C-11-917 Evaluate Out-of-State Provider Requests

👤 RESPONSIBLE POSITION | ROLE

Clinical Intake Coordinator or Designee

🎯 PURPOSE

This tip sheet assists the Clinical Intake Coordinator or Designee in determining whether it is appropriate to approve using an out-of-state provider for a specific client in a certain scenario.

Details of each specific case is sent in an email as laid out in C-11-212 Address Request to Add an Out-of-State Provider in HCHB.

🔄 PROCESS

The Clinical Intake Coordinator or Designee will be included in an email sent by the Medical Records Specialist using this template below. The branch will reply with their responses to the questions below, which provides information needed to determine whether we can approve use of the out-of-state provider in the particular scenario.

TEMPLATE

In the subject line of the email: Request to Add Out-of-State Provider: Client ____ _____

In the body of the email:

Provider _____ _________ is licensed only in the state of ___________. As the provider is not licensed in Minnesota, additional steps are needed to determine whether this provider can be used for this client, ________ ______.

Branch- please reply all including your responses to the questions below, specific to this client.

Has the appropriate Branch Clinical Team been notified, i.e. Clinical Supervisor (existing client), Area Manager (new referral), etc.?
What are the ordered services and payer sources for the client?
Is the provider a VA Provider?
Is the client receiving services under the VA benefit?
What is the primary and any secondary payer involved?
Has the out-of-state provider examined (had a physical visit with) the client in the state he/she is licensed in?
Did the out-of-state provider write the order in the state they are licensed in?
Did the out-of-state provider complete the clinical encounter note for the F2F?
What is the long term plan for home care orders?

Does the out-of-state provider plan to follow the client’s plan of care from out-of-state or hand off the care of the client to another provider within the state of MN?
If the provider is handing over care, when is the visit with the MN provider scheduled for?

Once the branch has responded to the template, consider the following when deciding whether to approve adding the out-of-state provider to HCHB.

Situation	Determination
Out-of-state VA provider:	It does not matter that the provider is not licensed in Minnesota. The provider can follow the home care episode.
Out-of-state VA benefit:	It does not matter that the provider is not licensed in Minnesota. The provider can follow the home care episode. The branch will need to monitor if they switch payers as this could be an issue. The direction to branch should be that they should reach out to the compliance team for further discussion if this occurs.
Out-of-state Face to Face (F2F) Encounter:	If the only need for the physician is because of the F2F encounter, we are okay to accept this provider as long as the encounter is clear that the provider examined the client in the state in which they are licensed. Exception: If the provider also wrote the admit to home care order AND we are billing Medicaid, we cannot accept this.
Out-of-state provider following client:	To accept orders, we need to ensure the provider has seen the client in the state in which they are licensed. Payer source will need to be checked. We cannot bill a Medicaid product if they are not enrolled in Medicaid/MHCP. We can only accept PT orders for 90 days. The branch will need to monitor this and if the client is recertified with PT, they will need to look at finding a MN-licensed provider to take over signing orders. Branch should reach out to compliance team with questions if this occurs.

📅 Effective: 04.09.2025 | 🛠️ Revised: 08.24.2026 | ✅ Approved: BL, JFJ