Relocation Service Coordination-Targeted Case Management (RSC-TCM)

Revised: May 23, 2023

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Authorization Requirements

· Limitations

· Billing

· Definitions

· Legal References

Overview

Relocation Service Coordination–Targeted Case Management (RSC–TCM), is a Medical Assistance (MA) reimbursed case management service to help people residing in eligible institutions gain access to needed medical, social, educational and other services and supports necessary to move from the institution to a community-based setting.

Case Management

RSC-TCM includes the provision of both county case management (counties and tribes) and relocation service coordination for the purpose of helping members gain access to needed services and supports if they choose to move from an institution to the community.

Eligible Providers

To be eligible to provide, bill and be paid by Minnesota Health Care Programs (MHCP) for providing RSC-TCM, providers must be enrolled with MHCP by meeting the requirements and submitting the forms listed on the Targeted Case Management (TCM) Enrollment Criteria and Forms section of the MHCP Provider Manual.

MHCP-enrolled private agencies and independent providers without a county contract to offer RSC-TCM services must be certified by the Minnesota Department of Human Services (DHS) Disability Services Division (DSD) to make available and directly bill services.

County and tribal providers are:

· American Indian tribes

· Federally recognized American Indian tribes

· Indian Health Service facility

· County case management

· County human services agency

· Local social services

Free Choice of Case Management Provider

Members using RSC-TCM may choose any eligible county, tribe, private agency (vendor), or independent practitioner as their RSC-TCM provider.

RSC-TCM Eligible Institutions

The following are eligible institutions:

· Hospitals

· Intermediate care facilities for persons with developmental disabilities or related conditions (ICF/DDs)

· Institutions for mental disease (IMDs); includes regional treatment centers (RTCs) licensed as hospitals or nursing facilities

· Nursing facilities (NFs); includes skilled nursing and certified boarding care facilities

Intensive residential treatment services (IRTS) facilities licensed as either board and lodging or supervised living facility are not eligible RSC facilities.

Facilities that have an additional federal designation such as an IMD or an RTC are eligible if they have a license as a hospital, nursing facility, or ICF/DD.

Private Agencies and Independent Providers

Private agencies and independent providers can apply for certification by DHS, not the individual service coordinators employed by the agency. DHS-certified private agencies and independent providers guarantee their employees’ qualifications and compliance with RSC-TCM education and experience requirements.

A DHS-certified private agency or independent provider must:

· Have or employ case managers who have a minimum of a bachelor's degree or a license in a health or human services field or comparable training and two years of experience in human services, meet all state requirements, or who have been credentialed by an American Indian tribe.

· Demonstrate the administrative capacity and case management experience to serve, coordinate and link community resources needed by the eligible MHCP population for whom services will be provided.

· Have the administrative capacity to coordinate with county administrative functions, ensure the quality of services, and to document and maintain individual case records under both state and federal requirements.

· Have a financial management system that provides accurate documentation of services and costs.

· Have no financial interest in the provision of out-of-home residential services (such as foster care and boarding care services) in the county where the member requesting services is seeking to relocate.

County or Tribe and Contracted Providers

County or tribal case managers must meet the employment requirements of their employer. County case manager’s employment qualifications are determined by the county or tribe but cannot be lower than the educational and experience requirements for service coordinators employed by certified agencies.

A county case management provider or tribe must:

· Enroll with MHCP and have the legal authority to provide RSC-TCM services.

· Demonstrate the ability to provide the services and activities outlined in Minnesota statutes.

A contracted provider with a county or tribe must:

· Demonstrate the ability to provide the services and activities that are defined in their contract. Contracted providers are monitored for quality assurance and compliance by the county or tribe.

· Employ case managers who meet minimum educational standards outlined in the county or tribal contract and any additional county requirements to provide RSC-TCM services.

· Receive referrals as stipulated in their contract.

· Comply with all conflict of interest regulations and have a procedure that notifies members or their legal representative of any conflict of interest if the contracted provider also provides, or will provide, the person’s services and supports. Contracted providers may provide RSC-TCM case management, out of home residential and direct services to the same person as allowed in their contract and under the supervision of the county or tribe.

