1115 Medicaid Waiver - See Medicaid Waiver 1115
1915 (c) Waivers - See Medicaid Waiver 1915
24 Hour Emergency Assistance - See Emergency Assistance 24 Hour
Accessible: Activity or place capable of being reached by persons with 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 an Individual Service 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 performance of routine self-care functions, such as dressing, bathing and eating.
Adaptive Behavior: Ability of the person to meet the standards of maturation, learning, and personal independence that are expected based on normative standards for age cultural background, and experience through skills or the ability to adjust ones behavior necessary to compensate for health, motor or sensory deficits.
Adult: Person who is 18 years of age or older.
Adult Companion Services: Non-medical care, assistance, supervision and socialization provided for an adult in accordance with a therapeutic goal in the plan of care.
Adult Day Care: Services provided to persons who are 18 years of age or older that are designed to meet the health and social needs of the person. The plan identifies the needs of the person and is directed toward the achievement of specific outcomes.
Adult Foster Care: Individual waiver services provided to persons living in a home licensed as foster care. Foster care services are individualized and based on the individual needs of the person and service rates must be determined accordingly.
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 Public Guardianship: Appointment of the Commissioner of the Minnesota Department of Human Services by the court to act as public guardian for an adult with a diagnosis of developmental disability who needs this level of supervision and protection, and has no other private party willing or able to act in this role.
Adult Rehabilitative Mental Health Services: Also known as the MA Rehab Option and Adult Mental Health Crisis Response Services, Medical Assistance (MA) State Plan Mental Health Services.
Advocate: Individual who has been 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.
Age Appropriateness: Aspect of normalization, which 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 with Choice: Fiscal support entity (FSE) model available to persons receiving CDCS, where the FSE is the employer and payer of services.
Alternative Care Program: State-funded program designed to support home and community-based services for Minnesotans age 65 years and over who are at risk of nursing home placement.
American with Disabilities Act (ADA): National civil rights legislation passed in 1990 that guarantees equal opportunity for persons with disabilities in public accommodations, employment, services and telecommunications.
Appeal: Grievance/complaint vehicle for persons who have disputes with DHS/county authorized services.
Appeal Process: Formal setting where a person may voice an objection if services are denied, terminated, suspended, reduced or not acted upon with reasonable promptness.
Applied Behavior Analysis (ABA): Type of therapy frequently used with children with Autism Spectrum disorder. See Intensive Early Intervention Behavior Therapy (IEIBT).
Assessment: Process of identifying: a) a person's strengths, preferences, functional skills and need for support and services; b) the extent to which natural supports and informal providers are able to meet the person's need for support and services; and c) the extent to which human services agencies and providers are able to provide or develop needed support or services.
Assisted Living: See Customized Living.
Assisted Living Plus: See 24 Hour Customized Living.
Assistive Technology: Devices or equipment or a combination of both that improve the ability of a person to communicate in the community; control or access their environment and perform activities of daily living.
Authorization: Written approval and issuance of an authorization number, when applicable, by a medical review agent under contract with Department of Human Services.
Authorized Representative: Individual who is at least 18 years of age and is designated by a waiver recipient’s legal representative to act on the waiver recipient’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 waiver recipient.
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Basis of Eligibility: Each applicant must meet a basis of eligibility for 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 Programming: Individually designed strategies to decrease severe maladaptive behaviors that interfere with the ability of a person to remain in the community.
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 may 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 nursing facility or neurobehavioral hospital.
BI-NB Conversion: Person eligible for Brain Injury – Neurobehavioral Hospital 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 prior to accessing the waiver.
BI-NF Conversion: Person eligible for Brain Injury – Nursing Facility 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 prior to accessing the waiver.
BI Diversion: Person eligible for the Brain Injury 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, such as Regional Treatment Centers, Rule 36 facilities and Rule 5 facilities.
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CAC Conversion: Person eligible for CAC enrolls in a 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 prior to accessing the waiver.
CAC Diversion: Person who is eligible for the CAC Waiver and does not meet the criteria for a CAC Conversion.
CADI Conversion: Person eligible for 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 prior to accessing the waiver.
CADI Diversion: Person who is eligible for the CADI Wavier and does not meet the criteria for a CADI Conversion.
Caregiver - Primary: Person principally responsible for the care and supervision of the person.
Caregiver Living Expenses: Expenses incurred by a caregiver who lives in the same household as the person receiving waiver services when the caregiver also provides one of four approved services.
Caregiver Training and Education: Training and education to a parent or primary caregiver when the parent or primary caregiver is not employed to provide supervision and care to the person.
Carve Out: Arrangement whereby specific services are eliminated from health insurance coverage under a capitated rate. The carved-out services may then be obtained on a fee-for-service basis.
Case Management/Service Coordination: Activities that help people access, coordinate and monitor needed services as they relate to the person’s assessed needs and preference regardless of funding sources.
Case Mix Classification: Classification of a person for the purposes of establishing payment levels that relies on the ability to complete certain activities of daily living (ADL) the need for behavioral interventions and clinical or nursing care required. Case Mix classification was developed as a payment system for nursing facilities; 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 specifically to assist persons with disabilities in achieving and maintaining independent lifestyles. CILS are run by persons with disabilities who themselves have been successful in establishing independent lives and have a deep commitment to assisting other persons with disabilities in becoming more independent. There are eight Centers for Independent Living in Minnesota.
