To provide guidance and clarification to counties and tribes when Families and Children (F/C) [PMAP] enrollees request county/tribe-provided programs and services, e.g., waivers for people with disabilities, Rule 185/DD case management, and Family Support Grant (FSG) and the counties and tribes are conducting the assessments using MnCHOICES.
Tasks | Notes |
- Intake and assessment
| Explanations |
County/tribe tasks:
- Processes intake assessment referral when requesting county/tribe-administered services and programs. If the enrollee is receiving PCA services at the time of the request, intake contacts the MCO for the amount of PCA services authorized.
- Completes a MnCHOICES assessment within 20 calendar days of the person requesting/accepting assessment – certified assessor responsibility.
- Enters a Long-Term Care (LTC) Screening Document (SD) into MMIS following every MnCHOICES assessment.
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- Intake staff should ask the enrollee/caller if any services are being provided, e.g., PCA, skilled nursing, home health aide or therapies, when processing a referral.
- Intake staff documents the number of PCA hours the MCO is authorizing at the time of the request to inform the certified assessor.
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- Following a MnCHOICES assessment, the enrollee is eligible for and accepts PCA services only
| Explanations |
County/tribe tasks:
- Provides the MnCHOICES Community Support Plan Worksheet DHS- 6791A to the person/legal representative at the assessment – certified assessor responsibility
- Provides the MnCHOICES Community Support Plan form DHS-6791B to the person/legal representative and MCO within 40 calendar days from the assessment
- Sends the MnCHOICES Assessment Report, Eligibility Summary and the PCA (Provider) Summary to the MCO within 10 working days from the assessment
- Instructs the member to contact the MCO member services to select a provider(s) within the MCO network – certified assessor responsibility
- Does not enter PCA services authorization in MMIS.
MCO tasks:
- Authorizes PCA services within 10 working days of receipt of the MnCHOICES information
- Authorizes PCA services from the date of the assessment
- Provides follow-up with the enrollee when the PCA Provider Summary and/or the MnCHOICES Assessment Report indicate a referral for other state plan services, such as skilled nursing visits, home health aide (HHA) and/or therapies.
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- The MnCHOICES Community Support Plan with the Coordinated Services and Support Plan DHS-6791B includes both the CSP and CSSP
- The member is eligible for PCA services from the date of the initial/new assessment1
- If more than one new/initial assessment request is made to both the MCO and the county/tribe, which results in multiple assessments, the assessment with the most recent date will be used to determine the authorization
- At the time of the notification of member choosing a provider, the authorization is pro-rated from assessment date to the end of the current authorization period
- Referrals are included in the PCA (Provider) Summary under “Recipient Referrals”
- PCA services may be authorized for up to one year.
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- Following a MnCHOICES assessment, the enrollee is eligible for PCA services but chooses not to accept services at the time of the assessment
| Explanations |
County/tribe tasks:
- Provides the MnCHOICES Community Support Plan Worksheet DHS- 6791A to the person/legal representative at the assessment – certified assessor responsibility
- Provides the MnCHOICES Community Support Plan form DHS-6791B to the person/legal representative and MCO within 40 calendar days of the assessment
- Sends the MnCHOICES Assessment Report, Eligibility Summary and the PCA (Provider) Summary to the MCO within 10 working days of the assessment
- If the enrollee chooses to access PCA services within a year of the assessment, instructs the member to contact MCO member services to select a provider(s) within the MCO network – certified assessor responsibility
- Enters the PCA screening document but does not enter PCA service authorization in MMIS – certified assessor responsibility.
MCO tasks:
- Follows the MCO process for retention of the MnCHOICES assessment results for PCA eligibility
- Authorizes PCA services from the time the person notifies the MCO he or she is choosing to access PCA services and has chosen a PCA provider
- Provides follow-up with the enrollee when the PCA Provider Summary and/or the MnCHOICES Assessment Report indicate a referral for other state plan services, such as skilled nursing visits, home health aide (HHA) and/or therapies.
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- The MnCHOICES Community Support Plan with the Coordinated Services and Support Form DHS-6791B includes both the CSP and CSSP
- The member is eligible for PCA services from the date of the initial/new assessment2
- If more than one new/initial assessment request is made to both the MCO and the county/tribe, which results in multiple assessments, the assessment with the most recent date will be used to determine the authorization
- At the time of the notification of member choosing a provider, the authorization is pro-rated from assessment date to the end of the current authorization period
- Referrals are included in the PCA (Provider) Summary under “Recipient Referrals”
- PCA services may be authorized for up to one year.
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- Following a MnCHOICES assessment, the enrollee is eligible for PCA services AND is eligible for and chooses a service or program administered by a county/tribe
| Explanations |
County/tribe tasks:
- Provides the MnCHOICES Community Support Plan Worksheet DHS- 6791A to the person/legal representative at the assessment – certified assessor responsibility
- Provides the MnCHOICES Community Support Plan (CSP) DHS-6791B to the person/legal representative and MCO within 40 calendar days of the assessment
- Sends the MnCHOICES Assessment Report, Eligibility Summary and the PCA (Provider) Summary to the MCO within 10 working days of the assessment
- Instructs the member to contact the MCO Member Services to select a provider within the MCO network – certified assessor responsibility
- Determines eligibility for a waiver, the Family Support Grant (FSG) and/or Rule 185/DD case management.
