Deficit Reduction Act, 2005 (PL 109), sec. 6071 (PDF), Patient Protection and Affordable Care Act, 2010 sec. 2403 (PDF), Minn. Stat. §256B.04, subd. 20

Lead agency: County, tribal nation or managed care organization (MCO).

County of financial responsibility (CFR): County or tribal nation responsible for payment of a person’s social services.

Managed care: A term used to describe a health care delivery system that coordinates a wide range of health services and support systems into one health care package. Enrollment may either be voluntary or required (i.e., mandatory).

Families & Children: A mandatory prepaid Medical Assistance (MA) program provided by an MCO for children, parents and single adults. It is commonly referred to as Prepaid Medical Assistance Program (PMAP).

Minnesota Senior Care Plus (MSC+): A mandatory prepaid MA program provided by an MCO for people age 65 and older who are enrolled in MA.

Minnesota Senior Health Options (MSHO): A voluntary prepaid MA program provided by an MCO for people age 65 and older who are enrolled in MA and Medicare Parts A and B.

Special Needs BasicCare (SNBC): A voluntary prepaid MA program for people ages 18 through 64 with a certified disability who are enrolled in MA.

Licensed alcohol and drug counselor (LADC): A person who holds a valid license issued under Minn. Stat. §148F.01 to provide alcohol and drug counseling.

Screening document: A tool to record an assessment for a person to evaluate the level of care they need.

Transition coordinator: A professional who helps a person move from a qualified institution to the community.

This page does not apply to LADCs. This page is only for lead agencies who administer long-term care assessments, as described in the lead agency roles and responsibilities section. For information about LADC roles and responsibilities, refer to MHM Manual – Guide for MHM access and substance use disorder (SUD).

The CFR serves as the lead agency for MHM for all populations except:

Lead agencies have the following responsibilities.

Complete screening documents

To authorize MHM services, the lead agency must complete one of the following:

For more information about screening document requirements, refer to MHM Manual – Eligibility.

Provide MHM transition coordination

If a transition coordinator is not already working with a person approved to receive MHM services, the lead agency will assign one. The lead agency must provide the person with informed choice of a lead agency staff member or a private MHCP-contracted provider for MHM transition coordination from CBSM – Transition services provider contact list.

People enrolled in MSHO or MSC+

For people enrolled in MSHO or MSC+, the MCO serves as the lead agency. The MCO must coordinate or provide a person with MHM transition coordination. The assigned MCO care coordinator will provide or arrange for MHM transition coordination services. A person who receives MHM or relocation service coordination – targeted case management (RSC-TCM) before enrolling in an MCO can either:

All other people not enrolled in MSHO or MSC+

For people not enrolled in MSHO or MSC+, the CFR or tribal nation serves as the lead agency for MHM and must coordinate or provide a person with MHM transition coordination.

Authorize MHM community services

People younger than age 65

For a person who is younger than age 65 and on a waiver, the CFR or tribal nation is responsible to authorize MHM community services on a waiver service agreement.

For a person who is younger than age 65 and not on waiver, the transition coordinator completes and submits MnCHOICES Community Support Plan with Coordinated Services and Supports, DHS-6791B to the DHS MHM home and community-based services (HCBS) coordinator using one of the following methods:

The DHS MHM HCBS coordinator enters the MHM community services on a type Z service agreement into MMIS.

For more information about authorizing MHM services, refer to MHM Manual – Services.

People age 65 and older

For a person who is age 65 or older and chooses to return to a disability waiver upon their return to the community, the CFR or tribal nation is responsible to authorize MHM community services on a waiver service agreement. The MCO is responsible to authorize MHM services not covered by the waiver.

For a person who is age 65 or older, enrolled in MSHO or MSC+ and receiving Elderly Waiver (EW) services, the MCO is responsible to authorize both MHM and EW services. Providers should contact the MCO directly for information on their billing and authorization processes. For contact information, refer to DHS – MCO contacts for MHCP providers.

For more information about authorizing MHM services, refer to MHM Manual – Services.

Authorize and provide MHM case management

People on waivers

The lead agency responsible to provide a person’s waiver case management also serves as the person’s MHM case manager when they are on one of the following programs:

For more information about authorizing MHM services, refer to MHM Manual – Services.

People not on waivers

The lead agency responsible for a person’s MHM transition coordination will assign an MHM demonstration case manager (DCM) to provide case management services if the person is not on a waiver.

For more information about authorizing MHM services, refer to MHM Manual – Services.