Home care billing · MN
Home care billing in Minnesota
Short answer
Home care billing in Minnesota means knowing which payer holds the member and whether the visit reached the aggregator. Elderly Waiver services are covered statewide through the prepaid plans, so MSHO and MSC+ plans pay those claims, while the disability waivers and fee-for-service personal care bill DHS under a 12-month filing rule.
HHAeXchange is the state-provided EVV system and the aggregator for every visit, enforcement began September 1, 2024, and PCA codes moved to CFSS on October 1, 2024. A dedicated Remitwright biller tracks the authorization, the EVV record and the payer for each visit, serving Minnesota agencies remotely. Rules for other states are on the home care billing by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Key facts for Minnesota home care billing
| Fact | In Minnesota | Source |
|---|---|---|
| Programs that pay | Elderly Waiver (0025.R09.00); Community Access for Disability Inclusion Waiver (CADI, 0166.R08.00); Brain Injury Waiver (BI, 4169.R07.00); Community Alternative Care Waiver (CAC, 4128.R08.00); Developmental Disabilities Waiver (DD, 0061.R08.00); Personal care assistance and Community First Services and Supports (Medicaid State Plan) | 1 |
| How it is delivered | Managed care and fee-for-service | 2 |
| EVV | Open vendor model with a state aggregator | 3 |
| Medicare home health and hospice | National Government Services, Jurisdiction 6 | 13 |
Programs that pay for home care in Minnesota1
Elderly Waiver (0025.R09.00)
Homemaker, chore services, respite, adult companion services, adult day service and adult day service bath, adult foster care, customized living services, extended state plan personal care assistance, extended state plan home health care, extended home care nursing, extended community first services and supports, family caregiver services, home delivered meals, individual community living supports, case management, consumer directed community supports (support planning, financial management, personal assistance, individual-directed goods and services, self-direction support, treatment and training, community integration and environmental modifications), environmental accessibility adaptations to the home and vehicle, specialized equipment and supplies, transitional services, transportation and managed care premiums, for people 65 and older who meet a nursing facility level of care.
Covered statewide under the prepaid medical assistance program for everyone eligible under chapter 256S (Minn. Stat. 256B.69, subd. 6b), so MSHO and MSC+ plans pay Elderly Waiver claims. Chapter 256S sets authorization of services and rates (256S.16) and monthly case mix budget caps (256S.18).
Community Access for Disability Inclusion Waiver (CADI, 0166.R08.00)
Homemaker, chore services, respite and crisis respite, adult day service and bath, extended personal care assistance, extended home health care, extended home care nursing, extended community first services and supports, individualized home supports, integrated community supports, customized living, community residential and family residential services, night supervision, 24-hour emergency assistance, caregiver living expenses, case management, consumer-directed community supports, employment development, exploration and support services, prevocational and day support services, family training and counseling, independent living skills therapies, positive support and specialist services, assistive technology, environmental accessibility adaptations to the home and vehicle, specialized equipment and supplies, home delivered meals, transitional services and transportation, for people with physical or other disabilities ages 0 to 64 who meet a nursing facility level of care.
Brain Injury Waiver (BI, 4169.R07.00)
The same home and community supports as CADI, including homemaker, chore, respite and crisis respite, adult day, extended personal care assistance, extended home health care and home care nursing, extended community first services and supports, individualized home supports, integrated community supports, customized living, residential services, night supervision, 24-hour emergency assistance, caregiver living expenses, case management, consumer directed community supports, employment and day services, family training and counseling, independent living skills therapies, positive support and specialist services, assistive technology, environmental accessibility adaptations, specialized equipment and supplies, home-delivered meals, transitional services and transportation, for people with brain injury ages 0 to 64 who meet a hospital or nursing facility level of care.
Community Alternative Care Waiver (CAC, 4128.R08.00)
Homemaker, chore services, respite and crisis respite, adult day service, extended personal care assistance, extended home health care, extended home care nursing, extended community first services and supports, individualized home supports, integrated community supports, community residential and family residential services, night supervision, 24-hour emergency assistance, caregiver living expenses, case management, consumer directed community supports, employment development, exploration and support, prevocational and day support services, family training and counseling, independent living skills therapies, positive support and specialist services, assistive technology, environmental accessibility adaptations, specialized equipment and supplies, home delivered meals, transitional services and transportation, for people with other disabilities ages 0 to 64 who meet a hospital level of care.