Centers for Medicaid and Medicare Services (CMS): Federal agency within the U.S. Department of Health and Human Services, previously known as the Health Care Financing Administration (HCFA), responsible to administer the Medicare and Medicaid program. CMS assures that states properly administer national health care programs, establish policies for paying health care providers, conduct research on the effectiveness of various methods of health care management, assess the quality of health care facilities/services and take enforcement actions as appropriate.
Child: Person who has not reached age 18 years.
Child Foster Care: Individual waiver services provided to persons living in a home licensed as foster care. Foster care services are individualized and based on the individual needs of the person and service rates must be determined accordingly.
Child Welfare Targeted Case Management (CW-TCM): MA service that reimburses counties and tribes for case management activities provided by qualified case managers to MA and Minnesota Care enrolled children. Reimbursement must be spent to develop and expand child welfare preventative services.
Chore Services: Support or assist to a person or their primary caregiver to maintain a clean, sanitary and safe home.
Cognitive Rehabilitation Therapy: Services and interventions specifically designed to improve cognitive functions.
Commissioner: Commissioner of the Minnesota Department of Human Services.
Commissioner's Designee: Individual who is designated by the Commissioner to work at the direction of the Commissioner.
Common Carrier: Transportation of a person by bus, taxicab, other commercial carrier or by private automobile.
Common Entry Point (CEP): Former name for the 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: When people are not treated differently because of the color of their skin, their religion or because they have a disability. Community inclusion refers to persons with and without disabilities living side by side in a city, town or neighborhood.
Community Services Information System (CSIS): Software application designed for billing case management time, specific county-provided services billable to Medical Assistance (MA), pay vouchers, and as a state and local reporting system.
Community Social Services Act-CSSA: Repealed
Community Support Plan: Person-centered plan that documents the services a person will use to meet their needs in order to remain in or return to the community. Also referred to as an addendum to the Individual Service Plan .
Community Support Services: Community-based crisis intervention services that support clinically complex individuals in the community and build community capacity. CSS provides clinical consultation and technical assistance in all 87 Minnesota counties.
Companion Services: Non-medical care, assistance, supervision and socialization provided to a person age 18 years or older in accordance with a therapeutic goal in the plan of care.
Competitive Employment: Employment in which the employee is compensated at or above the minimum wage and is employed on a full - time or part - time basis in an integrated and competitive labor market.
Compound (medication): A prescription prepared in accordance with Minnesota Rules 6800.3100.
Conciliation: Case management conciliation conference is an alternate dispute resolution mechanism for persons who have a grievance with, and are receiving case management services as a person with developmental disability or a related condition. The conference takes place in an informal setting, where the persons involved resolve the conflict with the help of a mediator.
Conflict of Interest: Financial or proprietary interest in a situation that could cause injury or damage to person or limit choices.
Conservatorship: Court procedure in which a court appoints a person (conservator) to manage another person’s assets and estate.
Consumer: Persons 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. The degree to which persons have choice must go beyond the range of service choices and include opportunities for persons to decide when, where, how and who will provide supports and services.
Consumer Directed Community Supports (CDCS): Service option available under the CAC, CADI, DD, EW, BI waivers that gives persons more flexibility and responsibility for directing their services and supports, including hiring and managing direct care staff. CDCS may include services, support and/or items currently available through the MA waivers, as well as additional allowable services that provide needed support to persons.
Consumer Direction: Philosophy and orientation to the delivery of home and community-based services whereby informed persons make choices about the services they receive. Consumer Direction provides the opportunity to benefit from the program flexibility and the self-reliance realized when the principles of self-determination are woven into public 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. record on immunization, physicals, dental exams, etc.) assessments, individual service plans, education plans and abuse prevention plans.
Consumer Support Grant (CSG): State funded alternative to Medical Assistance home care services of home health aide, personal care assistant and private duty nursing.
Consumer Training and Education: Training and education provided to help a person with developmental disabilities acquire skills to exercise control and responsibility over the supports received, develop self-advocacy skills and exercise their civil rights.
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 Service: County arranging for or providing social services to a person.
County Worker: Employee of a county, who determines eligibility, approves and monitors a person’s plan. The county worker may assist with planning and be the service coordinator if the person chooses. See Case Management/Service Coordination.
Crisis Respite: Services that provide specific short-term care and intervention strategies to a person due to the need for relief and support of the caregiver and/or protection of the person or others living with that person. This includes addressing both medical and behavioral needs.
Crisis Services: Services that provide specific short-term care and intervention strategies to a person due to the need for relief and support of the caregiver and/or protection of the person or others living with that person. This includes addressing both medical and behavioral needs.
Customized Living: Package of regularly scheduled individualized health-related and supportive services provided to a person residing in a residential center (apartment buildings) or housing with services establishment.
24 Hour Customized Living: Package of regularly scheduled individualized health-related and supportive services provided to a person residing in a residential center (apartment buildings) or housing with services establishment.
