CBSM glossary of terms and acronyms
A | B | C | D | E | F | G | H | I | L | M | N | O | P | Q | R | S | T | U | V | W
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1115 Medicaid Waiver: Refer to Medicaid Waiver 1115
1915(c) Waivers: Refer to Medicaid Waiver 1915(c)
24-hour customized living: Customized living services provided with 24-hour supervision. Also refer to customized living.
24-hour emergency assistance: On-call counseling and problem solving and/or immediate response for assistance at a person’s home due to a health or personal emergency.
45-day temporary start of service (PCA services): Process to begin PCA services temporarily until the lead agency assessor can schedule and complete a face-to-face assessment.
A
Accessible: Activity, place or information capable of being reached, entered or used by people who have disabilities.
Acquired brain injury: Injury to the brain that occurs after birth and can include anoxia, drug reactions, infection, stroke, trauma and tumors. Also refer to brain injury.
Active treatment: Aggressive, consistent implementation of a 24-hour program for a person with developmental disabilities or related conditions with specialized and generic training, treatment, health services and other related services.
Activities of daily living (ADL): Tasks essential to perform routine self-care functions (e.g., dressing, grooming, bathing, eating, transfers, mobility, positioning, toileting).
Adaptive behavior: Ability of a person to meet the standards of maturation, learning and personal independence that are expected based on normative standards for age, cultural background and experience. A person can demonstrate adaptive behavior through skills or the ability to adjust their own behavior to compensate for health, motor or sensory challenges.
Additional square footage: Increase to an existing private residence’s square footage when it is necessary to build or modify a bathroom to accommodate a wheelchair or scooter. Additional square footage includes:
Adult: Person who is age 18 or older.
Adult companion services: Non-medical care, supervision and socialization provided to a person age 18 or older.
Adult day services: Individualized program of activities designed to meet the assessed health and social needs of a person age 18 older outside of their residence during the day. Adult day services includes the delivery of supervision, care, assistance, training and activities directed toward achieving specific outcomes, as identified in the person’s support plan.
Adult day services bath: Bath provided by an adult day services or family adult day services (FADS) provider when it is not able to occur in the person’s home.
Adult foster care: Individual waiver services that provide ongoing residential care and supportive services to adults living in a home licensed as family foster care or a community residential setting (CRS). These services are individualized and based on the needs of the adult, as identified in the support plan.
Adult mental health targeted case management (AMH-TCM): Services that help adults with serious and persistent mental illness (SPMI) gain access to medical, social, educational, vocational and other necessary services connected to the person’s mental health needs.
Adult protection: Essential human services program provided by a county/tribal nation or service delivery authority. Adult protection includes investigation and protection response to reports of suspected abuse, neglect or financial exploitation of vulnerable adults.
Adult rehabilitative mental health services (ARMHS): Mental health services that are rehabilitative and enable the adult to develop and enhance psychiatric stability, social competencies, personal and emotional adjustment, and independent living and community skills when these abilities are impaired by the symptoms of mental illness.
Advertising: Form of marketing used to persuade someone to use a product or service.
Advocate: Individual designated by a person or their legal representative to speak on the person’s behalf and help the person understand and make informed choices in matters related to identification of needs and choices of supports and services.
Affected participant: Person who, as a roommate or significant other who lives with the person and is not a caregiver, may have their personally identifiable information viewed or recorded by monitoring technology.
Age-appropriate: Activities suitable for people of a certain chronological age, which is reflected in the way the person is perceived and treated by others.
Agency-initiated direct contact: Activity in which a person acting on behalf of an agency makes the first connection or approaches someone about a product or service the agency directly or indirectly provides.
Alternative Care (AC): Program that provides home and community-based services for people age 65 and older who require the level of care provided in a nursing facility, choose to live in the community and are not yet financially eligible for Medical Assistance (MA).
Alternative Care (AC) conversion case management: Support of a discharge planning process to help people relocate to community-based settings.
Alternative Care (AC) monthly fee: Monthly fee required for most people on the AC program to help pay for the cost of services provided under the program. People on AC pay cost-sharing fees that range from 5% to 30% of the average monthly cost of their AC services, unless they are exempt from paying a fee.
American with Disabilities Act (ADA): National civil rights legislation passed in 1990 that guarantees equal opportunity for people with disabilities in public accommodations, employment, services and telecommunications.
Anniversary month: Person’s annual reassessment month.
Appeal: Process through which a human services judge reviews a decision made by either DHS or a county/tribal nation that affects the services a person receives or requests.
Appellant: Person who files an appeal.
Applied Behavior Analysis (ABA): Treatment modality for people with autism spectrum disorder (ASD) with a set of data-driven practices grounded in behavioral science. This approach can be applied to people of all ages. ABA focuses on increasing positive and appropriate behaviors through reinforcement while decreasing interfering/unwanted behaviors or behaviors that interfere with learning. Under ABA, the provider systematically analyzes factors in the person’s environment that interfere with their success and teaches new and more appropriate ways of responding.
Approval-option services: Group of basic services available under the home and community-based services (HCBS) waivers and the Alternative Care (AC) program. An approval-option service provider enrolls with Minnesota Health Care Programs (MHCP) or is approved by a willing lead agency. Approval-option services include direct-delivery services and purchased-item services.
Assessment: Process of identifying all of the following:
Assisted living: Refer to customized living.
Assisted living plus: Refer to 24-hour customized living.
Assistive technology: Devices, equipment or a combination of both that improve a person’s ability to:
For the federal definition of assistive technology, refer to MN Guide to Assistive Technology – Definition.
Authorization: Written approval and issuance of an authorization number, when applicable, by a medical review agent under contract with DHS.
Authorized representative: Individual who is at least 18 years old and is designated by a person’s legal representative to act on the person’s behalf. The authorized representative must successfully pass a criminal background study and must not have a financial interest in the delivery of goods or services to the person.
Autism Resource Portal: Website that provides the Minnesota autism community with up-to-date information about resources related to autism spectrum disorder.
B
Basis of eligibility: Set of characteristics such as age, income, disability or family status used to access Medical Assistance (MA). The basis of eligibility is based on federal eligibility categories.
Behavioral support: Refer to positive support services.
Brain injury: Injury to the brain caused by an external physical force and not of a degenerative or congenital nature. The injury results in an impairment of cognitive abilities or physical functioning. Additional consequences of the injury might include changes in behavior and/or emotional functioning.
Brain injury diagnosis: Diagnosis that includes:
Brain Injury (BI) Waiver: Program that provides home and community-based services to children and adults with a diagnosis of brain injury who require the level of care provided in a specialized nursing facility or neurobehavioral hospital. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration.
Brain Injury – Neurobehavioral Hospital (BI-NB) conversion: Situation in which a person eligible for the BI-NB Waiver:
Brain Injury – Nursing Facility (BI-NF) conversion: Situation in which a person eligible for the BI-NF Waiver:
BI diversion: Situation in which a person eligible for the Brain Injury (BI) Waiver does not meet the criteria for the neurobehavioral hospital or nursing facility conversion. This includes people who meet waiver eligibility criteria and who are discharged from all other types of institutions or treatment facilities (e.g., regional treatment centers, Rule 36 facilities and Rule 5 facilities).
C
Care coordination: Service for people enrolled in Minnesota Senior Health Options (MSHO) and/or Minnesota Senior Care Plus (MSC+). It provides assessment and coordination of the delivery of all health and long-term care services among different health and social service professionals and across settings of care. Care coordination also includes waiver/AC case management responsibilities.
Caregiver (primary): Person principally responsible for the care and supervision of a person who receives services.
Caregiver (unrelated): Person who is not related by blood, marriage or adoption to any degree.
Caregiver living expenses: Certain expenses incurred by an unrelated caregiver who lives in the same household as a person age 18 or older who receives waiver services when the caregiver also provides an approved service.
Caregiver training and education: Refer to family training and counseling.
Carve out: Arrangement in which specific services are eliminated from health insurance coverage under a capitated rate. A person may then receive services on a fee-for-service basis.
Case management (waiver, Alternative Care and Essential Community Supports): Service that provides a person and their family with access to assessment, person-centered planning, referral, linkage, support plan monitoring, coordination and advocacy related to waiver services, resources and informal supports that are not necessarily funded through the waiver.
Case management aide: Professional who assists a case manager with administrative activities related to waiver case management services.
Case manager/care coordinator: Professional who assists a person with access to and navigation of social, health, education, vocational and other community and natural supports and services, based on the person’s values, strengths, goals and needs. The professional is responsible to provide the person with information necessary for them to make informed choices.
Case mix classification: Classification used to establish a person’s individual community budgets under various programs. The classification is based on the assessment of the person’s:
Category of service (COS): Three-digit code used to specify a type of service.
Centers for independent living (CILs): Service organizations designed to help people with disabilities achieve and maintain independent lifestyles. CILs are run by people with disabilities who themselves have successfully established independent lives and have a deep commitment to help other people with disabilities become more independent. There are eight CILs in Minnesota.
Centers for Medicaid & Medicare Services (CMS): Federal agency within the U.S. Department of Health and Human Services that administers the Medicare and Medicaid programs. CMS ensures states administer national health care programs properly, establishes policies for paying health care providers, conducts research on the effectiveness of various methods of health care management, assesses the quality of health care facilities/services and takes enforcement actions as appropriate.
Certified assessor: Individual who completes assessments and plans services for people who need long-term services and supports using the MnCHOICES web-based application.
Child: Person younger than age 18.
Child and Teen Checkups (C&TC): Minnesota’s Early Periodic Screening, Diagnosis and Treatment (EPSDT) program. Also refer to EPSDT program.
Child corporate foster care setting: A licensed residential setting that serves children and where the license holder does not reside. This setting typically uses a shift-staff model of support (i.e., paid staff work shifts on a 24-hour basis). In this type of setting, at least one person receives community residential services funded by an HCBS waiver program.
Child welfare targeted case management (CW-TCM): Activities that coordinate social and other services designed to help a child younger than age 21 and the child’s family gain access to needed social services, mental health services, habilitative services, educational services, health services, vocational services, recreational services and related services including, but not limited to, volunteer services, advocacy, transportation and legal services.
