1115 Medicaid Waiver: See Medicaid Waiver 1115
1915(c) Waivers: See Medicaid Waiver 1915(c)
24-hour customized living: Customized living services provided with 24-hour supervision. See also customized living.
24-hour emergency assistance: See emergency assistance (24-hour)
45-day temporary start of service (PCA services): Lead agencies use this process to begin PCA services temporarily until the lead agency assessor can schedule and complete a face-to-face assessment.
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Accessible: Activity, place or information capable of being reached, entered or used by people who have disabilities.
Acquired brain injury: Injury to the brain that occurs after birth and can include anoxia, drug reactions, infection, stroke, trauma and tumors. See also brain injury.
Active treatment: Services specified in a support plan that, when combined with services provided by a nursing facility, result in treatment that meets the federal requirements for active treatment services.
Activities of daily living (ADL): Tasks essential to perform routine self-care functions (e.g., dressing, bathing and eating).
Adaptive behavior: Ability of a person to meet the standards of maturation, learning and personal independence that are expected based on normative standards for age, cultural background and experience. A person can demonstrate through skills or the ability to adjust his/her own behavior to compensate for health, motor or sensory deficits.
Additional square footage: An increase to square footage of an existing home when it is necessary to build or modify a wheelchair-accessible bathroom.
Adult: Person who is age 18 or older.
Adult companion services: Non-medical care, assistance, supervision and socialization provided to a person age 18 or older.
Adult day services: Individualized program of activities designed to meet the health and social needs of a person age 18 or older who has a functional limitation and needs supervised care outside of his/her residence during the day.
Adult day services bath: A bath provided by an adult day services or family adult day services (FADS) provider when it is not able to occur in the person's home.
Adult foster care: Individual waiver services that provide ongoing residential care and supportive services to people living in a home licensed as foster care. These services are individualized and based on the needs of the person.
Adult mental health targeted case management (MH-TCM): Medical Assistance (MA) state plan services that assist people with ongoing assessment, planning, referral, service coordination and monitoring of multiple needs. MH-TCM is provided to adults determined to have a serious and persistent mental illness (SPMI).
Adult protection: An essential human services program provided by a county/tribal nation or service delivery authority. Adult protection includes investigation and protection response to reports of suspected abuse, neglect or financial exploitation of vulnerable adults.
Adult public guardianship: Court appointment of the DHS commissioner as the legal guardian of an adult with a developmental disability.
Adult rehabilitative mental health services (ARMHS): Mental health services that are rehabilitative and help a person develop and enhance psychiatric stability, social competencies, personal and emotional adjustment and independent living and community skills.
Advertising: Form of marketing used to persuade someone to use a product or service.
Advocate: Individual designated by a person or a person’s legal representative to speak on the person’s behalf and help the person understand and make informed choices in matters related to identification of needs and choices of supports and services.
Affected participant: A person who, as a roommate or significant other who lives with the person and is not a caregiver, may have their personally identifiable information viewed or recorded by monitoring technology.
Age appropriateness: Aspect of normalization that emphasizes recognition that the person is of a certain chronological age, which is reflected in the way the person is perceived and treated by others.
Agency-initiated direct contact: Person acting on behalf of an agency makes the first connection or approaches someone about a product or service the agency directly or indirectly provides.
Alternative Care (AC) program: State-funded program that funds home and community-based services for people age 65 and older who require the level of care provided in a nursing home, choose to live in the community and are not yet financially eligible for Medical Assistance.
Alternative Care conversion case management: Support of a discharge planning process to help people relocate to community-based settings.
American with Disabilities Act (ADA): National civil rights legislation passed in 1990 that guarantees equal opportunity for people with disabilities in public accommodations, employment, services and telecommunications.
Anniversary month: A person's annual reassessment month.
Appeal: The process through which a human services judge reviews a decision made by either DHS or a county/tribal nation that affects the services the person receives or requests.
Appellant: The person who files an appeal.
Applied Behavior Analysis (ABA): Type of therapy frequently used with children with autism spectrum disorder (ASD) that focuses on increasing positive and appropriate behaviors through reinforcement while decreasing interfering/unwanted behaviors or behaviors that interfere with learning.
Approval-option services (formerly Tier 2 and Tier 3 services): Group of basic services available under the home and community-based waiver and Alternative Care (AC) programs. An approval-option service provider enrolls with Minnesota Health Care Programs (MHCP) or is approved by a willing lead agency. Approval-option services include direct-delivery services and purchased-item services.
Assessment: Process of identifying all of the following:
Assisted living: See customized living.
Assisted living plus: See 24-hour customized living.
Assistive technology: Devices, equipment or a combination of both that improve a person's ability to:
Authorization: Written approval and issuance of an authorization number, when applicable, by a medical review agent under contract with DHS.
Authorized representative: Individual who is at least 18 years of age and is designated by a person's legal representative to act on the person's behalf. The authorized representative must successfully pass a criminal background study and must not have a financial interest in the delivery of goods or services to the person.
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Basis of eligibility: Each applicant must meet a basis of eligibility for Medical Assistance (MA). A basis of eligibility is a set of characteristics such as age, income, disability or family status. The basis of eligibility is based on federal eligibility categories.
Behavioral support: Service to increase positive behavior and decrease or eliminate interfering/challenging behavior.
Brain injury diagnosis: A diagnosis of brain injury includes:
Brain injury: Injury to the brain caused by an external physical force and not of a degenerative or congenital nature. The injury results in an impairment of cognitive abilities or physical functioning. Additional consequences of the injury might include changes in behavior and/or emotional functioning.
Brain Injury (BI) Waiver: Home and community-based services necessary as an alternative to institutionalization that promote the optimal health, independence, safety and integration of an eligible person and who would otherwise require the level of care provided in a specialized nursing facility or neurobehavioral hospital.
BI-NB conversion: Person eligible for Brain Injury – Neurobehavioral Hospital (BI-NB) enrolls in a BI-NB Waiver immediately upon discharge from a long-term care hospital having received neurobehavioral services and was a resident of the long-term care hospital receiving neurobehavioral services and Medical Assistance at least 30 days before accessing the waiver.
BI-NF conversion: Person eligible for Brain Injury – Nursing Facility (BI-NF) enrolls in a BI-NF Waiver immediately upon discharge from a nursing facility and was a resident of the nursing facility receiving Medical Assistance for the nursing facility services at least 30 days before accessing the waiver.
BI diversion: Person eligible for the Brain Injury (BI) Waiver who does not meet the criteria for nursing facility or neurobehavioral hospital conversion. This includes persons who are discharged from all other types of institutions or treatment facilities (e.g., Regional Treatment Centers, Rule 36 facilities and Rule 5 facilities).
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CAC conversion: Person eligible for Community Alternative Care (CAC) enrolls in a CAC Waiver immediately upon discharge from a hospital and was a resident of the hospital receiving Medical Assistance for the hospital services at least 30 days before accessing the waiver.
CAC diversion: Person who is eligible for the Community Alternative Care (CAC) and does not meet the criteria for a CAC conversion.
CADI conversion: Person eligible for Community Access for Disability Inclusion (CADI) enrolls in a CADI Waiver immediately upon discharge from a nursing facility and was a resident of the nursing facility receiving Medical Assistance for the nursing facility services at least 30 days before accessing the waiver.
CADI diversion: Person who is eligible for the Community Access for Disability Inclusion (CADI) and does not meet the criteria for a CADI conversion.
Care coordination: A service for people enrolled in Minnesota Senior Health Options (MSHO) and/or Minnesota Senior Care Plus (MSC+). It provides assessment and coordination of the delivery of all health and long-term care services among different health and social service professionals and across settings of care. Care coordination also includes waiver/AC case management responsibilities.
Caregiver – Primary: Person principally responsible for the care and supervision of the person.
Caregiver living expenses: Certain expenses incurred by a caregiver who lives in the same household as the person who receives waiver services when the caregiver also provides an approved service.
Caregiver training and education: See family training and counseling.
Carve out: Arrangement in which specific services are eliminated from health insurance coverage under a capitated rate. A person may then receive services on a fee-for-service basis.
Case management (waiver/AC): A service that provides a person and his/her family with access to assessment, person-centered planning, referral, linkage, support plan monitoring, coordination and advocacy related to waiver services, resources and informal supports that are not necessarily funded through the waiver.
Case management aide: Assists the case manager with administrative activities related to waiver case management services.
Case manager/care coordinator: Professional who assists with access to and navigation of social, health, education, vocational and other community and natural supports and services. This is based on the person's values, strengths, goals and needs. The professional is responsible to provide the person with information necessary for him/her to make informed choices.
Case mix classification: Classification of a person for the purposes of establishing payment levels that relies on a person's ability to complete certain activities of daily living (ADLs), his/her need for behavioral interventions and his/her need for clinical or nursing care. Case mix classification was developed as a payment system for nursing facilities, and it is used for establishing individual community budgets under various programs.