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Day Habilitation: Services focused on enabling the person to attain or maintain his or her maximum functional level and 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): Licensed supports to provide persons with help to develop and maintain life skills, participate in community life and engage in proactive and satisfying activities of their own choosing.
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 persons in the DD Waiver without decertifying an ICF/DD bed.
Deeming: To count the income or assets of a parent when determining the eligibility for a child and 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. For example, in TEFRA cases, parental income is not deemed to the child.
Deficits In Adaptive Behavior: Significant limitation in an individual's effectiveness in meeting the standards of maturation, learning, 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 or administers health care coverage, economic assistance and a variety of services for children, people with disabilities and older Minnesotans.
Developmental Disability (DD): Severe, chronic disability attributable to mental and/or physical impairment, which 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 needed.
Developmental Disability (DD) or Related Condition 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 disability or related conditions.
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 MA, GAMC and CAC Waiver.
Direct Service: Intervention services rendered by the provider in 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 MA benefits as a disabled person. 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 persons with a wide variety of disabilities and chronic illnesses.
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, health plans and DHS staff for the Medicaid Management Information System (MMIS) in the areas of Chemical Health, Developmental Disability, 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 with special needs 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 can be used for an extended period.
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Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program: Comprehensive child health program provided to Minnesota Health Care Program (MHCP) recipients under the age of 21 years to reduce the impact of childhood health problems by identifying, diagnosing and treating health problems early.
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.
Emergency Assistance 24 Hour: On-call counseling and problem solving and/or immediate response for assistance at a waiver recipient’s home due to a health or personal emergency.
Emotional Disturbance (ED): Organic disorder of the brain or clinically significant disorder of thought, mood, perception, orientation, memory or behavior that seriously limits a child’s capacity to function in primary areas of daily living such as personal relations, living arrangements, work, school and recreation.
Employer Identification Number (EIN): Nine-digit number the Internal Revenue Service assigns to an entity to identify business taxpayers.
Employer of Record (EOR): See Financial Sector Support.
Entitlement Program: Federal program that guarantees a certain level of benefits to persons 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 entitlement programs.
Enteral Nutritional Product: Commercially formulated substance that provides nourishment, and affects the nutritive and metabolic processes of the body.
Environmental Accessibility Adaptations: Purchase, installation, maintenance and repairs of environmental modifications and equipment provided the repairs are cost efficient compared to replacement of the item.
Environmental Modifications: See Modifications and Adaptations.
Environmental Modifications and Provisions (CDCS): Services, supports and/or items provided to a person that maintain the health and well-being of the person or physical environment that assists the person to live and participate in the community.
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, and lack wide recognition from the scientific community as a proven and effective measure of treatment. (Minnesota Rules, Part 9525.3015, subpart 16)
Extended Home Care Services: Services that exceed the amount, duration and scope specified for the MA State Plan service description.
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Fair Hearing: Administrative proceeding, as part of the appeal process, to examine facts concerning a matter in dispute and to advise the Commissioner if the decision to reduce or deny benefits is appropriate.
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 Support Grant (FSG): Statewide program to prevent the out-of-home placement of children with disabilities and promote family health and social well-being by assisting families with access to disability services and supports.
Family Training and Counseling: Services provided for the person and/or the family as identified in the individual plan of care. CAC Waiver has two separate services known as Family Training and Family Counseling. CADI and BI Waivers have one service known as Family Training and Counseling and Education.
Federal Financial Participation (FFP): Federal government’s contribution toward Medicaid services. FFP is dependent upon the state’s guarantee of assurances under its Medicaid and waiver plans.
Federal Government: Government of the United States. Federal laws/regulations apply to all states.
Federal Poverty Guidelines (FPG): Index of poverty in the United States that is updated annually; the measure forms the basis of eligibility for a number of means-tested programs.
Fee-For-Service (FFS): Payment to a provider for the provision of services on a service-by-service basis.
Financial Sector Supports: Services that assist waiver recipients to manage and distribute funds contained in an individual budget. Financial sector support providers must be knowledgeable of and comply with Internal Revenue Service requirements necessary to process employer and employee deductions and provide appropriate and timely submission of employer tax liabilities.
Fiscal Support Entity (FSE): Medical Assistance (MA) enrolled provider for Consumer Directed Community Supports that reimburses service providers for authorized CDCS services, supports and/or items.
Fiscal Year (FY): State’s budgetary year that goes from July 1 through the following June 30.
Flexible Case Management: See Support Planner
Foster Care: Individual waiver services provided to persons living in a home licensed as foster care. Foster care services are individualized and based on the individual needs of the person and service rates must be determined accordingly.
Fraud: Act that is intentional, unlawful or has an element of false representation.
Functional Status: Ability to carry out the tasks associated with daily living.
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General Assistance Medical Care (GAMC): 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 persons.
Group Residential Housing (GRH): State-funded, income-supplement program that pays for room and board costs for low-income persons who have been placed in a licensed or registered setting with which a county human service agency has negotiated a monthly rate.
Guardian Ad Litem: Person appointed by the court to look after the interests of a minor or a person with a disability who is involved in litigation.