Chore services: Assistance provided to a person or their primary caregiver to help maintain a clean, sanitary and safe environment.
Cognitive rehabilitation therapy: Services and interventions designed to improve cognitive functions.
Commissioner: Commissioner of the Minnesota Department of Human Services (for the purposes of this manual).
Commissioner’s designee: Person designated by the commissioner to work at the commissioner’s direction.
Common carrier: Transportation provider type that includes buses, taxis, light rail transit, other commercial carriers and vehicles owned or leased by a lead agency.
Common entry point (CEP): Refer to Minnesota Adult Abuse Reporting Center (MAARC).
Community Access for Disability Inclusion (CADI) Waiver: Program that provides home and community-based services to children and adults with disabilities who require the level of care provided in a nursing facility. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration.
Community Access for Disability Inclusion (CADI) conversion: Situation in which a person eligible for CADI:
Community Access for Disability Inclusion (CADI) diversion: Situation in which a person eligible for the CADI Waiver does not meet the criteria for a CADI conversion. This includes people who meet waiver eligibility criteria and who are discharged from all other types of institutions or treatment facilities (e.g., regional treatment centers, Rule 36 facilities and Rule 5 facilities).
Community Alternative Care (CAC) Waiver: Program that provides home and community-based services to children and adults who are chronically ill or medically fragile and require the level of care provided in a hospital. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration.
Community Alternative Care (CAC) conversion: Situation in which a person eligible for CAC:
Community Alternative Care (CAC) diversion: Situation in which a person eligible for the CAC Waiver does not meet the criteria for a CAC conversion. This includes people who meet waiver eligibility criteria and who are discharged from all other types of institutions or treatment facilities (e.g., regional treatment centers, Rule 36 facilities and Rule 5 facilities).
Community inclusion: Situation in which people are not treated differently because of the color of their skin, their religion, their disability status or other identities. Community inclusion refers to people with and without disabilities living side by side in a city, town or neighborhood.
Community living assistance (CLA): Assistance and support to help a person live in the community.
Community living service categories: Broad service categories for providing support and training to help a person to live independently in their community. The community living service categories are:
Community residential services: Services that provide training and/or habilitation, ongoing residential care and supportive services to adults and/or children in a licensed setting. These services are individualized and based on the needs of the person, as identified in the support plan.
Community residential setting: A licensed residential setting that serves adults and where the license holder does not reside. This setting typically uses a shift-staff model of support (i.e., paid staff work shifts on a 24-hour basis). In this type of setting, at least one person receives community residential services funded by an HCBS waiver program.
Community Services Information System (CSIS): Software application designed for billing case management time, specific county/tribal nation-provided services billable to Medical Assistance (MA) and pay vouchers. It is also used as a state and local reporting system.
Community support plan (CSP): Written summary completed for everyone who has an assessment, regardless of whether the person is eligible for Minnesota Health Care Programs (MHCP) or chooses to receive publicly funded home and community-based or state plan services. The document provides a summary of what the assessor discovered through the assessment process and identifies next steps based on the person’s needs.
Community Support Services (CSS): Program of the DHS Direct Care and Treatment (DCT) Division’s Community-Based Services (CBS). CSS provides short-term technical assistance and residential supports designed to:
Community Support Services (CSS) crisis home: Residential setting in which staff provide short-term services to people who need residential crisis stabilization. Crisis home staff use positive supports to help people return to successful, integrated community living.
Community Support Services (CSS) mobile team: Team that addresses behavioral crises in people’s current settings whenever clinically appropriate and safely possible. CSS mobile teams promote positive supports and build collaborative support networks to strengthen people’s ability to live in integrated community settings.
Companion services (adult): Non-medical care, supervision and socialization provided to a person age 18 or older.
Competitive, integrated employment: Employment that pays a minimum wage or an industry standard, customary or prevailing wage with comparable benefits (e.g., health insurance, leave time, etc.).
Compound (medication): Prescription prepared in accordance with Minn. R. 6800.3100.
Complex cognitive and/or behavioral health needs: Conditions or situations that cause a person to experience significant challenges related to their mental health or behavioral well-being that may require specialized and comprehensive interventions.
Complex medical needs: Health conditions or situations that may require extensive and/or specialized medical care, management or interventions.
Conciliation conference: Alternative way to solve a grievance a person with a developmental disability or related condition has with their case management services. During a conciliation conference, the people involved try to resolve the conflict with a mediator in an informal setting.
Conflict of interest: Financial or proprietary interest in a situation that could cause injury or damage to the person or limit the person’s choices.
Conservatorship: Court procedure in which a court appoints a person (i.e., conservator) to manage another person’s assets and estate.
Consumer: Person who use products, goods and services.
Consumer choice: Person’s ability to choose supports and services from a range of service options to meet their diverse and personalized needs. A person’s choice in services and supports must go beyond the range of service choices and include opportunities for them to decide when, where, how and who will provide supports and services.
Consumer directed community supports (CDCS): Service option available to people on the home and community-based services (HCBS) waivers and Alternative Care (AC) program. CDCS gives a person flexibility in service planning and responsibility for self-directing their services, including hiring and managing support workers. CDCS may include traditional services and goods and self-designed services.
Consumer direction: Philosophy through which people make informed choices about the services they receive. Consumer direction provides people flexibility and responsibility to direct their own services and supports.
Consumer records: Information about a person that could include name, gender, birth date, home address, telephone number where parents or legal representative may be reached and emergency numbers. Other types of consumer records include admission forms, health forms (e.g., records for immunizations, physicals, dental exams) assessments, support plans, education plans and abuse prevention plans.
Consumer Support Grant (CSG): Program that is a state-funded alternative to the following Medical Assistance home care services:
Coordinated services and supports plan (CSSP): Summary of a person’s choice of supports and/or services and the person’s preferences for the delivery of the supports/services. A CSSP is only completed if the person is eligible for and chooses to receive publicly funded home and community-based services and/or state plan services.
Corporate foster care moratorium: Moratorium on the growth of licensed adult and child corporate foster care and community residential settings. Effective Sept. 1, 2009, the legislature established a statewide capacity threshold for the duration of the moratorium. This threshold is based on results of an ongoing needs-determination process.
Corporate foster care setting: A licensed foster care setting where the license holder does not reside. This setting typically uses a shift-staff model of support (i.e., paid staff work shifts on a 24-hour basis).
County government: Government directly under the state level. In Minnesota, the county is typically responsible for the administration of various social services programs.
County of financial responsibility (CFR): County responsible for payment of a person’s social services. The CFR is typically the person’s county of residence.
County of residence (COR): County where the person resides.
County of service (COS): County or tribal nation that provides financial worker services. For more information, refer to Eligibility Policy Manual – County residency.
County/tribal worker: Employee of a county/tribal nation who determines eligibility and approves/monitors a person’s support plan. The county/tribal worker may help with planning and be the service coordinator if the person chooses.
Crisis respite: Short-term behavioral or medical intervention services to protect the person or others living with them and provide relief and support to the caregiver.
Customized living: An individualized package of regularly scheduled, health-related and supportive services provided to a person age 18 years or older who resides in a qualified setting.
Customized living (24-hour): Customized living services provided with 24-hour supervision.
D
Day support services: Individualized, community-based training and support services that help a person develop and maintain essential and personally enriching life skills so they can access and participate in activities they prefer in their community.
Day training and habilitation (DT&H): A service replaced by day support services during the rolling implementation of Waiver Reimagine streamlined services. Historically, DT&H included services that developed and maintained life skills for people with developmental disabilities or related conditions so they could participate fully in community life.
DD conversion: Situation in which a person in an existing intermediate care facility for persons with developmental disabilities (ICF/DD) bed receives home and community-based services and the ICF/DD bed the person previously occupied is decertified and removed from the community ICF/DD system.
DD diversion: Ability to serve additional people on the Developmental Disabilities (DD) Waiver without decertifying an intermediate care facility for persons with developmental disabilities (ICF/DD) bed.
Deeming: Act of counting the income or assets of one person when determining the eligibility of another person (e.g., a parent when determining the eligibility for a child or a spouse when determining eligibility for another spouse). If a person has a waiver of deeming, family income and assets are not included when eligibility is determined for the person. Eligibility is based only on the income and assets of the applicant and not on the income and assets of the household (e.g., in TEFRA cases, parental income is not deemed to the child).
Deficits in adaptive behavior: Significant limitations in a person’s ability to meet the standards of maturation, personal independence and social responsibility expected for the person’s age level and cultural group, as determined by clinical assessment and, generally, standardized scales.
Department of Human Services (DHS): State agency that provides Minnesotans with a variety of services intended to help people live as independently as possible. Working with many others, including counties, tribal nations and managed care organizations, DHS administers health care coverage, economic assistance and a variety of services for children, people with disabilities and older adults.
Designated billing person: Person responsible to ensure PCA service claims are billed according to DHS policies and procedures.
Developmental Disabilities (DD) Waiver: Program that provides home and community-based services to children and adults with a diagnosis of a developmental disability or a related condition who require the level of care provided in an intermediate care facility for persons with developmental disabilities (ICF/DD). These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration.
Developmental disability (DD): Severe, chronic disability attributed to mental and/or physical impairment that manifests before age 22 and is likely to continue indefinitely. The disability results in substantial limitations in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living and economic self-sufficiency, as well as the continuous need for individually planned and coordinated services.
Developmental disability (DD) screening: Assessment for a person with a diagnosis of developmental disability or a related condition to evaluate the level of care they need.
Diagnosis-related group (DRG): System used to classify and sort hospital patients by discharge diagnosis into categories that are medically similar and have approximately equivalent lengths.
Diagnostic and Statistical Manual of Mental Disorders (DSM) code: Code used to describe mental health conditions and symptoms.
Direct service: Intervention services delivered by the provider through face-to-face contact with the person.
