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

Assertive community treatment (ACT): Intensive nonresidential treatment and rehabilitative mental health services provided according to the ACT model. ACT provides a single, fixed point of responsibility for people’s treatment, rehabilitation and support needs. Services are offered 24-hours per day, seven days per week, in a community-based setting.

Behavioral health home (BHH) services: Minnesota’s version of the federal “health home” benefit for people enrolled in Medical Assistance (MA). BHH services include comprehensive care management, care coordination, health promotion and wellness, comprehensive transitional care, patient and family support, referral to community and social support services.

Home and community-based services (HCBS) waivers: Programs that provide HCBS to meet the needs of people with disabilities and older adults who choose to receive services and supports in their home or community, rather than in an institutional setting. For eligible people, these service options are available in addition to services covered by MA.

Home care: An option that offers a range of medical care and support services provided in the person’s home and community. Services range from simple assistance in activities of daily living to a level of care similar to care provided in a hospital. Home care includes home health aide, home care nursing, skilled nursing visit, home care therapies and personal care assistance.

Housing Support (formerly Group Residential Housing): A program for people with disabilities and older adults who have low income. Housing Support helps pay for housing and things people need to stay housed in certain group settings or in the community.

Housing Support supplemental services (HSSS): Services to help people receiving Housing Support room and board maintain their housing. HSSS can help pay for transportation, arranging meetings and appointments, arranging medical and social services, medication reminders and up to 24-hour supervision. A person might qualify for these services if they receive Housing Support benefits that help pay for room and board in an approved location.

Mental health targeted case management (MH-TCM): Adult mental health targeted case management (AMH-TCM) and children’s mental health targeted case management (CMH-TCM) services help adults with serious and persistent mental illness (SPMI) and children with severe emotional disturbance (SED) gain access to medical, social, educational, vocational and other necessary services connected to the person’s mental health needs. TCM services include developing a functional assessment (FA), an individual community support plan (ICSP) for an adult and an individual family community support plan (IFCSP). It also includes referring and linking the person to mental health and other services while ensuring coordination and monitoring of the delivery of 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.

State plan services: Services described in the MA state plan, such as doctor visits, prescriptions and hospital stays.

Vulnerable adult/developmental disability targeted case management (VA/DD-TCM): Services provided on behalf of a vulnerable adult or person with developmental disabilities intended to coordinate and link social and other services and designed to help gain access to needed protective services, social, health care, mental health, habilitative, educational, vocational, recreational, advocacy, legal, chemical, health and other related services.

A person cannot receive MHM and RSC-TCM at the same time. This is considered a duplication of services. The person must choose which service best meets their needs.

For a person receiving fee-for-service MA, Minnesota Health Care Programs (MHCP) will pay the first claim submitted in a calendar month for any one of the duplicative services. MHCP will not pay subsequent claims in the same calendar month for one of the identified duplicate services.

A person can receive MHM instead of (or before) RSC-TCM if all of the following are true:

If a person is using RSC-TCM, they can switch to MHM or use MHM if they run out of time on RSC-TCM. RSC-TCM has a 180-day limit that starts on the date of service listed on the first RSC-TCM claim. MMIS creates a 180-day window based on that date, which prevents providers from billing past the 180-day limit. This window cannot be paused.

RSC-TCM policy

For information about RSC-TCM policy, refer to CBSM – RSC-TCM.

For a detailed comparison, refer to MHM Program Manual – Comparison of MHM and RSC-TCM.

A person on MHM can receive Housing Support if they meet eligibility requirements.

Housing Support policy

For information about Housing Support eligibility, refer to DHS – Housing Support.

A person on MHM who does not receive HCBS waiver case management can receive HSSS and MHM. The MHM Type Z service agreement is allowed to overlap with the supplemental service rate in MMIS.

A person on MHM and an HCBS waiver cannot receive HSSS. There is an exception code in MMIS that prevents the supplemental service rate and waivers from being authorized at the same time.

HSSS policy

For information about HSSS policy, refer to MHCP Provider Manual – HSSS.

Elderly Waiver (EW)

A person age 65 or older must enroll in EW to access MHM services, unless they are eligible to enroll in a disability waiver program. For additional information, refer to:

For a person receiving fee-for-service EW, the lead agency authorizes MHM services on the waiver service agreement.

For a person receiving EW services through MSHO or MSC+, MHM services are covered by the managed care organization (MCO).

The following MHM post-transition services do not apply toward the EW budget cap:

The remaining MHM post-transition services are already available under EW, so those services are provided and covered under EW.

Examples

The environmental accessibility adaptations – home modifications waiver service (home assessment and install) is available under EW. EW will cover these services under T1028 and S5165 rather than the MHM procedure codes T1028 U6 and S5165 U6. The lead agency authorizes the service on the EW service agreement, and it counts toward the EW budget cap.

Comprehensive community support services are not available on EW. The lead agency can authorize comprehensive community support services H2015 U6 on the EW service agreement, and it will not count toward the EW budget cap.

