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

Respite: MHM service a person may receive after moving to the community. This service is for people who need support on a short-term basis due to the absence or need for relief of the person’s primary caregiver. This service must be:

In-home respite: Respite provided to a person in their home. This can include time spent in community locations used by the general public (e.g., malls, parks, libraries) while the person continues to stay in their home.

Out-of-home respite: Respite provided to a person in a licensed setting or unlicensed setting that is not the person’s home. This can include time spent in community locations used by the general public (e.g., malls, parks, libraries) while the person stays in a licensed or unlicensed setting that is not their home.

Demonstration case management (DCM): MHM service a person may receive after moving to the community. This service monitors and evaluates the person’s MHM community services and supports as they adjust in the community. DCM must be:

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).

Primary caregiver(s): Person or people principally responsible for the care and supervision of the person who receives MHM respite services.

A person is eligible to receive MHM respite for up to 365/366 days after their move into the community if they meet all the following criteria:

Waiver interaction

If the person enrolls in a home and community-based services (HCBS) waiver program, they must use the waiver version of the service, as described on CBSM – Respite. They cannot receive MHM respite services in addition to their waiver services.

MHM respite covers:

MHM respite does not cover:

A person can receive MHM respite in their own home, family home or in settings listed in the provider standards and qualifications section below.

Respite is available during the person’s 365/366 days of MHM community service, after their move from an qualified institution. Dates of service must be within the eligibility span. This service requires prior authorization. For more information, refer to the authorization, rates and billing section below.

Respite is limited to a maximum of eight days per calendar month. This service must be reasonable and necessary for a person to remain in their qualified community residence.

Respite is a DHS enrollment-required service. For more information, refer to MHCP Provider Manual – MHM and CBSM – Waiver/AC service provider overview.

The provider must:

In-home respite requirements

Unless excluded, an in-home respite provider must meet one of the following requirements to serve people in their qualified community residence (described on MHM Manual – Eligibility):

Out-of-home respite requirements

The following sections explain the age, setting license and service license requirements for out-of-home respite.

Hospital

A person can receive out-of-home respite in a hospital when all the following requirements are met:

Nursing facility

A person can receive out-of-home respite in a nursing facility when all the following requirements are met:

Residential hospice facility

A person can receive out-of-home respite in a residential hospice facility when all the following requirements are met:

Assisted living facility

A person can receive out-of-home respite in an assisted living facility when all the following requirements are met:

Adult family foster care

A person can receive out-of-home respite in an adult family foster care setting when all the following requirements are met:

Community residential setting

A person can receive out-of-home respite in a community residential setting when all the following requirements are met:

Child foster care (family or corporate/shift staff)

A person can receive out-of-home respite in a child foster care setting when all the following requirements are met:

Intermediate care facility for persons with developmental disabilities (ICF/DD)

A person can receive out-of-home respite in an ICF/DD when all the following requirements are met:

For each shift, ICF/DD staff must be assigned to either respite or ICF/DD services. Staff cannot provide both respite and ICF/DD services during a single shift. Providers must ensure respite services are operating in ways that do not interfere with the care for people who live in the ICF/DD.

Camp

A person can receive out-of-home respite in a camp when all the following requirements are met:

Unlicensed setting for adults

An adult can receive out-of-home respite in an unlicensed setting when all the following requirements are met:

Note: Providers who meet the exclusion may be related or unrelated. Refer to CBSM – Exclusions from Chapter 245D licensure for information about related and unrelated providers.

Respite providers in unlicensed settings for adults age 18 or older are limited to serving a maximum of six people.

Unlicensed setting for children

A child can receive out-of-home respite in an unlicensed setting when provided by a relative and all the following requirements are met:

245D exclusion

In some cases, a person who receives in-home respite or out-of-home respite in an unlicensed setting can use an individual provider who meets the requirements for exclusion from 245D licensure. For more information, refer to CBSM – Exclusions from Chapter 245D licensure.

Reporting

Providers licensed under 245D must report all uses of controlled procedures, emergency use of manual restraint and prohibited procedures according to Minn. Stat. §245D.06, subd. 5 to DHS via the Behavioral Intervention Report Form, DHS-5148.

Background studies

Minn. Stat. Ch. 245C requires a licensed program to conduct background studies. Providers who have direct contact with the person must have a completed background study (for a complete list, refer to Minn. Stat. §245D.03). A provider must complete and submit individual background studies using New Electronically Transmitted Study (NETStudy) through DHS licensing.

Service authorization

The lead agency (or transition coordinator if the person does not have a lead agency) assigns an MHM demonstration case manager. The demonstration case manager is responsible to authorize the person’s MHM post-transition community services.

This service requires a service authorization. DHS pays the provider as indicated on the service agreement.

For instructions about authorizing MHM community services and how to receive prior authorization, refer to MHM Manual – Services.

Rate

The rates cannot exceed the rate limit in Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF).

Billing

The provider must plan and deliver services based on the person's needs, as documented in the person’s TPT. All submitted claims must be based on actual services delivered.

The provider must not incur respite expenses until they receive a service authorization letter (SAL) in their MN–ITS SAL mailbox.