Recuperative Care

Posted: January 1, 2024

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Non Covered Services

· Billing

· Legal References

Overview

Recuperative care services are available to eligible Minnesota Health Care Programs (MHCP) members experiencing homelessness to help prevent hospitalizations; or provide medical care and support services when they are unable to recover from a physical illness when living in a shelter or they are otherwise unhoused. MHCP members receive recuperative care services when they don’t need to be hospitalized or remain hospitalized, or don’t meet severity of illness for other levels of care.

Eligible Providers

The following providers may provide recuperative care services:

· registered nurse

· licensed practical nurse

· case manager

· mental health counselor

· social worker

· community health worker

Providers must self-attest that they meet all the conditions by completing and submitting a Recuperative Care Provider Assurance Statement (DHS-8486) (PDF) to be eligible for reimbursement.

Eligible Members

To be eligible for recuperative care services, an MHCP member must be:

· 21 years or older if they have Medical Assistance, or 19 years or older if they have MinnesotaCare

· experiencing homelessness or are unhoused

· in need of short-term medical care for fewer than 60 days

· in need of assistance with the following covered services.

Covered Services

MHCP covers the following recuperative care services

· Basic nursing care including monitoring physical health and pain level

· Wound care

· Medication support

· Patient education

· Immunization review and update

· Clinical goals development for the recuperative care period and discharge plan

· Care coordination including initial assessment of medical, behavioral and social needs

· Care plan development

· Support and referral assistance for legal, housing,​ transportation, case management and community social services

· Support and referral assistance for health care benefits, health and other eligible benefits

· ​Care plan implementation follow-up and monitoring

· Medical, social and behavioral (counseling and peer support) services that can be provided​ in the recuperative care setting

· Community health worker services (Minnesota Statutes, 256B.0625,​ 43.25 subdivision 49.​ 43.26)

Recuperative Care Facility Requirements
Recuperative care may be provided in any setting, including, but not limited to, homeless shelters, congregate care settings, single room occupancy settings, or supportive housing, if the recuperative care or housing provider is able to provide the following to the MHCP member within the designated setting, at a minimum:

· 24-hour access to a bathroom (shower, sink and toilet)

· 24-hour access to a bed

· access to three meals per day (included in per diem)

· availability to environmental services

· access to a telephone

· secure place to store the MHCP member’s belongings

· staff available within the setting to provide a wellness check as needed (minimum of once every 24 hours)

Noncovered Services

The provider must evaluate their program’s capabilities.

· The member’s behavioral health needs cannot be greater than what can be managed by the​ provider within the setting.

· The member needs to be independent with activities of daily living and not need a higher level of care. For example, the member may have a temporary cast on their arm, however, needing assistance to stand or get to the bathroom is more than can be offered in the recuperative care setting.

Authorization Requirements

Recuperative Care Extended Stay
Providers may request an extension if a member requires recuperative care services for more than 60 days. Providers should complete and submit Recuperative Care Extended Stay Request (DHS-8513) (PDF) (will be available Feb. 1, 2024) along with required medical information to the medical reviewer. Refer to Authorization under Provider Basics in the MHCP Provider Manual to submit a prior authorization request.

Readmissions
Any consecutive readmission to recuperative care services for the same diagnosis will continue the same 60-day limit. If the member is close to the 60 days, submit the Recuperative Care Extended Stay Request (DHS-8513) (PDF) along with required medical information to ensure continued payment. Any readmission to recuperative care services for a new diagnosis starts a new 60-day coverage limit.

Discharge From Recuperative Care Services
Providers must ensure either one of the following before discharging a member from recuperative care services:

· The member’s medical condition has improved

· The member is being discharged to another setting that can meet their needs

Billing

Recuperative Care Services Rate
The recuperative care services rate is a bundled per diem payment of​ $300 per day for the services provided to the member. Services provided within the bundled payment may include, but are not limited to, the covered services.

Recuperative Care Facility Rate
The recuperative care facility rate includes the room and board daily rate.

The recuperative care facility rate is only paid when the recuperative care services rate is paid to a provider. Providers may opt to only receive the recuperative care services rate. The eligibility standards in chapter 256I do not apply to the recuperative care facility rate.

Recuperative Care Services Claim

· Bill on 837P claim format. Refer to the MN–ITS 837P Professional User Guides.

· Bill CPT code T2033 for the recuperative care bundled payment.

· Bill all CPT or HCPCS codes on the same exact claim that describes the services rendered with a $0.00 charge (these will be zero pay).

· One of the ICD-10 diagnosis codes for homelessness will also need to be on the claim and condition code 17. It is the provider’s responsibility to determine the appropriate diagnosis code for the service that was provided

Recuperative Care Facility Claim

· 86X Residential Facility claim format. Refer to the MN–ITS 837P Professional User Guides.

· One of the ICD-10 diagnosis codes for homelessness will also need to be on the claim and condition code 17. It is the provider’s responsibility to determine the appropriate diagnosis code for the service that was provided.

Note: The recuperative care services professional claim must be submitted and paid through MHCP prior to submitting the recuperative care facility claim.

Managed Care Members

The recuperative care facility (room and board) rate is a carve-out service and will be paid from state funds in an amount that equals the medical assistance room and board rate at the time the recuperative care services were provided.

These facility claims are covered through MHCP fee-for-service and should be billed directly to MHCP.

Recuperative care providers must contact the managed care organization (MCO) for enrollment requirements, billing and coverage policies when providing services to MCO enrollees.

Legal References

Minnesota Statutes, 256B.0701 (Recuperative Care Services)