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

Demonstration case management (DCM): MHM service a person may receive after moving to the community. This service monitors and evaluates the person’s MHM community services and supports as they adjust in the community. DCM must be:

Transition coordination: MHM service that provides coordination of activities to support a person who resides in a qualified institution to gain access to medical, social, education, financial, housing and other services and supports that are necessary to move to the community. For more information, refer to MHM Manual – Transition coordination.

Transition coordinator: Professional who carries out the transition coordination service and supports a person to move from a qualified institution to the community with MHM.

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

A person is eligible to receive DCM for up to 365/366 days after their move into the community if they meet all the following criteria:

Waiver interaction

If the person is on a home and community-based services (HCBS) waiver program, they are not eligible to receive DCM.

DCM covers the following activities:

DCM does not cover:

1. Habilitation support to acquire independent daily living skills (refer to CBSM – Habilitation).

2. Help for a person to find new housing options while they are in the community.

3. Administrative activities such as:

4. Room and board (including moving expenses).

5. Deposits for rent and utilities.

6. Food.

7. Furnishings.

8. Rent.

9. Utilities.

10. No-show appointments.

11. Services that duplicate other waiver or MA state plan services available to the person.

Note: The DCM provider is responsible to coordinate the delivery of DCM with other services.

DCM is available during the person’s 365/366-day MHM community service period after their move from an institution. This service requires prior authorization. For more information, refer to the authorization, rates and billing section below.

DCM is not available to people age 65 and older.

A provider cannot deliver DCM to more than one person at the same time.

A person cannot receive DCM if they also receive housing sustaining services through Housing Stabilization Services, as described on DHS – Housing Stabilization Services.

Reinstitutionalization

When a person is reinstitutionalized, they can receive DCM for up to 30 calendar days. DCM will stop after the 30th day of reinstitutionalization and may resume once the person returns to the community. For more information, refer to MHM Manual – Reporting enrollment changes, reinstitutionalization and disenrollment for MHM.

DCM is a DHS enrollment-required service. For more information, refer to MHCP Provider Manual – MHM.

License requirements

The provider must be one of the following:

Background studies

Minn. Stat. Ch. 245C requires a licensed program to conduct background studies. Providers who have direct contact with the person must have a completed background study (for a complete list, refer to Minn. Stat. §245D.03). A provider must complete and submit individual background studies using New Electronically Transmitted Study (NETStudy) through DHS licensing.

Service authorization

The lead agency (or transition coordinator if the person does not have a lead agency) assigns an MHM demonstration case manager. The demonstration case manager is responsible to authorize the person’s MHM post-transition community services.

This service requires a service authorization. DHS pays the provider as indicated on the service agreement.

For instructions about authorizing MHM community services and how to receive prior authorization, refer to MHM Manual – Services.

Rate

The lead agency (or transition coordinator if the person does not have a lead agency) authorizes DCM at a 15-minute unit rate that does not exceed the rate limit in Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF).

Billing

The DCM provider must plan and deliver services based on the person's needs as documented in the person’s TPT. All submitted claims must be based on actual services delivered.

The DCM provider cannot bill services based on an average of billable units provided to a person.