Minnesota Minnesota

Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


Vulnerable adult/developmental disability targeted case management (VA/DD-TCM)

Page posted: 10/1/03

Page reviewed: 10/3/23

Page updated: 10/3/23

Legal authority

Minn. Stat. §256B.0924, Minn. Stat. §256B.076, Minn. Stat. §626.5572, Minn. Stat. §252A.02, Minn. Stat. §252.27, subd. 1a, Minn. Stat. §256B.0625, subd. 20b

Definitions

VA/DD-TCM services: Services provided to a vulnerable adult or person with developmental disabilities to coordinate and link social and other services. VA/DD-TCM services help people gain access to needed protective, social, health care, mental health, habilitative, educational, vocational, recreational, advocacy, legal, chemical, health and other related services.

Institution: For the purposes of this page, “institution” means:

  • · Hospital.
  • · Intermediate care facility for persons with developmental disabilities (ICF/DD).
  • · Nursing facility, including a certified boarding care facility.

    • Eligibility

    A person is eligible to receive VA/DD-TCM services if they:

  • · Are age 18 or older.
  • · Receive Medical Assistance (MA).
  • · Need service coordination to attain or maintain living in an integrated community setting.
  • · Do not receive home and community-based waiver services.
  • · Meet the statutory definition of a vulnerable adult in need of adult protection or are an adult with developmental disabilities or related conditions.

    • For information about the county’s responsibilities to determine eligibility, refer to the assessment section lower on this page.

    VA/DD-TCM is covered under MinnesotaCare for people in certain eligibility groups that generate federal revenue (i.e., people between the ages of 18 and 21 and pregnant women are covered).

    Covered services

    Covered services include, but are not limited to the following activities:

  • · Assess the person’s need for TCM.
  • · Meet with the person via face-to-face and interactive video visits.
  • · Develop a person-centered service plan.
  • · Monitor and evaluate services identified in the service plan to ensure the services meet personal outcomes and to ensure the person’s satisfaction with services and service delivery.
  • · Plan services and interventions to stop, reduce risk of and prevent maltreatment.
  • · Communicate with the person or others identified by the person.
  • · Help the person or others identified by the person make informed decisions about available services.
  • · Coordinate referrals for needed services with qualified vendors.
  • · Advocate on behalf of the person when they encounter service barriers.
  • · Review and revise the service plan regularly with the person or others identified by the person.

    • Non-covered services

    VA/DD-TCM does not cover:

  • · Outreach services.
  • · Therapy.
  • · Treatment.
  • · Activities under Minn. Stat. §626.557 during an open adult protective services assessment to determine if maltreatment of a vulnerable adult has occurred.
  • · Case management services provided to a person admitted to an institution (as described in the definition section), unless those services help the person transition from the institution to the community; in this case, payment is limited to a six-month period.

    • When the person plans to transition to the community, the county/tribal nation must decide which case management benefit (i.e., VA/DD-TCM, relocation service coordination – targeted case management [RSC-TCM] or adult and children's mental health targeted case management [AMH-TCM and CMH-TCM]) to use for billing purposes. For additional information, refer to the limitations section lower on this page.

    Timelines

    The VA/DD case manager 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 they reviewed the plan at the meeting.

    If the person has a diagnosis of developmental disabilities or related conditions, the annual team meeting to update and review the service plan counts as a face-to-face meeting if the person is present at the meeting.

    The VA/DD-TCM plan is valid for 365 days. A formal revision of the VA/DD-TCM plan must occur in any of the following situations:

  • · On an annual basis.
  • · When revisions are necessary for health, welfare or safety.
  • · When the person chooses to make revisions.

    • Secondary information

    VA/DD-TCM is not included in any managed care contracts. Counties are responsible for VA/DD-TCM, regardless of whether a person is enrolled in:

  • · Families and Children.
  • · MinnesotaCare.
  • · Minnesota Senior Care Plus (MSC+).
  • · Minnesota Senior Health Options (MSHO).
  • · Special Needs BasicCare (SNBC).

    • If a person is eligible for VA/DD-TCM, the county or a contracted vendor may bill MA or MinnesotaCare as they would if the person were not enrolled in managed care. The county or contracted vendor must make all efforts to coordinate with the managed care organization if the person is enrolled in any of the programs listed above.

    Interactive video

    Interactive video (ITV) is the delivery of TCM services in real time through the use of two-way interactive audio and visual communication.

