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Relocation Service Coordination—Targeted Case Management (RSC—TCM)

Revised: 03-27-2014


  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Non-Covered Services
  • Authorization Requirements
  • Limitations
  • Billing
  • Definitions
  • Legal References
  • Overview

    Relocation Service Coordination –Targeted Case Management (RSC–TCM), is a Medical Assistance (MA) reimbursed case management benefit that was established in 2001 to help persons residing in eligible institutions gain access to needed medical, social, educational, and other services and supports necessary to move from the institution to a community-based setting. Federal approval of legislation effective February 1, 2007, made significant changes to increase transition service availability.

    Case Management

    MS 256B.0621 includes the provision of both county case management (counties/tribes) and relocation service coordination for the purpose of assisting recipients to gain access to needed services and supports if they choose to move from an institution to the community.

    Eligible Providers

    MHCP enrolled private agencies and independent providers without a county contract to offer RSC-TCM services must be certified by the Department of Human Services (DHS), Disabilities Services Division (DSD) to make available and directly bill services.

    County/Tribe providers are:

  • • American Indian tribe
  • • Federally recognized American Indian tribe
  • • An Indian Health Service Facility Provider
  • • County Case Management
  • • County Human Service Agency
  • • Local social services

  • Free Choice of Case Management Provider

    Recipients using RSC–TCM may choose, within the restrictions of the MS. 256B.0621, any county, tribe, private agency (vendor), or independent practitioner as their RSC–TCM provider.

    RSC–TCM eligible institutions are:

  • • Hospitals
  • • Intermediate care facilities for persons with developmental disabilities or related conditions (ICF/DDs)
  • • Institutions for Mental Disease (IMDs; includes Regional Treatment Centers (RTCs) licensed as hospitals or nursing facilities)
  • • Nursing facilities (NFs) (includes skilled nursing and certified boarding care facilities)

  • Intensive Residential Treatment Services (IRTS) facilities licensed as either board and lodging or supervised living facility are not eligible RSC facilities.

    Facilities that have an additional federal designation such as an IMD or an RTC are eligible if they have a license as a hospital, nursing facility, or ICF/DD.

    Private Agencies and Independent Providers

    Private agencies and independent providers can apply for certification by the Department of Human Services (DHS), Disabilities Services Division (DSD), not the individual service coordinators employed by the agency. DHS certified private agencies and independent providers guarantee their employees’ qualifications and compliance with RSC–TCM education and experience requirements.

    A DHS certified private agency or independent provider must:

  • • Have or employ case manager(s) who have a minimum of a bachelor's degree or a license in a health or human services field or comparable training and two years of experience in human services, meet all requirements of 256B.0625 subd. 20, or who have been credentialed by an American Indian tribe under MN Statutes, section 256B.02, subd 7
  • • Demonstrate the administrative capacity and case management experience to serve, coordinate, and link community resources needed by the eligible MHCP population for whom services will be provided
  • • Have the administrative capacity to coordinate with county administrative functions, ensure the quality of services, and to document and maintain individual case records under both state and federal requirements
  • • Have a financial management system that provides accurate documentation of services and costs
  • • Have no financial interest in the provision of-out-of home residential services (such as foster care and boarding care services) in the county where the recipient requesting services is seeking to relocate

  • County/Tribe and Contracted Providers

    County/tribal case managers must meet the employment requirements of their employer. County case manager’s employment qualifications are determined by the county/tribe but cannot be lower than the educational and experience requirements for service coordinators employed by certified agencies.

    A county case management provider/tribe must:

  • • Enroll with MHCP, and have the legal authority to provide RSC–TCM services
  • • Demonstrate the ability to provide the services and activities outlined in 256B.0621 subd 6(a)

  • A contracted provider with a county/tribe must:

  • • Demonstrate the ability to provide the services and activities outlined in 256B.0621 subd 6(a), that are defined in their contract. Contracted providers are monitored for quality assurance and compliance by the county/tribe.
  • • Employ case managers who meet minimum educational standards outlined in the county/tribal contract and any additional county requirements to provide RSC–TCM services.
  • • Receive referrals as stipulated in their contract.
  • • Comply with all conflict of interest regulations in 256B.0621 subd 4, and have a procedure that notifies a person or their legal representative of any conflict of interest if the contracted provider also provides, or will provide the person’s services and supports .Contracted providers may provide RSC–TCM case management, out of home residential and direct services to the same person as allowed in their contract and under the supervision of the county or tribe.
  • • Negotiates their payment rate with the county or tribe, and rely on the county or tribe for resolution of claim denials and disallowances.

