claims: modifier GO for OT services, modifier GP for PT services (regardless of whether provided by therapist or assistant), and modifier U7 when an assistant provides services without the supervising therapist on site. Authorization requests and corresponding claims must match exactly, including modifiers, or claims will be denied. For members with third-party liability or Medicare, modifiers KX, CO, and CQ must also be used when appropriate.
Medium impact
Minnesota WIC formula updates for health care providers
Minnesota Medicaid (MHCP)·Effective Jun 16, 2026
The Minnesota WIC (Women, Infants & Children) Program has updated its approved infant formula list for health care providers. Billing teams must consult the updated MDH WIC Formula Updates document (June 2026) and refer to the MDH WIC and Health Care Providers webpage to ensure accurate billing and documentation for WIC-covered formula products.
Medium impact
Reprocessing of incorrectly denied transportation claims
Minnesota Medicaid (MHCP)·Effective Jun 16, 2026
Minnesota Department of Human Services has resolved a system error that was incorrectly denying transportation claims for codes A0170, A0180, and A0190 with dates of service from October 1, 2025 through June 1, 2026. No action is required from providers; the state automatically reprocessed all impacted claims, which will appear on warrants starting June 16, 2026 and be fully completed by June 30, 2026.
Medium impact
Instructions for first-time access of MN–ITS through LoginMN
Minnesota Medicaid (MHCP)·Effective Jun 13, 2026
Minnesota Health Care Programs providers must transition from direct MN–ITS access to accessing the system through LoginMN starting June 13, 2026. Current users must complete email and phone number validation before the migration date and follow new LoginMN access procedures. Do not attempt to use LoginMN for MN–ITS access until after the scheduled move is complete.
Medium impact
LoginMN information for SFTP users
Minnesota Medicaid (MHCP)·Effective Jun 13, 2026
Minnesota's MN-ITS login system transitioned to LoginMN on June 13, 2026. All SFTP users must register with LoginMN, create a new password, and wait 15 minutes before accessing SFTP accounts. The new LoginMN password serves as the password for all SFTP accounts, while SFTP usernames remain unchanged.
Medium impact
Physical therapy (PT) and occupational therapy (OT) visits now displaying in MN–ITS, claims reprocessed
Minnesota Medicaid (MHCP)·Effective Jan 1, 2026
Minnesota Health Care Programs has updated the MN–ITS eligibility system to accurately display PT and OT visit utilization since January 1, 2026, and has reprocessed all PT/OT claims with dates of service from that date forward. Reprocessed claims will appear on the May 19, 2026 remittance advice. A broad CPT code pull during reprocessing may have affected other services (such as Early Intensive Developmental and Behavioral Intervention), but there is no payment impact on non-PT/OT services.
Medium impact
Revisions to the upcoming Substance Use Disorder (SUD) outpatient billing changes
Minnesota Medicaid (MHCP)·Identified Jun 17, 2026
Minnesota Department of Human Services is implementing new 15-minute outpatient Substance Use Disorder (SUD) billing procedure codes effective in 2025, pending federal approval. Billing will use existing revenue codes (0944, 0945, 0953) and current claim formats (837I/837P) with no changes to claim structure or new revenue code requirements.
Medium impact
Cost reporting demo for DWRS and CFSS providers
Minnesota Medicaid (MHCP)·Identified May 27, 2026
The Minnesota Department of Human Services is offering mandatory demonstration webinars for providers selected for Disability Waiver Rates System (DWRS) and Community First Services and Supports (CFSS) cost reporting in 2026. Selected providers must attend one of the scheduled webinar sessions to learn how to complete required cost reporting submissions.
Medium impact
Update: Early Intensive Developmental Behavioral Intervention claim denials for Comprehensive Multi-disciplinary Evaluation (CMDE) services (CPT codes 97151 UB, H0046 UB, T1024 UB)
Minnesota Medicaid (MHCP)·Identified May 26, 2026
Minnesota Health Care Programs (MHCP) has resolved a system issue that was incorrectly denying Comprehensive Multi-disciplinary Evaluation (CMDE) claims for specific CPT codes when billed with pay-to provider types 01 or 34. MHCP will automatically reprocess affected claims; no action is required from providers at this time. Billing teams should monitor remittance advices for reprocessed claims.
Medium impact
Deadline to transition to Community First Services and Supports extended
Minnesota Medicaid (MHCP)·Identified May 22, 2026
Minnesota Department of Human Services extended the deadline for Personal Care Assistance (PCA) and Consumer Support Grant (CSG) members to transition to Community First Services and Supports (CFSS) from the original deadline to September 30, 2027. Billing teams must verify member transition status and ensure proper service coding during the extended transition period. Extended PCA services will no longer be authorized after September 30, 2026.
Medium impact
Obstetric services global billing ends Dec. 31, 2026; providers recommended to bill by component
Minnesota Medicaid (MHCP)·Identified May 8, 2026