Developmental Disabilities Waiver (DD, 0061.R08.00)
Homemaker, chore, respite and crisis respite, adult day service and bath, extended personal care assistance, extended community first services and supports, individualized home supports, integrated community supports, community residential and family residential services, night supervision, 24-hour emergency assistance, caregiver living expenses, case management, consumer directed community supports, day training and habilitation, day support, prevocational and employment services, family training and counseling, independent living skills therapies, positive support and specialist services, assistive technology, environmental accessibility adaptations, specialized equipment and supplies, home delivered meals, transitional services and transportation, for people with intellectual or developmental disabilities of any age who meet an ICF/IID level of care.
Personal care assistance and Community First Services and Supports (Medicaid State Plan)
PCA services under Minn. Stat. 256B.0659, assessed by the county public health nurse or a certified public health nurse under contract, documented daily by each assistant on a commissioner-approved time sheet and supervised by a qualified professional; and CFSS under Minn. Stat. 256B.85, which replaces PCA upon federal approval through an agency-provider model or a budget model with support workers the participant employs, with service units set by a home care rating after a certified assessor's assessment.
HHAeXchange's Minnesota page dates the move from PCA to CFSS service codes to October 1, 2024, and the CMS tables place state plan personal care in the MSC+ and MSHO benefit grids but not in PMAP+ or SNBC.
How the program is delivered
Both. The 2024 CMS state tables list four statewide programs classed as MCO plus managed long-term services and supports: Prepaid Medical Assistance Plan Plus (since July 1, 1985), Minnesota Senior Care Plus (June 1, 2005, under 1915(b) and 1915(c)), Minnesota Senior Health Options (March 1, 1997, under 1915(a) and 1915(c)) and Special Needs Basic Care (January 1, 2008). MSC+ and MSHO carry HCBS waiver services, state plan personal care and private duty nursing in their benefit grids, MSC+ with mandatory and MSHO with voluntary enrollment for aged, blind or disabled members and full duals, while PMAP+ and SNBC do not carry waiver services or state plan personal care.2 Participating plans in 2024 were Blue Plus, Health Partners, Hennepin Health, Itasca Medical Care, Medica, Prime West Health, South Country Health Alliance, UCare and UnitedHealthcare, varying by program. Minn. Stat. 256B.69 says elderly waiver services are covered statewide under the prepaid medical assistance program for everyone eligible under chapter 256S (subd. 6b), excludes people eligible through blindness or disability from mandatory enrollment with limited exceptions (subd. 4), and requires a demonstration provider to pay a clean claim within 30 business days of accepting it (subd. 6). That leaves the CADI, BI, CAC and DD waivers billing the Department of Human Services fee-for-service for members outside a plan.
Electronic visit verification
Open vendor model with a state aggregator. Minn. Stat. 256B.073 requires providers to use an EVV system that meets all of the commissioner's technical and data submission requirements and to record all required EVV data at the time of service, directs the commissioner to make a state-provided system available at no cost and to allow third-party systems that meet the standards, and makes the data collected through EVV part of the department's process for validating claims for services subject to EVV.3 HHAeXchange is the state-provided system, offered at no cost to providers, and acts as the state aggregator that collects all visit data regardless of the EVV system used; a third-party system connects through an API configuration at the provider's own cost, and providers are not required to submit claims through HHAeXchange. DHS began monitoring and enforcing EVV compliance on September 1, 2024, after phases for financial management services (June 2022), managed care organizations (June 2023) and home health (October 2023), and PCA moved to CFSS service codes on October 1, 2024. The House Research brief of August 2026 adds that EVV expanded to further services in July 2026, that managed care and county-based purchasing plans must ensure EVV and claims system interoperability by January 1, 2027, and that the statute's third-party system requirements take effect January 1 or July 1, 2027 pending federal approval. Medicaid.gov lists Minnesota compliant for home health EVV as of January 1, 2024 and still not compliant on its personal care table.
Services under EVV5
- Personal care assistance services and community first services and supports
- Home health services
- Adult companion services and adult day services
- Adult rehabilitative mental health services, assertive community treatment, early intensive developmental and behavioral intervention, integrated community supports and recovery peer support
- Home and community-based services reimbursed at an hourly or specified minute-based rate under the federally approved waiver plans
- Nonemergency medical transportation and any other service federal law requires to be electronically verified
Authorizations
Through the lead agency's assessment and support plan. Minn. Stat. 256B.0911 makes a county, a tribe or a health plan under contract with the commissioner the lead agency, requires a MnCHOICES assessment by a certified assessor before someone receives home and community-based waiver services, personal care assistance or consumer-directed community supports, and has the assessor write a person-centered assessment summary and a support plan that documents assessed needs, service options and the eligibility determinations that open access to services; reassessment is annual or as federal and state law require.6 For PCA, 256B.0659 has the county public health nurse or a certified public health nurse under contract assess at least annually or on a significant change in condition, requires daily time sheets with arrival and departure times, and requires supervision by a qualified professional within the first 14 days, then at least every 90 days in the first year and every 120 days after. For CFSS, 256B.85 has the commissioner authorize services as soon as possible after the assessment and no later than 40 calendar days, with units set by a home care rating (designations P through Z and EN) plus additions for critical activities of daily living and complex health needs. Elderly Waiver authorization and rates follow chapter 256S (256S.16) within monthly case mix budget caps (256S.18), and a plan member's waiver services are authorized by the MSHO or MSC+ plan.