Category of service (COS): Three-digit code used to specify a specific type of service.
Centers for independent living (CILs): Service organizations designed to help people with disabilities achieve and maintain independent lifestyles. CILs are run by people with disabilities who themselves have successfully established independent lives and have a deep commitment to help other people with disabilities become more independent. There are eight CILs in Minnesota.
Centers for Medicaid & Medicare Services (CMS): Federal agency within the U.S. Department of Health and Human Services, previously known as the Health Care Financing Administration (HCFA). CMS administers the Medicare and Medicaid programs. CMS ensures states administer national health care programs properly, establishes policies for paying health care providers, conducts research on the effectiveness of various methods of health care management, assesses the quality of health care facilities/services and takes enforcement actions as appropriate.
Certified assessors – MnCHOICES: Individuals who complete assessments and planning services for people who need long-term services and supports using the MnCHOICES web-based application.
Child: Person younger than age 18.
Child and Teen Checkups (C&TC): Minnesota's Early Periodic Screening, Diagnosis and Treatment (EPSDT) program. See also EPSDT program.
Child foster care: Individual waiver services that provide ongoing residential care and supportive services in a home licensed as foster care. Child foster care services are provided to children younger than age 18 who cannot be cared for by their natural family. These services are individualized and based on the needs of the person.
Child welfare targeted case management (CW-TCM): Medical Assistance (MA) service that reimburses counties and tribal nations for case management activities provided by qualified case managers to children who receive Medical Assistance or MinnesotaCare. Reimbursement must be spent to develop and expand child welfare preventative services.
Chore services: Assistance provided to a person or his/her primary caregiver to help maintain a clean, sanitary and safe environment.
Cognitive rehabilitation therapy: Services and interventions designed to improve cognitive functions.
Commissioner: Commissioner of the Minnesota Department of Human Services.
Commissioner's designee: Person designated by the commissioner to work at the commissioner's direction.
Common carrier: Transportation provided by bus, taxicab, other commercial carrier or private automobile.
Common entry point (CEP): See Minnesota Adult Abuse Reporting Center (MAARC).
Community Alternative Care (CAC) Waiver: Home and community-based services necessary as an alternative to institutionalization that promote the optimal health, independence, safety and integration of a person who is chronically ill or medically fragile and who would otherwise require the level of care provided in a hospital.
Community Access for Disability Inclusion (CADI) Waiver: Home and community-based services necessary as an alternative to institutionalization that promote the optimal health, independence, safety and integration of a person who would otherwise require the level of care provided in a nursing facility.
Community inclusion: Situation in which people are not treated differently because of the color of their skin, their religion or because they have a disability. Community inclusion refers to people with and without disabilities living side by side in a city, town or neighborhood.
Community living assistance (CLA): Assistance and support to help a person live in the community.
Community living service categories: Broad service categories for providing support and training to help a person to live independently in his/her community. The community living service categories are:
Community residential setting: A licensed foster care setting where the license holder does not reside and everyone who lives in the setting is on the same disability waiver. This setting typically uses a shift-staff model of support (i.e., paid staff work shifts on a 24-hour basis).
Community Services Information System (CSIS): Software application designed for billing case management time, specific county/tribal nation-provided services billable to Medical Assistance (MA) and pay vouchers. It is also used as a state and local reporting system.
Community Social Services Act-CSSA: Repealed
Community support plan (CSP): A written summary completed for everyone who has an assessment, regardless of whether the person is eligible for Minnesota Health Care Programs or chooses to receive publicly funded home and community-based or state plan services. The document is a person-centered summary of what the assessor discovered through the assessment process and identifies next steps based on the person's needs.
Community Support Services (CSS): A service under DHS Direct Care and Treatment Division's Community-Based Services. (CBS). CSS are short-term services designed to:
Community Support Services (CSS) crisis home: Residential setting in which staff provide short-term services to people who need residential crisis stabilization. Crisis home staff use positive supports to help people return to successful, integrated community living.
Community Support Services (CSS) mobile team: At least two staff members with experience and training in behavior analysis, social work, psychology, nursing and/or organization development and training. CSS mobile teams address behavioral crises in people's current settings whenever clinically appropriate and safely possible.
Companion services: Non-medical care, supervision and socialization provided to a person age 18 or older.
Competitive, integrated employment: Employment situation in which a person's wages are at least minimum wage or at the industry's standard with comparable benefits (e.g., health insurance, leave time, etc.).
Compound (medication): A prescription prepared in accordance with Minn. R. 6800.3100.
Conciliation conference (case management): An alternative way to solve a grievance a person with a developmental disability or related condition has with his/her case management services. During a conciliation conference, the people involved try to resolve the conflict with a mediator in an informal setting.
Conflict of interest: Financial or proprietary interest in a situation that could cause injury or damage to the person or limit the person's choices.
Conservatorship: Court procedure in which a court appoints a person (i.e., conservator) to manage another person’s assets and estate.
Consumer: A person who use products, goods and services.
Consumer choice: Ability to choose supports and services from a range of service options to meet the diverse and personalized needs of a person. A person's choice in services and supports must go beyond the range of service choices and include opportunities for the person to decide when, where, how and who will provide supports and services.
Consumer directed community supports (CDCS): Service option available to people on the home and community-based services (HCBS) waivers and Alternative Care (AC) program. CDCS gives a person flexibility in service planning and responsibility for self-directing his/her services, including hiring and managing support workers. CDCS may include traditional services and goods and self-designed services.
Consumer direction: Philosophy through which people make informed choices about the services they receive. Consumer direction provides people flexibility and responsibility to direct their own services and supports.
Consumer records: Include information about the person such as name, gender, birth date, home address, telephone number where parents or legal representative may be reached and emergency numbers. Other types of consumer records include admission forms, health forms (e.g., records for immunizations, physicals, dental exams, etc.) assessments, support plans, education plans and abuse prevention plans.
Consumer Support Grant (CSG): A program that is a state-funded alternative to the following Medical Assistance home care services:
Consumer training and education: Training and education to help a person with developmental disabilities gain skills to exercise control and responsibility over the supports he/she receives, develop self-advocacy skills and exercise his/her civil rights.
Coordinated services and supports plan (CSSP): A summary of a person's choice of supports and/or services if the person chooses to receive publicly funding home and community-based services and/or state plan services.
Corporate foster care moratorium: The 2009 Minnesota Legislature authorized a moratorium on the growth of licensed adult and child corporate foster care and community residential settings. Effective Sept. 1, 2009, the legislature established a statewide capacity threshold for the duration of the moratorium. This threshold is based on results of an ongoing needs-determination process.
Corporate foster care setting: A licensed foster care setting where the license holder does not reside. This setting typically uses a shift-staff model (i.e., paid staff work shifts on a 24-hour basis).
County government: Government directly under the state level. In Minnesota, the county is typically responsible for the administration of various social services programs.
County of financial responsibility (CFR): County responsible for payment of a person’s social services. The CFR is typically the county of residence.
County of residence: The county where the person resides.
County/tribal worker: Employee of a county/tribal nation who determines eligibility and approves/monitors a person’s support plan. The county/tribal worker may help with planning and be the service coordinator if the person chooses.
Crisis respite: Short-term care and intervention strategies provided to a person due to:
Customized living: An individualized package of regularly scheduled, health-related and supportive services provided to a person who resides in a qualified, registered housing with services establishment.
Customized living (24-hour): Customized living services provided with 24-hour supervision.
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Day habilitation: Services focused on enabling the person to attain or maintain his or her maximum functional level. Services are coordinated with any physical, occupational or speech therapies listed in the plan of care. Day habilitation services may serve to reinforce skills or lessons taught in school, therapy or other settings.
Day training and habilitation (DT&H): Services that develop and maintain life skills for people with developmental disabilities or related conditions so they can participate fully in community life.
DD conversion: A person in an existing ICF/DD bed is provided home and community-based services and the ICF/DD bed the person previously occupied is decertified and removed from the community ICF/DD system.
DD diversion: Ability to serve additional people on the DD Waiver without decertifying an ICF/DD bed.
Declaration of professional practice: Contract between Successful Life Project and a service provider (or another party) that outlines each of their responsibilities.
Deeming: To count the income or assets of a parent (when determining the eligibility for a child) or a spouse (when determining eligibility for a spouse). If a person has a waiver of deeming, family income and assets are not included when eligibility is determined for the individual. Eligibility is based only on the income and assets of the applicant and not on the income and assets of the household (e.g., in TEFRA cases, parental income is not deemed to the child).
Deficits in adaptive behavior: Significant limitation in a person's effectiveness in meeting the standards of maturation, personal independence and social responsibility expected for the person's age level and cultural group, as determined by clinical assessment and, generally, standardized scales.
Department of Human Services (DHS): State agency that provides and administers health care coverage, economic assistance and a variety of services for children, people with disabilities and older adults.
Designated billing person (PCA services): Person responsible to ensure claims are billed according to DHS policies and procedures.