Failed to analyze policy change
Medium impact
There is a delay in processing provider enrollment requests
Minnesota Medicaid (MHCP)·Identified Apr 16, 2026
The Minnesota Department of Human Services is experiencing a backlog in processing provider enrollment requests (new enrollments, re-enrollments, and enrollment updates) due to a statewide provider revalidation initiative for high-risk services. Processing times will exceed the standard 30-day timeframe until the revalidation effort is completed by May 31, 2026.
Low impact
Waiver and AC Resources and MN–ITS Training certificates for June 16-17 session sent
Minnesota Medicaid (MHCP)·Effective Jun 23, 2026
The Minnesota Department of Human Services has distributed completion certificates to providers who attended the June 16-17 Waiver and Alternative Care (AC) Resources and MN-ITS Training session. Certificates were sent to providers' MN-ITS mailboxes using the NPI they used for registration and should be accessible by end of business June 23, 2026.
Low impact
Waiver and AC Resources and MN–ITS Training certificates for June session sent
Minnesota Medicaid (MHCP)·Effective Jun 5, 2026
The Minnesota Department of Human Services has distributed certificates of completion to providers who attended the June 2-3, 2026 Waiver and Alternative Care (AC) Resources and MN–ITS Training sessions. Certificates were sent to providers' MN–ITS mailboxes under their registered National Provider Identifier (NPI) and should be accessible by end of business June 5, 2026 in the 'Miscellaneous Received' PRVLTR folder.
Low impact
Waiver and AC Resources and MN–ITS Training certificates for May session sent
Minnesota Medicaid (MHCP)·Effective May 20, 2026
The Minnesota Department of Human Services has distributed certificates of completion to providers who attended Waiver and Alternative Care (AC) Resources and MN–ITS Training sessions in May 2026. Certificates were sent to providers' MN–ITS mailbox under their registered National Provider Identifier (NPI) and should appear in the 'Miscellaneous Received' folder under 'PRVLTR' by end of business May 20, 2026. This is an informational notification with no billing or claims processing impact.
Low impact
Links for Waiver and AC Resources and MN–ITS Training for May 13-14 session sent
Minnesota Medicaid (MHCP)·Effective May 13, 2026
The Minnesota Department of Human Services has distributed invitation links for the May 13-14, 2026 Waiver and Alternative Care (AC) Resources and MN-ITS Training. Registered providers will receive two separate email invitations (one per day) sent to their registration email address on May 12, 2026. Providers must use the correct invitation link for each day to join the training sessions.
Low impact
UPDATE: Continuity of care meeting for lead agencies
Minnesota Medicaid (MHCP)·Identified Jun 24, 2026
The Minnesota Department of Human Services (DHS) is hosting continuity of care meetings with lead agencies to discuss support for patients affected by provider disenrollments, including care transition strategies and provider appeal processes. This is an informational update about meeting participation opportunities rather than a billing policy change.
Low impact
Public feedback needed about Early Intensive Developmental and Behavioral Intervention (EIDBI) licensing standards
Minnesota Medicaid (MHCP)·Identified Jun 16, 2026
The Minnesota Department of Human Services is seeking public feedback to develop comprehensive licensing standards for Early Intensive Developmental and Behavioral Intervention (EIDBI) services. This is a feedback collection period with no immediate billing or coverage changes; however, the resulting standards may impact EIDBI service delivery, billing codes, and provider requirements in Minnesota.
Low impact
Reprocessed Individualized Education Program (IEP) special claims
Minnesota Medicaid (MHCP)·Identified Jun 11, 2026
The Minnesota Department of Human Services has automatically reprocessed Individualized Education Program (IEP) special claims that were previously denied due to system errors. No action is required from school districts or providers; impacted claims have already been reprocessed and payments have appeared on warrants dated May 5, 2026, June 2, 2026, and will appear June 16, 2026, depending on the error code.
Low impact
Midwife workforce survey
Minnesota Medicaid (MHCP)·Identified Jun 3, 2026
The Minnesota Department of Health and Department of Human Services are conducting a voluntary workforce survey for midwives to gather data on practices, barriers, and access to maternity care services. This is a data collection initiative, not a billing or coverage policy change, and does not directly impact medical billing operations or claim processing.
Low impact
Minnesota Department of Human Services Office of the Medicaid Medical Director wants provider feedback
Minnesota Medicaid (MHCP)·Identified May 18, 2026
The Minnesota Department of Human Services is conducting a survey to gather provider feedback on how immigration enforcement activity between December 2025 and February 2026 affected healthcare delivery. Providers are invited to complete an anonymous survey by June 26, 2026. This is informational only and does not change billing, coding, or coverage policies.

