Glossary
Page posted: 8/3/26
This page includes definitions of terms commonly used in this manual. For a more comprehensive glossary of terms related to long-term services and supports (LTSS), refer to CBSM – Glossary.
A | B | C | D | E | F | H | I | L | M | N | P | R | S | T | W
A
Activities of daily living (ADLs): Tasks essential to perform routine self-care functions (e.g., dressing, grooming, bathing, eating, transfers, mobility, positioning, toileting).
Alternative Care (AC): Program that provides home and community-based services for people age 65 and older who require the level of care provided in a nursing facility, choose to live in the community and are not yet financially eligible for Medical Assistance (MA).
Alternative Care (AC) conversion case management: Case management activities that coordinate and support the discharge planning process to help people relocate to community-based settings.
Assessment: Process of identifying all the following:
B
Brain Injury (BI) Waiver: Program that provides home and community-based services to children and adults with a diagnosis of brain injury who require the level of care provided in a specialized nursing facility or neurobehavioral hospital. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration.
C
Case manager/care coordinator: Professional who assists a person with access to and navigation of social, health, education, vocational and other community and natural supports and services, based on the person’s values, strengths, goals and needs. The professional is responsible to provide the person with information necessary for them to make informed choices.
Case mix classification: Classification of a person that is used to establish individual community budgets under various programs. The classification is based on the assessment of the person’s needs in:
Category of service (COS): Three-digit code used to specify a type of service.
Centers for Medicare & Medicaid Services (CMS): The federal agency that oversees and provides funding for health care, waiver programs and Alternative Care.
Claims adjudication: Decision by DHS about payment to a provider’s claim for service(s).
Community First Services and Supports (CFSS): A Minnesota Health Care Program that offers flexible options to meet the unique needs of people. It allows people greater independence in their homes and communities.
Community Access for Disability Inclusion (CADI) Waiver: Program that provides home and community-based services to children and adults with disabilities who require the level of care provided in a nursing facility. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration.
Community Alternative Care (CAC) Waiver: Program that provides home and community-based services to children and adults who are chronically ill or medically fragile and require the level of care provided in a hospital. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration.
Consumer directed community supports (CDCS): Service option available to people on the home and community-based services (HCBS) waivers and Alternative Care (AC) program. CDCS gives a person flexibility in service planning and responsibility for self-directing their services, including hiring and managing support workers. CDCS may include traditional services and goods and self-designed services.
Conversion: The use of home and community-based services to return a person to the community from an institutional setting.
County of financial responsibility (CFR): County responsible for payment of a person’s social services. The CFR is typically the person’s county of residence.
County of residence (COR): County where the person resides.
County of service (COS): County or tribal nation that provides financial worker services. For more information, refer to MHCP Eligibility Policy Manual – County residency.
County/tribal worker: Employee of a county/tribal nation who determines eligibility and approves/monitors a person’s support plan. The county/tribal worker may help with planning and be the service coordinator if the person chooses.
D
Data validity: Automatic action by MMIS to review and check that data fields are of the proper type and in the proper format.
Department of Human Services (DHS): State agency that provides Minnesotans with a variety of services intended to help people live as independently as possible. Working with many others, including counties, tribal nations and managed care organizations, DHS administers health care coverage, economic assistance and a variety of services for children, people with disabilities and older adults.
Diagnosis-related group (DRG): System used to classify and sort hospital patients by discharge diagnosis into categories that are medically similar and have approximately equivalent lengths.
Diversion: The use of home and community-based services to prevent or delay the use of institutional long-term care.
E
Elderly Waiver (EW): Program that funds home and community-based services for people age 65 and older who require the level of medical care provided in a nursing home and choose to reside in the community.
Essential Community Supports (ECS): Community-based services for people age 65 and older who do not require nursing facility level of care, choose to live in the community and are not yet financially eligible for Medical Assistance (MA).
Exception codes (i.e., edits): Errors posting against a screening document or service agreement in MMIS. Typically, exception codes prevent approval of the screening document or service agreement in MMIS.
Extended home care services: Services that follow Medical Assistance (MA) state plan home care policies but are allowed to exceed the limits on amount, duration and frequency.
F
Fiscal year: A period of time established for budgetary and accounting purposes. The state fiscal year is July 1 to June 30 of the following year. The federal fiscal year is Oct. 1 to Sept. 30 of the following year.