  • Required Certification and Enrollment

  • • All providers must be enrolled as a Minnesota Health Care Program (MHCP) provider
  • • Private agencies and independent providers qualify to provide services through one of the following:
  • • A county/tribal contract
  • • DHS certification
  • • Certification is not required for providers working as contractors to a county or tribe
  • • DHS requires recertification (DHS-5069) for certified private agencies and independent providers every two years
  • • Private agencies and independent providers must have an office in the region or county in which they request certification and recertification

  • Certification is dependent upon compliance with the minimum provider qualifications and requirements outlined in the Certification Application (DHS-5068), and the MHCP Provider Enrollment standards and regulations.

    Provider Certification Application Process

    Current or new providers requesting certification must complete and sign the Certification Application (DHS-5068) indicating they are applying for state certification as a provider of RSC–TCM.

    Providers complete and sign the Provider Certification Application and mail or fax it to:

    DHS RSC Certification
    P.O. Box 64967
    St. Paul MN, 55164-0967
    Fax: 651-431-7563

    The DHS DSD will review the application and send a response within ten working days upon receipt regarding approval, denial, or the need to provide additional documentation.

    If you have questions regarding certification or recertification, please call 651-431-4300, TTY-TDD number 711, or 800-267-7655.

    Monitoring and Recertification

    The DHS DSD will monitor and review compliance with RSC–TCM policy and procedures for DHS certified RSC–TCM private agencies and independent providers every two years and recommend decertification or corrective action if problems are identified.

    The counties/tribes will continue to provide oversight for contracted RSC–TCM providers and recommend corrective action if problems are identified. Contracted providers must submit the following information to the county/tribal contact person identified in their contract at the specific times identified in their contract.

    DHS certified private agencies or independent providers and contracted providers must submit all of the following information for review:

  • • Number of recipients who:
  • • Received RSC–TCM services
  • • Relocated from institutions in 180 days or less
  • • Relocated from institutions in one year
  • • Did not relocate after receiving RSC–TCM services
  • • Narrative summary and total hours of trainings attended, including:
  • • Conferences
  • • Lecture
  • • Online
  • • Summary of complaints (all sources) and steps taken to remedy concerns
  • • Summary of customer satisfaction results/outcomes

  • DHS certified RSC–TCM private agencies or independent providers must be recertified by the DHS every two years. Submit the Recertification Application (DHS-5069) to DHS – RSC Certification.

    Decertified private agencies or independent providers and terminated contractors may reapply for certification or county/tribal contracts after complying with all conditions listed in their written corrective action plan notice.

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    Eligible Recipients

    A recipient is eligible to receive services when all of the following criteria are met:

  • • Eligible for MA (including Program EH, IM, NM or RM)
  • • Resides in an institution that qualifies for services at the time of service delivery
  • • Chooses to move into the community
  • • Chooses to receive services
  • • TCM benefit is not exhausted
  • Covered Services

    Recipients in an institution may receive federally targeted case management reimbursements during the last 180 days of placement for the purposes of helping the recipient relocate to the community. The service must not duplicate the services of the institution’s discharge planner.

    This federal law applies to:

  • • RSC–TCM
  • • Mental Health-Targeted Case Management (MH–TCM)
  • • Vulnerable Adult Developmental Disability-Targeted Case Management (VADD–TCM)

  • Consequently, the use of any one of these case management types will begin the 180 day time span, and exhaust the benefit after 180 days.

    Recipients must have a service plan. A county case manager develops monitors and reviews the plan, using a recipient-centered process.

    At a minimum the service plan must identify:

  • • The consumer and their legal representative
  • • All case managers responsible for coordinating and planning services
  • • The consumer’s goals
  • • The needed services
  • • The amount, duration, and frequency of the services
  • • The anticipated service outcomes
  • • The method and frequency of monitoring the plan of care

  • If there are multiple case managers, the service plan must identify and attribute specific case management activities to each case manager to demonstrate their differing roles and responsibilities.