    The VA/DD case manager can provide the minimum required face-to-face contacts for TCM through ITV if it is:

  • · In the person’s best interest.
  • · Deemed appropriate by the person and/or their legal guardian and the case management provider.

    • The person or their legal guardian has the right to choose, consent to and refuse the use of ITV at any time.

    Documentation

    The VA/DD case manager must document the following for each occurrence of TCM provided by ITV:

  • · Time the contact began and ended, including a.m. and p.m. designation.
  • · How the case manager and the person made the decision that ITV is appropriate to meet the person’s needs and preferences effectively.
  • · Mode of transmission used to make the ITV contact.
  • · Location of the case manager and the person receiving services.

    • VA/DD case managers who choose to use ITV for MA reimbursement for TCM must attest to the safety and effectiveness of ITV for the person. Each provider must have a completed TCM Provider IVT Assurance Statement, DHS-8398 (PDF) on file with DHS to receive MA reimbursement for TCM through ITV.

    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

    Services for people with developmental disabilities

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

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

    • The county board may establish procedures to allow case aides to help provide case management services under the supervision of a qualified case manager. A case aide must:

  • · Work under the supervision of a case manager.
  • · Complete 40 hours of training in case management and education and treatment of people with developmental disabilities or related conditions.

    • A case aide cannot complete the assessment or service planning process.

    The county board establishes a plan to train the case managers and case aides it employs. The plan must include at least 20 hours annually in the area of case management and developmental disabilities or related conditions. The county board must document training and development activities case managers and case aides complete and keep this information on file.

    Services for vulnerable adults

    County providers that deliver case management to vulnerable adults in need of adult protection must:

  • · Be eligible through the Merit System or individual county personnel rules (refer to DHS – Minnesota Merit System).
  • · Complete eight hours of training about vulnerable adults 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 (i.e., county where the person is located). The contract specifies the MA rate for services and the effective dates.

    As part of the contracting process, the contracting county is responsible 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 they must also enroll as a separate provider with Minnesota Health Care Programs (MHCP).

    In addition to the provider qualifications above, contracted vendors must:

  • · 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 by providing services and to ensure quality of services.
  • · Have the capacity to document and maintain individual case records that comply with state and federal requirements.

    • Process and procedures

    The process and procedure section includes additional information about:

  • · Access.
  • · Assessment.
  • · Authorization.
  • · Limitations.
  • · Billing.

    • Additional resources

    CBSM – MA
    CBSM – RSC-TCM
    CountyLink – Social Service Time Study
    DHS – Minnesota Merit System
    MHCP Provider Manual – AMH-TCM and CMH-TCM
    Social Service Fund Report Instructions, DHS-2556 (PDF)
    TCM Provider IVT Assurance Statement, DHS-8398 (PDF)

    Process and procedure: VA/DD targeted case management

    Access

    A person can access VA/DD-TCM services through any of the following options:

  • · Request for service from the person or their legal representative
  • · Result of an adult protection investigation (e.g., findings of investigation could include a recommendation or referral for VA/DD-TCM services)
  • · Referral for VA/DD-TCM from within or outside the county.

    • Referrals

    The person’s situation (i.e., whether they are a vulnerable adult or have a developmental disability) determines who receives the referral. This process varies by county, depending on how the county structures intake and assessment functions.

    Assessment

    To be eligible for VA/DD-TCM, the county must assess and determine the person meets the requirements in the eligibility section on this page. The county uses its own process to assess the person’s eligibility.

    Authorization

    The county and its vendors must follow the county’s policies for service authorization.

    A vendor must receive authorization from the county of financial responsibility (CFR) for each person they serve before providing services. The vendor must work with the CFR for authorization procedures.

    Limitations

    If the person receives VA/DD-TCM while they reside in a nursing facility, ICF/DD or hospital and the person's institutional care is paid by MA, they are limited to 180 consecutive days of VA/DD-TCM per eligible institutional admission, starting on the date they first receive any of the following services:

  • · RSC-TCM.
  • · MH-TCM.
  • · VA/DD-TCM.

    • The 180-day limit starts on the date of service listed on the first TCM claim. MMIS will create a 180-day window based on that date, which prevents providers from billing past the 180-day limit.

    The person cannot receive RSC-TCM, MH-TCM and VA/DD-TCM during the same month. This is considered a duplication of services.