Developmental Disabilities (DD) Waiver: Home and community-based services necessary as an alternative to institutionalization that promote the optimal health, independence, safety and integration of a person who meets the waiver eligibility criteria and who would require the level of care provided in an intermediate care facility for persons with developmental disabilities.
Developmental disability (DD): Severe, chronic disability attributed to mental and/or physical impairment that manifests before age 22 years and is likely to continue indefinitely. The disability results in substantial limitations in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living and economic self-sufficiency, as well as the continuous need for individually planned and coordinated services.
Developmental disability (DD) screening: An assessment for a person with a diagnosis of developmental disability or a related condition to evaluate the level of care he/she needs.
Diagnosis-Related Group (DRG): Classification of procedures used to sort hospital patients by discharge diagnosis into categories that are medically similar and have approximately equivalent lengths. DRGs are utilized by Medical Assistance (MA), General Assistance Medical Care (GAMC) and the Community Alternative Care (CAC) Waiver.
Direct service: Intervention services delivered by the provider through face-to-face contact with the person.
Disability: Inability to engage in substantial gainful activity by reason of any medically determined physical or mental impairment that can be expected to last for a continuous period of not less than 12 months. To be eligible for one of the waiver programs, the Social Security Administration or the State Medical Review Team (SMRT) must certify the person as disabled.
Disability determination: Person must meet the disability definition from the Social Security Administration to be eligible to receive Medical Assistance benefits as a person who has a disability. A person may also be certified disabled by the Social Security Administration or State Medical Review Team (SMRT).
Disability Hub MN: A neutral, statewide access point for disability-related assistance and expertise.
Disability Services Division (DSD): Division of the Minnesota Department of Human Services responsible for the management of publicly funded programs that support people with a wide variety of disabilities and chronic illnesses.
Disability Waiver Rate System (DWRS): An initiative that determines individualized payment rates for certain Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Developmental Disabilities (DD) waiver services. DWRS divides disability waiver services into three categories:
Diversion: Ability to serve all people eligible for a waiver who do not meet criteria for waiver conversion.
DSD Resource Center: Help desk that provides technical assistance to counties, tribal nations, managed care organizations and DHS staff for the Medicaid Management Information System (MMIS) in the areas of chemical health, developmental disabilities, home and community-based services and long-term care.
DSM-IV Code: Diagnostic and Statistical Manual of Mental Disorders codes used to describe mental health conditions and symptoms.
Due process: Process mandated by the Individuals with Disabilities Education Act (IDEA), by which parents of children who have disabilities and public agencies can challenge decisions made by a public school system about the evaluation, placement or services for children with special needs.
Durable medical equipment (DME): Prescribed medical equipment (e.g., wheelchair, hospital bed, respirator) that a person can use for an extended period of time.
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Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program: Comprehensive child health program provided to people who are younger than age 21 and receive services through Minnesota Health Care Programs (MHCP). The EPSDT program aims to reduce the impact of childhood health problems by identifying, diagnosing and treating health problems early. Minnesota's EPSDT program is called Child and Teen Checkups (C&TC).
Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit: A Minnesota Health Care Program for people who:
Edit: See MMIS exception code.
Elderly Waiver (EW): Program that funds home and community-based services for people age 65 years and older who are eligible for Medical Assistance (MA), require the level of medical care provided in a nursing home and choose to reside in the community.
eDocs: DHS' document library that contains forms and documents in multiple languages.
eList: An electronic mailing that is a resource for counties, tribal nations, managed care organizations and stakeholders.
Emergency assistance (24-hour): On-call counseling and problem solving and/or immediate response for assistance at a person's home due to a health or personal emergency.
Emotional disturbance (ED): A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:
Employer Identification Number (EIN): Nine-digit number the Internal Revenue Service (IRS) assigns to an entity to identify business taxpayers.
Employer of Record (EOR): See financial sector support.
Employment development services: Individualized services designed to help a person achieve competitive, integrated employment, become self-employed or establish a microenterprise business in his/her community.
Employment exploration services: Services that help a person gain a better understanding of competitive, integrated employment opportunities in his/her community. Exploration activities and experiences strengthen a person's knowledge, interests and preferences so he/she can make informed decisions about competitive employment.
Employment support services: Individualized services and supports that help people maintain paid employment in community businesses/settings. Employment support services occur in integrated community settings.
Enhanced rate or budget for PCA, CDCS and CSG: A higher reimbursement rate or budget for work that is both:
Entitlement program: Federal program that guarantees a certain level of benefits to people who meet the eligibility requirements set by law. Examples of entitlement programs include Social Security, unemployment benefits and Medicaid. Home and community-based waiver services are not considered entitlement programs.
Enteral nutritional product: Commercially formulated substance administered via tube that provides nourishment.
Environmental accessibility adaptations (EAA): Physical adaptations to a person's primary home or primary vehicle to ensure his/her health and safety or that enable him/her to function with greater independence.
Environmental modifications and provisions (CDCS): Services and supports to help people maintain their environment so they can live and participate in the community.
Essential Community Supports: Community-based services for people who do not meet nursing facility level of care criteria.
Experimental treatment: Drugs, therapies or treatments that are unproven, have been confined largely to laboratory use or have progressed to limited human application and trials but lack widespread recognition from the scientific community as a proven and effective measure of treatment (Minn. R. 9525.3015, subp. 16).
Extended home care services: Additional home care services beyond the amount, duration and scope the state plan allows.
Extended personal care assistance (PCA) on a waiver: Additional PCA time beyond what state plan PCA allows. This service is authorized based on a need for increased duration or frequency of PCA care than the state plan allows for a person's assessed dependencies.
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Fair hearing: The meeting with the appellant, DHS, county/tribal nation and a human services judge to testify about the disputed decision. This meeting can be in person or via phone.
Family adult day services (FADS): Adult day services provided in a license holder's primary residence. The license holder must be the primary FADS provider. This setting is typically a family foster care setting.
Family caregiver coaching and counseling with assessment (Alternative Care and Elderly Waiver): An individualized, person-centered service intended to equip the caregiver with knowledge, skills and tools to become a stronger caregiver capable of self-directed care.
Family Community Supports Services (FCSS): Services available to a person under age 18 years who has been determined by diagnostic assessment to have a severe emotional disturbance (SED) or, if between the ages of 18 and 21 years, has been determined to have a serious and persistent mental illness (SPMI).
Family memory care (FMC): Coaching and counseling service for a caregiver who lives with a family member or friend with dementia. The goal of FMC is to improve a caregiver's ability to withstand the difficulties of caregiving by improving social support and minimizing family conflict.
Family Support Grant (FSG): A statewide program that provides cash grants to eligible families with children who have been certified disabled. The program:
Family training and counseling: Services provided for the person and/or the family as identified in the support plan.
Federal financial participation (FFP): Federal government’s contribution toward Medicaid services. FFP is dependent on the state’s guarantee of assurances under its Medicaid and waiver plans.
Federal government: Government of the United States. Federal laws and regulations apply to all states.
Federal poverty guidelines (FPG): Index of poverty in the United States that is updated annually. FPG is used to determine financial eligibility for certain federal programs.
Fee-for-service (FFS): Payment to a provider for the provision of services on a service-by-service basis.
Financial management services (FMS): Services that provide help with financial tasks, billing and employer-related responsibilities for people self-directing their services. These services are provided by financial management services (FMS) providers.
Financial management services (FMS) provider: A Minnesota Health Care Programs (MHCP)-enrolled organization that people use to help them with employer-related responsibilities and financial management service tasks.
Financial sector supports: Services that help people on a waiver manage and distribute funds contained in an individual budget. Financial sector support providers must be knowledgeable of and comply with Internal Revenue Service (IRS) requirements necessary to process employer and employee deductions and provide appropriate and timely submission of employer tax liabilities.
Fiscal support entity (FSE): A Medical Assistance-enrolled provider that people use to help them with consumer directed community supports employer-related responsibilities. DHS is in the process of transitioning from FSEs to financial management services (FMS) providers.
Fiscal year (FY): State’s budgetary year that goes from July 1 through the following June 30.
Foster care: Individual waiver services that provide ongoing residential care and supportive services to people living in a home licensed as foster care. These services are individualized and based on the needs of the person.
Fraud: Act that is intentional, unlawful or has an element of false representation.
Functional behavior assessment: Assessment of a person to better understand the purpose or reason for his/her interfering behaviors.
Functional status: Ability to carry out the tasks associated with daily living.
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General Assistance Medical Care (GAMC): A state health care program for low-income Minnesotans who do not qualify for Medical Assistance (MA) or other state and federal health care programs.
Generic services: Services offered or available to the public that are common to all and are not restricted to a special category of people.
Group Residential Housing (GRH): Former name for the Housing Support program.
Guardian Ad Litem: A person appointed by the court to be an advocate for a child who is involved in court proceedings.