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: Services designed to assist persons in acquiring, retaining and improving the self-help, socialization and adaptive skills necessary to reside successfully in home and community-based settings.
Healthcare Common Procedure Coding System (HCPCS): Current local “procedure codes” classification used to code all services and to bill claims for services rendered or for items purchased.
Health Care Financing Administration (HCFA): See Centers for Medicare and Medicaid.
Health Care Professional: Licensed professional who, within their scope of service or practice, can review and approve care plans for persons with overriding health needs.
Health Insurance Portability and Accountability Act (HIPAA): Federal Health Insurance Portability and Accountability Act (HIPAA) passed by Congress in 1996 as an industry-wide effort to enhance consumer control of insurance coverage, create health care industry standards to improve administration and protect and secure personal health information.
Health Maintenance Organization (HMO): Organization that provides an agreed-upon set of basic and supplemental health maintenance and treatment services to an enrolled group of persons in a particular geographic area. The HMO is reimbursed for those services through a predetermined and fixed periodic prepayment made by or on behalf of each person or family unit enrolled in the HMO without regard to the amounts of actual services provided.
Health Service: Service or treatment consistent with the health needs of a person, such as medication administration and monitoring, medical, dental, nutritional, health monitoring, wellness education and exercise eligible for Medical Assistance payments under Minnesota Statutes.
Hearing: Semi-formal proceeding where rules of testimony and evidence are in place and:
HIPAA: See Health Insurance Portability and Accountability Act.
Home and Community-Based Services (HCBS) Waiver: Services not normally covered by MA, which 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 persons 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 a different group of persons.
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: Option that offers a range of medical care and support services provided in the person’s home and community. Services range from simple assistance in activities of daily living to a level of care similar to cares provided in a hospital.
Home care nursing (HCN): The provision of professional nursing services to a person in or outside his or her home when normal life activities take the person outside the home, including school, with such services based on an assessment of the medical/health care needs of the person.
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 the home to improve or maintain a person’s functioning. Home care therapies include physical, occupational, speech-language pathology and respiratory.
Home Delivered Meals: Nutritionally balanced meals delivered to the person’s place of residence.
Home Health Aide Service: Provision of medically oriented task(s) to maintain health or to facilitate treatment of an illness or injury provided in a person’s place of residence.
Home Health Service: Home care is an option that offers a range of medical care and support services provided in the person’s home and community. Services range from simple assistance in activities of daily living to a level of care similar to cares provided in a hospital.
Homemaker Service: General household activities provided by a trained homemaker when the person (i.e., the person, family member or primary caregiver) who is regularly responsible for these activities is unable to manage the household activities or is temporarily absent.
Hospice Care: Palliative and supportive care for persons 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 individual service 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: Assistance to help people acquire housing and move from an unlicensed setting to another unlicensed setting in the community.
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ICD-9-CM: See International Classification of Diseases, 9th Edition, Clinical Modification.
In-Home Family Support Services: Services designed to assist persons in acquiring, retaining and improving the self-help, socialization and adaptive skills necessary to reside successfully in home and community-based settings provided to a person and his/her family, including extended family members who are not providing licensed foster care, in the family’s home and/or in the community to enable the person to remain in or return to the home. This may also include training family members to increase their capabilities to care for and maintain the person in their home.
Inclusion: When persons with disabilities are not only in the same place as persons without disabilities but also participate in the same activities at the same time. See also Community Inclusion.
Independent Living Services: Services tailored to the specific needs of a person with disabilities, including assistive technology, independent living skills training and/or connection to community - based support services.
Independent Living Skills (ILS): Services that develop and maintain the community living skills and community integration of a person.
Independent Living Skills - BI Therapies: Therapies specified in the individual plan of care that have specific therapeutic goals and outcomes established and are not merely diversional in nature.
Individual Education Program (IEP): Written individualized education program developed annually for a student based on an evaluation of the student’s performance, presenting problems and the effect of learning in appropriate settings.
Individualized Family Service Plan (IFSP): Written plan for providing services to a child and the child’s family through interagency agreements. Procedural and program requirements for the 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 ISP.
Individual Interagency Intervention Plan (IIIP): Single, written plan designed to be used in place of multiple plans (ISP, IEP and IFSP) that describes services and payment arrangements for eligible children. The purpose of the IIIP is to assure the development of a coordinated, multi-disciplinary interagency intervention system for children and youths with disabilities ages 3 to 21 years.
Individual Service Plan (ISP): Each person with developmental disability or a related condition, who is receiving 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 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.
Individuals with Disabilities Education Act (IDEA): Federal law that ensures eligible children with disabilities have available to them a free, appropriate public education.
Informed Choice: Voluntary decision, made by a person (consumer) or the person’s (consumer’s) legal representative, after becoming familiarized with alternatives to:
Instrumental Activities of Daily Living (IADL): Meal planning and preparation, managing finances, shopping for food, communication by telephone and other media, getting around and participating in the community.
Intensive Early Intervention Behavior Therapy (IEIBT): See Applied Behavioral Analysis (ABA).
Interdisciplinary Team (IDT): Team composed of the case manager, person, person’s legal representative and advocate, if any, and representatives of providers of the service areas relevant to the needs of the person as described in the individual service plan.