    Billing

    Rate and payment methodologies

    The VA/DD-TCM rate and payment methodologies are similar to the processes for child welfare targeted case management and MH-TCM. Each county has a monthly, per-person rate paid to county providers using the following rate methodology:

  • · Amount of case-management-related time spent on VA/DD-TCM by county staff, as documented through the Social Service Time Study (refer to CountyLink – Social Service Time Study).
  • · Number of people served (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. For instructions, refer to Social Service Fund Report Instructions, DHS-2556 (PDF).

    • If a county contracts out all of its VA/DD-TCM, the county will not have a rate for county-provided services.

    To develop a rate specific to VA/DD-TCM, DHS uses:

  • · Existing Social Service Time Study.
  • · TCM-CSR – DHS 3150.2.
  • · Social Services Information System (SSIS) and 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 differ depending on who provides the services:

  • · VA/DD-TCM provided by county staff: DHS pays only the federal share to the county that provided the service. DHS has no involvement in the non-federal share.
  • · VA/DD-TCM services provided by a contracted vendor: DHS pays 100% of the rate in the host county’s contract to the contracted vendor and then bills the CFR for the non-federal share.

    • People who use MinnesotaCare do not have a CFR. DHS will charge the person’s county of residence for the non-federal share of VA/DD-TCM.

    VA/DD-TCM does not have an appropriation to cover state administrative costs to develop county rates, train county staff, etc. The authorizing legislation includes a set-aside provision that allows DHS to retain 5% of each county’s federal reimbursement to cover DHS costs. DHS deducts this amount from each county payment. DHS completes an annual reconciliation of state administrative costs for VA/DD-TCM implementation and returns any unused set-aside funds to counties. DHS does not complete a set-aside deduction from contracted vendor payments.

    Contact requirements for reimbursement

    To be eligible for reimbursement, the provider must document, at minimum, one of the following:

  • · One face-to-face or ITV contact during the billing month with the person or their legal representative, family member, primary caregiver or others identified as necessary to develop and implement the service plan.
  • · One telephone contact during the billing month with the person or their legal representative, family member, primary caregiver or others identified as necessary to develop and implement the service plan, and a face-to-face contact with the identified parties during the previous two months.

    • The first contact must be a face-to-face contact, and a face-to-face contact must happen at least once every two months.

    Payments

    Payments are based on eligible contacts made with the person and other involved parties and consist of federal earnings only (i.e., no state share is included). Counties must pay the non-federal portion of the rate. Each provider has a monthly rate per person.

    Billing is handled on the same systems and forms as other covered services in MA and MinnesotaCare fee for service.

    Billing codes

    The county must use the place of service code (other than "99”) that is closest to the actual place of service.

    For services provided, the county must use the following billing codes:

  • · Procedure code for face-to-face contact: T2023 U1
  • · Procedure code for phone contact: T2023 U1 U4
  • · Service name: Targeted case management; per month
  • · Unit: 1 per month.

    • Billing after July 1, 2022, for county-contracted providers

    Effective July 1, 2022, county-contracted providers that have a DHS-approved rate exception must also include the following modifiers, as appropriate to the provider’s rate exception:

  • · UA – low intensity (caseload size rate exception for a higher average caseload size)
  • · TG – high intensity (caseload size rate exception for a lower average caseload size)
  • · UB – culturally specific rate exception.

    • Billing for ITV

    Providers must have a completed TCM ITV Assurance Statement, DHS-8398 (PDF) on file with DHS to receive MA reimbursement for TCM through ITV. Services provided via ITV have the same service thresholds, reimbursement rates and authorization requirements as services delivered in person.

    When the provider delivers services via ITV, they must provide the appropriate place of service in MN–ITS:

  • · Place of service 02: ITV contact provided somewhere other than the person’s home. The person is not located in their home when receiving VA/DD-TCM service through ITV.
  • · Place of service 10: ITV contact provided in the person’s home. The person is located in their home when receiving VA/DD-TCM service through ITV.

    • MHCP does not reimburse for connection charges or origination, set-up or site fees.

    Additional information

    Any provider who uses SSIS uses the following SSIS workgroups, services, activities and contact methods for documentation and billing purposes:

    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 older.

    • Adult protective services workgroup:

  • · 604x adult protection assessment/investigation – Effective Jan. 1, 2024, this code will no longer be used.
  • · 607x general assessment.
  • · 693x general case management.

    • SSIS activities:

  • · Client contact; contact method either face-to-face, interactive video or by telephone
  • · Collateral contact; contact method either face-to-face, interactive video or by telephone

    • SSIS contact methods:

  • · Face-to-face.
  • · Interactive video.
  • · Phone.

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