    Counties and tribes may use the Community Support Plan or the Developmental Disability Individual Service Plan to record services.

    The case manager must document the following information in the recipient’s case record following delivery of service:

  • • Date of service
  • • Name of the provider agency and person providing the service
  • • Narrative statement describing the nature of the service provided
  • • Place of service
  • • Recipient name
  • • Units of service

  • The narrative statement must be detailed in order to identify the activity as an approved case management service. Undocumented claims result in a claim’s disallowance and claims adjustment.

    RSC services provided by a county or certified private agency/independent or county/tribe contracted providers include:

  • • Assistance to access needed services, including travel to visit a recipient to develop or implement the goals of the written plan
  • • Coordinate, monitor and support overall service delivery and advocacy as needed to ensure quality of services, appropriateness and continued need
  • • Coordination with the facility discharge planner in the 180-day period before the recipient's discharge
  • • Documentation that supports and verifies the activities
  • • Routine contact or communication with:
  • • Legal representative
  • • Primary caregiver
  • • Recipient
  • • Recipient’s family members
  • • Service provider(s) or other persons identified as necessary to the development or implementation of the goals of the written plan
  • • Substitute care provider

  • County/Tribe required services include:

  • • Assessment of the recipient’s need for RSC–TCM and service coordination options
  • • Coordination of referrals for and the provision of appropriate service providers
  • • Development, completion, monitor and planned review of a written individual service plan designed to help a person access needed services and supports

  • A recipient has the right to appeal an action that denies, delays, suspends, reduced or terminates their services. County case mangers are responsible to inform recipients of their appeal rights under the law.

    Non-Covered Services

    The following list of non-covered services is not all-inclusive:

  • • Transition assistance when a recipient moves from one institution to another
  • Example: if a nursing facility closes, a provider cannot bill for activities related to finding another nursing facility for the recipient, unless the recipient’s relocation plan indicates that a move to another institution is a necessary step toward the eventual community integration of that recipient.

  • • Administrative functions:
  • • Intake for Medical Assistance and other MHCP programs
  • • Eligibility determinations and re-determinations for MA or an MA funded benefit such ARHMS, waivered services, VADD–TCM
  • • Prior authorization of services
  • • LTCC or DD screening
  • • Appeals or conciliation activities
  • • Direct services such as treatment, therapy, and other habilitative or rehabilitative services provided to the recipient
  • • Other non-billable activities:
  • • Outreach services and marketing activities
  • • Information and referral activities prior to eligibility determinations
  • • Services without proper documentation in the recipient’s service plan
  • • Services to recipients ineligible for MA
  • • Services covered by another billing source such as private insurance or other third party payers
  • • The time and services of the institution’s discharge planner
  • • Case management activities covered as a part of another covered service such as development of a treatment plan for home care or PT services
  • • Services prior to the county of financial responsibility (CFR) authorization
  • Authorization Requirements

    Services are available to eligible recipients at any time upon request during an institutional placement. After establishing a recipient is eligible for services, determine the date of the last Long Term Care Consultation (LTCC) or Developmental Disability (DD) face to face screening. If a new screening is necessary, complete the screening using LTCC form or DD screening form.

    Under MS 256B. 0621 subd 7, the CFR, or tribe must assign a county case manager, its contractor or the tribe to visit the recipient within 20 working days of the original request for services. The CFR or tribe can request another county or tribe complete county case management required activities.

    If the CFR, its contractor or tribe is unable meet with the recipient within the 20 working days of the original request for services, the recipient may obtain these services from another county, tribe or private provider. The Commissioner may waive certain provider qualifications to allow the recipient access to the assistance necessary to move from the institution to the community. The CFR, its contractor, or the tribe must complete a written request detailing the reason for waiving qualification standards and send this information to:

    Attention: RSCTCM Lead
    DHS — Disability Services Division
    PO Box 64967
    St. Paul, MN 55164-0967

    Telephone: 651-431-4300

    The recipient or their legal guardian must notify the CFR/tribe in writing of the decision to obtain services from another county, tribe or private vendor.