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 persons with developmental disability or a related condition 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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Least Restrictive Alternative: Alternative that is the least intrusive and most normalized given the level of supervision and protection required for the person. 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: Person with legal authority and duty to act on behalf of the ward as a substitute decision-maker to care for personal and property interests of another person.
Legal Representative: Parent or parents of a person under 18 years of age, 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): Care and services associated with a particular type of facility. LOC is an eligibility requirement and identifies the type of waiver and services available to eligible persons.
Licensed Provider: Provider who chooses to participate in Minnesota Health Care Programs and who meets professional requirements and/or licensure requirements as set forth in applicable state and federal laws and regulations.
Limited English Proficiency (LEP): Person with limited English proficiency or “LEP” is not able 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.
Live-In Care Giver Expenses: Certain expenses incurred by a caregiver who lives in the same household as the person receiving waiver services when the caregiver also provides one of four approved services.
Long Term Care Consultation (LTCC): Services that help people of any age with long-term or chronic care needs to make long-term care decisions through the selection of service options that meet their needs and reflect their preferences. The availability of, and access to, information and other types of assistance is intended to prevent or delay certified nursing facility placements and provide transition assistance after NF admission so a person can return to the community.
Long Term Care/ Long-Term Support Services: Services that will likely be needed by a person for the rest of his or her life.
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Maltreatment of Minors Act: Protection of persons under age 18 years whose health or welfare may be jeopardized through physical abuse, neglect or sexual abuse.
Managed Care: Health care delivery system that includes pre-established provider networks and reimbursement arrangements, administration and clinical systems.
Managed care Organization: Organization that agrees to provide all defined health care benefits to individuals in return for a capitated payment.
Mandated Reporter: Professional who is required to report suspected or known cases of Vulnerable Adult (VA) maltreatment to the Common Entry Point (CEP).
MAXIS: System that processes information to determine eligibility for public assistance programs and mails benefits and notices to public assistance recipients. MAXIS is not an acronym, the letters do not stand for anything in particular. Eligibility information for Medicaid and GAMC is passed through to the Medicaid Management Information System (MMIS).
Medicaid: Entitlement program designed to help states meet the costs of necessary medical and health related services to low-income persons who are aged, blind or disabled and others with low income. The Medicaid program is a service system that combines state and federal money. In Minnesota, Medicaid is also known as Medical Assistance. See Medical Assistance.
Medicaid Management Information System (MMIS): Claims processing and information retrieval system in a computer format. In Minnesota, Medicaid services are authorized and billed through MMIS.
Medicaid Waiver - 1115: This notation refers to section 1115 of the Social Security Act that grants the U.S. Department Health and Human Services 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): Section 1915 (c) of the Social Security Act refers to authority that allows the Health Care Financing Administration (HCFA) to waive federal Medicaid requirements to allow states to experiment with providing health care services in home and community-based settings as opposed to institutional settings (e.g., hospitals, nursing homes). These waiver services, often referred to as 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 Medicaid Program is the largest of Minnesota' publicly funded health care program and is jointly funded with state and federal funds. Within federal rules, each state decides the types of health care services that will be covered under its MA program.
Medical Assistance for Employed Persons with Disabilities (MA-EPD): Work incentive that promotes competitive employment and the economic self-sufficiency of people with disabilities by assuring continued access to Medical Assistance (MA) for necessary health care services.
Medical Assistance Rehabilitation (Rehab) Option: See Adult Rehabilitative Mental Health Services (ARMHS).
Medically Necessary or 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: National health insurance program administered by the U.S. Department of Health and Human Services under the Centers for Medicare and Medicaid Services (CMS) for persons who:
Medicare-Certified Home Health Agency (HHA): Private or public organization that provides skilled nurse visits, home health aide visits, therapies and medical supplies. A 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 Practitioner: Person who provides services in the treatment of mental illness, under the supervision of a mental health professional.
Mental Health Professional (MHP): Licensed Psychologist, Licensed Psychological Practitioner, Licensed Independent Clinical Social Worker, Clinical Nurse Specialist Mental Health, Licensed Marriage and Family Therapist or Psychiatrist providing clinical services in the treatment of mental illness.
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.
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: State-subsidized health care program for persons who live in Minnesota and do not have health insurance. The program is open to all Minnesota residents who meet program guidelines. Persons may be eligible for either MinnesotaCare or MA but may not have coverage from both programs at the same time (with certain time - limited exceptions).
Minnesota Children with Special Health Needs (MCSHN): Public program administered by the Minnesota Department of Health (MDH) that seeks to improve the quality of life for Minnesota children, age 0 - 21 years, with special health needs and their families. MCSHN pays for diagnostic services and medical care for eligible children. MCSHN also provides education, information, support and referral.
Minnesota Department of Health (MDH): State agency whose mission is to protect, maintain and improve the health of all Minnesotans.
Minnesota Family Investment Plan (MFIP): Program authorized under the federal Temporary Assistance to Needy Families (TANF) block grant to provide cash assistance and employment support to needy families. Medical Assistance also covers persons who receive MFIP. MFIP replaced the Aid to Families with Dependent Children (AFDC) program.