Guardianship: Court-ordered or confirmed protective arrangement whereby an interested person or party is nominated and appointed as a guardian for an incapacitated person for the purpose of managing the personal care and affairs of a person.
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Habilitation: Services designed to help people acquire, retain and improve the self-help, socialization and adaptive skills necessary to live successfully in home and community-based settings.
Healthcare Common Procedure Coding System (HCPCS): Set of health care procedure codes based on Current Procedural Technology (CPT) codes. HCPCS provides a standardized coding system to describe specific items and services provided in the delivery of health care.
Health Care Financing Administration (HCFA): Former name for Centers for Medicare & Medicaid Services (CMS).
Health care professional: Licensed professional who, within his/her scope of service or practice, can review and approve care plans for people with overriding health needs.
Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule: Federal law that provides individuals with rights over their health information and sets rules and limits on who can look at and receive personal health information.
Health Insurance Portability and Accountability Act (HIPAA) Security Rule: Federal law that protects health information in electronic form and requires entities covered by HIPAA to ensure electronic protected health information is secure and the confidentiality provisions of the Patient Safety Rule are enforced.
Health maintenance organization (HMO): Organization that provides an agreed-upon set of basic and supplemental medical services to an enrolled group of people in a particular geographic area. The HMO is reimbursed for those services through a predetermined and fixed periodic payment made by or on behalf of each person or family enrolled in the HMO, regardless of the amount of services provided.
Health service: Service or treatment consistent with the health needs of a person eligible for Medical Assistance payments under Minnesota Statutes (e.g., medication administration and monitoring, medical, dental, nutritional, health monitoring, wellness education and exercise).
Health-related procedures and tasks (PCA services): Procedures and tasks performed by a personal care assistant (PCA) that can be delegated or assigned by a licensed health care professional under state law.
Hearing: See fair hearing.
HIPAA: See Health Insurance Portability and Accountability Act.
Home and community-based services (HCBS) waiver: Services not normally covered by Medical Assistance that are covered under a 1915(c) federally funded waiver program or through state funds. HCBS waivers allow states flexibility to cover virtually all long-term care services that people with disabilities need to live independently in home and community settings. States may operate several 1915 (c) HCBS waiver programs at once, each offering a distinct package of services and supports to different groups of people.
Home and community-based services model contract: Written legal document that applies to home and community-based services and supports identified in the person’s service plan and provided through the HCBS disability waivers.
Home-based mental health service (HBMHS): Rehabilitative mental health service package that includes skills training (individual, family and group) and psychological services.
Home care: Medical and health-related services and assistance with day-to-day activities for people in their homes. Home care can provide short-term care for people moving from a hospital or nursing home back to their home, or it can provide continuing care for people with ongoing needs.
Home care nursing (HCN): Provision of professional nursing services to a person in or outside his/her home when normal life activities take the person outside the home (e.g., school). Services are based on an assessment of the person's medical/health care needs.
Home care nursing (HCN) hardship waiver: Allows parents/family foster parents of minor children, legal guardians or spouses to provide home care nursing to a person who is eligible for Medical Assistance and authorized to receive home care nursing services.
Home care therapies: Therapies provided in a person's home to improve or maintain a person's functioning. Home care therapies include physical, occupational, speech-language pathology and respiratory therapies.
Home-delivered meals: Appropriate, nutritionally balanced meals delivered to a person’s home.
Home health agency services: Services delivered by a home health agency to a person with medical needs due to illness, disability or physical conditions in the person's place of residence or in the community where normal life activities occur.
Home health aide: A qualified employee of a home health agency who completes medically oriented task(s) that maintain health or facilitate treatment of an illness or injury. Home health aide services may be provided in a person's place of residence or in the community where normal life activities occur.
Home health therapies: Therapies provided in a person's place of residence or in the community where normal life activities occur. These therapies improve or maintain a person's functioning and include physical, occupational, speech-language pathology and respiratory.
Homemaker: Services that help a person manage general cleaning and household activities. There are three homemaker services:
Hospice: Palliative and supportive care for people who are terminally ill and their families to meet the physical, nutritional, emotional, social, spiritual and special needs experienced during the final stages of illness, dying and bereavement.
Host county: County in which the services set forth in a person's support plan are provided. If supported employment or community integration services are provided in a setting outside the county where the license holder is located, the county where supported employment services are provided is not considered to be the host county.
Host county concurrence: If services are to be provided in a county other than the county of financial responsibility, the county of financial responsibility must request concurrence from the county where services are to be provided. Concurrence must be granted or deemed under Minnesota Statute for all services to be provided. .
Housing access coordination: A waiver service that helps a person plan for, find and move to his/her own home. It is a pay-for-performance, person-centered service that pays for staff assistance based on the results achieved. A provider is reimbursed for actual time spent helping a person get housing.
Housing Support program: Program that pays for room and board for older adults and adults with disabilities who have low incomes. The program aims to reduce and prevent people from living in institutions or becoming homeless. Housing Support was formerly known as Group Residential Housing (GRH).
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ICD-9-CM: See International Classification of Diseases, 9th Edition, Clinical Modification code.
Inclusion: When people with disabilities are in the same place as people without disabilities and participate in the same activities at the same time. See also community inclusion.
Independent living skills (ILS) therapies: Art, music or recreational therapies with specific therapeutic goals and outcomes.
Independent living skills (ILS) training: Services that develop, maintain, and improve the community living skills of a person.
Individual community living supports (ICLS): Bundled service that includes six service categories. ICLS services offer assistance and support for people who need reminders, cues, intermittent/moderate supervision or physical assistance to remain in their own homes.
Individual Education Program (IEP): A plan that outlines special education and related services for children who have been evaluated and are in need of special education. IEP services are based on information gathered from evaluations, state and district assessments and current levels of achievement on IEP goals and in the general education curriculum.
Individual provider: A service provider who is not employed by an agency, organization or other type of provider business entity.
Individual Interagency Intervention Plan (IIIP): Single, written plan designed to be used in place of multiple plans (Individual Service Plan, Individual Education Program and Individualized Family Service Plan) that describes services and payment arrangements for children who are eligible. The purpose of the IIIP is to ensure the development of a coordinated, multi-disciplinary, interagency intervention system for children and young adults with disabilities ages 3 to 21 years.
Individual Service Plan (ISP): Each person with developmental disability or a related condition who receives services must have an ISP. The ISP is developed after an assessment of the person’s preferences, functional skills and need for services and supports, and it is completed before services are authorized. The ISP is based on the service recommendations from the completed assessment(s) and the service needs identified by the team.
Individualized Family Service Plan (IFSP): A plan for providing services to a child and the child’s family through interagency agreements. Procedural and program requirements for the Individual Education Program (IEP) also apply to the educational components of the IFSP. The purpose of the IFSP is to provide family-centered programs for infants and toddlers up to 3 years of age with disabilities. The IFSP may substitute for the Individual Service Plan (ISP).
Individualized home supports (IHS): Services providing support and training in community living service categories for a person who lives in his/her own home. IHS can be provided in the person's own home or in public community settings and either in person or remotely.
Individuals with Disabilities Education Act (IDEA): Federal law that makes available a free, appropriate public education to eligible students with disabilities throughout the nation and ensures special education and related services are provided to those students.
Informed choice: A choice a person makes that is based on his/her likes, dislikes, community-based experiences, the potential impact on his/her quality of life and information about other available options he/she receives from his/her support system.
In-home family supports: Services provided to a person and his/her family (including extended family members) in the family's home to enable the person to remain in or return to the home. This includes training of the person and family members to increase their capabilities to care for and maintain the person in the home.
In-home respite: Respite provided in the person's home or place of residence. See also respite.
Instrumental activities of daily living (IADLs): Meal planning and preparation, managing finances, shopping for food, communication by telephone and other media, getting around and participating in the community.
Intermediate care facility for persons with developmental disabilities (ICF/DD): Residential facility licensed as a health care institution and certified by the Minnesota Department of Health to provide health or rehabilitative services for people with developmental disabilities or a related conditions who require active treatment.
International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9) code: Codes to describe medical conditions and symptoms.
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Lead agency: A county, tribal nation or managed care organization.
Lead investigative agency (LIA): Primary administrative agency responsible for responding to Minnesota Adult Abuse Reporting Center (MAARC) reports using prioritization guides for investigation. The LIA is determined by the relationship between the alleged perpetrator and a licensed service. The LIA can be the county, Office of the Inspector General or the Minnesota Department of Health Office of Health Facility Complaints.
Lease: A legal agreement between a landlord and tenant. It outlines the responsibilities of each party.
Least restrictive alternative: Alternative that is the least intrusive and most normalized given the level of supervision and protection the person requires. This level of supervision and protection allows risk-taking to the extent that there is no reasonable likelihood that serious harm will happen to the person or others.
Least restrictive environment: Environment where services:
Legal guardian: A person with legal authority and duty to act on behalf of another person. The legal guardian can make decisions for the person about where to live, medical treatment, training and education, etc. Decision-making is limited to the specific powers the court assigns to the legal guardian.
