Minnesota Minnesota

Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


Extended home care services

Page posted: 10/01/03

Page reviewed: 5/15/26

Page updated: 5/15/26

Legal authority

Federally approved Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD) and Elderly Waiver (EW) waiver plans

Definition

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 for people on an MA waiver.

Overview

This page describes policies for home care nursing (HCN), home health aide (HHA) and home health therapies.

For information about extended personal care assistance (PCA)/Community First Services and Supports (CFSS), refer to CFSS Manual – Extended PCA/CFSS services.

Note: Extended services are not available for skilled nursing visits (SNVs).

Eligibility

BI, CAC and CADI

The following extended services are available for eligible people on BI, CAC and CADI waivers:

  • · HCN.
  • · HHA.
  • · Home health therapies (physical, occupational, speech language/pathology and respiratory).

    • EW

    The following extended services are available for eligible people on EW:

  • · HCN.
  • · HHA.

    • EW does not cover extended home health therapies.

    Alternative Care (AC) and DD

    DD and AC do not cover extended HCN, HHA or home health therapies.

    Service-specific information

    For service-specific information, refer to the following sections:

  • · Extended HCN and HHA.
  • · Extended home health therapies.

    • Resources

    CBSM – HCN
    CBSM – HHA
    CBSM – Home health therapies
    CFSS Manual – Extended PCA/CFSS services
    Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF)
    Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF)
    Instructions for Completing and Entering the LTCC Screening Document and Health Risk Assessment into MMIS for MSC+ and MSHO Programs, DHS-4669 (PDF)
    HCN Service Decision Tree, DHS-4071C (PDF)

    Extended HCN and HHA

    Covered services

    Extended HCN and HHA services are covered when all the following are true:

  • · The case manager authorizes up to the state-set limit for the MA state plan service.
  • · The case manager authorizes the extended services.
  • · The provider follows the policies for the applicable state plan home care service on CBSM – HCN or CBSM – HHA.

    • Non-covered services

    Extended HCN and HHA services are not covered when they:

  • · Are not authorized by the case manager.
  • · Do not follow the policies for HCN and HHA state plan services.

    • AC and DD

    Extended HCN and HHA are not available to people on AC or DD. For information about home care services available on those programs, refer to:

  • · CBSM – AC program.
  • · CBSM – DD Waiver.

    • Authorization

    The case manager must authorize both MA state plan and extended HCN and/or HHA on the same service agreement.

    Services not through a managed care organization (MCO)

    For a person not receiving HCN/HHA through an MCO, the case manager must:

  • · Authorize the MA state plan service(s) using the applicable procedure code(s) with the number of units up to the state plan service limit in Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).
  • · Authorize extended services using the applicable procedure code(s) and modifier(s).

    • Services through an MCO

    BI, CAC and CADI

    To authorize extended HCN and HHA services for people age 65 or older on BI, CAC and CADI waivers who are enrolled in an MCO, the county/Tribal Nation case manager must:

  • · Authorize the state plan service using the placeholder procedure code X5609. For more information, refer to CBSM – HCN or CBSM – HHA.
  • · Authorize the extended HCN or HHA services using the applicable service code(s) and modifier(s) in Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF), including the extended services modifier (UC).

    • Note: The county/Tribal Nation case manager does not use the placeholder procedure code X5609 to authorize extended services.

    For more information, refer to Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF).

    EW

    To authorize extended HCN and HHA services for people on EW who are enrolled in an MCO, the care coordinator follows the MCO’s procedure, unless the person receives case management through a Tribal Nation. The MCO care coordinator must contact the case manager at the Tribal Nation for more information. For more information, refer to CBSM – Tribal administration and management of HCBS programs.

    Provider standards and qualifications

    The provider standards and qualifications for extended HCN and HHA services are the same as for MA state plan services. For more information, refer to CBSM – HCN or CBSM – HHA.

    Extended home health therapies

    Covered services

    Extended home health therapies are covered when all the following are true:

  • · The person is using up to the state-set limit for that MA state plan service.
  • · The case manager authorizes the extended services.
  • · The provider follows the policies for state plan home health therapies on CBSM – Home health therapies.

    • Non-covered services

    Extended home health therapies are not covered when they:

  • · Are not authorized by the case manager.
  • · Do not follow the policies for the MA state plan service.

    • AC, DD and EW

    Extended home health therapy services are not available to people on AC, DD or EW. For information about home care services available on those programs, refer to:

  • · CBSM – AC program.
  • · CBSM – DD Waiver.
  • · CBSM – EW.

    • Authorization

    The case manager does not prior authorize MA state plan home health therapies on a service agreement. The case manager only authorizes extended home health therapies on the person's service agreement.

    The case manager must authorize extended home health therapies using the applicable procedure code(s) and the extended modifier (UC) for service units over MA state plan home health therapy limits, as determined in coordination with the person's therapist(s).

    For information about limits and procedure codes, refer to Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

    For more information, refer to Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF).

    Provider standards and qualifications

    The provider standards and qualifications for extended home health therapies are the same as for MA state plan home health therapies. For more information, refer to CBSM – Home health therapies.

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