Minnesota Health Care Programs (MHCP): DHS administered health service program that includes The Medical Assistance (MA) Program, General Assistance Medical Care (GAMC) Program, MinnesotaCare, Consolidated Chemical Dependence Treatment Fund (CCDTF) Program, Prepaid Medical Assistance Program (PMAP), Home and Community-Based Services under a waiver from CMS.
Minnesota Senior Health Options Program (MSHO): Health care program for seniors, age 65 years and over, who are eligible for Medical Assistance (MA) and Medicare. People with only MA can also join. MSHO combines the health care and support services that normally are offered by separate programs into one seamless package to make it simpler for people to get these services. Seniors can choose to join MSHO or stay in their current Medical Assistance Program.
MMIS Exception Code: Three-digit numeric code that Medicaid Management Information System (MMIS) uses when information entered into MMIS is invalid or needs review.
Modifications and Adaptations: Physical adaptations to the person’s home and/or vehicle.
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Neurobehavioral Hospital (NBH): Rehabilitation hospital providing specialized services to persons with neurological-based cognitive and behavioral challenges.
New Freedom Initiative: 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, choose where to live and participate in community life.
Night Supervision: Overnight assistance and monitoring in the home of a person for a period of no more than twelve (12) hours in a 24-hour period.
Normalization: Making the typical patterns and conditions of everyday life available to persons with developmental disability or a related condition.
Notice of Action: By law, written communication from the county/state to the service recipient is required any time services are denied, terminated, reduced or suspended. Notice must be sent at least ten days before the action is to take effect.
Nursing Facility (NF): Facility or part of a facility licensed to provide nursing care for persons who are unable to care for themselves properly.
Nutrition Counseling: One or more individual sessions in which a qualified professional provides advice or guidance in solving a person’s diet related health problems.
Nutrition Education: Individual or group event, which provides formal or informal opportunities for persons to acquire knowledge, experience and skills about foods and nutrition.
Nutritional Therapy: Includes nutrition counseling and nutrition education.
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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 vs. L.C., all public entities are required to administer their 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 persons 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 NF services.
Options Initiative: Minnesota’s initiative to provide community living options to persons with disabilities under age 65 years. This initiative began July 1, 2001, to reflect Minnesota’s commitment to helping persons with disabilities live where they choose with appropriate services to assure their health and safety. It also responds to obligations under the 1999 U.S. Supreme Court decision (Olmstead vs. L.C.)
Outcome: Benefit of services or supports as defined by the individual recipient of service.
Overriding Health Needs: Medical condition that affects service options available to a person because the condition requires:
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Paying Parents of Minor Children and Spouses: Option to pay parents of minor children to provide services that fall under personal assistance category of CDCS to their child or a spouse to provide services that fall under personal assistance category of CDCS to their spouse.
Personal Assistance (CDCS): Range of direct assistance services provided in the person’s home or community. The assistance provided may include hands-on, cueing, monitoring, supervision and behavioral interventions.
Personal Care Assistant (PCA): Individual who is trained in the skills needed to perform covered services to help persons with some basic daily routines and whose services may be supervised by an registered nurse of qualified professional. PCA services are also referred to as Personal Assistance Services (PAS).
Personal Care Assistance (PCA) Assessment: Review and evaluation of a person’s need for home care services and must include:
Personal Care Assistance (PCA) Choice Option: Consumer option in the PCA program to allow a person more flexibility, choice, control and responsibility to provide for their service needs.
Personal Care Assistant (PCA) Choice Provider: Serves in a fiscal intermediary role with the person and their staff and for financial management tasks.
Personal Care Assistance Service: Assistance and support to eligible persons with disabilities and special health care needs including the elderly, who live independently in the community. Services are provided by a qualified personal care assistant (PCA) and may be provided in the person’s own home or in the community where a person may go in a typical day and included on the PCA Care Plan.
Personal Care Provider Organization (PCPO): Provides the traditional services of recruiting and hiring of staff, training and orientation, scheduling, collecting time cards, financial management, and termination of staff, if needed.
Personal Emergency Response System (PERS): A system typically worn as a pendant or bracelet that includes an alert or panic button the person can press in the event of a fall or other emergency.
Personal Master Index (PMI) Number: Eight-digit Minnesota Health Care Programs (MHCP) identification number assigned to each Medical Assistance recipient. The PMI number is often referred to as the recipient ID and is printed on the MHCP identification card.
Personal Support: Non-medical care, supervision and assistance provided in the home of the person or in the community to achieve increased independence, productivity and inclusion in the community.
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.
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.
Prepaid Health Plan (PHP): Health plan contracted with DHS to provide health care services to recipients of Prepaid Minnesota Health Care Programs.
Prescription Drugs: For purposes of the CAC Waiver, a prescription drug:
Prevocational Services: Services designed to prepare persons for paid or unpaid employment, as reflected in the plan of care.
Primary Care Utilization Review (PCUR): Purpose of PCUR is to identify persons who have used Medical Assistance services at a frequency or amount that is not medically necessary and/or have obtained services in a fraudulent manner.