Disability: Condition of the body or mind that makes it more difficult for a person with the condition to do certain activities and interact with the world around them that can expected to last for a continuous period of no less than 12 months. To be eligible for one of the waiver programs, the Social Security Administration (SSA) or the State Medical Review Team (SMRT) must certify the person as disabled.
Disability determination: Decision that a person meets the disability definition from the Social Security Administration (SSA) to be eligible to receive Medical Assistance benefits as a person who has a disability. A person may be certified disabled by the SSA or State Medical Review Team (SMRT).
Disability Hub MN: Free statewide resource network that helps people with disabilities solve problems, navigate the system and plan for the future.
Disability Services Division (DSD): Division of the Minnesota Department of Human Services responsible to manage publicly funded programs that support people with a wide variety of disabilities and chronic illnesses.
Disability Services Division (DSD) Response Center: Help desk that provides support to lead agency staff who administer DSD home and community-based services, programs and waivers. The Response Center provides:
Disability Waiver Rate System (DWRS): Initiative that determines individualized payment rates for certain Brain Injury (BI), Community Access for Disability Inclusion (CADI), Community Alternative Care (CAC) and Developmental Disabilities (DD) waiver services. DWRS divides disability waiver services into three categories:
Diversion: Ability to serve all people eligible for a waiver who do not meet criteria for waiver conversion.
Due process: Requirement to respect all the legal rights owed to a person.
Due process for special education: Process mandated by the Individuals with Disabilities Education Act (IDEA), by which parents of children who have disabilities and public agencies can challenge decisions made by a public school system about the evaluation, placement or services for children.
Durable medical equipment (DME): Prescribed medical equipment (e.g., wheelchair, hospital bed, respirator) that a person can use for an extended period of time.
E
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program: Federal comprehensive child health program provided to people younger than age 21 who are enrolled in Medicaid. The EPSDT program aims to reduce the impact of childhood health problems by identifying, diagnosing and treating health problems early. Minnesota’s EPSDT program is called Child and Teen Checkups (C&TC).
Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit: A Minnesota Health Care Program (MHCP) that offers medically necessary treatment for people who:
Edit: Refer to MMIS exception code.
Effective environment checklist: Successful Life Project tool used to identify what a person needs in their environment to be successful.
Elderly Waiver (EW): Program that funds home and community-based services for people age 65 years and older who require the level of medical care provided in a nursing home and choose to reside in the community.
eDocs: DHS’ document library that contains forms and documents in multiple languages.
Eligibility update: Activity that follows an initial assessment and is used to extend the time in which the lead agency can determine a person’s program eligibility without another in-person assessment.
eList: Electronic mailing sent by DHS’ Aging and Adult Services Division (AASD) and/or Disability Services Division (DSD) that is a resource for counties, tribal nations, managed care organizations and stakeholders.
Emergency assistance (24-hour): On-call counseling and problem solving and/or immediate response for assistance at a person’s home due to a health or personal emergency.
Emotional disturbance (ED): General term intended to reflect all categories of disorder described in the International Classification of Diseases (ICD) code ranges in the diagnostic code list, as usually first evident in childhood or adolescence.
Employer Identification Number (EIN): Nine-digit number the Internal Revenue Service (IRS) assigns to an entity to identify business taxpayers.
Employment development services: Individualized services designed to help a person achieve competitive, integrated employment, become self-employed or establish a microenterprise business in their community.
Employment exploration services: Services that help a person gain a better understanding of competitive, integrated employment opportunities in their community. Exploration activities and experiences strengthen a person’s knowledge, interests and preferences so they can make informed decisions about competitive employment. Employment exploration includes:
Employment support services: Individualized services and supports that help people maintain paid employment in community businesses/settings. Employment support services occur in integrated community settings.
Enabling technology: Technology that makes on-demand remote supervision and support possible.
Enhanced rate or budget for PCA, CDCS and CSG: A higher reimbursement rate or budget for work that is both:
Entitlement program: Federal program that guarantees a certain level of benefits to people who meet the eligibility requirements set by law. Examples of entitlement programs include Social Security, unemployment benefits and Medicaid. Home and community-based waiver services are not considered entitlement programs.
Enteral nutritional product: Commercially formulated substance administered via feeding tube that provides a person with nourishment.
Environmental accessibility adaptations (EAA): 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.
Environmental modifications and provisions: Services and supports through the consumer directed community supports (CDCS) option that help people maintain their environment so they can live and participate in the community.
Essential Community Supports (ECS): Community-based services for people age 65 and older who do not require nursing facility level of care, choose to live in the community and are not yet financially eligible for Medical Assistance (MA).
EW hospital high-needs budget exception: Exception to the monthly case mix budget for a person on EW who is discharging from a hospital. The hospital high-needs exception is a budget amount requested by the lead agency that reflects the person’s individual needs to be supported in the community.
EW nursing facility (NF) conversion budget: Exception to the monthly case mix budget for a person on EW who is leaving an NF. The NF conversion budget calculation process determines a new maximum set amount to be used for the person’s EW services.
Experimental treatment: Drugs, therapies or treatments that are unproven, have been confined largely to laboratory use or have progressed to limited human application and trials but lack widespread recognition from the scientific community as a proven and effective measure of treatment (Minn. R. 9525.3015, subp. 16).
Extended home care services: Services that follow Medical Assistance (MA) state plan home care policies but are allowed to exceed the limits on amount, duration and frequency.
F
Fair hearing: Meeting with the appellant, DHS, county/tribal nation and a human services judge to testify about the disputed decision. This meeting can be in person or via phone.
Family adult day services (FADS): Adult day services provided in a license holder’s primary residence. The license holder must be the primary FADS provider. This setting is typically a family foster care setting.
Family caregiver coaching and counseling with assessment: Individualized, person-centered service intended to equip the caregiver with knowledge, skills and tools to become a stronger caregiver capable of self-directed care.
Family caregiver training and education: Training and education provided to improve or maintain the health and wellbeing of a family caregiver and the quality of care they provide to the person.
Family foster care setting: Licensed family foster care setting where the license holder resides in the home.
Family memory care (FMC): Coaching and counseling service for a caregiver who lives with a family member or friend with dementia. The goal of FMC is to improve a caregiver’s ability to withstand the difficulties of caregiving by improving social support and minimizing family conflict.
Family residential services: Services that provide training and/or habilitation, ongoing residential care and supportive services to adults and/or children in a licensed family foster care setting where the license holder resides in the home. These services are individualized and based on the needs of the person, as identified in the support plan.
Family Support Grant (FSG): A statewide program that provides cash grants to eligible families with children who have been certified disabled. The program:
Family training and counseling: Professional services that provide instruction and guidance to the person and/or their family in areas covered by the service.
Federal financial participation (FFP): Federal government’s contribution toward Medicaid services. FFP depends on the state’s guarantee of assurances under its Medicaid and waiver plans.
Federal government: Government of the United States. Federal laws and regulations apply to all states.
Federal poverty guidelines (FPG): Index of poverty in the United States that is updated annually. FPG is used to determine financial eligibility for certain federal programs.
Fee-for-service (FFS): Method in which health care providers receive payment for each service provided (i.e., on a service-by-service basis).
Financial management services (FMS): Services that provide help with financial tasks, billing and employer-related responsibilities for people who self-direct their services through consumer directed community supports (CDCS), the Consumer Support Grant (CSG) and Community First Services and Supports (CFSS). These services are provided by financial management services (FMS) providers.
Financial management services (FMS) provider: Minnesota Health Care Programs (MHCP)-enrolled organization that people use to help them with employer-related responsibilities and financial management service tasks.
Fiscal support entity (FSE): Provider type replaced by financial management services (FMS) providers.
Fiscal year (FY): State’s budgetary year that goes from July 1–June 30.
Foster care: Individual waiver services that provide ongoing residential care and supportive services to people living in a licensed setting.
Fraud: Act that is intentional, unlawful or has an element of false representation.
Functional behavior assessment: Assessment used to better understand the purpose or reason for a person’s challenging behavior. This assessment defines the challenging behavior, identifies the situation in which it is most likely to occur/not occur and generates a hypothesis of why it occurs.
Functional status: Ability to carry out the tasks associated with daily living.
G
General Assistance Medical Care (GAMC): A state health care program for low-income Minnesotans who do not qualify for Medical Assistance (MA) or other state and federal health care programs.
Generic services: Services offered or available to the public that are common to all and are not restricted to a special category of people.
Group Residential Housing (GRH): Former name for the Housing Support program.
Guardian: Individual appointed by the court to make personal decisions for a person, as identified in a court order.
Guardian ad litem: Individual who looks after the interests of a person involved in litigation, often appointed in civil commitment cases and as part of child custody hearings.
H
Habilitation: Designed to help people with developmental disabilities develop, maintain and improve the self-help, socialization and adaptive skills necessary to live successfully in their home and the community. Habilitation is directed toward increasing and maintaining physical, intellectual, emotional and social functioning. Habilitation is different from rehabilitation, which involves the restoration of function a person lost.
Healthcare Common Procedure Coding System (HCPCS): Set of health care procedure codes based on Current Procedural Technology (CPT) codes. HCPCS provides a standardized coding system to describe specific items and services provided in the delivery of health care.
Health Care Financing Administration (HCFA): Former name for Centers for Medicare & Medicaid Services (CMS).
Health care professional: Licensed professional who, within their scope of service or practice, can review and approve care plans for people with overriding health care needs.
Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule: Federal law that provides individuals with rights over their health information and sets rules and limits on who can look at and receive personal health information.
Health Insurance Portability and Accountability Act (HIPAA) Security Rule: Federal law that protects health information in electronic form and requires entities covered by HIPAA to ensure electronic protected health information is secure and the confidentiality provisions of the Patient Safety Rule are enforced.
Health maintenance organization (HMO): Organization that provides an agreed-upon set of basic and supplemental medical services to an enrolled group of people in a particular geographic area. The HMO is reimbursed for those services through a predetermined and fixed periodic payment made by or on behalf of each person or family enrolled in the HMO, regardless of the amount of services provided.
Health service: Service or treatment consistent with the health needs of a person eligible for Medical Assistance payments under Minnesota Statutes (e.g., medication administration and monitoring, medical, dental, nutritional, health monitoring, wellness education and exercise).