· Negotiate their payment rate with the county or tribe and rely on the county or tribe for resolution of claim denials and disallowances.

Required Certification and Enrollment

Follow these requirements for certification and enrollment:

· All providers must be enrolled as a Minnesota Health Care Program (MHCP) provider.

· Private agencies and independent providers qualify to provide services through one of the following:

· A county or tribal contract

· DHS certification

· Certification is not required for providers working as contractors to a county or tribe.

· DHS requires a Recertification Application (DHS-5069) (PDF) for certified private agencies and independent providers every two years.

· Private agencies and independent providers must have an office in the region or county in which they request certification and recertification.

Certification is dependent upon compliance with the minimum provider qualifications and requirements outlined in the Certification Application (DHS-5068) (PDF), and the MHCP Provider Eligibility and Compliance standards and regulations. Find more information in HCBS Waiver Services and Home and Community-Based Services (HCBS) Programs Provider Enrollment sections of the MHCP Provider Manual.

Provider Certification Application Process

Current or new providers requesting certification must complete and sign the Certification Application (DHS-5068) (PDF) indicating they are applying for state certification as a provider of RSC-TCM.

Providers must complete and sign the provider certification application and mail or fax it to:

DHS – RSC Certification
P.O. Box 64250
St. Paul, MN 55164-0250
Fax: 651-431-7745

Providers may also scan and email the application to: MovingHomeMN.MFP@state.mn.us.

The DHS DSD will review the application and send a response within 10 working days upon receipt confirming approval, denial or the need to provide additional documentation.

If you have questions about certification or recertification, please call 651-431-4300, TTY-TDD number 711, or 800-267-7655.

Monitoring and Recertification

The DHS DSD will monitor and review compliance with RSC-TCM policy and procedures for DHS-certified RSC-TCM private agencies and independent providers every two years and recommend decertification or corrective action if problems are identified.

The counties and tribes will continue to provide oversight for contracted RSC-TCM providers and recommend corrective action if problems are identified. DHS-certified private agencies or independent providers and contracted providers must submit the following information to the county or tribal contact person identified in their contract at the specific times identified in their contract:

· Number of members who:

· Received RSC-TCM services

· Relocated from institutions in 180 days or less

· Relocated from institutions in one year

· Did not relocate after receiving RSC-TCM services

· Narrative summary and total hours of trainings attended, including:

· Conferences

· Lectures

· Online

· Summary of complaints (all sources) and steps taken to remedy concerns

· Summary of customer satisfaction results or outcomes

DHS-certified RSC-TCM private agencies or independent providers must be recertified by DHS every two years. Submit the Recertification Application (DHS-5069) (PDF) to DHS – RSC certification.

Decertified private agencies or independent providers and terminated contractors may reapply for certification or county or tribal contracts after complying with all conditions listed in their written corrective action plan notice.

Provider Type Home Page Links Review related webpages for the latest news and additions, forms and quick links. · Case Management · Clinical Nurse Specialist · County Case Manager · Federally Qualified Health Center (FQHC) · HBCS Waivered Services · Home Health Agencies (HHA) · Hospitals · Indian Health Services (IHS) & Tribal Social Services · Licensed Independent Clinical Social Workers (LICSWs) · Managed Care & Prepaid Health Plans · Nursing Facilities · Nurse Practitioners · Occupational Therapists · Physicians/Clinics · Physician Assistants · Psychologists · Regional Treatment Centers · Rehabilitation Centers · Rural Health Clinics (RHC) · RN/LPN/Private Duty Nursing

Eligible Members

A member is eligible to receive services when all of the following criteria are met:

· Eligible for MA (including Program IM, NM or RM)

· Resides in an institution that qualifies for services at the time of service delivery

· Chooses to move into the community

· Chooses to receive services

· TCM benefit is not exhausted

Covered Services

Members in an institution may receive federally targeted case management reimbursements during the last 180 days of placement for the purposes of helping the member relocate to the community. The service must not duplicate the services of the institution’s discharge planner.

