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Legal authority

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

Definitions

Transition integration fund: MHM service a person may choose receive that covers the purchase of essential items or services to address special or unmet needs to support a person’s transition and integration to the community. 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).

General utility items: Items that serve a practical use to maintain a person’s residency in the community.

Eligibility

General requirements

The transition integration fund service must address a person’s transition and community integration needs to complete and maintain a successful transition to the community. The service must meet at least one of the following requirements:

Pre-transition

A person is eligible for the transition integration fund service pre-transition if they meet all the following criteria:

Waiver interaction

The person is not enrolled in a home and community-based services (HCBS) waiver program while they are in an institution, so there is no overlap in services.

Post-transition

A person is eligible to receive the transition integration fund service for up to 365/366 days after their move into the community if they meet all the following criteria:

Waiver interaction

A person enrolled in an HCBS waiver program cannot receive essential items or services available under the transition integration fund service if they are covered by their waiver.

Covered services

Transition integration fund essential items or services can include:

1. Culturally appropriate items, activities or supports (e.g., blessings, smudging, spiritual ceremonies).

2. Electronics, technology or communication devices for general utility purposes (e.g., cell phones, computers, routers/modems, tablets, televisions).

3. Large appliances for general utility purposes (e.g., dryer, freezer, refrigerator, washer).

4. Mobility devices not covered by the MA state plan, per MHCP Provider Manual – Mobility devices. The transition integration fund service is limited to:

5. Personal items, including:

6. Small appliances for general utility purposes (e.g., portable or window air conditioning unit, air fryer, air purifier, blender, food processor, iron, ironing board, dehumidifier, humidifier, electric can opener, electric kettle, electric griddle, fans, hand/stand mixer, microwave, space heaters, vacuum, carpet cleaner).

7. Specialized furniture or equipment, including lift chairs and furniture to accompany the electric lift mechanisms.
Note: Per MHCP Provider Manual – Mobility devices, the lift chair is not covered under the MA state plan because it is considered furniture rather than medical equipment.

8. Storage fees for up to six months at market rate cost.

Non-covered services

The transition integration fund service does not include:

Limitations

The transition integration fund service:

Storage fees through the transition integration fund service are limited to up to six months at market rate cost. Coverage for fees can begin at any time pre- or post-transition but cannot go beyond the end of the person’s MHM participation. The person is responsible for any storage fees they incur after six months. The transition coordinator must explain this limitation to the person when developing their TPT. The transition plan must include a strategy for how the person’s items will be stored or moved at the end of the six-month storage period.

There are no exceptions to these limitations.

Provider standards and qualifications

The provider must:

License requirements

The provider must be one of the following:

Background studies

Minn. Stat. Ch. 245C requires a licensed program to conduct background studies. Providers who have direct contact with the person must have a completed background study (for a complete list, refer to Minn. Stat. §245D.03). A provider must complete and submit individual background studies using New Electronically Transmitted Study (NETStudy) through DHS licensing.

Authorization, rates and billing

Service authorization

The transition coordinator, demonstration case manager, waiver case manager or care coordinator authorizes the transition integration fund service.

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

The transition integration fund service 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.

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 transition integration fund expenses until DHS has confirmed the qualified community residence. The provider must not deliver transition integration fund services until they receive a service authorization letter (SAL) in their MN–ITS SAL mailbox.