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Minnesota Medicaid (MHCP) Policy Changes 2026 | Prior Auth & Coverage Updates | PolicyChanges.app

Changes to Substance Use Disorder (SUD) treatment services

Provider signature requirements for HCBS members support plans

Online payment processing fees effective July 1

Adaptive transportation services policy updates effective July 1, 2026

Upcoming changes to Behavioral Health Fund application processing will benefit potential patients, place less burden on county and tribal staff

New authorization requirements for manual irrigation systems and rectal catheters effective July 1

Directed pharmacy dispensing payment update

Single pharmacy benefit manager update

CMS Managed Care Plan audit and record requests for EIDBI and peer recovery services providers

Early Intensive Developmental and Behavioral Intervention (EIDBI) claim denials for services billed with CPT code H0046 UB resolved

Update on H0032 and H0046 reimbursement rates for EIDBI services

2026 Mental Health Codes and Maximum Adjusted Fee For Service (FFS) Rate by Date of Rate Change grid published

Jan. 1, 2026, PCA and CFSS reimbursement rates and wage floor retroactive payment requirements

System issue affecting certain Early Intensive Developmental and Behavioral Intervention (EIDBI) claims resolved

Potential scam related to revalidation

Use modifiers with physical therapy (PT) and occupational therapy (OT) authorizations

Minnesota WIC formula updates for health care providers

Reprocessing of incorrectly denied transportation claims

Instructions for first-time access of MN–ITS through LoginMN

LoginMN information for SFTP users

Physical therapy (PT) and occupational therapy (OT) visits now displaying in MN–ITS, claims reprocessed

Revisions to the upcoming Substance Use Disorder (SUD) outpatient billing changes

Cost reporting demo for DWRS and CFSS providers

Update: Early Intensive Developmental Behavioral Intervention claim denials for Comprehensive Multi-disciplinary Evaluation (CMDE) services (CPT codes 97151 UB, H0046 UB, T1024 UB)

Deadline to transition to Community First Services and Supports extended

Obstetric services global billing ends Dec. 31, 2026; providers recommended to bill by component

There is a delay in processing provider enrollment requests

Waiver and AC Resources and MN–ITS Training certificates for June 16-17 session sent

Waiver and AC Resources and MN–ITS Training certificates for June session sent

Waiver and AC Resources and MN–ITS Training certificates for May session sent

Links for Waiver and AC Resources and MN–ITS Training for May 13-14 session sent

UPDATE: Continuity of care meeting for lead agencies

Public feedback needed about Early Intensive Developmental and Behavioral Intervention (EIDBI) licensing standards

Reprocessed Individualized Education Program (IEP) special claims

Midwife workforce survey

Minnesota Department of Human Services Office of the Medicaid Medical Director wants provider feedback