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Community Living Assistance (CLA) Services

Revised: 07-27-2015

  • Overview
  • Covered Services
  • Noncovered Services
  • Eligible Providers
  • Provider Standards and Qualifications
  • MN–ITS
  • Eligible Recipients
  • Authorization
  • Billing
  • Submitting Claims
  • Managed Care Enrollees
  • Legal References
  • Overview

    Community Living Assistance (CLA) services will provide help or support to a person to maintain his or her community living, including employment.

    Covered Services

    Services will help and support recipients in the following areas:

  • • Basic living and social skills, such as the following:
  • • Interpersonal communication
  • • Accessing community resources (transportation, employment, housing, etc.)
  • • Activities of daily living reminders (eating, toileting, grooming, dressing, bathing, etc.)
  • • Developing and maintaining informal support systems
  • • Help maintaining socialization with friends and family
  • • Household management, such as:
  • • Budgeting and money management
  • • Maintaining and applying for benefits
  • • Reading and responding to mail
  • • Making and managing appointments and maintaining a calendar
  • • Making lists (for example, grocery, cleaning)
  • • Basic help with technology to support community living
  • • Health maintenance reminders to ensure a person follows treatments according to orders from an appropriately licensed professionals:
  • • Reminding the person to take their medication
  • • Coordinating or help with obtaining medication refills
  • • Coordinating with case manager about health issues as identified in the support plan
  • • Monitoring overall well-being (for example, check-ins)
  • • Problem solving
  • Services can be provided:

  • • In the person’s home or place of employment
  • • In community settings typically used by the public
  • • Over the phone when the recipient needs help with problem solving
  • Consultative activities may be delivered face-to-face or through remote communication, such as telephone or web. Either the recipient or the staff can initiate contact.

    Face-to-face contact by the provider must occur at least once every three months unless the support plan indicates more frequent contact is needed.

    Services are designed to supplement existing supports and services, not supplant or duplicate existing supports and services or those available through other funding sources.

    Noncovered Services

    CLA services do not include:

  • • Companionship
  • • Assistance and support not directed at a need in the person’s support plan
  • • Nursing care
  • • Services provided by people related to the person by blood, marriage or adoption (includes spouse, children, parents, stepparents, siblings, step-siblings or grandparents)
  • • Transporting the person (staff time or mileage)
  • The following tasks related to medications are not covered under this service:

  • • Preparing medication for administration
  • • Setting up medications
  • • Administering medication
  • • Coordination and communication with the prescriber or nurse, including any concerns about the medication, side effects, adverse reactions, effectiveness, or the person’s refusal to take the medication
  • • Documenting administration of medication
  • Eligible Providers

    Providers eligible to provide, bill and receive payment from MHCP for providing CLA services must meet all of the following:

  • • Be an enrolled MHCP provider and continuously maintain qualifications to provide the CLA services
  • • Have a home care license (basic home care minimum)
  • • Be selected by the service recipient or case management/service coordinator of the lead agency (county/tribe/managed care organization (MCO))
  • • Have a DHS approved service authorization (SA) to provide services for the recipient
  • An unrelated person may receive payment to deliver CLA services without being licensed if:

  • • The person is excluded from licensing according to MN Statute 245A.03, Subd. 2 (a)(2) and
  • • The lead agency determines the person meets the staff qualifications
  • Provider Standards and Qualifications

    Direct care staff must have a background study through the MHCP Provider Enrollment process.

    Before providing CLA services, staff must take data privacy training.

    In addition, staff must be able to:

  • • Work independently
  • • Communicate effectively with the person related to tasks, preferences and concerns either directly or through an interpreter
  • • Read, write and follow written and verbal instructions
  • • Meet the needs identified in the person’s support plan
  • • Follow the person’s individualized support plan
  • • Recognize the need for and provide help or arrange for appropriate help
  • • Identify and address emergencies, including calling for help
  • • Understand, respect and maintain confidentiality
  • • Understand the mandated reporting requirements under Minnesota Statutes
  • MN–ITS Accounts

    MHCP requires providers to register their MN–ITS account. Registration information is in your MHCP welcome letter when you complete enrollment.

    MN–ITS is an internet based application you will use to do the following:

  • • Retrieve mail including:
  • • Important notices
  • • Verification of Enrollment status
  • • Other enrollment information
  • • Service authorization letters
  • • Check recipient eligibility
  • • Submit claims
  • • Reconcile claims
  • MHCP encourages all providers to allow user access to anyone in the agency who may have a need to receive any of the information we provide through MN–ITS.

    To learn more about MN–ITS, review MN–ITS and Electronic Billing.

    Eligible Recipients

    Recipients must have an assessed need for CLA services.

    Providers must verify program eligibility for each recipient, each month either by phone through the Eligibility Verification System (EVS) or through MN–ITS. Failure to confirm eligibility may result in non-payment for services.

    Use MN–ITS Eligibility Request (270/271) to review information for each recipient before providing services to identify the recipient’s:

  • • MA eligibility
  • • Waiver eligibility
  • • Enrollment with a Managed Care Organization (MCO)
  • • Other insurance (third party liability, private insurance coverage)
  • • Medicare Coverage
  • • MA spenddown
  • Authorization

    The lead agency must do an LTCC or MnCHOICES assessment to determine the recipient’s eligibility for CLA.

    CLA services are added to the service agreement.

    Billing

  • • Bill MHCP directly for services incurred on or after Jan. 1, 2015, for fee-for-service (FFS) MHCP recipients
  • • Use the 837P format to submit claims
  • • Use HCPC codes H2015 or H2016 as approved on the Service Agreement
  • Submitting Claims

    When you submit claims for CLA Services:

  • • Use MN–ITS Direct Data Entry (DDE) or your own X12 compliance software (batch billing system)
  • • Use the Professional (837P) claim bill only for services already provided
  • • Bill only for services that are approved on the authorization
  • • Enter a diagnosis code on claims for all CLA services. You must use the most current, most specific diagnosis code on the claim. MHCP will display the diagnosis code of the recipient onto the service agreement letter.
  • • Use the information listed on your service agreement when submitting claims for reimbursement through CLA services.
  • • Bill for face-to-face time and remote communication according to the following:
  • • $4.55 for each 15-minute unit for services on or after 7/1/2015
  • • Use HCPC code H2015
  • • Bill for direct contact time only
  • • Bill for remote assistance only according to the following:
  • • $6.06 per day for services on or after 7/1/2015
  • • Use HCPC code H2016
  • • Bill for direct contact only
  • Refer to the Billing Policy section for more information about MHCP billing guidelines.

    Managed Care Enrollees

    Managed care enrollees are eligible to receive CLA if they meet eligibility requirements for the Essential Community Supports program.

    Bill these services to MHCP, not the health plan.

    Legal References

    Minnesota Statutes 256B.0922 (Essential Community Supports)
    Minnesota Statutes 626.557
    (Reporting of Maltreatment of Vulnerable Adults)
    Minnesota Statutes 245A.03, Subd. 2 (a) (2)
    (Who Must Be Licensed)

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    Updated: 7/27/15 10:39 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 7/27/15 10:39 AM