Waiver case manager tasks:
MCO tasks:
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- Member cannot access the Consumer Support Grant (CSG) when on Families and Children
- SNBC members can access Consumer Support Grant (CSG).
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- Following a MnCHOICES assessment, enrollee is not eligible for PCA services
| Explanations |
County/tribe tasks:
- Provides a Notice of Action DHS-2828 when PCA services are requested and enrollee is determined not eligible for PCA services
- Sends the eligibility summary to the MCO within 10 working days of the assessment.
MCO tasks:
- Processes PCA assessments as requested, per MCO policy.
| n/a |
- Agency provider model and PCA choice/participant employer model
| Explanations |
County/tribe tasks:
- Informs the enrollee of the options of models of service delivery: the Agency Provider Model and the PCA Choice/Participant Employer Model
- Determines the enrollee’s eligibility for choice of model by checking MMIS to see if the enrollee is in the Minnesota Restricted Recipient Program – certified assessor responsibility.
MCO tasks:
- Makes changes to authorization to reflect enrollees choice of model, if required by MCO process.
PCA provider tasks:
- Complies with and provides the enrollee with the Home Care Bill of Rights.
- Has a written agreement on file for all PCA recipients that includes all of the components outlined in Minn. Stat. §256B.0659, subd. 20 and 28.
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- Certified assessor is required to explain the limitations of choice of model to the person who is a restricted recipient
- The MnCHOICES certified assessor does not need to be notified when an enrollee changes providers or models
- MCOs are not required by DHS to track an enrollee’s use of Agency Provider Model or PCA Choice/Participant Employer Model.
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- Shared Care
| Explanations |
County/tribe tasks:
- Determines selection of shared care option – certified assessor responsibility.
MCO tasks:
- Makes changes to authorization when enrollee moves to shared care per MCO process
- Communicates with the qualified professional regarding shared care, if the enrollee is interested in shared care.
Provider tasks:
- Works with enrollee to arrange shared care
- Maintains the enrollee’s shared care written agreement
- Develops the care plan for use of shared care
- Submits claims with a modifier that indicates the amount of shared care utilized by each enrollee.
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- Shared care information is communicated in the MnCHOICES Assessment Report in the “Assessor Conclusions” domain.
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- Responsible party
| Explanations |
County/tribe tasks:
- Notifies/invites the responsible party to the assessment, if a responsible party is known
- Includes the name of the responsible party in the MnCHOICES Assessment and PCA (Provider) Summary, if a responsible party is known/identified.
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- If a person needs a responsible party, the responsible party is not required to be present during the MnCHOICES assessment.
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- Notice of action (NOA) / Denials, terminations or reductions (DTR)
| Explanations |
County/tribe tasks:
- Gives a Notice of Action DHS-2828 to the enrollee and MCO when PCA services are denied, decreased or terminated as a result of the assessment – certified assessor responsibility.
MCO tasks:
- Provides a DTR to the enrollee when the MCO receives the Notice of Action DHS-2828 from the county or tribe
- Provides a DTR with a denial, termination or reduction in PCA services when the MCO action is not consistent with the results of the MnCHOICES assessment due to duplication of services
| n/a |
- Appeals
| Explanations |
County/tribe tasks:
- Notify the MCO the enrollee/representative is appealing the results of the MnCHOICES assessment
- Represents the action taken when the enrollee/representative appeals the MnCHOICES assessment results.
- Notify the current MCO of the outcome of the appeal.
MCO tasks:
- Provides a continuation of the enrollee’s PCA benefit pending the results of the appeal whether the action is taken by the MCO or the county or tribe
- Represents the action taken when the enrollee/representative appeals an MCO authorization that is not consistent with the MnCHOICES assessment results.
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- The MCO authorization may not be consistent with the MnCHOICES eligibility results when the MCO determines the services are duplicative, e.g., home health aide services (HHA).
Note: Not all HHA services are duplicative of PCA services. HHA services may be appropriate due to the skill required to perform the tasks and the supervision needed by a nurse. |
- Minnesota Restricted Recipient Program (MRRP)
| Explanations |
MCO tasks:
- Follows the MRRP requirements according to the contract
- Provides prior authorization and ensures continuity of care.
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- DHS may restrict enrollees to certain providers of health care services for the following reasons:
- To prevent duplication or abuse of services
- To prevent violation of prior authorization requirements
- To ensure continuity of care.
- MCOs enter their own restricted recipients into MMIS; do not need to contact financial workers.
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- Interpreters
| Explanations |
County/tribe tasks:
- Bills Minnesota Health Care Programs (MHCP) for interpreter services.
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- All MHCP-enrolled providers may bill MHCP for sign and spoken language interpreter services, if the provider cannot effectively communicate with the recipient
- Use code T1013 to bill for interpreter services.
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