Primary spoken languages: Languages other than English most commonly spoken by DHS clientele, as identified by the DHS’ methodology workgroup. Currently there are 10 primary languages: Arabic, Hmong, Khmer (Cambodian), Lao, Oromo, Russian, Serbo-Croatian (Bosnian), Somali, Spanish and Vietnamese.
Program Records: Generally include information governing the operation of the licensed program and include required policies and procedures.
Protection and Advocacy (P & A): Federally funded organizations located in every state that protect the rights of persons 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 Medical Assistance (MA) or Alternative Care (AC) eligible persons.
Public Agency: Organization that provides the services required under programs and initiatives listed in Minnesota Statutes. Private agencies are considered a public agency when they are vendors of public services and have contracted with a public agency.
Public Guardianship: Appointment of the Commissioner of the Minnesota Department of Human Services by the court to act as public guardian of an adult with developmental disability who is in need of this level of supervision and protection and who has no other private party willing and able to act in this role.
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Qualified Developmental Disability Professional (QDDP): Individual qualified to work as an expert with persons with developmental disability or related conditions. The QDDP has a four-year college degree in an area related to developmental disability and a minimum of one-year experience working in that field. For more information on QDDP standards, see CFR Title 42, sec. 483.430.
Qualified Professional (QP): Registered nurse or mental health professional responsible to supervise the delivery of PCA services when a person or the person’s responsible party chooses another to supervise the PCA. See Mental Health Professional.
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Rate: Fixed charge per unit of a commodity or service
Referee: Individual who conducts fair hearings and provides recommendations to the commissioner as a part of the appeal process.
Regional Resource Specialist (RRS): DSD employs Regional Resource Specialists (RRS) to work with local agencies providing technical assistance at both the system and individual level.
Regional Treatment Center (RTC): State facility for treating persons with mental illness, developmental disability or chemical dependency that is under the direct administrative authority of the Commissioner.
Rehabilitative/Restorative: Restoration of a person’s functional status to a former state or condition.
Related: Individuals related to a child by marriage, blood or adoption. Related individuals include a parent, grandparent, brother, sister, stepparent, stepsister, stepbrother, niece, nephew, uncle or aunt. “Related” also refers to a legally appointed guardian.
Related Condition: Diagnosis of severe, chronic disabilities that meet all of the following conditions:
Result 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 resides 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.
Required Case Management: Case management activities provided to CDCS recipients by county agencies, tribal health entities or health plans who have entered into contracts with Department of Human Services.
Residential Care Services: Supportive and health supervision services provided in a licensed residential setting as identified in an Individual Service Plan.
Residential Habilitation: Services provided to a person who cannot live in his or her home without such services or who need outside support to remain in his or 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.
Respite Service: Service provided to persons unable to care for themselves, furnished on a short-term basis because of the absence or need for relief of those persons normally providing the care.
Responsible Party: A person who is capable of providing the support necessary to assist a person to live in the community. A personal care assistance (PCA) program requirement for people who cannot direct their own care.
Retirement, Survivors, and Disability Insurance (RSDI): Program operated by the Social Security Administration that provides a monthly income to retired people, survivors or dependents of insured people and people with disabilities.
Rule 185 Case Management: Minnesota Rule 185 Case Management is a mandated service for persons with a diagnosis of developmental disability or related conditions. A child under the age of 5 years without a conclusive diagnosis must demonstrate significant sub-average intellectual function.
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Screening Document (SD): Document used to record the outcome of assessments, screenings or case management activities.
Screening Team: Team designated by the county and assembled to assess a person’s needs and plan for services.
Section 504: Refers to Section 504 of the Rehabilitation Act of 1973 in which guarantees are provided for the civil rights of students and adults with disabilities.
Self-Advocate: Person who advocates on his or her own behalf. See also Advocate.
Self-Determination: 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 expenses incurred for administering or assisting the person and/or their authorized representative in administering CDCS.
Semi-Independent Living Services (SILS): Services needed by an adult with developmental disability or related condition(s) to successfully live in the community. The goal of SILS is to support people in ways that will enable them to achieve personally desired outcomes and lead self-directed lives.
Serious and Persistent Mental Illness (SPMI): Person age 18 years or older who has a mental illness diagnosis and meets one of the following conditions:
Service Agreement (SA): Document used to identify services, providers and payment information for a person receiving home care or waiver services, allows providers to bill for approved services and allows DHS to audit usage and payment data.
Service Coordination: See Case Management/Service Coordination.
Services and Supports: Services and supports both refer to work that is done to help a person. Persons often use either word or both words to refer to the same thing.
Services During the Day: Services or supports provided to a person that enables the person to be fully integrated into the community. Services during the day may include a variety of supports to enable the person to 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 PDN: Services provided in the same setting at the same time by the same worker for consumers who have entered into an agreement to share services for private duty nursing.
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 optimal health.
Social Security Act: Federal act that provides a variety of funding and program Titles:
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 in the form of a 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- Medicare, provides payment of needed medical care for persons aged 65 years and older
Title XIX-Medical Assistance Program
Title XX-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 the Retirement, Survivors and Disability Insurance (RSDI) and Supplemental Social Security Income (SSI) programs. These two major programs provide cash benefits to individuals who meet the SSA definition of disability. Disability under Social Security is based on the existence of a severe medical impairment(s) that prevents the person from participating in substantial gainful work.
