Federally approved Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD) and Elderly Waiver (EW) waiver plans, federally approved Alternative Care (AC) 1115 demonstration, Minn. Stat. §256B.0913, Minn. Stat. §256B.0625, Minn. Stat. §256B.0651, Minn. Stat. §256B.0652, Minn. Stat. 256B.0653, subd. 7, 42 C.F.R. 440.70, 42 C.F.R. 484.36, 42 C.F.R. 484.55

Home health aide (HHA): A qualified employee of a home health agency who completes medically oriented task(s) that maintain a person’s health or facilitate treatment of an illness or injury.

Medical review agent: Agent contracted with DHS to determine a person’s eligibility based on clinical documentation.

The face-to-face visit requirement applies to HHA services. For information about this requirement, refer to the face-to-face visit requirement section on CBSM – Home health agency services.

Covered HHA services, including extended HHA services, must be:

Examples

Examples of covered HHA services include when the employee:

The employee can provide HHA services in the following locations:

The employee cannot deliver services in the following locations:

HHA services are not covered if:

HHA services also are not covered for the sole purpose to provide:

For process and procedural information, refer to the specific sections:

Only Medicare-certified home health agencies may provide HHA services. The home health agency determines if the employee is qualified to provide HHA services.

To access HHA, anyone may make a referral directly to a Medicare-certified home health agency.

An RN from an enrolled Medicare-certified home health agency completes an assessment to document the person’s need for service and keeps it in the person’s record. This assessment:

All HHA services require prior authorization. There are two options for the home health agency to submit the request:

The medical review agent reviews the materials submitted for completeness, need for service and number of visits. The medical review agent may request documentation of the required face-to-face visit.

Length of authorization

If approved, the medical review agent provides one of the following authorizations:

Timeline

The medical review agent must receive the request for authorization within 20 working days of the start of service.

The county/Tribal Nation uses the MnCHOICES assessment to determine the person’s need for service. To initiate service, a certified assessor, case manager or care coordinator may make a referral to a Medicare-certified home health agency.

An RN or appropriate therapist from an enrolled Medicare-certified home health agency completes an assessment to document the person’s need for service and keeps it in the person’s record. This assessment:

All HHA visits need prior authorization from the county/Tribal Nation. The home health agency collaborates with the case manager for authorization.

The county/Tribal Nation:

1. Enters an authorization into the MMIS service agreement using the rates and codes in Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

2. Bases the length of the authorization on the person’s needs and/or the length of the current service agreement.

Extended HHA

If the county/Tribal Nation determines a person on BI, CAC, CADI or EW requires more than one HHA visit per day, the county/Tribal Nation can authorize extended HHA services. For more information, refer to CBSM – Extended home care services.

Extended HHA services are not available for people on AC or DD.

Services through an MCO

BI, CAC, CADI and DD

For people on BI, CAC, CADI and DD who are enrolled in managed care, the county/Tribal Nation case manager must use placeholder code X5609 in MMIS to authorize services for which the MCO is responsible for payment. When using this code, the case manager must indicate all the following:

For more information, refer to Instructions for completing and entering the LTCC screening document and service agreement into MMIS, DHS-4625 (PDF).

The case manager and MCO staff members can use MCO, County Agency and Tribal Nation Communication Form – Recommendation for Home Care Services, DHS-5841 to initiate home care recommendations. The form includes detailed instructions for use.

Then, the MCO follows its procedure to authorize the service.

EW

For people on EW who are enrolled in managed care, the care coordinator follows the MCO’s procedure to authorize the service, unless the person receives case management through a Tribal Nation. In this arrangement, services may be authorized by the Tribal Nation through MMIS and also by the MCO through its billing system. Contact the case manager at the Tribal Nation for more information.