Earlier today it was announced that Governor Walz has ordered a third-party audit of billing for 14 high-risk Medicaid services. Payments for these programs will be paused for up to 90 days while the audits take place. PCA/CFSS is included in the list of 14 service types. The full new release can be found here: https://mn.gov/governor/newsroom/press-releases/?id=1055-711001.  As of now this press release is the only official information we have on this development, I suspect more information will come.

The following email was subsequently sent out by DHS. We will be sending an email to all members by tomorrow morning. I am hoping to get some additional information from DHS leadership before we sent that out. Stay tuned!

Kind Regards,

Kathy Messerli
Executive Director
Minnesota Home Care Association

2909 S. Wayzata Blvd. | Minneapolis, MN 55405
Direct: 651.635.0038 | Main: 651.635.0607
www.mnhomecare.org<http://www.mnhomecare.org/page/A17> | kmesserli@mnhomecare.org<mailto:kmesserli@mnhomecare.org>
[cid:image002.jpg@01DC48F3.18DBC0E0]<https://www.mnhomecare.org/general/custom.asp?page=Committees>

From: Simons, Anni <asimons@fredgov.com>
Sent: Wednesday, October 29, 2025 3:48 PM
To: Kathy Messerli <kmesserli@mnhomecare.org>
Cc: Goodno, Kevin <KGoodno@fredlaw.com>
Subject: FW: Governor Walz announces new claims prepayment review process

Kathy:

Below is further information that DHS just shared out about the new process/payment pause. Press conference still has not gone live...

Anni Simons (she/her/hers)
Senior Government Relations Specialist
asimons@fredgov.com<mailto:simons@fredgov.com>

Fredrikson Government Relations, LLC  /  525 Park Street  /  Suite 350  /  St. Paul MN 55103-2111
main 612-492-7700<votel://+16124927000/>  direct 612-492-7516<votel://+16124927000/>   web fredgov.com<https://www.fredlaw.com/>
[cid:image001.jpg@01DC48EB.589CAE90]
This is a transmission from Fredrikson Government Relations, LLC.  The information contained in this e-mail and any attachments are confidential or otherwise protected from disclosure and is for the intended use of the designated recipients. The use, distribution, or re-transmittal by an unintended recipient is strictly prohibited. If you have received this communication in error, please delete this material without copying it and immediately notify us immediately at our telephone number at 612-492-7700. The name and biographical data provided above are for informational purposes only and are not intended to be a signature or other indication of an intent by the sender to authenticate the contents of this electronic message.

From: Minnesota Department of Human Services <dhs.mhcp.providerrelations@public.govdelivery.com<mailto:dhs.mhcp.providerrelations@public.govdelivery.com>>
Sent: Wednesday, October 29, 2025 3:17 PM
To: Simons, Anni <asimons@fredgov.com<mailto:asimons@fredgov.com>>
Subject: Governor Walz announces new claims prepayment review process

CAUTION: EXTERNAL E-MAIL

________________________________

[Minnesota Department of Human Services logo]<https://links-1.govdelivery.com/CL0/http:%2F%2Fmn.gov%2Fdhs%2F/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/nyoeizV3z1184S8Cg7LxOh8JpmsX5QnPBioyvhQBHRg=429>
Minnesota Health Care Programs (MHCP)
MHCP Providers

Oct. 29, 2025

Governor Walz announces new claims prepayment review process

In a coordinated effort to reduce fraud, waste and abuse in Minnesota's Medicaid program, Governor Tim Walz announced on Oct. 29 a new process for Minnesota Department of Human Services (DHS) to review claims for certain Medicaid benefits and services before they are paid. Read the news release on the governor's office Press Releases<https://links-1.govdelivery.com/CL0/https:%2F%2Fmn.gov%2Fgovernor%2Fnewsroom%2Fpress-releases%2F%23%2Fdetail%2FappId%2F1%2Fid%2F711001/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/HiyzAYyCVqoHCf_52JpH4ggxu-c_amSjsLGYlBi76cE=429> webpage

This new "prepayment review" process will be overseen by a third-party vendor, Optum. For 14 specific services that have been identified as high risk, Optum will verify that billed services were necessary, correctly documented and provided before DHS makes payments.