Social Security Disability Insurance (SSDI): Program under RSDI that provides cash payments to individuals 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 years or older, blind or have a disability. Children who are blind or disabled can also receive SSI benefits. Social Security looks at how the disability of the child affects their everyday life to determine if the child is eligible for the monthly cash benefits.
Social Services Information System (SSIS): Software application for county social workers that provides assistance with all aspects of case management, from intake through case closing, including time reporting. The data collected by SSIS is used for state and federal reporting, primarily for child maltreatment and child placement programs.
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 enable the child to benefit from the educational program. See Individual Education Program.
Special Transportation: Transportation of a person who is unable to safely use a common carrier and does not require ambulance service.
Specialist Services: Services that exceed the scope and duration of available Minnesota State Plan or waiver services.
Specialized Supplies and Equipment: Devices, controls or appliances specified in the plan of care that enable the person to increase their ability to perform activities of daily living and perceive, control or communicate with the environment in which they live.
Spenddown: Amount of money that a person enrolled in a MHCP is responsible to pay before they are eligible for Medical Assistance (MA).
Staff Records: Include information on staff qualifications (education and work experience) employment information (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 who makes blind and disability determinations using criteria from the Social Security Administration. SMRT determines disability status for:
State Register: Official daily publication for rules, proposed rules and notices of state and federal agencies and organizations, as well as executive orders and other Presidential documents. State and federal law frequently require DHS to give notice of certain actions or information by publishing in the State Registry, which is the official publication of the State of Minnesota. Documents related to rule making (Requests for Public Comment, Notice of Intent to Adopt a Rule) or contracts (Requests for Proposals) account for most DHS submissions. However, many DHS program areas are also required to publish meeting notices, program guidelines and other information.
Structured Day Program: Service designed for persons who may 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.
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, physical disabilities, or are chemically dependent.
Support Coordination: Service that assists waiver recipients and families to 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 assure that waiver recipients understand the responsibilities involved with self-direction and assist in the development of an effective plan, including backup and emergency needs. Cost of this service is within the individual budget and is identified in the plan.
Supported Employment: Services for persons for whom competitive employment at or above the minimum wage is unlikely, and who, because of their disabilities, needs intensive ongoing support to perform in a work setting. The person receiving services must be in a paid employment situation.
Supported Living Services: Habilitation services provided to persons under 18 years of age who require daily staff intervention due to severe behavior problems, medical conditions, physical deficits and/or lack of adequate survival skills that result in the family’s inability to maintain them in their home.
Support Planner Services: Option under CDCS where a person can receive assistance with developing and implementing the Community Support Plan (CSP). Support planner activities are provided by an individual or entity chosen by the recipient and are in addition to required case management activities.
Surveillance and Integrity Review Section (SIRS): Within DHS, SIRS is responsible to ensure compliance with Minnesota Health Care Program 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 helps people who are eligible for Medical Assistant and meeting certain other criteria to access needed medical, social, educational and other services.
Tax Equity and Fiscal Responsibility Act (TEFRA): Program available for some disabled children who ordinarily would not be eligible for MA because of parental incomes. The State Medical Review Team must review applicants. TEFRA is also known as the Katie Beckett Provision.
Telehomecare: 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.
Teletypewriter (TTY): Device that transmits and receives instantaneous typewritten messages over telephone lines. It is a means of electronic communication between deaf people and other people with a TTY.
Third Party Liability (TPL): Medical Assistance 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 health care costs incurred by a person.
Ticket to Work and Work Incentives Improvement Act (1999): Enacted to increase opportunities for persons with disabilities to work. Title I of the act provides access to employment training and placement services and Title II of the act provides health care supports for working persons with disabilities.
Title Program: Federal and state programs available to persons with special needs. Programs are often based on economic need and criteria vary widely. Examples of Federal Title Programs include:
Transition Services: Services that assist a person from one phase of life to another. Examples of transitions are high school to employment, post-secondary education and/or adult services, living services and community activities.
Transitional Services: Items, expenses and related supports necessary and reasonable for a person to transition from a licensed setting to their own home. For purposes of this service, home means a setting that a person receiving transitional services owns, rents or leases.
Transportation Services: Waiver transportation necessary to gain access to services as specified in the individualized service plan and is provided by common carrier or special transportation vehicles.
Treatment and Training (CDCS): Range of services that promote the person’s ability to live and participate in the community.
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Ventilator dependent consumer: 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 (VR) Services: Wide range of services and job training available to assist persons with disabilities in preparing for and engaging in gainful employment.
Vulnerable Adult (VA): Person 18 years of age or older who is a resident of facility, receives services from a licensed provider or has an impairment that makes them unable to meet basic needs and protect themselves from harm.
Vulnerable Adult/Developmental Disability 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 that 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 MA and meet the needs of targeted populations based on eligibility requirements specific to each waiver program. Minnesota offers the following waivers:
Ward: Person placed under the protection of a legal guardian.
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