Health-related procedures and tasks (PCA services): Procedures and tasks performed by a personal care assistant (PCA) that can be delegated or assigned by a licensed health care professional under state law.
Hearing: Refer to fair hearing.
HIPAA: Refer to Health Insurance Portability and Accountability Act.
Home and community-based services (HCBS) waiver: Services not normally covered by Medical Assistance that are covered under a 1915(c) federally funded waiver program or through state funds. HCBS waivers allow states flexibility to cover virtually all long-term care services that people with disabilities need to live independently in home and community settings. States may operate several 1915 (c) HCBS waiver programs at once, each offering a distinct package of services and supports to different groups of people.
Home and community-based services model contract: Written legal document that applies to home and community-based services and supports identified in the person’s service plan and provided through the HCBS disability waivers.
Home-based mental health service (HBMHS): Rehabilitative mental health service package that includes skills training (individual, family and group) and psychological services.
Home care: Medical and health-related services and assistance with day-to-day activities for people in their homes. Home care can provide short-term care for people moving from a hospital or nursing home back to their home, or it can provide continuing care for people with ongoing needs.
Home care nursing (HCN): Provision of professional nursing services to a person in or outside their home when normal life activities take the person outside the home (e.g., school). Services are based on an assessment of the person’s medical/health care needs.
Home care nursing (HCN) hardship waiver: Allows parents/family foster parents of minor children, legal guardians or spouses to provide home care nursing to a person who is eligible for Medical Assistance and authorized to receive home care nursing services.
Home care therapies: Therapies provided in a person’s home to improve or maintain a person’s functioning. Home care therapies include physical, occupational, speech-language pathology and respiratory therapies.
Home-delivered meal: Appropriate, nutritionally balanced meal that is delivered to the person’s home.
Home health agency services: Services delivered by a home health agency to a person with medical needs due to illness, disability or physical conditions in the person’s place of residence or in the community where normal life activities occur.
Home health aide: A qualified employee of a home health agency who completes medically oriented task(s) that maintain health or facilitate treatment of an illness or injury. Home health aide services may be provided in a person’s place of residence or in the community where normal life activities occur.
Home health therapies: Therapies provided in a person’s place of residence or in the community where normal life activities occur. These therapies improve or maintain a person’s functioning and include physical, occupational, speech-language pathology and respiratory.
Homemaker: Services that help a person manage general cleaning and household activities. There are three homemaker services:
Hospice: Palliative and supportive care for people who are terminally ill and their families to meet the physical, nutritional, emotional, social, spiritual and special needs experienced during the final stages of illness, dying and bereavement.
Hospital: An acute care institution licensed under Minn. Stat. §144.50 to 144.58.
Host county: County in which the services set forth in a person’s support plan are provided. If supported employment or community integration services are provided in a setting outside the county where the license holder is located, the county where supported employment services are provided is not considered to be the host county.
Host county concurrence: If services are to be provided in a county other than the county of financial responsibility, the county of financial responsibility must request concurrence from the county where services are to be provided. Concurrence must be granted or deemed under Minnesota Statute for all services to be provided. .
Housing access coordination: A waiver service discontinued June 30, 2021, as Housing Stabilization Services became available. Historically, housing access coordination helped a person plan for, find and move to their own home. It was a pay-for-performance, person-centered service that paid for staff assistance based on the results achieved.
Housing Benefits 101 (HB101): An online resource to help people make informed choices about where they want to live. It helps lead agencies, formal supports and informal supports engage people in the planning and transition process.
Housing Stabilization Services: A Medical Assistance benefit to help people with disabilities, including mental illness and substance abuse disorder, and older adults find and keep housing.
Housing Support: Program that pays for room and board for older adults and adults with disabilities who have low incomes. The program aims to reduce and prevent people from living in institutions or becoming homeless. Housing Support was formerly known as Group Residential Housing (GRH).
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ICD-9-CM: Refer to International Classification of Diseases, 9th Edition, Clinical Modification code.
Inclusion: When people with disabilities are in the same place as people without disabilities and participate in the same activities at the same time. Also refer to community inclusion.
Independent living skills (ILS) therapies: Art, music or recreational therapies with specific therapeutic goals and outcomes.
Individual community living supports (ICLS): Bundled service that includes six service categories. ICLS services offer assistance and support for older adults who need reminders, cues, intermittent/moderate supervision or physical assistance to remain in their own homes.
Individual community living supports (ICLS) planning form: Required communication and planning tool for the person, lead agency and ICLS provider. Access the form here: ICLS Planning Form, DHS-3751.
Individual driver: Transportation provider type that includes natural supports such as family members, neighbors, friends, community agencies and volunteer driver programs.
Individual Education Program (IEP): A plan that outlines special education and related services for children who have been evaluated and are in need of special education. IEP services are based on information gathered from evaluations, state and district assessments and current levels of achievement on IEP goals and in the general education curriculum.
Individual provider: A person who is not employed by an agency, organization or other type of provider business entity to deliver home and community-based services (HCBS) waiver services to an eligible person.
Individual Interagency Intervention Plan (IIIP): Single, written plan designed to be used in place of multiple plans (Individual Service Plan, Individual Education Program and Individualized Family Service Plan) that describes services and payment arrangements for children who are eligible. The purpose of the IIIP is to ensure the development of a coordinated, multi-disciplinary, interagency intervention system for children and young adults with disabilities ages 3 to 21 years.
Individual Service Plan (ISP): Each person with developmental disability or a related condition who receives services must have an ISP. The ISP is developed after an assessment of the person’s preferences, functional skills and need for services and supports, and it is completed before services are authorized. The ISP is based on the service recommendations from the completed assessment(s) and the service needs identified by the team.
Individualized Family Service Plan (IFSP): A plan for providing services to a child and the child’s family through interagency agreements. Procedural and program requirements for the Individual Education Program (IEP) also apply to the educational components of the IFSP. The purpose of the IFSP is to provide family-centered programs for infants and toddlers up to 3 years of age with disabilities. The IFSP may substitute for the Individual Service Plan (ISP).
Individualized home supports: Services for people who live in their own home or family home that provide support and/or training in community living service categories. There are three types of individualized home supports:
All types of individualized home supports can be provided in the person’s own home, family’s home or in community spaces used by the general public, and either in person or remotely.
Individualized home supports – support in community living service categories: Cueing, skill maintenance, guidance, instruction, assistance with activities of daily living, assistance with coordination of community living activities or direct supervision. Support must be within an allowable community living service category.
Individualized home supports – training in community living service categories: Skill-building and instructional services to acquire, retain and improve the person’s experience living in the community. Training must be within an allowable community living service category, and training must meet identified needs specified in the person’s assessment (e.g., MnCHOICES, long-term care consultation).
Individuals with Disabilities Education Act (IDEA): Federal law that makes available a free, appropriate public education to eligible students with disabilities throughout the nation and ensures special education and related services are provided to those students.
Informal supports: Any unpaid support provided by family, friends, coworkers, neighbors or other community members.
Informed choice: A choice a person makes that is based on their likes, dislikes, community-based experiences, the potential impact on their quality of life and information about other available options they receive from their support system. Per Minn. Stat. §256B.4905, all people with disabilities have the right to make an informed choice and to be provided with an informed decision-making process.
Initial assessment: An assessment that happens when a person either:
In-home respite: Respite provided in the person’s home or place of residence. Also refer to respite.
Instrumental activities of daily living (IADLs): Meal planning and preparation, managing finances, shopping for food, communication by telephone and other media, getting around and participating in the community.
Integrated community supports (ICS): Services that provide support and training in community living service categories to adults age 18 and older who reside in a living unit of a provider-controlled, ICS setting (e.g., apartment in a multi-family housing building). ICS can be delivered up to 24 hours per day in the person’s living unit or in the community.
Integrated community supports (ICS) setting: A setting in which a provider has an approved setting capacity report and has direct/indirect control over a person’s living unit. A provider has direct or indirect control over a person’s living unit when the provider either:
An ICS setting does not meet the requirements for a person’s own home, community residential program or family residential program.
Integrated community supports (ICS) – support in community living service categories: Cueing, skill maintenance, guidance, instruction, assistance with activities of daily living, assistance with coordination of community living activities or direct supervision within an allowable community living service category.
Integrated community supports (ICS) – training in community living service categories: Skill-building and instructional services to acquire, retain and improve the person’s experience living in the community within an allowable community living service category. Training must meet the person’s identified needs.
Intermediate care facility for persons with developmental disabilities (ICF/DD): Residential facility licensed as a health care institution and certified by the Minnesota Department of Health to provide health or rehabilitative services for people with developmental disabilities or a related conditions who require active treatment.
International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9) code: Codes to describe medical conditions and symptoms.
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Lead agency: A county, tribal nation or managed care organization.
Lead agency employment liaison: The main point of contact for each lead agency to help build a coordinated system for people on waivers to meet their employment goals. They build regional collaboration capabilities by working closely with Vocational Rehabilitation Services/State Services for the Blind (VRS/SSB) and employment service providers. They also build internal capacity by ensuring lead agency staff and contracted staff are aware of new processes and have resources and tools to help them in their work.
Lead investigative agency (LIA): Primary administrative agency responsible for responding to Minnesota Adult Abuse Reporting Center (MAARC) reports using prioritization guides for investigation. The LIA is determined by the relationship between the alleged perpetrator and a licensed service. The LIA can be the county, Office of the Inspector General or the Minnesota Department of Health Office of Health Facility Complaints.
Lease: A legal agreement between a landlord and tenant. It outlines the responsibilities of each party.
Least restrictive alternative: Alternative that is the least intrusive and most normalized given the level of supervision and protection the person requires. This level of supervision and protection allows risk-taking to the extent that there is no reasonable likelihood that serious harm will happen to the person or others.
Least restrictive environment: Environment where services:
Legal guardian: A person with legal authority and duty to act on behalf of another person. The legal guardian can make decisions for the person about where to live, medical treatment, training and education, etc. Decision-making is limited to the specific powers the court assigns to the legal guardian.