This federal law applies to:

· Relocation Service Coordination–Targeted Case Management (RSC-TCM)

· Mental Health-Targeted Case Management (MH-TCM)

· Vulnerable Adult Developmental Disability-Targeted Case Management (VADD-TCM)

Consequently, the use of any one of these case management types will begin the 180-day time span and exhaust the benefit after 180 days.

Members must have a service plan. A county case manager develops, monitors and reviews the plan using a person-centered process. At a minimum, the service plan must identify:

· The member and the member’s legal representative

· All case managers responsible for coordinating and planning services

· The member’s goals

· The needed services

· The amount, duration and frequency of the services

· The anticipated service outcomes

· The method and frequency of monitoring the plan of care

If there are multiple case managers, the service plan must identify and attribute specific case management activities to each case manager to demonstrate their differing roles and responsibilities.

Counties and tribes may use the community support plan or the developmental disability individual service plan to record services.

The case manager must document the following information in the member’s case record following delivery of service:

· Date of service

· Name of the provider agency and person providing the service

· Narrative statement describing the nature of the service provided

· Place of service

· Member name

· Units of service

The narrative statement must be detailed to identify the activity as an approved case management service. Undocumented claims result in a claim’s disallowance and claims adjustment.

RSC services provided by a county, certified private agency or independent agency, or county or tribe contracted providers, include:

· Assistance to access needed services, including travel to visit a member to develop or implement the goals of the written plan.

· Coordinate, monitor and support overall service delivery and advocacy as needed to ensure quality of services, appropriateness and continued need.

· Coordination with the facility discharge planner in the 180-day period before the member's discharge.

· Documentation that supports and verifies the activities.

· Routine contact or communication with:

· Legal representative

· Primary caregiver

· Member

· Member’s family members

· Service providers or other people identified as necessary to the development or implementation of the goals of the written plan

· Substitute care provider

County or tribe required services include:

· Assessment of the member’s need for RSC-TCM and service coordination options.

· Coordination of referrals for and the provision of appropriate service providers.

· Development, completion, monitor and planned review of a written individual service plan designed to help a person access needed services and supports.

Members have the right to appeal an action that denies, delays, suspends, reduces or terminates their services. County case managers are responsible to inform members of their appeal rights under the law.

Noncovered Services

The following list of noncovered services is not all-inclusive:

· Transition assistance when a member moves from one institution to another

Example: If a nursing facility closes, a provider cannot bill for activities related to finding another nursing facility for the member, unless the member’s relocation plan indicates that a move to another institution is a necessary step toward the eventual community integration of that member.

· Administrative functions:

· Intake for Medical Assistance and other MHCP programs

· Eligibility determinations and re-determinations for MA or an MA funded benefit such ARHMS, waivered services, VADD–TCM

· Prior authorization of services

· LTCC or DD screening

· Appeals or conciliation activities

· Direct services such as treatment, therapy and other habilitative or rehabilitative services provided to the member

· Other non-billable activities:

· Outreach services and marketing activities

· Information and referral activities before eligibility determinations

· Services without proper documentation in the member’s service plan

· Services to members ineligible for MA

· Services covered by another billing source such as private insurance or other third-party payers

· The time and services of the institution’s discharge planner

· Case management activities covered as a part of another covered service such as development of a treatment plan for home care or PT services

· Services prior to the county of financial responsibility (CFR) authorization

Authorization Requirements

Services are available to eligible members at any time upon request during an institutional placement. After establishing a member is eligible for services, determine the date of the last long-term care consultation (LTCC) or developmental disability (DD) face-to-face screening. If a new screening is necessary, complete the screening using LTCC form (DHS-3428) (PDF) or DD screening (DHS-3067) (PDF) form.

The CFR or tribe must assign a county case manager, its contractor or the tribe to visit the member within 20 working days of the original request for services. The CFR or tribe can request that another county or tribe complete county case management required activities.

If the CFR, its contractor or tribe is unable to meet with the member within the 20 working days of the original request for services, the member may obtain these services from another county, tribe or private provider. The commissioner may waive certain provider qualifications to allow the member access to the assistance necessary to move from the institution to the community. The CFR, its contractor or the tribe must complete a written request detailing the reason for waiving qualification standards and send this information to:

Attention: RSC-TCM Lead
DHS — Disability Services Division
P.O. Box 64967
St. Paul, MN 55164-0967

Telephone: 651-431-4300

Members or their legal guardians must notify the CFR or tribe in writing of the decision to obtain services from another county, tribe or private vendor. Follow these timelines:

· Within five working days from receipt of the notice, the county or tribe must provide the other county, tribe or private provider written results of their eligibility determination.

