Minnesota’s Medicaid provider revalidation process, designed to prevent fraud and abuse, has left scores of legitimate health care providers facing billing suspension and organizational uncertainty due to missed deadlines and inconsistent implementation.
What Revalidation Required
The revalidation process, with a May 31 deadline, involved more than 5,000 Minnesota organizations in 13 categories considered at high-risk for Medicaid fraud, waste and abuse. The Minnesota Department of Human Services conducted on-site visits to verify compliance. On Monday, June 1, a coalition of providers reported that those whose revalidation paperwork remained in “pending” status had their Medicaid billing access terminated.
Provider Struggles
MAC Midwest, operating 18 autism care centers, had mixed results from the process. Eight of its locations were approved, including its Rochester center, but 10 others “failed their site visits” for reasons including late applications and lack of required documentation. However, the clinic missed a visit at its Mankato location entirely. MAC Midwest’s chief compliance officer noted the state did not give grace for errors, including when DHS misread documents or failed to complete scheduled visits, straining provider-agency relationships.
Similarly, Rochester Center for Children, another early intensive developmental and behavioral intervention provider, was “experiencing real difficulty with the process” and awaited the state agency’s answers to its questions. The revalidation process also coincided with a May 31 deadline for new state licensure requirements for EIDBI services, though that process proceeded more smoothly.
Appeal Process and Cash Flow Concerns
Providers appealed DHS terminations while continuing to bill for services. MAC Midwest expressed concern about cash flow if appeals dragged on, noting that “the revenue from eight centers can’t balance our entire organization.” The Association of Residential Resources in Minnesota stated that providers had “spent months attempting to comply with a process plagued by confusion, inconsistent communication, repeated requests for information and an inability to get answers from DHS.”
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.inforum.com/health/state-medicaid-revalidation-process-leaves-some-providers-in-limbo