Legal representative: Parent(s) of a person younger than 18 years old, guardian, conservator, guardian ad litem (authorized by the court) or other representative legally authorized to act on behalf of a person, including the right to make decisions about services for the person.
Legally responsible individual: Any of the following people:
Level of care (LOC): A particular amount of care and services required to meet a person’s needs. There are four level of care distinctions:
Licensed home care agency with a home and community-based services (HCBS) designation: A basic home care provider or a comprehensive home care provider with an HCBS designation under Minn. Stat. §144A.484. The Minnesota Department of Health (MDH) licenses this type of provider.
Licensed provider: Provider who chooses to participate in Minnesota Health Care Programs (MHCP) and who meets professional requirements and/or licensure requirements as set forth in applicable state and federal laws and regulations.
Life sharing: A relationship-based living arrangement that carefully matches an adult age 18 or older who has a disability with an individual or family who will share their life and experiences and support the person using person-centered practices.
Limited English proficiency (LEP): A person with limited English proficiency (LEP) does not speak English as their primary language and has a limited ability to speak, read, write or understand the English language well enough to allow them to interact effectively with health and social services agencies and other providers.
Limited English Proficiency (LEP) program (DHS): Provides spoken and written language assistance services to people who limited English skills prevent them from accessing health and human services.
Live, two-way communication: Real-time transfer of information between a person receiving services and an actively involved caregiver. This communication can happen through the exchange of speech, visuals, signals or writing, but it must flow both ways and be in actual time.
Live-in caregiver expenses: Refer to caregiver living expenses.
Living unit: A self-contained residential unit with living, sleeping, eating, cooking and bathroom areas.
Long-term care consultation (LTCC): A service designed to help people make decisions about long-term care needs and choose services and supports that reflect their needs and preferences.
Long-term care consultation (LTCC) team: A multidisciplinary team established by the county board of commissioners or through tribal nation/managed care contracts with DHS. Each local team must include at least one social worker and one nurse. The social worker, public health nurse or registered nurse can provide a component of the LTCC and then consult with one another to determine the most appropriate care for the person. Two or more counties/tribal nations may collaborate to establish a joint, multidisciplinary team.
Long-term care/long-term support services: Services that a person will likely need for the rest of their life.
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Maintenance needs allowance (MNA): A budget deduction used for people requesting Elderly Waiver (EW) services who have income at or below the special income standard (SIS). The MNA is the sum of:
Maltreatment: May include physical, mental or emotional abuse; financial exploitation; caregiver neglect of a person’s needs (e.g., food, shelter, clothing, education, health, supervision); or a vulnerable adult’s neglect of their own needs.
Maltreatment of Minors Act: Establishes a system for reporting possible child abuse and neglect to government agencies that provide protective services for the child or conduct criminal investigations.
Managed care: Health care delivery system that includes pre-established provider networks and reimbursement arrangements, administration and clinical systems.
Managed care organization (MCO): An organization certified by the Minnesota Department of Health to provide all defined health care benefits to people enrolled in a Minnesota Health Care Program (MHCP) in return for a capitated payment. MCOs are also referred to as health plans or prepaid health plans.
Managing employee (PCA services): General manager, business manager, administrator, director or other individual who exercises operational or managerial control over or who directly/indirectly conducts the day-to-day operation of personal care services for an institution, organization, or personal care provider agency. This does not include managing employees who solely manage non-PCA areas of the business.
Mandated reporter: Professionals required to report suspected maltreatment of a vulnerable adult (e.g., social service professionals, law enforcement, educators, professionals who care for vulnerable adults, providers licensed by DHS or Minnesota Department of Health, enrolled Medical Assistance providers, medical examiners, coroners, lead investigative agencies).
Market rates: Rates that allow lead agencies and providers to determine rates that meet the person’s assessed needs, are appropriate according to identifiable service costs and are allowable Medical Assistance expenses.
Marketing: Presentation of products or services in such a way as to make them desirable.
MAXIS: System that processes information to determine eligibility for public assistance programs and mails benefits and notices to people who receive public assistance. MAXIS is not an acronym; the letters do not stand for anything in particular. Eligibility information for Medicaid and General Assistance Medical Care (GAMC) is passed through to the Medicaid Management Information System (MMIS).
Medicaid: A jointly funded, federal-state health insurance program for people who have a low income or other needs. It covers children, people who are older, people who have disabilities and others who are eligible to receive federally assisted income maintenance payments. Minnesota’s Medicaid program is called Medical Assistance. Also refer to Medical Assistance.
Medicaid Management Information System (MMIS): A mechanized claims-processing and information-retrieval system for Medicaid. The federal government requires all states operate an MMIS to support Medicaid business functions and maintain information in several areas (e.g., provider enrollment, eligibility, benefit package maintenance, managed care enrollment, claims processing, prior authorization).
Medicaid Waiver – 1115: This notation refers to section 1115 of the Social Security Act that gives the U.S. Department Health and Human Services (HHS) the authority to waive certain Medicaid laws to allow states flexibility in designing their Medicaid programs. These waivers are also known as research and demonstration waivers.
Medicaid Waiver – 1915(c): This notation refers to section 1915(c) of the Social Security Act that gives the Health Care Financing Administration (HCFA) the authority to waive federal Medicaid requirements to allow states to experiment with providing health care services in home and community-based settings instead of institutional settings (e.g., hospitals, nursing facilities). These waiver services, often called home and community-based waivers, include day treatment, habilitation, supported employment, respite care, semi-independent living services and adaptive equipment. Waivers may also allow reimbursement for services not usually covered by Medicaid but are provided to help a person stay out of an institution.
Medical Assistance (MA): Minnesota’s name for the federal Medicaid program that provides medical care for people with low incomes.
Medical Assistance for Employed Persons with Disabilities (MA-EPD): Minnesota Health Care Program (MHCP) that allows people with disabilities to qualify for or keep their Medical Assistance while working.
Medical Assistance Rehabilitation (Rehab) Option: Includes two sets of mental health services that expand support and intervention services in the community:
Medical Assistance under the TEFRA option: An option for children with disabilities who are otherwise ineligible for Medical Assistance because household income is about the Medical Assistance for Families with Children and Adults (MA-FCA) income limit. The TEFRA option for children with disabilities is named after the Tax Equity and Fiscal Responsibility Act (TEFRA) that created the option.
Medically necessary/medical necessity: Health service that is consistent with a person’s diagnosis or condition and is recognized as the prevailing medical community standards or current practice by the provider’s peer group and is rendered according to one of the following:
Medicare: Federal health insurance program administered by the U.S. Department of Health and Human Services under the Centers for Medicare & Medicaid Services (CMS) for people who:
Medicare-certified home health agency (HHA): Private or public organization that provides skilled nurse visits, home health aide visits, therapies and medical supplies. An HHA is required to meet all federal, state conditions of participation and sign an agreement with Medicare and Medicaid to furnish home health services according to a plan of care for a person.
Mental health targeted case management (MH-TCM): Refer to adult mental health targeted case management (MH-TCM).
Mental illness: Organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory or behavior.
Metro Crisis Coordination Program (MCCP): A collaborative effort among the seven metropolitan counties: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington. MCCP provides a range of crisis safety net services for people with developmental disabilities and related conditions.
Microenterprise business: A commercial business with five or fewer employees, including the owner of the business.
Minnesota Adult Abuse Reporting Center (MAARC): Minnesota’s centralized 24-hour hotline for reporting suspected abuse, neglect or exploitation of vulnerable adults. If law enforcement or a lead investigative agency receives an adult maltreatment report, the agency must forward the report to the MAARC immediately. The MAARC immediately refers cases involving an identified safety need to county social services. The MAARC notifies the lead investigative agency responsible for report review and investigation within two working days.
MinnesotaCare: A health care program for Minnesotans with low incomes. People who are enrolled in MinnesotaCare get health care services through a health plan. MinnesotaCare is funded by a state tax on Minnesota hospitals and health care providers, Basic Health Program funding and enrollee premiums and cost sharing.
Minnesota Children and Youth with Special Health Needs (CYSHN): Collection of public programs administered by the Minnesota Department of Health (MDH) that works to achieve public health policies that will provide more positive health outcomes and better serve children and youth with special health needs and their families throughout Minnesota.
Minnesota Department of Health (MDH): State agency whose mission is to protect, maintain and improve the health of all Minnesotans.
Minnesota Disability Law Center (MDLC): The designated Protection and Advocacy system (P&A) for Minnesota. MDLC addresses the unique legal needs of Minnesotans with disabilities. MDLC provides free legal assistance to people with disabilities statewide on legal issues related to their disabilities. All people with disabilities are eligible to receive help, regardless of age or income level.
Minnesota Family Investment Plan (MFIP): Minnesota’s welfare reform program for low-income families with children. MFIP helps families and children with basic needs while helping parents move to financial stability through work. Parents are expected to work and are supported in working with both cash and food assistance.
Minnesota Health Care Programs (MHCP): DHS-administered programs that include:
Minnesota Intensive Therapeutic Homes (MITH): A program under the DHS Direct Care and Treatment Division’s Community-Based Services. MITH services are provided in family foster homes and represent an add-on service over-and-above regular foster care. MITH cannot provide hospital level of care for a medical condition or psychiatric illness.
Minnesota Life Bridge (MLB): A residential treatment program for people who have developmental disabilities and exhibit extreme behavior that presents a risk to public safety. MLB is part of Community Support Services (CSS), which is a program under the DHS Direct Care and Treatment Division’s Community-Based Services (CBS).
Minnesota Rule 185: Minnesota Rules, parts 9525.0004 through 9525.0036, establishes standards that govern the provision of case management administration and case management services to people with developmental disabilities or related conditions by county boards or others authorized by the DHS commissioner to provide case management.
Minnesota Senior Care Plus (MSC+): A mandatory prepaid Medical Assistance (MA) program for people age 65 years and older.
Minnesota Senior Health Options Program (MSHO): A voluntary Minnesota Health Care Program for people age 65 years and older who are enrolled in Medical Assistance (MA) and Medicare Parts A and B.
Minnesota State-Operated Community Services (MSOCS): A program under the DHS Direct Care and Treatment Division’s Community-Based Services (CBS). MSOCS includes both residential and day training and habilitation (DT&H)/vocational services.
Minnesota Unitary Residency and Financial Responsibility Act: Rules about county residence that determine county of financial responsibility and county of service.
MMIS exception code: Three-digit numeric code that Medicaid Management Information System (MMIS) uses when information entered into MMIS is invalid or needs review.
MnCHOICES: A web-based application tool for conducting and creating person-centered assessments and support plans. It helps people with long-term or chronic care-needs make decisions about their care. MNCHOICES includes two electronic tools:
MnCHOICES certified assessor: Individual who completes assessments and planning services for people who need long-term services and supports using the MnCHOICES web-based application.
Modifications and adaptations: Physical adaptations to a person’s home and/or vehicle.
Monitoring technology supervision: The use of equipment to oversee, monitor and supervise someone who receives waiver/Alternative Care services. It can help keep people safe and support independence. The equipment used may include alarms, sensors, cameras and other devices.
Monthly case mix budget: The total dollar amount available per month to support Alternative Care (AC), Elderly Waiver (EW) and Medical Assistance (MA) state plan home care services for a person based on their case mix classification.
Monthly conversion budget limit: An exception to the monthly case mix budget caps for a person on the Elderly Waiver (EW) who is leaving a nursing facility.
My Move Plan Summary: A transition plan that:
N
Neurobehavioral hospital (NBH): A rehabilitation hospital that provides specialized services to people with neurological-based, significant cognitive and severe behavioral impairments.
Neurobehavioral hospital (NB) level of care: Includes specialized therapies and supports for people with brain injuries who exhibit significant cognitive and severe behavioral impairments requiring intensive behavior intervention or support. The Brain Injury (BI)-NB Waiver requires a person to have an NB level of care.
New Freedom Initiative: A comprehensive plan, announced by President Bush on February 1, 2001, that represents an important step in working to ensure that Americans have the opportunity to learn and develop skills, engage in productive work, make choices about their daily lives and participate fully in community life.
Night supervision: Overnight assistance and monitoring provided by an awake staff in the person’s own home.
Normalization: Making the typical patterns and conditions of everyday life available to people with developmental disabilities or related conditions.
Notice of action: Document used by the certified assessor or case manager/planner to inform a person that the county/tribal nation has made a decision about their services and will take an action that affects them.
Nursing facility (NF): A facility licensed to provide nursing care for people who need long-term care, as defined in Minn. R. 9505.0175, subp. 23 and Minn. R. 4658.
Nutrition counseling (Alternative Care): One or more individual sessions to advise and assist people on appropriate nutritional intake. Nutrition counseling includes assessment of a person’s nutritional needs that results in an individualized plan with goals and follow-up on established goals.
Nutrition education (Alternative Care): One or more individual or group sessions that provide formal and informal opportunities for people to gain knowledge and skills in managing their diet and nutritional needs.
Nutrition services (Alternative Care): Services that include nutrition education and nutrition counseling to address an older adult’s nutritional needs. The goal of these services is to improve or maintain a person’s nutritional status and improve management of their chronic diseases or conditions.
O
OBRA (Omnibus Budget Reconciliation Act): Federal law that mandates the screening and review of all people with a diagnosis or suspected diagnosis of developmental disability or a related condition who seek admission to a nursing facility, regardless of the source of payment for the nursing facility services.
OBRA Level I screening: Part of the preadmission screening (PAS) process used to determine if a person has a diagnosis or suspected diagnosis of developmental disabilities/related conditions or mental illness. It must happen before a person is admitted to a Medical Assistance-certified nursing facility.
OBRA Level II evaluative report for people with developmental disabilities: A document that records the results of the in-person evaluation used to assess a person’s need for specialized services. The county/tribal nation completes this document when a person needs nursing facility level of care. The in-person evaluative must occur before the person is admitted to a nursing facility.
Olmstead decision: 1999 decision by the U.S. Supreme Court concerning two women from Georgia that played a major role in the expansion of consumer-directed services in Minnesota as well as other states. Because of the decision, called Olmstead v. L.C., all public entities are required to administer programs “in the most integrated setting appropriate to the needs of qualified persons with disabilities.”
Ombudsman: Independent governmental official who hears and investigates complaints from private citizens against government and government-regulated agencies.
Oral nutritional product: Commercially formulated substance taken by mouth that provides a person with nourishment.
Outcome: Benefit of services or supports as defined by the person who receives them.
Out-of-home respite: Respite provided outside of the person’s home or place of residence. Also refer to respite.
Over-the-counter medication: Drug/medication that can be purchased without a prescription (e.g., Prilosec OTC, vitamins).
Overriding health care needs: A health care condition that affects the service options available to the person because the condition requires both:
Own home: A single-family home or unit in a multi-family home (e.g., apartment) where a person lives, and the person or their family owns/rents and maintains control over the individual unit, demonstrated by a lease agreement (if applicable). This means a service provider does not own, operate or lease the home/unit or have direct or indirect financial interest in the person’s housing.
A person’s own home does not include a single-family home or multi-family home where the service provider subleases or has a master lease agreement and subleases.
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Patient Safety Rule, subpart C: Federal law that describes confidentiality protections, which protect identifiable information being used to analyze patient safety events and improve patient safety.
Permanent fifth bed: Licensed under home and community-based services (HCBS) waiver plan funding policy and DHS licensing statute to allow home and community-based settings licensed for adult corporate foster care to increase to a fifth bed on a permanent basis.
Person Master Index (PMI) number: A unique identification number that MAXIS assigns to a person.
Person subject to public guardianship: A person placed under the protection of the DHS commissioner.
Person-Centered, Informed Choice and Transition Protocol: A document that addresses the federal and state statutes, rules and court requirements related to person-centered practices and principles. It is a framework for understanding how to incorporate a person-centered approach into the support-planning process.
Person-centered planning (PCP): Process focusing on a person and what they want for the future. There are many different approaches to person-centered planning.
Person-centered planning facilitation: A formal process of working with a skilled facilitator to explore, discover and identify a person’s vision and direction for their life. The methods used to facilitate person-centered planning can vary based on the person and their life circumstances and the outcome or results the person is trying to achieve.
Person-centered practices and principles: A way of ensuring people who receive supports and services have the same rights and responsibilities as other people. This includes having control over their lives, making their own choices and contributing to the community in a way that makes sense for themselves. Person-centered practices include:
Personal assistance (CDCS): Consumer directed community supports service category that includes services to help a person with their activities of daily living (ADLs) and instrumental activities of daily living (IADLs) through hands-on assistance, cues, prompts and instruction.
Personal care assistance (PCA): Services to help a person with day-to-day activities in their home and community to help maximize their independence.
Personal care assistance (PCA) assessment: A review and evaluation of a person’s need for PCA services.
Personal care assistance (PCA) care plan: A written description identifying the PCA services to be delivered to a person based on the PCA Assessment and Service Plan, DHS-3244 (PDF).
Personal Care Assistance (PCA) Choice option: Option in which the person is responsible for hiring, training, scheduling and terminating their personal care assistants.
Personal Care Assistance (PCA) Choice provider: Serves in a fiscal intermediary role with the person and their staff and for financial management tasks.
Personal care assistance (PCA) time and activity documentation: A written document recording PCA services provided to a person.
Personal care assistant: Individual employed by a personal care assistance provider agency, enrolled by DHS and provides personal care assistance services.
Personal emergency response system (PERS): A service that covers:
Place of residence: The following are considered a person’s place of residence:
Plan of care – 24-hour: Written plan that provides access to direct or indirect supports 24 hours a day.
Positive behavior support plan (related to Successful Life Project): A plan to help all caregivers provide the same behavior support on a consistent basis. The plan is based on a functional behavior assessment and includes person-centered practices (e.g., understanding the strengths, preferences and interests of the person).
Positive behavior support – system evaluation tool (related to Successful Life Project): Assessment tool used by Successful Life Project staff that provides a brief snapshot of a person’s health, safety, quality of life and person-centered positive behavior supports.
Positive support services (formerly behavioral support): Services that consist of developing, implementing and monitoring a person-centered, individually designed, proactive plan to address challenging behaviors. A waiver positive support professional develops this plan to enhance a person’s quality of life through the process of teaching or increasing positive behavior. When possible, the person leads the process to develop a positive behavior support plan and/or positive support transition plan.
Positive supports: Strategies used to increase quality of life and decrease challenging behavior. These strategies teach new life skills and change a person’s environment.
Preadmission screening (PAS): Activities that determine a person’s need for nursing facility level of care for Medical Assistance. Lead agencies and the Senior LinkAge Line work in conjunction to complete the various PAS activities, which includes activities required by the federal Omnibus Budget Reconciliation Act (OBRA).
Prepaid health plan (PHP): Refer to managed care organization.
Prescription drugs: For purposes of the CAC Waiver, a prescription drug:
Prevocational services: Services that prepare people with disabilities for jobs with competitive pay and help them achieve greater independence in their community. Prevocational services teach general work skills and concepts rather than specific work skills for a particular job.
Primary Care Utilization Review (PCUR): Purpose of PCUR is to identify people who have used Medical Assistance (MA) services at a frequency or amount that is not medically necessary and/or have obtained services in a fraudulent manner.
Primary caregiver(s): Person or people principally responsible for the care and supervision of the person who receives services.
Primary spoken languages: Languages other than English most commonly spoken by DHS clientele, as identified by the DHS’ methodology workgroup. These are the current primary languages: Amharic, Arabic, Burmese, Cantonese, French, Hmong, Karen, Khmer (Cambodian), Lao, Oromo, Russian, Somali, Spanish and Vietnamese.
Professional guardian or conservator: An individual, agency, organization or business entity that provides guardianship or conservatorship services for a fee.
Program HH: Minnesota HIV/AIDS services that provide HIV-positive people who meet program eligibility guidelines with access to:
Program records: Generally include information governing the operation of the licensed program and include required policies and procedures.