Legal representative: Parent(s) of a person younger than age 18, guardian, conservator, guardian ad litem (authorized by the court) or other representative legally authorized to act on behalf of a person, including the right to make decisions about services for the person.
Level of care (LOC): A particular amount of care and services required to meet a person's needs. There are four level of care distinctions:
Licensed provider: Provider who chooses to participate in Minnesota Health Care Programs (MHCP) and who meets professional requirements and/or licensure requirements as set forth in applicable state and federal laws and regulations.
Limited English proficiency (LEP): A person with limited English proficiency (LEP) does not speak English as his/her primary language and has a limited ability to speak, read, write or understand the English language. well enough to allow him/her to interact effectively with health and social services agencies and other providers.
Limited English Proficiency (LEP) program (DHS): Provides spoken and written language assistance services to people who limited English skills prevent them from accessing health and human services.
Live-in caregiver expenses: See caregiver living expenses.
Long-term care consultation (LTCC): A service designed to help people make decisions about long-term care needs and choose services and supports that reflect their needs and preferences.
Long-term care consultation (LTCC) team: A multidisciplinary team established by the county board of commissioners or through tribal nation/managed care contracts with DHS. Each local team must include at least one social worker and one nurse. The social worker, public health nurse or registered nurse can provide a component of the LTCC and then consult with one another to determine the most appropriate care for the person. Two or more counties/tribal nations may collaborate to establish a joint, multidisciplinary team.
Long-term care/long-term support services: Services that a person will likely need for the rest of his/her life.
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Maltreatment: May include physical, mental or emotional abuse; financial exploitation; caregiver neglect of a person's needs (e.g., food, shelter, clothing, education, health, supervision); or a vulnerable adult's neglect of his/her own needs.
Maltreatment of Minors Act: Establishes a system for reporting possible child abuse and neglect to government agencies that provide protective services for the child or conduct criminal investigations.
Managed care: Health care delivery system that includes pre-established provider networks and reimbursement arrangements, administration and clinical systems.
Managed care organization (MCO): An organization certified by the Minnesota Department of Health to provide all defined health care benefits to people enrolled in a Minnesota Health Care Program (MHCP) in return for a capitated payment. MCOs are also referred to as health plans or prepaid health plans.
Managing employee (PCA services): General manager, business manager, administrator, director or other individual who exercises operational or managerial control over or who directly/indirectly conducts the day-to-day operation of personal care services for an institution, organization, or personal care provider agency. This does not include managing employees who solely manage non-PCA areas of the business.
Mandated reporter: Professionals required to report suspected maltreatment of a vulnerable adult (e.g., social service professionals, law enforcement, educators, professionals who care for vulnerable adults, providers licensed by DHS or Minnesota Department of Health, enrolled Medical Assistance providers, medical examiners, coroners, lead investigative agencies).
Marketing: Presentation of products or services in such a way as to make them desirable.
MAXIS: System that processes information to determine eligibility for public assistance programs and mails benefits and notices to people who receive public assistance. MAXIS is not an acronym; the letters do not stand for anything in particular. Eligibility information for Medicaid and General Assistance Medical Care (GAMC) is passed through to the Medicaid Management Information System (MMIS).
Medicaid: A jointly funded, federal-state health insurance program for people who have a low income or other needs. It covers children, people who are older, people who have disabilities and others who are eligible to receive federally assisted income maintenance payments. Minnesota's Medicaid program is called Medical Assistance. See also Medical Assistance.
Medicaid Management Information System (MMIS): A mechanized claims-processing and information-retrieval system for Medicaid. The federal government requires all states operate an MMIS to support Medicaid business functions and maintain information in several areas (e.g., provider enrollment, eligibility, benefit package maintenance, managed care enrollment, claims processing, prior authorization).
Medicaid Waiver – 1115: This notation refers to section 1115 of the Social Security Act that gives the U.S. Department Health and Human Services (HHS) the authority to waive certain Medicaid laws to allow states flexibility in designing their Medicaid programs. These waivers are also known as research and demonstration waivers.
Medicaid Waiver – 1915(c): This notation refers to section 1915(c) of the Social Security Act that gives the Health Care Financing Administration (HCFA) the authority to waive federal Medicaid requirements to allow states to experiment with providing health care services in home and community-based settings instead of institutional settings (e.g., hospitals, nursing facilities). These waiver services, often called home and community-based waivers, include day treatment, habilitation, supported employment, respite care, semi-independent living services and adaptive equipment. Waivers may also allow reimbursement for services not usually covered by Medicaid but are provided to help a person stay out of an institution.
Medical Assistance (MA): Minnesota's name for the federal Medicaid program that provides medical care for people with low incomes.
Medical Assistance for Employed Persons with Disabilities (MA-EPD): Minnesota Health Care Program (MHCP) that allows people with disabilities to qualify for or keep their Medical Assistance while working.
Medical Assistance Rehabilitation (Rehab) Option: Includes two sets of mental health services that expand support and intervention services in the community:
Medical Assistance under the TEFRA option: An option for children with disabilities who are otherwise ineligible for Medical Assistance because household income is about the Medical Assistance for Families with Children and Adults (MA-FCA) income limit. The TEFRA option for children with disabilities is named after the Tax Equity and Fiscal Responsibility Act (TEFRA) that created the option.
Medically necessary/medical necessity: Health service that is consistent with a person’s diagnosis or condition and is recognized as the prevailing medical community standards or current practice by the provider’s peer group and is rendered according to one of the following:
Medicare: Federal health insurance program administered by the U.S. Department of Health and Human Services under the Centers for Medicare & Medicaid Services (CMS) for people who:
Medicare-certified home health agency (HHA): Private or public organization that provides skilled nurse visits, home health aide visits, therapies and medical supplies. An HHA is required to meet all federal, state conditions of participation and sign an agreement with Medicare and Medicaid to furnish home health services according to a plan of care for a person.
Mental health targeted case management (MH-TCM): See adult mental health targeted case management (MH-TCM).
Mental illness: Organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory or behavior.
Metro Crisis Coordination Program (MCCP): A collaborative effort among the seven metropolitan counties: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington. MCCP provides a range of crisis safety net services for people with developmental disabilities and related conditions.
Microenterprise business: A commercial business with five or fewer employees, including the owner of the business.
Minnesota Adult Abuse Reporting Center (MAARC): Minnesota's centralized 24-hour hotline for reporting suspected abuse, neglect or exploitation of vulnerable adults. If law enforcement or a lead investigative agency receives an adult maltreatment report, the agency must forward the report to the MAARC immediately. The MAARC immediately refers cases involving an identified safety need to county social services. The MAARC notifies the lead investigative agency responsible for report review and investigation within two working days.
MinnesotaCare: A health care program for Minnesotans with low incomes. People who are enrolled in MinnesotaCare get health care services through a health plan. MinnesotaCare is funded by a state tax on Minnesota hospitals and health care providers, Basic Health Program funding and enrollee premiums and cost sharing.
Minnesota Children and Youth with Special Health Needs (CYSHN): Collection of public programs administered by the Minnesota Department of Health (MDH) that works to achieve public health policies that will provide more positive health outcomes and better serve children and youth with special health needs and their families throughout Minnesota.
Minnesota Department of Health (MDH): State agency whose mission is to protect, maintain and improve the health of all Minnesotans.
Minnesota Disability Law Center (MDLC): The designated Protection and Advocacy system (P&A) for Minnesota. MDLC addresses the unique legal needs of Minnesotans with disabilities. MDLC provides free legal assistance to people with disabilities statewide on legal issues related to their disabilities. All people with disabilities are eligible to receive help, regardless of age or income level.
Minnesota Family Investment Plan (MFIP): Minnesota's welfare reform program for low-income families with children. MFIP helps families and children with basic needs while helping parents move to financial stability through work. Parents are expected to work and are supported in working with both cash and food assistance.
Minnesota Health Care Programs (MHCP): DHS-administered programs that include:
Minnesota Intensive Therapeutic Homes (MITH): A service line under the DHS Direct Care and Treatment Division's Community-Based Services. MITH services are provided in family foster homes and represent an add-on service over-and-above regular foster care. MITH cannot provide hospital level of care for a medical condition or psychiatric illness.
Minnesota Life Bridge (MLB): A residential treatment program for people with developmental disabilities or related conditions who exhibit severe behaviors that pose a risk to public safety. MLB is part of Community Support Services (CSS), which is a service line under the DHS Direct Care and Treatment Division's Community-Based Services (CBS).
Minnesota Senior Care Plus (MSC+): A mandatory prepaid Medical Assistance (MA) program for people age 65 years and older.
Minnesota Senior Health Options Program (MSHO): A voluntary Minnesota Health Care Program for people age 65 years and older who are enrolled in Medical Assistance (MA) and Medicare Parts A and B.