Brain Injury (BI), Community Access for Disability Inclusion (CADI), Community Alternative Care (CAC) and Developmental Disabilities (DD) waivers

A person may receive MHM services in addition to waiver services if they are either:

For additional information, refer to CBSM – Waiver, AC and ECS general processes and procedures.

For a person receiving fee-for-service MA or enrolled in managed care (Families & Children or Special Needs Basic Care [SNBC]), the lead agency authorizes MHM services on the waiver service agreement.

For a person receiving MA through MSHO or MSC+, MHM services not covered by the waiver will be covered by the MCO.

The following MHM post-transition services are available in addition to waiver services:

The remaining MHM post-transition services are already available under BI, CAC, CADI and DD, so those services are provided and covered under BI, CAC, CADI and DD.

Examples

Waiver transitional services (i.e., deposits, moving expenses, furniture and household supplies) are available under BI, CAC, CADI, and DD. The waivers will cover these services under T2038, T2038 U1 and T2038 U2 on the waiver service agreement rather than the MHM procedure codes T2038 U6 U1, T2038 U6 U2 and T2038 U6 UA.

Comprehensive community support services are not available on BI, CAC, CADI or DD. The lead agency can authorize comprehensive community support services H2015 U6 on the waiver service agreement.

Service agreement overlap

A person cannot have a waiver service agreement and MHM service agreement open at the same time in MMIS.

A person on a waiver receives certain MHM services (as explained in the previous sections) that are authorized on their waiver service agreement, and they also have a waiver case manager.

A person younger than age 65 who is not on a waiver receives the full spectrum of MHM supplemental and demonstration services on a separate Type Z service agreement, and they also have an MHM demonstration case manager. They still must meet an institutional level of care to receive MHM community services.

MHM transition coordination

A person eligible for BHH services is eligible for all MA-covered services. A person can choose to receive MHM transition coordination and BHH services at the same time.

MHM demonstration case management

A person cannot receive MHM demonstration case management and BHH services at the same time. This is considered a duplication of services. The person must choose which service best meets their needs.

For a person receiving fee-for-service MA, MHCP will pay the first claim submitted in a calendar month for any one of the duplicative services. MHCP will not pay subsequent claims in the same calendar month for one of the identified duplicate services.

MCOs are also prohibited from paying for duplicative services in the same calendar month. However, MCOs may develop different mechanisms to avoid duplicate payments, such as a take-back of payment following a reconciliation of monthly claims or denial of a subsequent duplicate claim in the same calendar month. Providers should contact the MCO directly to learn what procedures the MCO will use to ensure there are no duplicate payments.

Procedure codes

The following procedure codes can overlap with MHM TC:

BHH policy

For information about BHH services policy, refer to MHCP Provider Manual – BHH services.

A person can receive MHM and Medicaid state plan services (including home care) at the same time.

A person on MHM without a waiver is allowed to have their MHM Type Z service agreement overlap with their Home Care Type B service agreement.

A person on MHM and an HCBS waiver can have all MHM services, waiver services and home care services authorized on the waiver service agreement.

Home care policy

For information about home care policy, refer to CBSM – Home care overview.

MHM transition coordination

A person can receive MHM transition coordination and VA/DD-TCM at the same time.

MHM demonstration case management

A person cannot receive MHM demonstration case management and VA/DD-TCM at the same time. This is considered a duplication of services. The person cannot receive any type of targeted case management (MH-TCM, RSC-TCM, CW-TCM) during the month(s) they receive MHM demonstration case management. The person must choose which service best meets their needs.

For a person receiving fee-for-service MA, MHCP will pay the first claim submitted in a calendar month for any one of the duplicative services. MHCP will not pay subsequent claims in the same calendar month for one of the identified duplicate services.

Procedure codes

The following procedure codes can overlap with MHM TC:

VA/DD policy

For information about VA/DD-TCM policy, refer to CBSM – VA/DD-TCM.

MHM transition coordination

A person can receive MHM transition coordination and AMH-TCM at the same time.

MHM demonstration case management

A person cannot receive MHM demonstration case management and AMH-TCM at the same time. This is considered a duplication of services. The person must choose which service best meets their needs.

For a person receiving fee-for-service MA, MHCP will pay the first claim submitted in a calendar month for any one of the duplicative services. MHCP will not pay subsequent claims in the same calendar month for one of the identified duplicate services.

Procedure codes

The following procedure codes can overlap with MHM TC:

AMH-TCM policy

For information about AMH-TCM policy, refer to MHCP Provider Manual – AMH-TCM and CMH-TCM.

MHM transition coordination

A person can receive MHM transition coordination and CMH-TCM at the same time.

MHM demonstration case management

A person cannot receive MHM demonstration case management and CMH-TCM at the same time. This is considered a duplication of services. The person must choose which service best meets their needs.

For a person receiving fee-for-service MA, MHCP will pay the first claim submitted in a calendar month for any one of the duplicative services. MHCP will not pay subsequent claims in the same calendar month for one of the identified duplicate services.

Procedure codes

The following procedure codes can overlap with MHM TC:

CMH-TCM policy

For information about CMH-TCM policy, refer to MHCP Provider Manual – AMH-TCM and CMH-TCM.