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

Environmental modifications: Physical adaptations to a person’s primary home to ensure their health and safety or enable them to function with greater independence. The service must be:

Primary home: Privately owned home, rental unit/home or foster care home. A vacation home is not considered a primary home. The home must meet the definition of an MHM qualified community residence, as described on MHM Manual – Eligibility.

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.

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 costs for MHM environmental modifications for up to 365/366 days after their move into the community if they meet all the following criteria:

Waiver interaction

If the person will enroll in a home and community-based services (HCBS) waiver program, they must use the waiver service, as described on CBSM – Environmental accessibility adaptations (EAA). If the person is not eligible for waiver EAA, they may use MHM environmental modifications.

Home assessment

This part of the MHM environmental modifications service covers the assessment to:

Installation

This part of the MHM environmental modifications service covers installation, purchase, maintenance, repairs of modifications, labor, portable or permanent equipment, materials, devices and systems that are fundamental to the home modification project. This includes, but is not limited to:

MHM environmental modifications does not cover home modifications that:

Examples of non-covered services include, but are not limited to:

The combined total for MHM environmental modifications assessments, MHM environmental modifications installations and MHM specialized supplies and equipment may not exceed $3,000 without DHS approval. For more information, refer to the authorization, rates and billing section below.

The costs must be reasonable and necessary expenses for a person to establish their basic living arrangement.

MHM environmental modifications are available during the person’s 365/366 days of MHM community service, after their move from an qualified institution. Dates of service must be within the eligibility span. This service requires prior authorization. For more information, refer to the authorization, rates and billing section below.

Discussing the process with the person and others

At the beginning of and throughout the home modification process, the transition coordinator/demonstration case manager should discuss the assessment, authorization and installation process with:

This discussion should include:

Authorizing an MHM home modification assessment

If the transition coordinator/demonstration case manager determines the project is complex, an MHM assessment professional (e.g., occupational therapist, aging-in-place specialist, accessibility specialist, physical therapist) can help:

The transition coordinator/demonstration case manager should consider using the MHM home modification assessment service when they need support in the above areas to determine a person’s home modification needs.

Coordinating, reviewing and accepting bid(s)

The assessment professional, person, family or transition coordinator/demonstration case manager can solicit comparable, itemized bid(s). The transition coordinator/demonstration case manager must review the bid(s) to ensure:

Accepting a bid

The transition coordinator/demonstration case manager should accept the bid from a qualified provider that offers the most cost-effective item(s) to meet the person’s assessed needs. The most cost-effective bid is not necessarily the lowest bid. For example, the provider with the lowest bid may have a history of low-quality work or be unable to begin or complete the project promptly.

The transition coordinator/demonstration case manager works with the provider to finalize the bid and keeps a copy in the person's record.

Verifying a provider's qualifications

The transition coordinator/demonstration case manager must:

Addressing problems with the provider or project

The transition coordinator/demonstration case manager can use the following resources if they have concerns about a provider’s integrity:

Primary home

The modification can be made only to the person’s primary home in Minnesota.

New construction/unfinished rooms

For new construction or unfinished rooms in existing homes, MHM environmental modifications only covers the additional costs directly related to the person’s assessed needs. It does not cover the typical costs related to building or finishing a room.

Upgrades

MHM environmental modifications covers the most cost-effective modification that meets the person’s assessed needs. The person may choose upgrades as long as the item continues to meet their needs (e.g., upgrade from linoleum to marble tiles). The person must pay out of pocket for any difference and additional labor costs associated with the upgraded materials.

Costs for materials and installation related to upgrades must be in a separate, private pay agreement between the person and the provider.

Repairs

MHM environmental modifications covers repairs to MHM environmental modifications and equipment only when they are cost-effective given the condition of the item and compared to replacement of the item.

Home assessments for MHM home modifications are DHS-enrollment required services.

Installations of MHM home modifications are approval-option: direct-delivery services.

For more information about enrollment requirements, refer to CBSM – Waiver/AC service provider overview.

The provider must:

Home assessments

To perform a home assessment for MHM home modifications, the individual or provider agency must have at least one year of experience with home modification assessments and be one of the following:

Installations

To install a home modification, the individual or provider agency must be qualified by professional certification or references to install, repair and/or maintain the home modification. The provider must install the home modification in accordance with applicable state and local building codes.

A provider who meets the definition of residential building contractor as defined in Minn. Stat. §326B.802, subd. 11 must have a license as a residential building contractor.

A provider who exclusively does small installation projects (e.g., grab bars, ramps) is exempt from licensure when the skills they perform meet the definition of “special skill” as defined in Minn. Stat. §326B.802, subd. 15.

Conflict of interest

An assessment provider who completes an evaluation of the person’s home cannot bid on the same project unless there are no other installation providers within the person’s region.

The transition coordinator/demonstration case manager must document in the person’s TPT that there are no other installation providers within the person’s region.

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 transition coordinator is responsible to authorize the person’s MHM pre-transition community services. 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.

The transition coordinator/demonstration case manager must determine the payment schedule with the provider. The transition coordinator/demonstration case manager has the option to authorize the home modification project on multiple line items. Doing so may help the transition coordinator/DCM oversee the project’s integrity. For example:

Initially, the transition coordinator/demonstration case manager approves line 1 for materials and permits. The transition coordinator/demonstration case manager waits to approve line 2 until the work begins. The transition coordinator/demonstration case manager waits to approve line 3 until the provider’s work is completed and verified by a city inspection, assessment professional or the case manager, and the person confirms the project meets their needs.

Note: The time span for multiple MMIS line items cannot overlap.

For instructions about authorizing MHM community services and how to receive prior authorization, refer to MHM Manual – Services.

Discharging from an institution

The lead agency (or transition coordinator if the person does not have a lead agency) may give approval for a provider to begin a modification before the person discharges from an institution if both of the following are true:

The lead agency/transition coordinator authorizes MHM environmental modifications using Community Support Plan with Coordinated Services and Supports Plan, DHS-6791B after the person moves to the qualified community residence, as described on MHM Manual – Eligibility.

Rate

The provider claims a rate that cannot exceed the rate limit in Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

Billing

The lead agency/transition coordinator/demonstration case manager/provider must: