Page posted: 10/1/03 | Page reviewed: 11/21/25 | Page updated: 11/21/25 |
Legal authority | Minn. Stat. §256B.0911 |
Definitions | Long-term care consultation (LTCC): Various activities that provide people with disabilities and older adults information to plan, coordinate, access and navigate support options to meet their long-term care needs. 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 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. |
Purpose | LTCC activities: · Ensure people are aware of available home and community-based services (HCBS) options.· Prevent or delay long-term placement of people in facilities, such as nursing facilities, hospitals, certified boarding care facilities, intermediate care facilities for persons with developmental disabilities (ICFs/DD) or regional treatment centers.· Provide options to people so they can make informed decisions about where they want to live and how they can receive the community supports they need. |
Overview | LTCC includes the following components, which can be provided in any combination: · MnCHOICES assessment for HCBS programs (i.e., Alternative Care [AC], Essential Community Supports [ECS], Brain Injury [BI], Community Alternative Care [CAC], Community Access for Disability Inclusion [CADI], Developmental Disabilities [DD] and Elderly Waiver [EW]) and Community First Services and Supports (CFSS). · Referral to long-term care options counseling services for telephone assistance to identify community supports (without participating in a complete LTCC assessment).· Information about self-directed services and supports, including self-directed funding options, to ensure people can make an informed choice about those options.· Recommendations for facilities when there are no cost-effective community services available.· Information about competitive employment and independent living. · Certain preadmission screenings (PASs) for nursing facility admission.· Access to transition assistance for people who reside in a facility and want to relocate to the community (refer to the next section for more information). |
Transition assistance | The LTCC team: · Provides transition assistance to people who request or are referred for assistance and reside in a facility.· Must provide transition assistance to people younger than age 65 in a nursing facility. For additional information, refer to CBSM – Nursing facility assessment for people age 64 and younger.Transition assistance: · Helps people determine if they meet criteria to access relocation assistance through relocation service coordination – targeted case management (RSC-TCM), AC conversion case management or Moving Home Minnesota.· Provides information about the Centers for Independent Living, Disability Hub MN, Minnesota Aging Pathways (formally known as Senior LinkAge Line) and other organizations that can help with relocation from a facility.· Provides information to help people access Minnesota Health Care Programs (MHCP).LTCC transition assistance is different from formal transitional services available through AC or a waiver. Transition assistance is for anyone who receives LTCC, but transitional services are only available to people on AC or a waiver. For more information about transitional services, refer to CBSM – Transitional services – BI, CAC, CADI and DD and CBSM – Transitional services – AC and EW. |
Who can receive LTCC | Any person can request and is entitled to receive LTCC, regardless of their age or eligibility for MHCP. |
Referral information | People, families, human services and health professionals, providers or hospital/nursing facility staff may make referrals for LTCC. To access brochures or a video link outlining the MnCHOICES assessment referral process, refer to PartnerLink – MnCHOICES. To make a referral for long-term care options counseling or preadmission screening, refer to Minnesota Aging Pathways – Make a referral. |
Who completes LTCC | Depending on the LTCC, activities may be performed by: · Minnesota Aging Pathways (formally known as Senior LinkAge Line) staff.· County/tribal nation staff.· MCO staff and their delegates. For more information about who completes MnCHOICES assessments, refer to CBSM – Assessment applicability and timelines. |
Additional resources | ResourcesCBSM – Assessment applicability and timelines
CBSM – Developmental disabilities screening
CBSM – Employment
CBSM – Level of care
CBSM – MnCHOICES
CBSM – OBRA
CBSM – Support planning for long-term services and supports
Disability Hub MN – Benefits planning toolkit
Disability Hub MN – Housing toolkit
Disability Hub MN – Informed choice toolkit
DD Screening Document Codebook
Minnesota Centers for Independent Living Technical guidanceMinnesota Board on Aging – Preadmission screening for nursing facility admission (PDF)
Instructions for Completing and Entering the LTCC Screening Document and Service Agreement Into MMIS, DHS-4625 (PDF)
Instructions for Completing and Entering the LTCC Screening Document into the MMIS for the MSHO and MCS+ Programs, DHS-4669 (PDF) |
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