· Within 10 working days from receipt of the notice, the county, tribe or private vendor must arrange to meet with the new county, tribe or private vendor and member to fulfill county case management responsibilities.

The private provider ought to withhold billing or providing services until the CFR completes the eligibility determination, plan development and service authorization. The private provider may bill for time spent aiding or assisting the member with relocation activities before the written plan is signed.

For counties and tribes, notification of the CFR that a member wants services may be considered part of the LTCC or DD screening activities.

Limitations

Members living in the community or an ineligible institution such as an intensive residential treatment services (IRTS) that is not licensed as a hospital or nursing facility cannot receive RSC-TCM.

The RSC-TCM benefit is available during the last 180 consecutive days of a continuous institutional placement following the date on the first paid claim for RSC-TCM, MH-TCM or VADD-TCM regardless of the length of that placement.

RSC-TCM benefits end once a member is discharged from an eligible institution.

RSC-TCM is available for each and every institutional placement episode. If a person is discharged from an institution with or without RSC-TCM services, remains in a community living arrangement for a full day, and then returns to an institution, he or she may receive RSC-TCM services to assist with the relocation. MHCP must have a record of community placement that lasts for at least one day.

Members cannot receive RSC-TCM and another type of targeted case management (MH, VA/DD, CW) during the same month while they reside in an institution. Do not bill for another type of targeted case management during the months RSC-TCM is provided.

Minnesota Senior Health Option (MSHO) members should contact their managed care organization (MCO) to request relocation assistance. The RSC-TCM provider must coordinate with the MCO to ensure continuity of care and non-duplication of effort.

Waiver Transitional Services
A service provider may simultaneously provide waiver transitional services and RSC-TCM to an eligible member who meets the requirements and limitations for waiver transitional services. Waiver transitional services reimburse items, expenses and related supports necessary and reasonable for members to transition to their permanent place of residence in the community from the institution and do not duplicate these services.

Payment for these services may not duplicate payments made, or services provided under other programs authorized for the same purpose.

Billing

A contracted county or tribe, certified private agency or independent provider may receive direct referrals from a member. If these provider types receive a request for service, they must direct interested persons to contact their CFR or tribe. Before any service can be provided and billed, the CFR must determine a potential member’s eligibility, then develop a service plan and have it signed by all parties.

Notifying the CFR of a request for service is not billable; it is considered information (referral before eligibility determination, or an outreach or marketing activity).

Providers are not required to wait for discharge to occur before billing. Providers may submit a claim regardless of whether the community reintegration takes place through a home and community-based waiver, by other means, or not at all.

Providers contracting with the county or tribe must negotiate a rate based on their costs. This rate cannot exceed federally approved rate limits.

If the private provider functions as both a certified private agency or independent provider and county or tribe contracted provider to one member, the provider should bill the same rate for all services provided to that member.

The rate for counties, tribes or county or tribe contracted and certified private agencies or independent providers is up to $15.53 for each 15 minute unit.

Bill targeted case management 15-minute increments claims using procedure code T1017.

Services are limited to 32 units per day (8 hours maximum) and 5 days a week.

Bill each date of service separately, date spans will deny. Bill electronically using your NPI or UMPI number.

While VA/DD-TCM, MH-TCM and RSC-TCM can be used alternately (VA/DD-TCM one month, MH–TCM one month and RSC-TCM the next), DHS does not recommend this practice. Use one of these TCMs for the duration of the relocation effort. The 180-day limit starts with the service date of the first paid VA/DD-TCM, MH-TCM, or RSC-TCM claim. RSC-TCM services provided after the 180-day limit will deny.

Certified private agencies, independent providers and county or tribe contracted providers must work closely with county case managers to avoid claim denials due to ended eligibility or exceeded service limits.

