Page posted: 10/01/03
Page updated: 1/13/11
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.
A person is eligible to receive VA/DD-TCM services if the local county agency assesses and determines that:
1. The person is:
2. Is a vulnerable adult in need of adult protection, or is an adult with developmental disability or related condition.
The county agency determines eligibility and refers the person to a qualified provider for services.
VA/DD-TCM is a covered service under MinnesotaCare for persons in certain eligibility groups that generate federal revenue. Specifically, persons between the ages of 18 and 21 years and pregnant women are covered.
Activities include, but are not limited to:
Case management services rendered to persons who have been admitted to an institution are not claimable unless those services are provided to assist the person transition from the institution to the community. In this case, payment is limited to a six-month period.
Institutions are defined as:
VA/DD TCM does not cover:
The VA/DD service coordinator must meet face-to-face with the person at least twice a year to monitor and evaluate the success and effectiveness of the service plan. If no revisions to the plan are necessary, the case manager documents in the case record that the plan was reviewed at the meeting.
The VA/DD plan is good for 365 days. A formal revision of the VA/DD plan must occur on an annual basis or when revisions are necessary for health, welfare, safety or consumer choice. For persons with a diagnosis of developmental disability or a related condition, the annual team meeting to update and review the ISP meets this condition.
VA/DD-TCM is not included in any managed care contracts. Counties are responsible for VA/DD-TCM regardless of whether or not a person is enrolled in Families and Children, MinnesotaCare, Minnesota SeniorCare Plus, Minnesota Senior Health Options, Special Needs BasicCare.
If a person is otherwise eligible, the county or a contracted vendor may bill MA or MinnesotaCare as they would if the person were not enrolled in managed care. All efforts are to be made to coordinate with the health plan if the person is enrolled in any of the programs designated above.
Provider Standards and Qualifications
County boards or providers under contract with the county are eligible to receive MA reimbursement for VA/DD-TCM.
County case managers and contracted case managers are to meet the following qualifications to provide services to people with developmental disabilities:
The county board may establish procedures permitting others to assist in providing case management services under the supervision of a qualified case manager. A case aide works under the supervision of a case manager and must complete 40 hours of training in case management and the education and treatment of persons with developmental disabilities or a related condition. A case aide does not complete the screening or service planning process.
A county board establishes a plan for the training of case managers and case aides it employs. The plan is to include at least 20 hours annually in the area of case management and developmental disability or a related condition. Training and development activities attended by case managers and case aides are to be documented and kept on file with the county.
Those providing case management to vulnerable adults in need of adult protection must be eligible per Merit System or individual county personnel rules and must complete eight hours of training in VA annually.
State law allows counties to contract with private vendors to deliver VA/DD-TCM services. Private vendors enter into a service provision contract with the host county (county where they are located). The contract specifies the negotiated MA rate for services and the effective dates.
As part of the contracting process, it is the responsibility of the contracting county to ensure the vendor meets all provider standards.
Branch offices of a regional or statewide agency may enter into separate contracts with the host county for their location, but must also enroll as a separate provider with the MA program.
In addition to the provider qualifications noted above, contracted vendors must meet the following:
Process and Procedures
Access to VA/DD - TCM Services can happen as a:
A referral for VA/DD-TCM could come from within a county or outside the county. The person’s situation (vulnerable adult or developmental disability) would determine who receives the referral. This will vary by county depending on how the county structures intake and assessment functions.
To be eligible for VA/DD-TCM, a person must be assessed and determined to:
The county policies for authorization of service must be followed. Before a vendor provides VA/DD-TCM to a person who is the responsibility of another county, the vendor is to obtain authorization from the county of financial responsibility. The vendor is to work with its host county regarding authorization procedures.
Providers, whether county or contracted, cannot bill for VA/DD-TCM services and another form of case management for the same person during the same month.
Each provider, whether county or contracted, is to document at least:
1. One face-to-face contact during the billing month with the person, or the persons legal representative, family member, primary caregiver or other relevant parties identified as necessary to the development and implementation of the service plan OR
The first contact is to be face-to-face and no more than two consecutive months may go by without a face-to-face contact.
Rate and payment methodologies
The rate and payment methodologies used for VA/DD-TCM have been closely modeled after the processes used for Child Welfare Targeted Case Management and Mental Health Targeted Case Management. An all-inclusive, monthly, per person rate will be developed and paid to county providers that will be specific to that particular county. The methodology used for establishing the rates will consist of the:
If a county contracts out all of its VA/DD-TCM case management, the county will not have a rate for county-provided services.
To develop a rate specific for the VA/DD-TCM benefit, the following changes were required:
Under state law, counties are responsible for the non-federal share of VA/DD-TCM. The payment procedures will differ depending on whether the services are provided by county staff or contracted vendors.
If VA/DD-TCM is provided by county staff, the state pays only the federal share to the county that provided the service. In this case, DHS has no involvement in the non-federal share.
If VA/DD-TCM services are provided by a contracted vendor, the state pays 100 percent of the rate negotiated by the host county to the contracted vendor and then bills the CFR for the non-federal share.
MinnesotaCare does not have a CFR. The non-federal share of TCM for enrollee’s will be charged to the county of residence.
As with CW-TCM and MH-TCM, there was no appropriation to cover state administrative costs to develop county rates, train county staff, etc. The authorizing legislation includes a set-aside provision allowing the Department to retain five percent of each county’s federal reimbursement, to cover DHS costs. The set-aside will be deducted from each county payment. There will be an annual reconciliation of state administrative costs for VA/DD-TCM implementation and any unused set-aside will be returned to counties. There will be no set-aside deduction from contracted vendor payments.
Payment will be based on eligible contacts made with the person and other involved parties and will consist of federal earnings only (no state share will be included in the rate). Counties are expected to pay the non-federal portion of the rate.
The billing mechanics for VA/DD-TCM have been modeled after other forms of TCM. Each provider, county or contracted, has an all-inclusive monthly rate per person.
Billing is handled on the same forms as other covered services in MA and MinnesotaCare fee for service.
Face-to-face contact billing
Use the place of service code, other than "99,” that most closely approximates the actual place of service.
Billing - After January 1, 2004
Effective for services provided on or after January 1, 2004, the use of Place of Service code "99" will no longer be used to track contacts made via the phone.
For services provided on or after January 1, 2004, use the following billing codes:
The following Social Service Information System workgroups, services, activities and contact methods will be utilized for documentation and billing purposes:
Chemical Dependency (General) workgroup
Developmental Disabilities (General) workgroup
Adult Protective Services workgroup
SSIS contact methods