  • • Within five (5) working days from receipt of the notice, the county/tribe must provide the other county, tribe or private provider written results of their eligibility determination
  • • Within 10 working days from receipt of the notice, the county, tribe or private vendor must arrange to meet with the new county, tribe or private vendor and recipient to fulfill county case management responsibilities

  • The private provider ought to withhold billing or providing services until the CFR completes the eligibility determination, plan development and service authorization. The private provider may bill for time spent aiding/assisting the recipient with relocation activities before the written plan is signed.

    For counties/tribes, notification of the CFR that a recipient wants services may be considered part of the LTCC or DD screening activities.

    Limitations

    Recipients living in the community or an ineligible institution such as an Intensive Residential Treatment Services (IRTS) that is not licensed as a hospital or nursing facility cannot receive RSC–TCM.

    The RSC–TCM benefit is available during the last 180 consecutive days of a continuous institutional placement following the date on the first paid claim for RSC–TCM, MH–TCM or VADD–TCM regardless of the length of that placement.

    RSC–TCM benefits end once a recipient is discharged from an eligible institution.

    RSC–TCM is available for each and every institutional placement episode. If a person is discharged from an institution with or without RSC–TCM services, remains in a community living arrangement for a full day, and then returns to an institution, they may receive RSC–TCM services to assist with their relocation. MHCP must have a record of community placement that lasts for at least one day.

    Recipients cannot receive RSC–TCM and another type of targeted case management (MH, VA/DD, CW) during the same month while they reside in an institution. Do not bill for another type of targeted case management during the month(s) RSC–TCM is provided.

    Minnesota Senior Health Option (MSHO) recipients should contact their MCO to request relocation assistance. The RSC–TCM provider must coordinate with the MCO to ensure continuity of care and non-duplication of effort.

    Waiver Transitional Services
    A service provider may simultaneously provide waiver transitional services and RSC–TCM. Waiver transitional services reimburse items, expenses, and related supports necessary and reasonable for the recipient to transition to their permanent place of residence in the community from the institution and do not duplicate these services.

    Payment for these services may not duplicate payments made or services provided under other programs authorized for the same purpose.

    Billing

    A contracted county/tribe, certified private agency or independent provider may receive direct referrals from a recipient. If these provider types receive a request for service, they must direct interested persons to contact their CFR or tribe. Before any service can be provided and billed, the CFR must determine a potential recipient’s eligibility, then develop a service plan and have it signed by all parties. .

    Notifying the CFR of a request for service is not billable; this is considered information (referral prior to eligibility determination, or an outreach or marketing activity).

    Providers are not required to wait for discharge to occur before billing. Providers may submit a claim regardless of whether the community reintegration takes place through a home and community-based waiver, by other means, or not at all.

    Providers contracting with the county or tribe must negotiate a rate based on their costs. This rate cannot exceed federally approved rate limits.

    If the private provider functions as both a certified private agency/independent provider and county/tribe contracted provider to one recipient, they should bill the same rate for all services provided to that recipient. .

    The rate for counties, tribes, or county/tribe contracted and certified private agencies/independent providers is up to $15.53 for each 15 minute unit.

    Bill Targeted Case Management 15 minute increments claims using procedure code:

  • • T1017 for service dates of 09/01/08 and after
  • • T1016 for service dates prior to 08/31/08.

  • Services are limited to: 32 units per day (8 hours maximum) and 5 days a week.

    Bill each date of service separately, date spans will deny.
    Bill electronically using your NPI or UMPI number.

    While VA/DD–TCM, MH–TCM and RSC–TCM can be used alternately-(VA/DD–TCM one month, MH–TCM one month and RSC–TCM the next), DHS does not recommend this practice. Use one of these TCMs for the duration of the relocation effort. The 180-day limit starts with the service date of the first paid VA/DD–TCM, MH-TCM, or RSC–TCM claim. RSC–TCM services provided after the 180 day limit will deny.

    Certified private agencies, independent providers and county/tribe contracted providers must work closely with county case managers to avoid claim denials due to ended eligibility or exceeded service limits.