Protected information: Personal information about an individual or their family that they would not generally want shared with the public.
Protection and Advocacy (P&A): Federally funded organizations located in every state that protect the rights of people with developmental disabilities. In Minnesota, the Disability Law Center is the designated Protection and Advocacy agency.
Provider: Person, organization or entity that has entered into an agreement with DHS to provide health services, including waiver services, to people eligible for Medical Assistance (MA) or Alternative Care (AC).
Public agency: Organization that provides the services required under programs and initiatives listed in Minnesota Statutes. Private agencies are considered public agency when they are vendors of public services and have contracted with a public agency.
Public guardian: Court appointment of the DHS commissioner as the legal guardian for an adult with a developmental disability.
Q
Qualified developmental disability professional (QDDP): Individual qualified to work as an expert with people with developmental disabilities or related conditions. QDDPs conducting DD screenings must be employed by counties and tribal nations. The QDDP has a four-year college degree in an area related to developmental disabilities and a minimum of one-year experience working in that field. For more information on QDDP standards, refer to 42 CFR 483.430.
Qualified professional (QP) (PCA services): Professional who provides oversight and supervision of personal care assistance (PCA) services and staff in the delivery of PCA services.
Qualified professional (QA) visit (PCA services): A visit by the QP, at the location where PCA services are being delivered, to do the following:
Quality assurance (PCA services): Guarantee program integrity through review of the services that are reimbursed by Medicaid/Medical Assistance, a combination of state and federal government funds.
R
Rate: Fixed charge per unit of a commodity or service.
Rate Management System (RMS): Web-based application for the Disability Waiver Rate System (DWRS). Lead agencies use RMS to determine service rates.
Real-time, two-way communication: Remote support delivered through one of the following methods:
Regional resource specialist (RRS): DHS staff member who provides support to lead agency staff who administer DHS Disability Services Division services, programs and waivers. Each lead agency is assigned an RRS.
Regional treatment center (RTC): State facility for treating people with diagnoses of mental illnesses, developmental disabilities or chemical dependencies who are under the direct administrative authority of the DHS commissioner.
Rehabilitative/Restorative: Restoring a person’s functional status to a former state or condition.
Related condition (autism spectrum disorder): A condition that is closely related to autism spectrum disorder (ASD) and:
1. Is severe and chronic.
2. Results in impairment of a person’s adaptive behavior and function similar to that of a person with ASD.
3. Requires treatment or services similar to those required for a person with ASD.
4. Results in challenges in the following symptom areas (similar to symptoms of ASD):
Related condition (developmental disabilities): Diagnosis of severe, chronic disabilities that meets all of the following conditions:
1. Is attributed to cerebral palsy, epilepsy, autism, Prader-Willi syndrome, fetal alcohol spectrum disorder or any other condition other than mental illness (mental illness does not include autism or other pervasive developmental disorders) or an emotional disturbance
2. Is found to be closely related to developmental disabilities because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of people with developmental disabilities and requires treatment or services similar to those required for people with developmental disabilities.
3. Is manifested before the person reaches 22 years of age.
4. Is likely to continue indefinitely.
5. Results in substantial limitations in three or more of the following areas of major life activity:
Relative: A person who is related by blood, marriage or adoption. This can include:
Relocation service coordination targeted case management (RSC-TCM): A form of TCM that provides coordination of activities to help a person who resides in an eligible institution gain access to medical, social, educational, financial, housing and other services and supports that are necessary to move to the community.
Remote support: The provision of a covered service by a staff member or caregiver who is at a remote location and is engaged with the person through enabling technology that uses live, two-way communication.
Required case management (CDCS): Case management activities provided to people who use CDCS by counties, tribal nations and managed care organizations who have entered into contracts with DHS.
Residential program: A single-family home or multi-family home that is under direct or indirect control of a service provider licensed under Minn. Stat. Chapter 245D, and in which at least one person receives one of the following services:
Residential programs provide care, supervision, food, lodging, rehabilitation, training, education, habilitation or treatment in a setting that does not meet the requirements of a person’s own home. Multi-family homes in which people receive integrated community supports are not considered residential programs.
Respite: Short-term care services provided to a person when the person’s primary caregiver is absent or needs relief.
Response Center: Provides support to lead agency staff who administer DHS Disability Services Division home and community-based services, programs and waivers.
Responsible party (PCA services): A person who is at least 18 years old and capable of providing the support necessary to help a person who receives personal care assistance (PCA) services to live in the community when the person is assessed as unable to direct their own care.
Retirement, Survivors, and Disability Insurance (RSDI): A federally funded program designed to ensure the continuation of income to people who are disabled, have reached retirement age or are surviving dependents of those who qualified for Social Security Disability Insurance.
Risk: Potential exposure to danger, harm or loss.
Rule 185 case management: Rule 185 case management for people with developmental disabilities or related conditions assists people in gaining access to needed social, medical, educational and other supports and services. The case manager works on behalf of the person to identify their unique needs and to minimize the impact of the disability on their life, while ensuring continuity of services and supports.
S
Service Agreement and Screening Document (SASD) Support Team: Help desk that provides technical assistance to lead agencies and DHS staff for the Medicaid Management Information System (MMIS), related specifically to screening documents and service agreements in the following areas:
Screening document (SD): Document used to record the outcome of assessments, screenings or case management activities.
Screening team (DD): If using the legacy DD Screening Document, DHS-3067 (PDF), the lead agency must convene a screening team to conduct the developmental disabilities (DD) screening process. The team consists of:
Section 504 of the Rehabilitation Act of 1973: A civil rights law that prohibits discrimination against people with disabilities.
Secure email: DHS-initiated email thread through which people can send private and protected information to DHS.
Self-administered medication: Medication taken orally, by injection, nebulizer, insertion or applied topically without the need for assistance.
Self-advocacy: A movement to empower people with disabilities to:
Self-advocate: A person who advocates on their own behalf.
Self-determination: Situation in which a person, or their authorized representative, makes their own decisions, plans their own future, determines how money is spent for their supports and takes responsibility for the decision they make. Self-determination is a guiding principle behind consumer-directed services.
Self-direction support activities (CDCS): Services, supports and costs related to helping a person or their representative manage consumer directed community supports (CDCS).
Semi-independent living services (SILS): Services needed by an adult with developmental disability or related condition(s) to live successfully in the community.
Serious and persistent mental illness (SPMI): Situational in which a person age 18 or older who has a mental illness diagnosis and meets one of the following conditions:
1. Has undergone two or more episodes of inpatient care for mental illness within the previous 24 months.
2. Has experienced a continuous psychiatric hospitalization or residential treatment for longer than six months within the previous 12 months.
3. Has all of the following:
4. Has, in the last three years, been committed by a court as a mentally ill person under Minnesota statutes, or the adult’s commitment as a mentally ill person has stayed or continued.
5. Was eligible under one of the above criteria but the specified time period has expired or the person was eligible as a child with severe emotional disturbance and the person has a written opinion from a mental health professional from the last three years stating that they are reasonably likely to have future episodes requiring inpatient or residential treatment, of a frequency described in the above criteria, unless they receive ongoing case management or community support services.
Service agreement (SA): Document used to identify services, providers and payment information for a person who receives home care, Alternative Care (AC) or waiver services. A service agreement allows providers to bill for approved services and DHS to audit usage and payment data.
Service coordination: Refer to care coordination.
Services and supports: A term that refers to work that is done to help a person that includes both:
Services during the day: Services or supports provided to a person that enable them to be fully integrated into the community. Services during the day can include a variety of supports to help the person exercise choices for community integration and inclusion activities.
Severe emotional disturbance (SED): Child who has an emotional disturbance and meets one of the following conditions:
1. Has been admitted for inpatient or residential treatment within the last three years, or is at risk of being admitted.
2. Is a Minnesota resident and is receiving inpatient or residential treatment for an emotional disturbance through the interstate compact.
3. Has been determined by a mental health professional to have one of the following:
Shared service option for personal care assistance (PCA): Services provided in the same setting at the same time by the same worker for people who have entered into an agreement to share services for PCA.
Short-term admission to ICF/DD from DD Waiver: When a person who receives Developmental Disabilities (DD) Waiver supports and services (including consumer directed community supports) chooses to dis-enroll from the waiver for a brief time for admission to an intermediate care facility for persons with developmental disabilities (ICF/DD).
Significantly sub-average intellectual functioning: Full-scale IQ score of 70 or less based on assessment that includes one or more individually administered standardized intelligence testes developed for the purpose of assessing intellectual functioning. Errors of measurement and actual changes in performance outcome must be considered in the interpretation of test results.
Skilled nurse visit (SNV): Visit to a person’s place of residence, on an intermittent basis, by a registered nurse (RN) or licensed practical nurse (LPN) under the supervision of a RN, to initiate and complete professional nursing tasks based on the assessed need for services to maintain or restore the person’s optimal health.
Social Security Act: Federal act that provides a variety of funding and program Titles, including:
Title I: Grants to States for Old-Age Assistance for the Aged
Title IV-A: Temporary Assistance for Needy Families (TANF) Block Grant
Title IV-B: Child Welfare Services and Funding Block Grant
Title IV-D: Child Support
Title IV-E: Foster Care, Training, and Related Case Management Requirements and Funding (also pays for out-of-home placement costs for eligible children)
Title V: Maternal and Child Health Services Block Grant
Title X: Grants to States for Aid to the Blind
Title XI: Demonstration Grants (used to fund demonstration projects to prove the feasibility of a social services program or service before it is fully funded)
Title XIV: Grants to States for Aid to the Permanently and Totally Disabled
Title XVI-A: Grants to States for Aid to the Aged, Blind or Disabled
Title XVI-B: Supplemental Security Income for the Aged, Blind and Disabled
Title XVIII: Health Insurance for Aged and Disabled
Title XIX: Grants to States for Medical Assistance Programs
Title XX: Block Grants to States for Social Services (also referred to as the Social Services Block Grant or SSBG)
Title XXI: State Children’s Health Insurance Program (SCHIP) (provides enhanced federal funding to states that expand health insurance coverage for children)
Social Security Administration (SSA): Federal agency that administers Social Security, a program consisting of disability, retirement and survivors’ benefits.