Minnesota Health Care Programs has 30 days to pay or deny clean claims (without attachments), and 90 days to pay or deny complex claims (replacement claims, Medicare crossovers, third-party liability claims, claims with information in the notes or comment fields, or claims with attachments). The DHS Commissioner has the legislative authority to suspend and perform a deeper analysis on any claims which may be potentially suspect with regard to fraud, waste or abuse. There may be payment processing delays as we roll out this new prepayment review process. We are working with Optum on a regular interval to review any suspended claims for these 14 Medicaid services and will continue to adjudicate claims timely and efficiently without compromising needed review. DHS is not holding all submitted claims for these 14 Medicaid services for 90 days. Some submitted claims could be suspended for up to 90 days and, of course, some of these claims may be denied.

DHS recognizes that payment delays have impacts on providers, and we are committed to processing claims as quickly as possible and within the mandated timelines. We appreciate your patience as we initiate and refine our new prepayment review process. Please continue to provide services to MHCP members and submit your claims as you normally would. We are implementing this new process for fee-for-service claims only.

Prepayment review will be an ongoing and permanent new business process for DHS as fee-for-service claims come in and before provider payments go out. Importantly, this new safeguard will be tied to services, not provider types.

For reference, here are the 14 high-risk benefits and services with a link to their Provider Manual sections:

  1.  Adult Companion Services<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=ID_002442/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/OuMASv2D4bxhLJ0r3rgiCKte5J5wTq42SfvUWA4zK5U=429>
  2.  Adult Day Treatment<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=id_058152/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/3CiG8LzFuxO3p0T6F6TAmsJMQO3WHgj_N4JI2TQSec8=429>
  3.  Adult Rehabilitative Mental Health Services<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=id_058153/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/9rNT73DeEtfPEX6NMXrBTHL9gWlpJHkxcvS5Th5vA4o=429>
  4.  Assertive Community Treatment<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=ID_058151/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/8pHE4tktJTmT8c03uwsZzuOdVK4XOSel5l0MP5tUNRw=429>
  5.  Community First Services and Supports<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=mndhs-067912/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/tweK3lAk2Cp7kNDM5PggUsHuB1XCoXz7qZSkfH44uZc=429>
  6.  Early Intensive Developmental and Behavioral Intervention<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=dhs16_195658/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/m2UUBezjA2hXYEt6vfI_UGbLyrVM8VGg1_WeaAjucVw=429>
  7.  Housing Stabilization Services<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=dhs-316637/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/LNe3F5XmSXdw7y-BU86Az2eN-eVOhyr4ykDwQaHPQmM=429>
  8.  Individualized Home Supports<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=dhs-327070/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/zF2oFrjXEtkM-BL9PCk5bq6-4q_kKwz4yT92i83LwGs=429>
  9.  Integrated Community Supports<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=DHS-327069/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/qNVxnERUtbK79VIQFVOAERSLE1XJbooVUxt0rn7o7bU=429>
  10. Intensive Residential Treatment Services<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=id_058155/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/mSpkiHG8HjHb93x3iO9k8psN99FLgewXEDpzhMQV8N8=429>
  11. Night Supervision Services<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=ID_002446/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/LGVn9C5N_aJCDlYP647CWYU10PBMzpdBzb2sntEuU3M=429>
  12. Nonemergency Medical Transportation Services<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=mndhs-067228/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/YQdjCPoMrownR3-6Jcjsw3qOsu0_Ja7ZdbGF9koHNu0=429>
  13. Recovery Peer Support<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=id_008949%23CS/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/-bx-giynacVdtsI0MdjzvhSIf2fsPbHWmZgeOxn5tn4=429>
  14. Recuperative Care<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.dhs.state.mn.us%2Fmain%2Fidcplg%3FIdcService=GET_DYNAMIC_CONVERSION%26RevisionSelectionMethod=LatestReleased%26dDocName=mndhs-064912/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/QYFUTZBMqxjZBzA1shQF_cpuA8sWctBQR6lf2j7hiVM=429>

Continue to submit claims for these services based on information outlined in our MHCP Provider Manual and Community-Based Services Manual. If you have questions, contact the Provider Resource Center<https://links-1.govdelivery.com/CL0/https:%2F%2Fmn.gov%2Fdhs%2Fpartners-and-providers%2Fcontact-us%2Fminnesota-health-care-programs%2Fproviders%2F/1/0100019a319dba3b-10ac9cc1-327c-4d60-b586-74b93255064f-000000/99Pmc3tWStdad64vM_rmQeHM_OpIT3HhfsMcARsR00k=429>.

________________________________

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