    Definitions

    Continuous institutional placement: is an uninterrupted placement in one or more RSC–TCM eligible institutions. A transfer from one eligible institution to another does not interrupt a continuous placement. (Moves to hospitals, which are eligible institutions, are not community placements for RSC purposes; consequently, moves from a nursing facility to a hospital and back to a nursing facility do not interrupt a continuous placement.).

    County Case Management services include: assessment of need, plan development and review, referrals to relocation service coordination providers, and conflict of interest management.

    County/Tribe case management are counties, tribes who meet the qualifications in MS256B. 0621 subd 4; and any additional county requirements to provide RSC–TCM services. Counties and tribes may contract for RSC–TCM county case management. Certification is not required for providers working as contractors to a county or tribe.

    County of Financial Responsibility (CFR): The entity responsible for the costs of a recipient’s MHCP as specified in MS 256G.02 Subd. 4.

    Developmental Disability (DD) Screening Document: Assessment tool required for any person being admitted to an institution. This process is to be used to provide persons with community service options in order to prevent admissions OR to provide transition assistance in the event an admission cannot be avoided. If a person is admitted and requests RSC services, this process includes a means for assessing the recipient’s health, psychosocial and functional strengths and needs, in addition to, assisting the recipient identify needed and available services.

    DHS Certified RSC—TCM private agency: Corporation, partnership, voluntary association and other organization other than a county agency or a tribe enrolled-Medical Assistance provider who meets RSC–TCM provider qualifications and has been certified by the DHS to provide RSC–TCM services.

    DHS Certified RSCTCM private independent provider: Individual who meets the definition of a self-employed person (someone who is in business for themselves as a sole proprietor), is an enrolled MA provider, meets RSC–TCM provider qualifications and is certified by the DHS to provide RSC-TCM services.

    Institutions: Include hospitals, nursing facilities (NFs), including certified boarding care facilities, intermediate care facilities for recipients with developmental disabilities or related conditions (ICF/DDs), regional treatment centers (RTCs) providing inpatient services to recipients currently receiving Medical Assistance.

    Long Term Care Consultation (LTCC Screening) Document: An assessment tool required for any recipient seeking nursing home level of care/admitted to an institution. The screening is to provide community service options in order to prevent admissions OR to provide transition assistance in the event an admission cannot be avoided. If a recipient is admitted and requests transition services, the screening includes a means for assessing a recipient’s health, psychosocial and functional strengths and needs, in addition to assisting the recipient identify needed and available services.

    Relocation Service Coordination Targeted Case Management (RSCTCM): A type of targeted case management for eligible recipients residing in eligible institutions who want to move into the community. RSC–TCM helps a recipient who resides in an eligible institution to plan, arrange and gain access to needed medical, social, educational, financial, housing and other services and supports that are necessary to move from an eligible institution to the community.

    Relocation Service Coordination: Services include implementation of a service plan including referrals and coordination of service providers; client and collateral contacts necessary for the implementation of the plan; monitoring, and advocacy.

    Targeted Case Management (TCM): Services that assist an eligible recipient gain access to needed medical, social, educational and other services as defined in their service plan.

    Tribal Facility: A health care facility, operated by a Tribal organization that is recognized by the Federal government, which has not elected designation as a 638 IHS provider.

    Tribal Facility Designated as a 638 IHS Provider (638 IHS): Includes all facilities that are under contract, compact, or are receiving grants from the IHS under Public Law 93-638. The 638 facility is operated by a tribal organization that is recognized by the Federal government, under a funding agreement with IHS. The 638 facilities that have elected to be paid at the IHS rates are hereafter referred to as 638 IHS facilities.

    Legal References

    MS 256B.02 (definitions)
    MS 256B.77 (coordinated service delivery system for disabled)
    MS 256B.0621 (TCM covered services)
    MS.256B.0621 subd 4(RSC–TCM provider qualifications)
    MS 256B.0621 subd 5 (provider qualifications & minimum educational requirements)
    MS.256B.0621 subd 6 (eligible services)
    MS.256B.0621 subd 7 (timelines)
    MS 256B.0625 sub. 20 (mental health case management services)
    MS 256B.092 (county of financial responsibility)
    MS 256G.02 Subd. 4 CFR definitions)

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