Minnesota State-Operated Community Services (MSOCS): A service line under the DHS Direct Care and Treatment Division's Community-Based Services (CBS). MSOCS includes both residential and day training and habilitation (DT&H)/vocational services.
Minnesota Unitary Residency and Financial Responsibility Act: Rules about county residence that determine county of financial responsibility and county of service.
MMIS exception code: Three-digit numeric code that Medicaid Management Information System (MMIS) uses when information entered into MMIS is invalid or needs review.
MMIS Resource Center: A help desk that provides technical assistance to counties, tribal nations, managed care organizations and DHS staff for the Medicaid Management Information System in the following areas:
MnCHOICES: A web-based application tool for conducting and creating person-centered assessments and support plans. It helps people with long-term or chronic care-needs make decisions about their care. MNCHOICES includes two electronic tools:
MnCHOICES certified assessor: Individual who completes assessments and planning services for people who need long-term services and supports using the MnCHOICES web-based application.
Modifications and adaptations: Physical adaptations to a person’s home and/or vehicle.
Monitoring technology supervision: The use of equipment to oversee, monitor and supervise someone who receives waiver/Alternative Care services. It can help keep people safe and support independence. The equipment used may include alarms, sensors, cameras and other devices.
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Neurobehavioral hospital (NBH): A rehabilitation hospital that provides specialized services to people with neurological-based, significant cognitive and severe behavioral impairments.
Neurobehavioral hospital (NB) level of care: Includes specialized therapies and supports for people with brain injuries who exhibit significant cognitive and severe behavioral impairments requiring intensive behavior intervention or support. The Brain Injury (BI)-NB Waiver requires a person to have an NB level of care.
New Freedom Initiative: A comprehensive plan, announced by President Bush on February 1, 2001, that represents an important step in working to ensure that Americans have the opportunity to learn and develop skills, engage in productive work, make choices about their daily lives and participate fully in community life.
Night supervision: Overnight assistance and monitoring provided by an awake staff in the person's own home.
Normalization: Making the typical patterns and conditions of everyday life available to people with developmental disabilities or related conditions.
Notice of action: Document used by the certified assessor or case manager/planner to inform a person that the county/tribal nation has made a decision about his/her services and will take an action that affects them.
Nursing facility (NF): Facility licensed to provide nursing care for people who need long-term care.
Nutrition counseling (Alternative Care): One or more individual sessions to advise and assist people on appropriate nutritional intake. Nutrition counseling includes assessment of a person's nutritional needs that results in an individualized plan with goals and follow-up on established goals.
Nutrition education (Alternative Care): One or more individual or group sessions that provide formal and informal opportunities for people to gain knowledge and skills in managing their diet and nutritional needs.
Nutrition services (Alternative Care): Services that include nutrition education and nutrition counseling to address an older adult's nutritional needs. The goal of these services is to improve or maintain a person's nutritional status and improve or maintain a person's nutritional status and improve management of his/her chronic diseases or conditions.
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Olmstead decision: 1999 decision by the U.S. Supreme Court concerning two women from Georgia that played a major role in the expansion of consumer-directed services in Minnesota as well as other states. Because of the decision, called Olmstead v. L.C., all public entities are required to administer programs “in the most integrated setting appropriate to the needs of qualified persons with disabilities.”
Ombudsman: Independent governmental official who hears and investigates complaints from private citizens against government and government-regulated agencies.
Omnibus Budget Reconciliation Act (OBRA) 1987: Federal law that mandates the screening and review of all people with a diagnosis or suspected diagnosis of developmental disability or a related condition who seek admission to a nursing facility, regardless of the source of payment for the nursing facility services.
Oral nutritional product: Commercially formulated substance taken by mouth that provides nourishment.
Outcome: Benefit of services or supports as defined by the person who receives them.
Out-of-home respite: Respite provided outside of the person's home or place of residence. See also respite.
Over-the-counter medication: Drug/medication that can be purchased without a prescription (e.g., Prilosec OTC, vitamins).
Overriding health care needs: A health care condition that affects the service options available to the person because the condition requires both:
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Patient Safety Rule, subpart C: Federal law that describes confidentiality protections, which protect identifiable information being used to analyze patient safety events and improve patient safety.
Permanent fifth bed: Licensed under home and community-based services (HCBS) waiver plan funding policy and DHS licensing statute to allow home and community-based settings licensed for adult corporate foster care to increase to a fifth bed on a permanent basis.
Person Master Index (PMI) number: A unique identification number that MAXIS assigns to a person.
Person-centered planning (PCP): Process focusing on a person and what they want for the future. There are many different approaches to person-centered planning.
Person-centered practices and principles: A way of ensuring people who receive supports and services have the same rights and responsibilities as other people. This includes having control over their lives, making their own choices and contributing to the community in a way that makes sense for themselves. Person-centered practices include:
Personal assistance (CDCS): Consumer directed community supports service category that includes services to help a person with his/her activities of daily living (ADLs) and instrumental activities of daily living (IADLs) through hands-on assistance, cues, prompts and instruction.
Personal care assistance (PCA): Services to help a person with day-to-day activities in their home and community to help maximize his/her independence.
Personal care assistance (PCA) assessment: A review and evaluation of a person’s need for PCA services.
Personal care assistance (PCA) care plan: A written description identifying the PCA services to be delivered to a person based on the PCA Assessment and Service Plan, DHS-3244 (PDF).
Personal Care Assistance (PCA) Choice option: Option in which the person is responsible for hiring, training, scheduling and terminating his/her personal care assistants.
Personal Care Assistance (PCA) Choice provider: Serves in a fiscal intermediary role with the person and his/her staff and for financial management tasks.
Personal care assistance (PCA) time and activity documentation: A written document recording PCA services provided to a person.
Personal care assistant: Individual employed by a personal care assistance provider agency, enrolled by DHS and provides personal care assistance services.
Personal emergency response system (PERS): An electronic device typically worn as a pendant or bracelet that includes an alert or panic button. The person can press the alert or panic button in the event of a fall or other emergency.
Personal support: Services provided in a person's home or community to:
Place of residence: The following are considered a person’s place of residence:
Plan of care – 24-hour: Written plan that provides access to direct or indirect supports 24 hours a day.
Positive behavior support plan (Successful Life Project): Plan to help all caregivers provide the same behavior support on a consistent basis. It is based on a functional behavior assessment and includes person-centered practices (e.g., understanding the strengths, preferences and interests of the person).
Positive behavior support system evaluation tool (Successful Life Project): Assessment tool used by Successful Life Project staff that provides a brief snapshot of a person's health, safety, quality of life and person-centered positive behavior supports.
Positive supports: Strategies used to increase quality of life and decrease challenging behavior. These strategies teach new life skills and change a person's environment.
Prepaid health plan (PHP): See managed care organization.
Prescription drugs: For purposes of the CAC Waiver, a prescription drug:
Prevocational services: Services that prepare people with disabilities for jobs with competitive pay and help them achieve greater independence in their community. Prevocational services teach general work skills and concepts rather than specific work skills for a particular job.
Primary Care Utilization Review (PCUR): Purpose of PCUR is to identify people who have used Medical Assistance (MA) services at a frequency or amount that is not medically necessary and/or have obtained services in a fraudulent manner.
Primary caregiver: Person or people principally responsible for the care and supervision of the person who receives services.
Primary spoken languages: Languages other than English most commonly spoken by DHS clientele, as identified by the DHS’ methodology workgroup. These are the current primary languages: Amharic, Arabic, Burmese, Cantonese, French, Hmong, Karen, Khmer (Cambodian), Lao, Oromo, Russian, Somali, Spanish and Vietnamese.
Program HH: Minnesota HIV/AIDS services that provide HIV-positive people who meet program eligibility guidelines with access to:
Program records: Generally include information governing the operation of the licensed program and include required policies and procedures.
Protected information: Personal information about an individual or his/her family that they would not generally want shared with the public.
Protection and Advocacy (P&A): Federally funded organizations located in every state that protect the rights of people with developmental disabilities. In Minnesota, the Disability Law Center is the designated Protection and Advocacy agency.
Provider: Person, organization or entity that has entered into an agreement with DHS to provide health services, including waiver services, to people eligible for Medical Assistance (MA) or Alternative Care (AC).
Public agency: Organization that provides the services required under programs and initiatives listed in Minnesota Statutes. Private agencies are considered public agency when they are vendors of public services and have contracted with a public agency.
Public guardianship: Court appointment of the DHS commissioner as the legal guardian for an adult with a developmental disability.
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Qualified developmental disability professional (QDDP): Individual qualified to work as an expert with people with developmental disabilities or related conditions. QDDPs conducting DD screenings must be employed by counties and tribal nations. The QDDP has a four-year college degree in an area related to developmental disabilities and a minimum of one-year experience working in that field. For the federal definition of a QDDP, see 42 CFR 483.430.
