Non-covered services

Community education and integration costs do not include:

Limitations

Dates of service must be within the MHM enrollment span and can only begin after the person’s move to the community. This service requires prior authorization through a service agreement. For more information, refer to the authorization, rates and billing section below.

Community education and integration costs:

There are no exceptions to these limitations.

Provider standards and qualifications

The provider must:

License requirements

The provider must be one of the following:

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.

Authorization, rates and billing

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.

Managed care

For people enrolled in Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+), the provider should contact the MCO directly for information on their authorization process. For contact information, refer to DHS – MCO contacts for MHCP providers.

For people enrolled in Special Needs BasicCare (SNBC) or Families and Children (PMAP), the provider should follow the fee-for-service authorization instructions.

Fee for service

Community education and integration costs 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 lead agency or provider claims the actual cost of the items purchased. The rates cannot exceed the rate limit in Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF).

Billing

Costs for community education and integration must be reasonable and necessary expenses for a person to establish their integration in the community.

The provider must:

All submitted claims must be based on actual classes or services purchased.

Managed care

For people enrolled in MSHO and MSC+, the provider should contact the MCO directly for information on their billing process. For contact information, refer to DHS – MCO contacts for MHCP providers.

For people enrolled in SNBC or PMAP, the provider should follow the fee-for-service billing instructions.

Fee for service

The provider must not incur community education and integration expenses until DHS has confirmed the qualified community residence and receives a service authorization letter (SAL) in their MN–ITS SAL mailbox.

Additional resources

MHM Manual – Eligibility
MHM Manual – Services
MHM Manual – Transition coordination
MHCP Provider Manual – MHM
MHM Communication Form, DHS-6759H
MHM Transition Planning, Transition Coordination and Demonstration Case Management – Provider Assurance Statement, DHS-3879 (PDF)
MHM TPT, DHS-6759J
Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF)
DHS – MCO contacts for MHCP providers