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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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VA/DD Targeted Case Management

Page posted: 10/01/03

Page reviewed:

Page updated: 1/13/11

Legal Authority

Minn. Stat. §256B.0924, Minn. Stat. §626.5572, Minn. Stat. §252A.02, Minn. Stat. §252.27, subd. 1a

Definition

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.

Eligibility

A person is eligible to receive VA/DD-TCM services if the local county agency assesses and determines that:

1. The person is:

  • • Eighteen years of age or older
  • • Receiving Medical Assistance (MA)
  • • In need of service coordination to attain or maintain living in an integrated community setting
  • • Not receiving home and community-based waiver services
  • 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.

    Covered Services

    Activities include, but are not limited to:

  • • Advocating on behalf of the person when service barriers are encountered
  • • Assistance to the person or other interested parties in making informed decisions about available services
  • • Communication with the person or other interested parties
  • • Completing and maintaining necessary documentation
  • • Coordination and monitoring of the overall service delivery to ensure quality and effectiveness of services
  • • Coordination of referrals for needed services with qualified vendors
  • • Development of a written service plan
  • • Monitoring and evaluating services identified in the service plan to ensure personal outcomes are met and to ensure satisfaction with services and service delivery
  • • Regular review and revision of the service plan with the person or other interested parties
  • • Travel time
  • Non-Covered Services

    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:

  • • Hospitals
  • • Intermediate Care Facilities for Persons with Developmental Disabilities
  • • Nursing facilities, including Certified Boarding Care Facilities
  • When transition to the community is planned, a county must decide which case management benefit (VA/DD-TCM, RSC or MH-TCM) to use for billing purposes.

    VA/DD TCM does not cover:

  • • Outreach services
  • • Therapy
  • • Treatment
  • Secondary Information

    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 providers

    County case managers and contracted case managers are to meet the following qualifications to provide services to people with developmental disabilities:

  • • Have at least a bachelor degree in social work, special education, psychology, nursing, human services, or other fields related to the education or treatment of persons with developmental disability or related conditions
  • • Have at least one year of experience in the education or treatment of persons with developmental disabilities or a related condition
  • 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.

    Private vendors

    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:

  • • Be able to coordinate and link community resources needed by a person receiving services
  • • Be able to coordinate with county social service agencies
  • • Be able to coordinate with health care providers to ensure access to necessary services
  • • Have a financial management system that provides accurate documentation of services and costs
  • • Have a procedure in place that notifies a person receiving services and their legal representative of any conflict of interest issues if the vendor also provides that person with other services and supports
  • • Have demonstrated the capacity and experience to provide the activities of case management services
  • • Have the administrative capacity and experience to serve the eligible population in providing services and to ensure quality of services
  • • Have the capacity to document and maintain individual case records complying with state and federal requirements
  • Process and Procedures

    1. Access
    2. Assessment
    3. Authorization
    4. Limitations
    5. Documentation
    6. Billing

    Process/Procedure: VA/DD Targeted Case Management

    Access

    Access to VA/DD - TCM Services can happen as a:

  • • Request for service from the person or person’s legal representative
  • • Result of an Adult Protection Investigation (Findings of investigation could include a recommendation or referral for VA/ DD-TCM services)
  • 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.

    Assessment

    To be eligible for VA/DD-TCM, a person must be assessed and determined to:

  • • Be 18 years of age or older
  • • Be in need of service coordination to attain or maintain their community status
  • • Not be receiving community-based waiver services
  • • Not be residing in an MA funded institution
  • • Meet the statutory definition of a vulnerable adult in need of adult protection or adult with developmental or related condition
  • Authorization

    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.

    Limitations

    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.

    Documentation

    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
    2. A telephone contact during the billing month with the person, or the person’s legal representative, family member, primary caregiver or other relevant parties identified as necessary to the development and implementation of the service plan, and a face to face contact to these identified parties during the previous two months.

    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.

    Billing

    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:

  • • Amount of case management-related time spent on VA/DD-TCM by county staff, as documented through the Social Service Time Study
  • • Number of persons serviced (excluding those served by contracted providers)
  • • Total county expenses, excluding purchased services, as documented by the Social Service Cost Pool in the Social Service Fund (Schedule 2556.1)
  • 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:

  • • Modification of the existing SSTS
  • • Modification of the TCM-CSR - DHS 3150.2
  • • Modification in the Social Services Information System or other county information systems for counties not using SSIS
  • 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.

    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:

  • • Procedure Code (face-to-face contact): T2023 U1
  • • Procedure Code (phone contact): T2023 U1 U4
  • • Service Name: Targeted Case Management; Per Month
  • • Unit: 1 Per Month
  • Additional Information

    The following Social Service Information System workgroups, services, activities and contact methods will be utilized for documentation and billing purposes:

    Chemical Dependency (General) workgroup

  • • 393x General Case Management - Effective with the next SSIS Release, Version 3.6, this code will no longer be used
  • Developmental Disabilities (General) workgroup

  • • 592x Child Rule 185 case management, <21 for those age 18-21 years
  • • 593x Adult Rule 185 case management non-waiver, age 21 years and over
  • Adult Protective Services workgroup

  • • 604x Adult Protection Assessment/Investigation
  • • 607x General Assessment
  • • 693x General Case Management
  • SSIS Activities

  • • Client Contact; contact method either face-to-face or by telephone
  • • Collateral Contact; contact method either face-to-face or by telephone
  • SSIS contact methods

  • • Face-to-face
  • • Phone
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