Legal authority

Definition

Face-to-face visit requirement

Covered services

Non-covered services

Process and procedure

Provider standards and qualifications

Applicability

This section applies to HHA through the Medical Assistance (MA) state plan

Access

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

Assessment

A registered nurse or appropriate therapist completes an assessment to determine the person’s need for service and documents it in the person’s record. This assessment:

Authorization

To authorize HHA through the MA state plan, the Medicare-certified home health agency submits a request following the instructions on MHCP Provider Manual – Home care authorization requests. For additional information, see MHCP Provider Manual – Home care services.

DHS reviews the request for completeness of information, need for service and number of visits. DHS may request documentation of the required face-to-face visit.

Length of authorization

If approved, DHS provides one of the following authorizations:

Timeline

DHS must receive the request for authorization within 20 business days of the start of service.

Applicability

This section applies to HHA through:

Access

The county/tribal nation uses the MnCHOICES or legacy assessment process 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.

Assessment

A registered nurse or appropriate therapist completes an assessment to determine the person’s need for service and documents it in the person’s record. This assessment:

Authorization

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

The county/tribal nation:

Type of authorization

The county/tribal nation case manager is limited to authorizing one HHA visit per day on the waiver or AC service agreement.

For people on BI, CAC, CADI and EW who are not enrolled in managed care, the case manager can use extended 15-minute HHA units to authorize all subsequent HHA services on the same day as a visit. For people on AC, the case manager uses 15-minute HHA units to authorize all subsequent HHA services on the same day as a visit.

People on DD cannot receive subsequent HHA services on the same day as a visit.

Services through an MCO

For people on BI, CAC and CADI waivers 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 of the following:

For more information, see 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 the 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.

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.