H
Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule: Federal law that provides people with rights over their health information and sets rules and limits on who can look at and receive personal health information.
Health Insurance Portability and Accountability Act (HIPAA) Security Rule: Federal law that protects health information in electronic form and requires entities covered by HIPAA to ensure electronic protected health information is secure and the confidentiality provisions of the Patient Safety Rule are enforced.
Home and community-based services (HCBS) waiver: Services not normally covered by Medical Assistance that are covered under a 1915(c) federally funded waiver program or through state funds. HCBS waivers allow states flexibility to cover virtually all long-term care services that people with disabilities need to live independently in home and community settings. States may operate several 1915(c) HCBS waiver programs at once, each offering a distinct package of services and supports to different groups of people.
Home care: Medical and health-related services and assistance with day-to-day activities for people in their homes. Home care can provide short-term care for people moving from a hospital or nursing home back to their home, or it can provide continuing care for people with ongoing needs.
Hospice: Palliative and supportive care for people who are terminally ill and their families to meet the physical, nutritional, emotional, social, spiritual and special needs experienced during the final stages of illness, dying and bereavement.
Hospital: An acute care institution licensed under Minn. Stat. §144.50 to 144.58.
I
Informal caregivers/informal supports: Family, friends, neighbors and others who provide services and assistance to people without reimbursement.
Information transfer system (ITS): A computer-based system that allows data from forms such as screening documents, service agreements, prior authorizations and claims to be batch-entered into MMIS.
Informed choice: A choice a person makes that is based on their likes, dislikes, community-based experiences, the potential impact on their quality of life and information about other available options they receive from their support system. Per Minn. Stat. §256B.4905, all people with disabilities have the right to make an informed choice and to be provided with an informed decision-making process.
Instrumental activities of daily living (IADLs): Meal planning and preparation, managing finances, shopping for food, communication by telephone and other media, getting around and participating in the community.
L
Lead agency: A county, tribal nation or managed care organization (MCO).
Legal guardian: A person with legal authority and duty to act on behalf of another person. The legal guardian can make decisions for the person about where to live, medical treatment, training and education, etc. Decision-making is limited to the specific powers the court assigns to the legal guardian.
Legal representative: Parent(s) of a person younger than age 18, guardian, conservator, guardian ad litem (authorized by the court) or other representative legally authorized to act on behalf of a person, including the right to make decisions about services for the person.
Legally responsible individual: Any of the following people:
Level of care (LOC): A particular amount of care and services required to meet a person’s needs. There are four level of care distinctions:
Long-term care consultation (LTCC): A service designed to help people make decisions about long-term care needs and choose services and supports that reflect their needs and preferences.
Long-term care (LTC) screening document: A part of the prior authorization subsystem in MMIS that captures assessment, HCBS eligibility and other information.
M
Managed care organization (MCO): An organization certified by the Minnesota Department of Health to provide all defined health care benefits to people enrolled in a Minnesota Health Care Program (MHCP) in return for a capitated payment. MCOs are also referred to as health plans or prepaid health plans.
MAXIS: System that processes information to determine eligibility for public assistance programs and mails benefits and notices to people who receive public assistance. MAXIS is not an acronym; the letters do not stand for anything in particular. MAXIS passes eligibility information for Medicaid and General Assistance Medical Care (GAMC) through to MMIS.
Medicaid: A jointly funded, federal and state health insurance program for people who have a low income or other needs. It covers children, people who are older, people who have disabilities and others who are eligible to receive federally assisted income maintenance payments. Minnesota’s Medicaid program is called Medical Assistance (MA).
Medicaid Management Information System (MMIS): A mechanized claims-processing and information-retrieval system for Medicaid. The federal government requires all states operate an MMIS to support Medicaid business functions and maintain information in several areas (e.g., provider enrollment, eligibility, benefit package maintenance, managed care enrollment, claims processing, prior authorization).
Medical Assistance (MA): Minnesota’s name for the federal Medicaid program that provides medical care for people with low incomes.
