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

Pre-transition clean-up: MHM service a person may choose to receive to establish a clean, sanitary and safe environment before moving into their qualified community residence. The service 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).

A person is eligible to receive pre-transition clean-up if they meet all the following criteria:

Waiver interaction

The person is not enrolled in a home and community-based services (HCBS) waiver program while they are in a qualified institution, so there is no overlap in services.

MHM pre-transition clean-up services include:

Pre transition clean-up does not include:

Costs for pre-transition clean-up must be reasonable and necessary expenses for a person to establish their qualified community residence.

The total available funds for pre-transition clean-up cannot exceed a combined total of $3,000 per year (within a 365-day period), which includes:

Pre-transition clean-up services:

There are no exceptions to these limitations.

The provider must:

License requirements

Providers for pre-transition clean-up must complete either:

1. Lead Agency Assurance Statement: HCBS Provider Review and Approval, DHS-6383 (PDF).

2. Chore Services Provider Assurance Statement, DHS-6189F (PDF) and 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.

Service authorization

The transition coordinator or care coordinator authorizes pre-transition clean-up.

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

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

Billing

The provider must:

All submitted claims must be based on actual items 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 MHM pre-transition clean-up expenses until DHS has confirmed the qualified community residence and the provider receives a service authorization letter (SAL) in their MN–ITS SAL mailbox.