Social Security Disability Insurance (SSDI): Program under Retirement, Survivors, and Disability Insurance (RSDI) that provides cash payments to people who have a disability, have worked a certain number of quarters or had a parent or spouse that worked a certain number of quarters and paid Federal Insurance Contributions Act (FICA).
Social Security Supplemental Security Income (SSI): Federal program that pays monthly cash benefits to people who have limited resources and income and are age 65 or older, blind or have a disability. Children who are blind or have a disability can also receive SSI benefits. Social Security looks at how the disability of the child affects their everyday life to determine if the child is eligible for the monthly cash benefits.
Social Services Information System (SSIS): Case management and data collection application for foster care, out-of-home placement, children’s mental health, adoption information and vulnerable adult tracking.
Solicit: Approach someone with a request to use a product or service.
Special education: Education provided to children with disabilities whose abilities (physical, cognitive and social) and learning styles require alternative teaching methods and/or related support services to help the child benefit from the educational program. Refer to Individual Education Program.
Special income standard – Elderly Waiver (SIS-EW): An income limit to qualify for the Elderly Waiver (EW) that is 300% of the federal benefit rate (FBR).
Special Needs BasicCare (SNBC): A voluntary managed care program for people with a certified disability, ages 18 through 64, who are enrolled in Medical Assistance. Please note: Certain home and community-based services remain covered by DHS fee-for-service and are not covered by the managed care organization.
Special transportation: Services required to transport people who, because of a physical or mental disability, are unable to use a common carrier and do not require ambulance transportation. It includes either ambulatory or non-ambulatory services.
Specialist services: Services that exceed the scope and duration of available Minnesota state plan or waiver services.
Specialized equipment and supplies: Devices (including assistive technology), controls, medical appliances or supplies specified in the person’s support plan.
Specialized services: Services provided to a person with a diagnosis of developmental disabilities or related conditions that result in active treatment (e.g., day training and habilitation, semi-independent living services).
Specialized staff: Professional staff who are specially trained in crisis prevention, intervention and resolution and meet certain qualifications.
Spenddown: Amount of money a person enrolled in a Minnesota Health Care Program (MHCP) is responsible to pay before they are eligible for Medical Assistance (MA).
Staff records: Information on staff qualifications (e.g., education and work experience) employment information (e.g., position description, work schedule, payroll information) and background study clearance forms.
State government: Each state has its own government. State laws and regulations apply only to the state for which they were written. State laws and regulations can be more restrictive than federal laws that establish a minimal standard of compliance.
State Medical Review Team (SMRT): Division of the Department of Human Services that makes disability determinations using criteria defined by the Social Security Administration.
State Register: Official publication of the State of Minnesota’s Executive Branch of government, published weekly to fulfill the legislative mandate in Minn. Stat. Chapter 14 and Minn. R. 1400. It contains proposed, adopted, exempt, expedited withdrawn and vetoed rules; executive orders of the governor; commissioners’ orders; contracts for professional, technical and consulting services; appointments; revenue notices; state grants and loans; proclamations; official notices; and non-state public bids, contracts and grants. To view the most recent edition, refer to Department of Administration – Minnesota State Register.
Structured day program: A service replaced by day support services during the rolling implementation of Waiver Reimagine streamlined services. Historically, structured day program was a service designed for people who might have benefited from continued rehabilitation and community integration directed at the development and maintenance of community living skills.
Substantial functional limitations: Long-term inability to significantly perform an activity or task.
Successful Life Project: Provides ongoing consultation and therapeutic follow-up to people previously services at either of the following:
Successful Life Project support agreement: Contract between Successful Life Project and all team members that outlines expectations for all people involved.
Supervised living facility (SLF): Facility that provides supervision, lodging, meals, counseling, developmental habilitation or rehabilitation services under a Minnesota Department of Health license to five to more adults who have developmental disabilities or related conditions, mental illness diagnoses, physical disabilities or are chemically dependent.
Support coordination: Service that helps people on a waiver and families make informed decisions about what will work best for them, is consistent with their needs and reflects their personal circumstances. The service provides sufficient information to ensure people who receive services understand the responsibilities involved with self-direction and helps develop an effective plan, including backup and emergency needs. Cost of this service is within the individual budget and identified in the plan.
Support planning: A person-centered process that helps people identify and access social, health, educational, vocational and other supports and services based on each person’s values, strengths, goals, preferences and needs. The process encourages the use of technology, informal supports, formal supports and services. The support planning process is documented in the community support plan (CSP) and coordinated services and supports plan (CSSP).
Supported employment: A discontinued service (effective July 1, 2018).
Support planner: A professional who helps the person with the long-term services and supports (LTSS) support planning process. Professionals who can provide this support include certified assessors, case managers and care coordinators.
Support planner services (CDCS): Option under CDCS in which a person can receive help with developing and implementing the community support plan (CSP). Support planner activities are provided by an individual or entity chosen by the person and are in addition to required case management activities.
Surveillance and Integrity Review Section (SIRS): Section within DHS responsible to ensure compliance with Minnesota Health Care Program (MHCP) requirements by monitoring the use and delivery of health services through a post-payment review process.
T
Targeted case management (TCM): Service coordination that helps people who are eligible for Medical Assistant and meet other criteria to access needed medical, social, educational and other services.
Tax Equity and Fiscal Responsibility Act (TEFRA): Program available for some children with disabilities who ordinarily would not be eligible for Medical Assistance (MA) because of parental incomes. The State Medical Review Team must review applicants. TEFRA is also known as the Katie Beckett Provision.
Technology for HOME (T4H): A state-funded service that provides assistive technology consultations for people who receive home care or home and community-based services who need assistive technology to live independently. Technology for HOME offers a team approach that allows multiple professionals to assess and meet a person’s assistive technology needs concurrently.
Technology for HOME team: A group of professionals who support people during the technology for HOME process. The team might include occupational therapists, physical therapists, speech therapists, nurses and engineers.
Tele-homecare: Use of telecommunications by a home health care professional to deliver home health care services within the professional’s scope of practice to a person located at a site other than the site where the professional is located.
Telephone Equipment Distribution (TED) program: Provides telephone equipment to people who are deaf, hard of hearing, deaf blind, speech impaired or have a physical disability and need adaptive equipment to use the phone. The TED program loans phone equipment to qualified applicants at no cost for as long as they need the equipment.
Teletypewriter (TTY): Device that transmits and receives instantaneous typewritten messages over telephone lines. It is a means of electronic communication between people who are deaf and other people with a TTY.
Temporary fifth bed variance: Temporary variance of home and community-based services (HCBS) waiver plan funding policy and DHS licensing statute to allow home and community-based settings licensed for adult corporate foster care to increase to a fifth bed on a temporary basis.
Third party liability (TPL): Medical Assistance (MA)-enrolled providers are required to bill liable third-party payers and receive the maximum payment before billing Minnesota Health Care Programs (MHCP). MHCP will not pay for services that could have been covered by a third-party payer if applicable rules of that plan had been followed.
Third party payer: Person, entity or program that is, or may be, responsible to pay all or part of the medical costs provided to people enrolled in Medical Assistance (MA).
Ticket to Work and Work Incentives Improvement Act (1999): Enacted to help people who get Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits. It offers a variety of services to help people prepare for, find, get and keep a job (e.g., vocational rehabilitation, training, referrals, job coaching, job counseling, placement services).
Title Program: Federal and state programs available to people with special needs. Programs are often based on economic need and criteria vary widely. Examples of Federal Title Programs include:
Transitional services (BI, CAC, CADI and DD): Items and expenses necessary and reasonable for a person to transition from an eligible setting to their own home or an integrated community supports setting.
Transitional services (EW): Items and supports necessary for a person to move from a licensed setting to independent or semi-independent community-based housing.
Transportation: Transportation services necessary to meet the person’s needs and preferences in covered areas, as documented in their support plan.
Treatment and training (CDCS): Range of services that increase a person’s ability to live and take part in the community.
Tribal administration of home and community-based services (HCBS) programs: Option that allows DHS to contract with federally recognized tribal nations that have a reservation in Minnesota to operate a federally approved program or any other DHS program.
U
Unforeseen circumstance: For the purposes of this policy, an unforeseen circumstance is a death or a significant change in condition that occurs after an assessment was completed and the person was expected to enroll in one of the following programs:
Unrelated caregiver: A person who is not related by blood, marriage or adoption to any degree.
V
Vendor: An entity that a lead agency approves to delivery an approval-option service. A Minnesota Health Care Programs (MHCP) enrolled, approval-option service provider cannot also seek approval to deliver services through a lead agency.
Ventilator-dependent: Person dependent on mechanical ventilation for life support for at least six hours a day and who is expected to be or has been dependent for at least 30 consecutive days.
Vocational rehabilitation services (VRS): Wide range of services and job training available to help people with disabilities prepare for, find and keep a job.
Vulnerable adult (VA): A person 18 years of age or older who meets one of the following criteria:
Vulnerable adult/developmental disabilities targeted case management services: Services provided on behalf of a vulnerable adult or person with developmental disabilities intended to coordinate and link social and other services and designed to help gain access to needed protective services, social, health care, mental health, habilitative, educational, vocational, recreational, advocacy, legal, chemical, health and other related services.
W
Waiver: Intentional suspension or change of a state or federal regulation, service limitation or eligibility requirement.
Waiver and Alternative Care (AC) case management: A service that provides people and their families with access to assessment, person-centered planning, referral, linkage, support plan monitoring, coordination and advocacy related to waiver services, resources and informal supports that are not necessarily funded through the waiver
Waiver span: Period of time that identifies both the begin and end date for the specific waiver program the person has been approved to receive.
Waiver services programs: Programs that have received federal approval for expanded coverage for services not usually covered under Medical Assistance (MA) and meet the needs of targeted populations based on eligibility requirements specific to each waiver program. Minnesota offers the following waivers:
Ward: Refer to “person subject to public guardianship.”
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