Definitions

Continuous institutional placement: An uninterrupted placement in one or more RSC–TCM eligible institutions. A transfer from one eligible institution to another does not interrupt a continuous placement. (Moves to hospitals, which are eligible institutions, are not community placements for RSC purposes; consequently, moves from a nursing facility to a hospital and back to a nursing facility do not interrupt a continuous placement).

County Case Management: Services include assessment of need, plan development and review, referrals to relocation service coordination providers, and conflict of interest management.

County or Tribe case management: Counties or tribes who meet the qualifications in statutes and any additional county requirements to provide RSC-TCM services. Counties and tribes may contract for RSC-TCM county case management. Certification is not required for providers working as contractors to a county or tribe.

County of Financial Responsibility (CFR): The entity responsible for the costs of a member’s MHCP as specified in statutes.

Developmental Disability (DD) Screening Document: An assessment tool required for any person being admitted to an institution. This process is to be used to provide persons with community service options in order to prevent admissions or to provide transition assistance in the event an admission cannot be avoided. If a person is admitted and requests RSC services, this process includes a means for assessing the member’s health, psychosocial and functional strengths and needs, in addition to, assisting the member identify needed and available services.

DHS-certified RSC-TCM private agency: Corporation, partnership, voluntary association and other organization other than a county agency or a tribe enrolled-Medical Assistance provider who meets RSC-TCM provider qualifications and has been certified by the DHS to provide RSC-TCM services.

DHS-certified RSC-TCM private independent provider: Individual who meets the definition of a self-employed person (someone who is in business for themselves as a sole proprietor), is an enrolled MA provider, meets RSC–TCM provider qualifications and is certified by the DHS to provide RSC-TCM services.

Institutions: Hospitals, nursing facilities (NFs), including certified boarding care facilities, intermediate care facilities for members with developmental disabilities or related conditions (ICF/DDs), regional treatment centers (RTCs) providing inpatient services to members currently receiving Medical Assistance.

Long-Term Care Consultation (LTCC Screening) Document: An assessment tool required for any member seeking nursing home level of care or admitted to an institution. The screening is to provide community service options to prevent admissions or to provide transition assistance in the event an admission cannot be avoided. If a member is admitted and requests transition services, the screening includes a means for assessing a member’s health, psychosocial and functional strengths and needs, in addition to assisting the member identify needed and available services.

Relocation Service Coordination Targeted Case Management (RSC-TCM): A type of targeted case management for eligible members residing in eligible institutions who want to move into the community. RSC-TCM helps a member who resides in an eligible institution to plan, arrange and 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.

Relocation Service Coordination: Services include implementation of a service plan including referrals and coordination of service providers; client and collateral contacts necessary for the implementation of the plan; monitoring, and advocacy.

Targeted Case Management (TCM): Services that assist an eligible member gain access to needed medical, social, educational and other services as defined in their service plan.

Tribal Facility: A health care facility, operated by a tribal organization that is recognized by the federal government, which has not elected designation as a 638 IHS provider.

Tribal Facility Designated as a 638 IHS Provider (638 IHS): All facilities that are under contract, compact, or are receiving grants from the IHS under Public Law 93-638. The 638 facility is operated by a tribal organization that is recognized by the Federal government, under a funding agreement with IHS. The 638 facilities that have elected to be paid at the IHS rates are hereafter referred to as 638 IHS facilities.

Legal References

Minnesota Statues 256B.02 (Definitions)
Minnesota Statues 256B.77 (Coordinated service delivery system for disabled)
Minnesota Statues 256B.0621 (TCM covered services)
Minnesota Statues 256B.0621 subdivision 4 (RSC-TCM provider qualifications)
Minnesota Statues 256B.0621 subdivision 5 (Provider qualifications and minimum educational requirements)
Minnesota Statues 256B.0621 subdivision 6 (Eligible services)
Minnesota Statues 256B.0621 subdivision 7 (Timelines)
Minnesota Statues 256B.0625 subdivision 20 (Mental health case management services)
Minnesota Statues 256B.092 (County of financial responsibility)
Minnesota Statues 256G.02 subdivision 4 (CFR definitions)
Minnesota Statues 256B.02, subdivision 7 (Vendor of medical care)