Qualified professional (QP) (PCA services): Professional who provides oversight and supervision of personal care assistance (PCA) services and staff in the delivery of PCA services.
Qualified professional (QA) visit (PCA services): A visit by the QP, at the location where PCA services are being delivered, to do the following:
Quality assurance (PCA services): Guarantee program integrity through review of the services that are reimbursed by Medicaid/Medical Assistance, a combination of state and federal government funds.
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Rate: Fixed charge per unit of a commodity or service.
Rate Management System (RMS): Web-based application for the Disability Waiver Rate System (DWRS). Lead agencies use RMS to determine framework service rates for residential, date and unit-based services.
Real-time, two-way communication: Remote support delivered through one of the following methods:
Regional resource specialist (RRS): DHS staff member who provides support to lead agency staff who administer DHS Disability Services Division services, programs and waivers. Each lead agency is assigned an RRS.
Regional treatment center (RTC): State facility for treating people with diagnoses of mental illnesses, developmental disabilities or chemical dependencies who are under the direct administrative authority of the DHS commissioner.
Rehabilitative/Restorative: Restoring a person’s functional status to a former state or condition.
Related: People related to a child by marriage, blood or adoption. Related individuals include parents, grandparents, brothers, sisters, stepparents, stepsiblings, nieces, nephews, uncles or aunts.
Related condition (autism spectrum disorder): A condition that is closely related to autism spectrum disorder (ASD) and:
1. Is severe and chronic
2. Results in impairment of a person's adaptive behavior and function similar to that of a person with ASD
3. Requires treatment or services similar to those required for a person with ASD
4. Results in challenges in the following symptom areas (similar to symptoms of ASD):
Related condition (developmental disabilities): Diagnosis of severe, chronic disabilities that meets all of the following conditions:
1. Is attributed to cerebral palsy, epilepsy, autism, Prader-Willi syndrome, fetal alcohol spectrum disorder or any other condition other than mental illness (mental illness does not include autism or other pervasive developmental disorders) or an emotional disturbance
2. Is found to be closely related to developmental disabilities because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of people with developmental disabilities and requires treatment or services similar to those required for people with developmental disabilities
3. Is manifested before the person reaches 22 years of age
4. Is likely to continue indefinitely
5. Results in substantial limitations in three or more of the following areas of major life activity:
Relocation service coordination (RSC): Activities coordinated and designed to help a person who lives in an eligible institution to 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.
Remote support: A real-time, two-way communication between the provider and the person. Remote support:
Required case management (CDCS): Case management activities provided to people who use CDCS by counties, tribal nations and managed care organizations who have entered into contracts with DHS.
Residential care services: A discontinued service (effective June 30, 2018). See CBSM – Discontinuation of the residential care waiver service.
Residential habilitation: Services provided to a person who cannot live in his/her home without such services or who needs outside support to remain in his/her home. Habilitation services are provided in the person’s residence and in the community, and should be directed toward increasing and maintaining the person’s physical, intellectual, emotional and social functioning.
Residential program: A program that provides care, supervision, food, lodging, rehabilitation, training, education, habilitation or treatment in a setting that does not meet the requirements of a person's own home.
Resource Center: See MMIS Resource Center.
Respite: Short-term care services provided to a person when his/her primary caregiver is absent or needs relief.
Response Center: Provides support to lead agency staff who administer DHS Disability Services Division home and community-based services, programs and waivers.
Responsible party (PCA services): A person who is at least 18 years old and capable of providing the support necessary to help a person who receives personal care assistance (PCA) services to live in the community when the person is assessed as unable to direct his/her own care.
Retirement, Survivors, and Disability Insurance (RSDI): A federally funded program designed to ensure the continuation of income to people who are disabled, have reached retirement age or are surviving dependents of those who qualified for Social Security Disability Insurance.
Risk: Potential exposure to danger, harm or loss.
Risk assessment survey: Assessment tool developed by the Successful Life Project to help identify the people who could be at behavioral, psychiatric or medical risk and might need intensive supports.
Rule 185 case management: Helps people with developmental disabilities gain access to needed social, medical, educational and other supports and services. The case manager works with the person to identify his/her unique needs.
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Screening document (SD): Document used to record the outcome of assessments, screenings or case management activities.
Screening team (DD): If using the legacy DD Screening Document, DHS-3067 (PDF), the lead agency must convene a screening team to conduct the developmental disabilities (DD) screening process. The team consists of:
Section 504 of the Rehabilitation Act of 1973: A civil rights law that prohibits discrimination against people with disabilities.
Secure email: DHS-initiated email thread through which people can send private and protected information to DHS.
Self-administered medication: Medication taken orally, by injection, nebulizer, insertion or applied topically without the need for assistance.
Self-advocate: A person who advocates on his or her own behalf.
Self-determination: Situation in which a person, or his or her authorized representative, makes his/her own decisions, plans his/her own future, determines how money is spent for his/her supports and takes responsibility for the decision he/she makes. Self-determination is a guiding principle behind consumer-directed services.
Self-direction support activities (CDCS): Services, supports and costs related to helping a person or his/her representative manage consumer directed community supports (CDCS).
Semi-independent living services (SILS): Services needed by an adult with developmental disability or related condition(s) to live successfully in the community.
Serious and persistent mental illness (SPMI): Situational in which a person age 18 or older who has a mental illness diagnosis and meets one of the following conditions:
1. Has undergone two or more episodes of inpatient care for mental illness within the previous 24 months
2. Has experienced a continuous psychiatric hospitalization or residential treatment for longer than six months within the previous 12 months
3. Has all of the following:
4. Has, in the last three years, been committed by a court as a mentally ill person under Minnesota statutes, or the adult’s commitment as a mentally ill person has stayed or continued
5. Was eligible under one of the above criteria but the specified time period has expired or the person was eligible as a child with severe emotional disturbance and the person has a written opinion from a mental health professional from the last three years stating that he/she is reasonably likely to have future episodes requiring inpatient or residential treatment, of a frequency described in the above criteria, unless he/she receives ongoing case management or community support services
Service agreement (SA): Document used to identify services, providers and payment information for a person who receives home care, Alternative Care (AC) or waiver services. A service agreement allows providers to bill for approved services and DHS to audit usage and payment data.
Service coordination: See care coordination.
Services and supports: A term that refers to work that is done to help a person that includes both:
Services during the day: Services or supports provided to a person that enable him/her to be fully integrated into the community. Services during the day can include a variety of supports to help the person exercise choices for community integration and inclusion activities.
Severe emotional disturbance (SED): Child who has an emotional disturbance and meets one of the following conditions:
1. Has been admitted for inpatient or residential treatment within the last three years, or is at risk of being admitted
2. Is a Minnesota resident and is receiving inpatient or residential treatment for an emotional disturbance through the interstate compact
3. Has been determined by a mental health professional to have one of the following:
Shared service option for personal care assistance (PCA): Services provided in the same setting at the same time by the same worker for people who have entered into an agreement to share services for PCA.
Short-term admission to ICF/DD from DD Waiver: When a person who receives Developmental Disabilities (DD) Waiver supports and services (including consumer directed community supports) chooses to dis-enroll from the waiver for a brief time for admission to an intermediate care facility for persons with developmental disabilities (ICF/DD).
Significantly sub-average intellectual functioning: Full-scale IQ score of 70 or less based on assessment that includes one or more individually administered standardized intelligence testes developed for the purpose of assessing intellectual functioning. Errors of measurement and actual changes in performance outcome must be considered in the interpretation of test results.
Skilled nurse visit (SNV): Visit to a person’s place of residence, on an intermittent basis, by a registered nurse (RN) or licensed practical nurse (LPN) under the supervision of a RN, to initiate and complete professional nursing tasks based on the assessed need for services to maintain or restore the person's optimal health.
Social Security Act: Federal act that provides a variety of funding and program Titles, including:
Title I: Grants to States for Old-Age Assistance for the Aged
Title IV-A: Temporary Assistance for Needy Families (TANF) Block Grant
Title IV-B: Child Welfare Services and Funding Block Grant
Title IV-D: Child Support
Title IV-E: Foster Care, Training, and Related Case Management Requirements and Funding (also pays for out-of-home placement costs for eligible children)
Title V: Maternal and Child Health Services Block Grant
Title X: Grants to States for Aid to the Blind
Title XI: Demonstration Grants (used to fund demonstration projects to prove the feasibility of a social services program or service before it is fully funded)
Title XIV: Grants to States for Aid to the Permanently and Totally Disabled
Title XVI-A: Grants to States for Aid to the Aged, Blind or Disabled
Title XVI-B: Supplemental Security Income for the Aged, Blind and Disabled
Title XVIII: Health Insurance for Aged and Disabled
Title XIX: Grants to States for Medical Assistance Programs
Title XX: Block Grants to States for Social Services (also referred to as the Social Services Block Grant or SSBG)
Title XXI: State Children’s Health Insurance Program (SCHIP) (provides enhanced federal funding to states that expand health insurance coverage for children)
Social Security Administration (SSA): Federal agency that administers Social Security, a program consisting of disability, retirement and survivors' benefits.
