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Effective January 1, 2012, MHCP covers hospital in-reach service coordination (IRSC) to reduce instances of emergency department (ED) and other non-medically necessary health care use. Hospital IRSC brings together health care and community-based services for MHCP recipients for up to 60 days after hospital discharge. It includes helping recipients find services to address dental, mental and chemical health, housing, transportation, employment, peer support services, and other health, social and economic needs. IRSC can connect the recipient with existing covered services available to them, such as targeted or waiver case management, or care coordination in a health care home.
Hospitals may employ or contract with the following individual providers or community-based providers to provide hospital IRSC:
MHCP enrolled community-based providers need to sign and submit to MHCP a Community-based Providers for In-Reach Service Coordination (IRSC) – Applicant Assurance Statement (DHS-3898) so their records indicate they are IRSC program participants.
Eligible in-reach service coordinators must hold a minimum of a bachelor’s degree in social work, public health, corrections or a related field.
Before performing the assessment, MHCP recommends that providers determine if the recipient is already receiving services that would make them ineligible for participation in in-reach care coordination.
Recipients receiving the following services are not eligible for participation:
IRSC is available to recipients of any age with three or more emergency department (ED) visits in the previous four consecutive months.
The qualifying ED services and inpatient stays are not limited to a single hospital. Clinicians may use the MN–ITS Health Information Request (HIR) User Guide clinical tool to access a more complete medical history for MHCP recipients. The HIR User Guide clinical tool can help prevent duplication of services. If multiple providers deliver IRSC one or more days during a 60-day service period, MHCP will reimburse all providers for the initial assessment; however, only the provider whose claim is filed first with the state will be reimbursed for the follow-up continuing service.
Recipients under the age of 21 who are diagnosed with SED are eligible for IRSC services if they meet one of the following criteria:
Recipients enrolled in the following MHCP programs are eligible for hospital IRSC services:
MinnesotaCare Plus One
Recipients enrolled in the following programs are not eligible for MHCP hospital IRSC services:
MHCP covers hospital IRSC performed through a hospital ED. This includes working with other providers to connect eligible recipients with existing MHCP covered services, community-based services and other resources available to them.
The provider must perform an initial assessment of the recipient to evaluate:
Follow-up services after the initial assessment include working with other providers to coordinate services to help the recipient access a variety of services. Services under IRSC focus on reducing the number of visits to a hospital ED or inpatient readmissions for non-medically necessary health care. These services must address the recipient’s needs determined in the initial assessment. Services may be provided in the recipient’s living environment or by phone.
Hospital IRSC may be provided for up to 60 days from the discharge date of the ED visit or of the inpatient hospital stay that resulted from an ED visit and is:
The following services are not covered under hospital IRSC:
Submit claims for MCO enrollees to the appropriate prepaid MCO.
Minnesota Statute 256B.0625, subd. 56 Covered Services; Medical service coordinationReport/Rate this page