Deficit Reduction Act, 2005 (PL 109) §6071 (PDF), Patient Protection and Affordable Care Act, 2010 §2403 (PDF), Minn. Stat. §256B.04, subd. 20

Environmental accessibility adaptations (EAA): Home and community-based services (HCBS) waiver service a person may choose to receive. It covers physical adaptations to a person’s primary home or primary vehicle to ensure the person’s health and safety or enable them to function with greater independence. For more information, refer to CBSM – EAA.

Environmental modifications: MHM service a person may choose to receive to move into their qualified community residence. It covers physical adaptations to a person’s primary home to ensure the person’s health and safety or enable them to function with greater independence. For more information, refer to MHM Manual – Environmental modifications.

Pre-transition environmental modifications deposit: MHM service a person may choose to receive before moving into their qualified community residence. An environmental modification deposit is a monetary pre-payment for home modifications through waiver EAA or MHM environmental modifications. The service must be:

Transition coordination: MHM service that provides coordination of activities to support a person who resides in a qualified institution to gain access to medical, social, education, financial, housing and other services and supports that are necessary to move to the community. For more information, refer to MHM Manual – Transition coordination.

Transition coordinator: Professional who carries out the transition coordination service and supports a person to move from a qualified institution to the community with MHM.

Lead agency: County, tribal nation or managed care organization (MCO).

A person is eligible to receive an environmental modifications deposit for an EAA or MHM environmental modifications if they meet all the following criteria:

Waiver interaction

If a person plans to enroll in an HCBS waiver and wants to receive an environmental modifications deposit through MHM, the person’s transition coordinator must be in contact and coordinate with the lead agency on:

EAA modifications must comply with all requirements outlined in CBSM – EAA and CBSM – Guide to home modifications under EAA.

Environmental modifications deposit can cover a monetary deposit of up to 50% of the cost (up to $10,000) for a home assessment, materials, and/or labor for home modifications through waiver EAA or MHM environmental modifications that include, but are not limited to:

The provider can receive the MHM environmental modification deposit to start the EAA or MHM environmental modification before the person moves from the qualified institution.

Environmental modifications deposit does not include:

1. The waiver EAA home assessment (T1028) or MHM environmental modifications home assessment (T1028 U6). These must be billed as separate services.

2. Duplicate services or services currently available to the person through other funding sources (e.g., community nonprofit organizations, MA state plan services, waiver programs).

3. Transition coordinator time supporting this service. This time must be billed as a separate service under MHM Manual – Transition coordination.

4. Deposits for:

MHM environmental modifications deposits:

There are no exceptions to these limitations.

The EAA or MHM environmental modifications provider must meet all provider standards and qualifications as described on CBSM – EAA and MHM Manual – Environmental modifications.

Service authorization

Managed care

For people enrolled in Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+), the provider should contact the MCO directly for information on their authorization process. For contact information, refer to DHS – MCO contacts for MHCP providers.

For people enrolled in Special Needs BasicCare (SNBC) or Families and Children (PMAP), the provider should follow the fee-for-service authorization instructions.

Fee for service

Environmental modifications deposit requires a service authorization. DHS pays the provider as indicated on the service agreement.

For instructions about authorizing MHM community services and how to receive prior authorization, refer to MHM Manual – Services.

Deposits for waiver EAA

The lead agency authorizing the waiver EAA must provide the transition coordinator with a copy of the person’s MnCHOICES support plan or other lead agency documentation that includes:

· Name of the EAA provider.

· Provider’s national provider identifier (NPI) number

· Description of the EAA.

· Total cost of the approved EAA.

Deposits for MHM environmental modifications

The transition coordinator or MHM demonstration case manager can authorize both the MHM environmental modification and the environmental modifications deposit.

Rate

The lead agency or provider claims the actual cost of the items purchased. The rates cannot exceed the rate limit in Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF).

Billing

The provider must plan and deliver services based on the person's needs, as documented in the person’s TPT. All submitted claims must be based on actual items purchased.

Managed care

For people enrolled in MSHO and MSC+, the provider should contact the MCO directly for information on their billing process. For contact information, refer to DHS – MCO contacts for MHCP providers.

For people enrolled in SNBC or PMAP, the provider should follow the fee-for-service billing instructions.

Fee for service

The provider must not incur MHM home modifications deposit expenses until DHS has confirmed the qualified community residence and receives a service authorization letter (SAL) in their MN–ITS SAL mailbox.