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

Membership fees: MHM service a person may receive after moving to the community. This covers costs related to exercise classes, or health club or fitness center membership fees. This service must be:

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).

A person is eligible to receive membership fees 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 can receive membership fees in addition to their waiver services.

Covered items include:

This service does not cover:

Membership fees are available during the person’s 365/366-day MHM community eligibility span, after their move from a qualified institution. Dates of service must be within the eligibility span. This service requires prior authorization through a service agreement. For more information, refer to the authorization, rates and billing section below.

This service is limited to:

This service must be reasonable and necessary for a person to remain in their qualified community residence.

Membership fees is a DHS enrollment-required service. For more information, refer to MHCP Provider Manual – MHM.

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.

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 lead agency or provider claims the actual cost of the services provided. 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 membership fee expenses until they receive a service authorization letter (SAL) in their MN–ITS SAL mailbox.