61% of high-risk Minnesota Medicaid providers face disenrollment amid $2B threat

 In Minnesota’s review of 5,583 “high-risk” Medicaid providers, 2,061 were revalidated, but 3,411 were notified of their disenrollment.

A state report confirmed Minnesota completed its revalidation by May 31. The review removed 111 providers who were no longer offering high-risk services, and it referred 59 to the state’s Department of Human Services Office of Inspector General.

Of the 3,411 notified about disenrollment, 2,491 had incomplete or inaccurate administrative data, 916 failed verification during site visits and four did not pass an owner background check.

The state’s review spanned five months. The rest of the country has two years to submit a provider revalidation strategy after the federal government called for broader audits. Minnesota providers had to submit ownership disclosures, location and contact information, licenses, and proof of qualified service providers. The review also included on-site visits and fingerprint background checks for owners.

Common issues included failures to disclose management, maintain credentials and grant access. Incomplete applications also contributed to disenrollment notices. The state said it tried contacting individual providers multiple times, in writing and over the phone.

“The paperwork is a critical step,” DHS Deputy Commissioner Shireen Gandhi said in a June 4 news release. “This is just not checking the box. DHS uses the information to check requirements are met. And when we go on site what we see must match what was submitted to us.”

Providers have 60 days to appeal their revalidation decision, and the state is offering support to Medicaid beneficiaries needing a new provider.

At the beginning of the year, CMS directed Minnesota to pause provider enrollment across 13 service categories. The agency also froze nearly $260 million in Medicaid funding — and was met with a lawsuit by the state — and planned to withhold up to $2 billion annually.

https://www.beckershospitalreview.com/finance/61-of-high-risk-minnesota-medicaid-providers-face-disenrollment-amid-2b-threat-to-program/