Access

To access HCN, anyone may make a referral directly to an approved HCN provider.

Assessment

An RN (either from an approved HCN provider or an independent RN) completes an HCN assessment to document the person’s need for services in the person’s record. This assessment:

Authorization

All HCN services require prior authorization. There are two options for the HCN provider to submit the request:

The required information for the request depends on the type of authorization.

Temporary authorization up to 45 days

A temporary service authorization up to 45 days allows for initial starts and increases due to a person’s change in condition in an expedited process for certain situations.

When making this type of request, the HCN provider does not need to submit supporting documentation. The HCN provider can enter all required information electronically.

DHS must receive the request for temporary authorization within five business days of the first date of service.

Long-term authorization

The HCN provider includes the following information when they submit a request for long-term authorization:

DHS approval

DHS reviews the material submitted to:

Process for combining HCN and state plan PCA/CFSS

The process to combine HCN with PCA/CFSS depends on the person’s circumstances.

Adding HCN to PCA/CFSS

If the person has an authorization for PCA/CFSS and adds HCN, the HCN provider uses the authorization instructions in the previous section of this page.

Adding PCA/CFSS to HCN

If the person has an authorization for HCN and adds PCA/CFSS:

1. The county/tribal nation enters a new PCA/CFSS authorization into MMIS and manually routes the service agreement to DHS by following the instructions on DSD MMIS Reference Guide – Finalize a type B service agreement for PCA/CFSS.

2. DHS merges the service agreements.

3. The medical review agent reviews and approves the services.

Note: The county/tribal nation must not edit the service agreement while the medical review agent is reviewing it.

Managed care organization (MCO) enrollment

People age 65 and older who are enrolled in an MCO and not using a waiver receive their HCN services through their MCO. The MCO follows its own processes and procedures.

People younger than age 65 and enrolled in an MCO receive their services through the state plan. Providers follow the authorization instructions above.

Access

The lead agency uses the MnCHOICES process to determine the person’s need for service. To initiate HCN services, a certified assessor, case manager or care coordinator makes a referral to an approved HCN provider.

Assessment

An RN (either from an enrolled HCN provider or an independent RN) completes an HCN assessment to document the person’s need for services in the person’s record. This assessment:

The RN must send a copy of the assessment to the person’s case manager or care coordinator.

Authorization

All HCN services require prior authorization from the county/tribal nation. The HCN provider collaborates with the county/tribal nation for authorization.

The county/tribal nation:

State plan and extended HCN

People on BI, CAC, CADI and EW can receive both state plan and extended HCN.

For people eligible for extended HCN, the case manager authorizes both MA state plan HCN services and extended HCN services on the same service agreement. The case manager must:

For information about limits and procedure codes, refer to Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF) and Home Care Nursing Decision Tree, DHS-4071C (PDF).

People on AC and DD cannot receive extended HCN.

Services through an MCO

For people ages 65 and older on BI, CAC, CADI and DD who are enrolled in managed care, the county/tribal nation must use placeholder code X5609 in MMIS to authorize the services for which the MCO is responsible for payment. When using this code, the case manager must indicate all of the following on the HCN line(s) on the ASA3 screen:

For more information, refer to Instructions for completing and entering the LTCC screening document and service agreement into MMIS, DHS-4625 (PDF).

The case manager and MCO staff members can use MCO, County Agency and Tribal Nation Communication Form – Recommendation for Home Care Services, DHS-5841 to initiate home care recommendations. The form includes detailed instructions for use. Then, the MCO follows its procedure to authorize the service.

For people on EW who are enrolled in managed care, the care coordinator follows the MCO’s procedure to authorize the service, unless the person receives case management through a tribal nation. In this arrangement, services may be authorized by the tribal nation through MMIS and also by the MCO through its billing system. The MCO care coordinator must contact the case manager at the tribal nation for more information.