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

Records and fees: MHM service a person may choose to receive to address administrative barriers for successful transition to the community. It can cover the records and documents the person needs to secure and maintain 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).

Pre-transition

A person is eligible for records and fees pre-transition 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 an institution, so there is no overlap in services.

Post-transition

A person is eligible to receive records and 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 an HCBS waiver program, they may choose to receive post-transition MHM records and fees in addition to their waiver services.

This service can cover costs for:

This service does not cover:

Costs for records and fees must be reasonable and necessary expenses for a person to establish their basic living arrangement.

The total available funds for records and fees cannot exceed $800 per year (within a 365-day period).

A person cannot be reimbursed directly for records and fees. There are no exceptions to this limitation.

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 transition coordinator or care coordinator authorizes records and fees.

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

Records and fees 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

The provider must:

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