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

Pre-discharge case consultation and collaboration: MHM service that covers comprehensive evaluation and consultation sessions with a credentialled provider to support the person’s transition plan when they reside in a qualified institution. The service must be:

Credentialled provider: Health care professional who passed the credentialing process and is allowed to provide care to people (e.g., physicians, nurses and other allied health care professionals).

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 MHM pre-discharge case consultation and collaboration before discharge from an MHM qualified institution if they meet all the following criteria:

MHM pre-discharge case consultation and collaboration covers comprehensive evaluations and consultation sessions with a credentialled provider to assist in the development of a transition or service plan that supports MHM transition planning. Covered activities include:

MHM pre-discharge case consultation and collaboration does not include:

Note: The MHM pre-discharge case consultation and collaboration provider is responsible to coordinate the delivery of MHM pre-discharge case consultation and collaboration with other services.

Before the service

Before an MHM pre-discharge case consultation and collaboration session can begin, the transition coordinator, care coordinator and/or case manager must:

After the service

After an MHM pre-discharge case consultation and collaboration session, the transition coordinator, care coordinator and/or case manager must document service delivery in the following ways:

MHM pre-discharge case consultation and collaboration:

A transition coordination provider must be present if the provider delivers MHM pre-discharge case consultation and collaboration in person with the person present.

Consultation and collaboration must be directly related to the credentialed provider’s specialty or profession. The credentialed provider cannot consult on subjects beyond their licensure.

The provider must:

License requirements

Either the credentialled provider or the transition coordination provider/lead agency billing on behalf of the credentialled provider must be an enrolled Minnesota Health Care Programs (MHCP) provider. The entity billing must be one of the following:

Service authorization

MHM pre-discharge case consultation and collaboration does not require a service authorization.

Rate

The lead agency or transition coordination providers should use specific components of the person’s service and support needs to work with the provider to determine an appropriate agreed upon service rate for a MHM pre-discharge case consultation and collaboration session. The following items may be appropriate components to consider when setting a session rate:

The lead agency or provider claims the actual cost of the consultation, limited to the actual cost per session not to exceed $1,500 per session. The rates cannot exceed the rate limit in Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF).

These costs must be reasonable and necessary expenses for the person to establish their basic living arrangement.

Billing

If the credentialled provider is not enrolled as an MHCP provider for MHM pre-discharge case consultation and collaboration, the lead agency or transition coordination provider must be enrolled as a MHM pre-discharge case consultation and collaboration provider to serve as a pass-through biller for the service.