Medically necessary/medical necessity: Health service that is consistent with a person’s diagnosis or condition and is recognized as the prevailing medical community standards or current practice by the provider’s peer group and is rendered according to one of the following:
Medicare: Federal health insurance program administered by the U.S. Department of Health and Human Services under the Centers for Medicare & Medicaid Services (CMS) for people who:
Minnesota Eligibility Technology System (METS): The IT system that determines eligibility for Medical Assistance, MinnesotaCare or tax credits to help pay for a private health insurance plan, among other things.
MinnesotaCare: A health care program for people with low incomes. People who are enrolled in MinnesotaCare get health care services through a health plan. MinnesotaCare is funded by a state tax on Minnesota hospitals and health care providers, Basic Health Program funding and enrollee premiums and cost sharing.
Minnesota Health Care Programs (MHCP): DHS-administered programs that include:
Minnesota Senior Care Plus (MSC+): A mandatory prepaid Medical Assistance (MA) program for people age 65 years and older.
Minnesota Senior Health Options Program (MSHO): A voluntary Minnesota Health Care Program for people age 65 years and older who are enrolled in Medical Assistance (MA) and Medicare Parts A and B.
MnCHOICES: Term that refers to both the computer application used by lead agencies to complete long-term services and supports (LTSS) assessments, support plans and health risk assessments and the assessment conducted to determine eligibility for LTSS.
Moving Home Minnesota (MHM): Minnesota’s Money Follows the Person Rebalancing Demonstration, offered through the federal Centers for Medicare & Medicaid Services (CMS). The goal of MHM is to establish services for people on Minnesota’s Medical Assistance (MA) program to move from qualified institutions to their own home in the community.
N
Notice of action: Document used by the certified assessor or case manager/support planner to inform a person that the county/tribal nation has made a decision about their services and will take an action that affects them.
P
Prior authorization subsystem: A subsystem of the MMIS that collects and processes information about services that require prior authorization before claims can be paid. The prior authorization subsystem includes both screening documents (i.e., screenings) and service agreements (i.e., prior authorization).
Person master index (PMI) number: A unique identification number that MAXIS assigns to a person.
Preadmission screening (PAS): Activities that determine a person’s need for nursing facility level of care for Medical Assistance. Lead agencies and Minnesota Aging Pathways work in conjunction to complete the various PAS activities, which includes activities required by the federal Omnibus Budget Reconciliation Act (OBRA).
Prepaid Medical Assistance Program (PMAP): Minnesota’s Managed Medicaid Program for people who receive Medical Assistance. State and federal dollars fund PMAP, and it is the largest of Minnesota’s publicly funded health care programs. Various PMAP programs enroll children, families, single adults, people age 65 or older and people with disabilities.
R
Rate: Fixed charge per unit of a commodity or service.
Reassessment: Annual activity to reevaluate a person’s eligibility for programs and services.
Relocation service coordination targeted case management (RSC-TCM): A form of TCM that provides coordination of activities to help a person who resides in an eligible institution gain access to medical, social, educational, financial, housing and other services and supports that are necessary to move to the community.
S
Service agreement: A part of the prior authorization subsystem in MMIS that allows providers to bill for approved services and allows DHS to audit usage and payment data.
Service Agreement and Screening Document (SASD) Support Team: Help desk that provides technical assistance to lead agencies and DHS staff for MMIS, related specifically to screening documents and service agreements in the following areas:
Special Needs BasicCare (SNBC): A voluntary managed care program for people with a certified disability, ages 18 through 64, who are enrolled in Medical Assistance. For people enrolled in SNBC, certain home and community-based services remain covered by DHS fee-for-service and are not covered by the managed care organization.
T
Transaction control number (TCN): A unique 17-digit number assigned to each claim for identification purposes.
Third party liability (TPL): Medical Assistance (MA)-enrolled providers are required to bill liable third-party payers and receive the maximum payment before billing Minnesota Health Care Programs (MHCP). MHCP will not pay for services that could have been covered by a third-party payer if applicable rules of that plan had been followed.
Third-party payer: Person, entity or program that is, or may be, responsible to pay all or part of the medical costs provided to people enrolled in Medical Assistance (MA).
W
Waiver programs: Programs that have received federal approval for expanded coverage for services not usually covered under Medical Assistance (MA) and meet the needs of targeted populations based on eligibility requirements specific to each waiver program. Minnesota offers the following waivers:
Waiver span: Period of time that identifies both the begin and end date for the specific waiver program the person has been approved to receive.
Report this page