Where the claims go
Fee-for-service claims go to the Department of Human Services electronically, and Minnesota Rules part 9505.0450 requires a claim no later than 12 months after the date of service and an adjustment request no later than six months after the payment date; the department has no obligation to pay a claim submitted late. Six more months are allowed when Medicare was billed first (from the Medicare determination), a court orders payment, the department gave erroneous eligibility information, or the department wrongly rejected the original claim and the provider resubmits it with documentation.11 Minn. Stat. 62J.536 has required providers and group purchasers to exchange claims electronically with the standard transactions since July 15, 2009 and payment and remittance advice since December 15, 2009. Elderly Waiver, state plan personal care and private duty nursing for MSHO and MSC+ members go to the member's plan, which must pay a clean claim within 30 business days of accepting it under 256B.69, subd. 6. HHAeXchange is not a claims channel: visits go to the aggregator and claims go to the payer.
Medicare home health and hospice in Minnesota
National Government Services, the A/B MAC for Jurisdiction 6, processes Medicare home health and hospice claims for Minnesota along with Alaska, Arizona, California, Hawaii, Idaho, Michigan, Nevada, New Jersey, New York, Oregon, Washington, Wisconsin and the Pacific and Caribbean territories; its Part A and Part B jurisdiction is Illinois, Minnesota and Wisconsin.13 On the Medicaid side, home health sits in the benefit grid of all four prepaid programs, came under EVV in October 2023, and CMS lists Minnesota compliant with the Cures Act home health EVV requirement as of January 1, 2024, a year after the federal deadline of January 1, 2023.
Common rejections in Minnesota, and the fix
Visit recorded in a third-party EVV system never reached the aggregator
The fixHHAeXchange collects every visit regardless of the system that recorded it, and a third-party system has to be connected through an approved API configuration. The biller confirms the connection is live before the first claim, checks the aggregator for each visit before billing, and treats a gap as an EVV problem to fix at the agency rather than a claim to resubmit.
PCA service code billed for a date after October 1, 2024
The fixPCA moved to CFSS service codes on that date. The biller rebuilds the claim with the CFSS code the authorization carries and checks the authorization itself was converted, since CFSS units come from a home care rating rather than the old PCA assessment.
Elderly Waiver claim sent to DHS for an MSHO or MSC+ member
The fixElderly waiver services are covered statewide under the prepaid medical assistance program, so the plan is the payer and must pay a clean claim within 30 business days. The eligibility check records the plan on each date of service and the biller files to it, keeping DHS for members outside a plan.
Claim submitted more than 12 months after the date of service
The fixMinnesota Rules 9505.0450 gives 12 months and the department has no obligation to pay a late claim. The biller files as soon as the visit is in the aggregator and keeps the six-month extensions, for a prior Medicare determination, a court order, erroneous eligibility information or a wrongful rejection, for the cases they cover, with the documentation attached.
CFSS or PCA units billed beyond the authorization
The fixCFSS units come from the home care rating and the commissioner's authorization; PCA hours come from the public health nurse's assessment. The biller reconciles delivered units to the authorization before the claim and asks the lead agency for a reassessment when the participant's needs have changed.
Time sheet or qualified professional visit missing from the PCA record
The fixThe statute requires each assistant to document daily on an approved time sheet with arrival and departure times and the recipient's identification and signature, and a qualified professional to evaluate within 14 days, then every 90 days in year one and every 120 days after. The biller checks both before release, because a claim that pays without them is the one that is recouped later.
Remitwright serves Minnesota home care and home health agencies remotely, inside the agency software you already use, with a dedicated biller.
FAQ
Questions from Minnesota agencies
Do we have to use HHAeXchange in Minnesota, or can we keep our own EVV system?
Which of our services fall under EVV after the July 2026 expansion?
Who pays an Elderly Waiver claim, the state or the health plan?
How long do we have to file a fee-for-service claim with DHS?
How are PCA and CFSS hours set, and who authorizes them?
Who pays our Medicare home health and hospice claims in Minnesota?
Which programs pay for home care in Minnesota?
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