Social Security Disability Insurance (SSDI): Program under Retirement, Survivors, and Disability Insurance (RSDI) that provides cash payments to people who have a disability, have worked a certain number of quarters or had a parent or spouse that worked a certain number of quarters and paid Federal Insurance Contributions Act (FICA).
Social Security Supplemental Security Income (SSI): Federal program that pays monthly cash benefits to people who have limited resources and income and are age 65 or older, blind or have a disability. Children who are blind or have a disability can also receive SSI benefits. Social Security looks at how the disability of the child affects his/her everyday life to determine if the child is eligible for the monthly cash benefits.
Social Services Information System (SSIS): Case management and data collection application for foster care, out-of-home placement, children's mental health, adoption information and vulnerable adult tracking.
Solicit: Approach someone with a request to use a product or service.
Special education: Education provided to children with disabilities whose abilities (physical, cognitive and social) and learning styles require alternative teaching methods and/or related support services to help the child benefit from the educational program. See Individual Education Program.
Special Needs BasicCare (SNBC): A voluntary managed care program for people with a certified disability, ages 18 through 64, who are enrolled in Medical Assistance. Please note: Certain home and community-based services remain covered by DHS fee-for-service and are not covered by the managed care organization.
Special transportation: Transportation of a person who is unable to use a common carrier safely and does not require ambulance service.
Specialist services: Services that exceed the scope and duration of available Minnesota state plan or waiver services.
Specialized equipment and supplies: Devices, controls or appliances specified in the community support plan.
Spenddown: Amount of money a person enrolled in a Minnesota Health Care Program (MHCP) is responsible to pay before he/she is eligible for Medical Assistance (MA).
Staff records: Information on staff qualifications (e.g., education and work experience) employment information (e.g., position description, work schedule, payroll information) and background study clearance forms.
State government: Each state has its own government. State laws and regulations apply only to the state for which they were written. State laws and regulations can be more restrictive than federal laws that establish a minimal standard of compliance.
State Medical Review Team (SMRT): Division of the Department of Human Services that makes disability determinations using criteria defined by the Social Security Administration.
State Register: Official publication of the State of Minnesota's Executive Branch of government, published weekly to fulfill the legislative mandate in Minn. Stat. Chapter 14 and Minn. R. 1400. It contains proposed, adopted, exempt, expedited withdrawn and vetoed rules; executive orders of the governor; commissioners' orders; contracts for professional, technical and consulting services; appointments; revenue notices; state grants and loans; proclamations; official notices; and non-state public bids, contracts and grants. To view the most recent edition, see Department of Administration – Minnesota State Register.
Structured day program: Service designed for people who might benefit from continued rehabilitation and community integration directed at the development and maintenance of community living skills.
Substantial functional limitations: Long-term inability to significantly perform an activity or task.
Successful Life Project: Provides ongoing consultation and therapeutic follow-up to people previously services at either of the following:
Supervised living facility (SLF): Facility that provides supervision, lodging, meals, counseling, developmental habilitation or rehabilitation services under a Minnesota Department of Health license to five to more adults who have developmental disabilities or related conditions, mental illness diagnoses, physical disabilities or are chemically dependent.
Support coordination: Service that helps people on a waiver and families make informed decisions about what will work best for them, is consistent with their needs and reflects their personal circumstances. The service provides sufficient information to ensure people who receive services understand the responsibilities involved with self-direction and helps develop an effective plan, including backup and emergency needs. Cost of this service is within the individual budget and identified in the plan.
Support for individualized home supports (IHS): A staff member providing direct supervision, cueing, maintenance, guidance, instruction, incidental assistance with activities of daily living or assistance with coordination of community living activities.
Supported employment: Services that help people find and keep paid employment in community businesses where people without disabilities are employed.
Supported living services for people age 18 and older: Services provided to an adult who requires daily staff intervention due to severe behavior problems, medical conditions, physical deficits and/or lack of adequate survival skills
Supported living services for people younger than age 18: Services provided to people younger than age 18 who require daily staff intervention due to severe behavior problems, medical conditions, physical deficits and/or lack of adequate survival skills that result in a family's inability to maintain him/her in the home.
Support planner services: Option under CDCS in which a person can receive help with developing and implementing the community support plan (CSP). Support planner activities are provided by an individual or entity chosen by the person and are in addition to required case management activities.
Surveillance and Integrity Review Section (SIRS): Section within DHS responsible to ensure compliance with Minnesota Health Care Program (MHCP) requirements by monitoring the use and delivery of health services through a post-payment review process.
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Targeted case management (TCM): Service coordination that helps people who are eligible for Medical Assistant and meet other criteria to access needed medical, social, educational and other services.
Tax Equity and Fiscal Responsibility Act (TEFRA): Program available for some children with disabilities who ordinarily would not be eligible for Medical Assistance (MA) because of parental incomes. The State Medical Review Team must review applicants. TEFRA is also known as the Katie Beckett Provision.
Tele-homecare: Use of telecommunications by a home health care professional to deliver home health care services within the professional’s scope of practice to a person located at a site other than the site where the professional is located.
Telephone Equipment Distribution (TED) program: Provides telephone equipment to people who are deaf, hard of hearing, deaf blind, speech impaired or have a physical disability and need adaptive equipment to use the phone. The TED program loans phone equipment to qualified applicants at no cost for as long as they need the equipment.
Teletypewriter (TTY): Device that transmits and receives instantaneous typewritten messages over telephone lines. It is a means of electronic communication between people who are deaf and other people with a TTY.
Temporary fifth bed variance: Temporary variance of home and community-based services (HCBS) waiver plan funding policy and DHS licensing statute to allow home and community-based settings licensed for adult corporate foster care to increase to a fifth bed on a temporary basis.
Third party liability (TPL): Medical Assistance (MA)-enrolled providers are required to bill liable third-party payers and receive the maximum payment before billing Minnesota Health Care Programs (MHCP). MHCP will not pay for services that could have been covered by a third-party payer if applicable rules of that plan had been followed.
Third party payer: Person, entity or program that is, or may be, responsible to pay all or part of the medical costs provided to people enrolled in Medical Assistance (MA).
Ticket to Work and Work Incentives Improvement Act (1999): Enacted to help people who get Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits. It offers a variety of services to help people prepare for, find, get and keep a job (e.g., vocational rehabilitation, training, referrals, job coaching, job counseling, placement services).
Title Program: Federal and state programs available to people with special needs. Programs are often based on economic need and criteria vary widely. Examples of Federal Title Programs include:
Training for individualized home supports (IHS): Instructional services through which a person receives direct training from a staff member on community living skills identified in a person's assessment (e.g., MnCHOICES, long-term care consultation). Training includes skill building to acquire, retain and improve the person's experience living in the community.
Transitional services (BI, CAC, CADI and DD): Items and expenses necessary and reasonable for a person to transition from an eligible setting to his/her own home.
Transitional services (EW): Items and supports necessary for a person to move from a licensed setting to independent or semi-independent community-based housing.
Transportation: Transportation necessary to gain access to community services, resources and activities.
Treatment and training (CDCS): Range of services that increase a person’s ability to live and take part in the community.
Tribal administration of home and community-based services (HCBS) programs: Option that allows DHS to contract with federally recognized tribal nations that have a reservation in Minnesota to operate a federally approved program or any other DHS program.
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Unforeseen circumstance: A death or significant change in condition that occurs after an assessment was completed and the person was expected to enroll in a waiver/Alternative Care program.
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Vendor: An entity that a lead agency approves to delivery an approval-option service. A Minnesota Health Care Programs (MHCP) enrolled, approval-option service provider cannot also seek approval to deliver services through a lead agency.
Ventilator-dependent: Person dependent on mechanical ventilation for life support for at least six hours a day and who is expected to be or has been dependent for at least 30 consecutive days.
Vocational rehabilitation services (VRS): Wide range of services and job training available to help people with disabilities prepare for, find and keep a job.
Vulnerable adult (VA): A person 18 years of age or older who meets one of the following criteria:
Vulnerable adult/developmental disabilities targeted case management services: Services provided on behalf of a vulnerable adult or person with developmental disabilities, are services intended to coordinate and link social and other services, designed to help gain access to needed protective services, social, health care, mental health, habilitative, educational, vocational, recreational, advocacy, legal, chemical, health and other related services.
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Waiver: Intentional suspension or change of a state or federal regulation, service limitation or eligibility requirement.
Waiver span: Period of time that identifies both the begin and end date for the specific waiver program the person has been approved to receive.
Waiver services programs: Programs that have received federal approval for expanded coverage for services not usually covered under Medical Assistance (MA) and meet the needs of targeted populations based on eligibility requirements specific to each waiver program. Minnesota offers the following waivers:
Ward: A person placed under the protection of a legal guardian.
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