256B.0924 TARGETED CASE MANAGEMENT SERVICES.
Subdivision 1. Purpose.
The state recognizes that targeted case management services
can decrease the need for more costly services such as multiple emergency room visits
or hospitalizations by linking eligible individuals with less costly services available in the
Subd. 2. Definitions.
For purposes of this section, the following terms have the meanings
(a) "Targeted case management" means services which will assist medical assistance eligible
persons to gain access to needed medical, social, educational, and other services. Targeted case
management does not include therapy, treatment, legal, or outreach services.
(b) "Targeted case management for adults" means activities that coordinate and link social
and other services designed to help eligible persons gain access to needed protective services,
social, health care, mental health, habilitative, educational, vocational, recreational, advocacy,
legal, chemical, health, and other related services.
Subd. 3. Eligibility.
Persons are eligible to receive targeted case management services under
this section if the requirements in paragraphs (a) and (b) are met.
(a) The person must be assessed and determined by the local county agency to:
(1) be age 18 or older;
(2) be receiving medical assistance;
(3) have significant functional limitations; and
(4) be in need of service coordination to attain or maintain living in an integrated community
(b) The person must be a vulnerable adult in need of adult protection as defined in section
, or is an adult with a developmental disability as defined in section
, or a related condition as defined in section
252.27, subdivision 1a
, and is not receiving home
and community-based waiver services, or is an adult who lacks a permanent residence and who
has been without a permanent residence for at least one year or on at least four occasions in
the last three years.
Subd. 4. Targeted case management service activities.
(a) For persons with developmental
disabilities, targeted case management services must meet the provisions of section
(b) For persons not eligible as a person with a developmental disability, targeted case
management service activities include:
(1) an assessment of the person's need for targeted case management services;
(2) the development of a written personal service plan;
(3) a regular review and revision of the written personal service plan with the recipient and
the recipient's legal representative, and others as identified by the recipient, to ensure access to
necessary services and supports identified in the plan;
(4) effective communication with the recipient and the recipient's legal representative and
others identified by the recipient;
(5) coordination of referrals for needed services with qualified providers;
(6) coordination and monitoring of the overall service delivery to ensure the quality and
effectiveness of services;
(7) assistance to the recipient and the recipient's legal representative to help make an
informed choice of services;
(8) advocating on behalf of the recipient when service barriers are encountered or referring
the recipient and the recipient's legal representative to an independent advocate;
(9) monitoring and evaluating services identified in the personal service plan to ensure
personal outcomes are met and to ensure satisfaction with services and service delivery;
(10) conducting face-to-face monitoring with the recipient at least twice a year;
(11) completing and maintaining necessary documentation that supports and verifies the
activities in this section;
(12) coordinating with the medical assistance facility discharge planner in the 180-day
period prior to the recipient's discharge into the community; and
(13) a personal service plan developed and reviewed at least annually with the recipient and
the recipient's legal representative. The personal service plan must be revised when there is a
change in the recipient's status. The personal service plan must identify:
(i) the desired personal short and long-term outcomes;
(ii) the recipient's preferences for services and supports, including development of a
person-centered plan if requested; and
(iii) formal and informal services and supports based on areas of assessment, such as:
social, health, mental health, residence, family, educational and vocational, safety, legal,
self-determination, financial, and chemical health as determined by the recipient and the
recipient's legal representative and the recipient's support network.
Subd. 5. Provider standards.
County boards or providers who contract with the county are
eligible to receive medical assistance reimbursement for adult targeted case management services.
To qualify as a provider of targeted case management services the vendor must:
(1) have demonstrated the capacity and experience to provide the activities of case
management services defined in subdivision 4;
(2) be able to coordinate and link community resources needed by the recipient;
(3) have the administrative capacity and experience to serve the eligible population in
providing services and to ensure quality of services under state and federal requirements;
(4) have a financial management system that provides accurate documentation of services
and costs under state and federal requirements;
(5) have the capacity to document and maintain individual case records complying with state
and federal requirements;
(6) coordinate with county social service agencies responsible for planning for community
social services under chapters 256E and 256F; conducting adult protective investigations under
, and conducting prepetition screenings for commitments under section
(7) coordinate with health care providers to ensure access to necessary health care services;
(8) have a procedure in place that notifies the recipient and the recipient's legal representative
of any conflict of interest if the contracted targeted case management service provider also
provides the recipient's services and supports and provides information on all potential conflicts of
interest and obtains the recipient's informed consent and provides the recipient with alternatives;
(9) have demonstrated the capacity to achieve the following performance outcomes: access,
quality, and consumer satisfaction.
Subd. 6. Payment for targeted case management.
(a) Medical assistance and
MinnesotaCare payment for targeted case management shall be made on a monthly basis. In order
to receive payment for an eligible adult, the provider must document at least one contact per
month and not more than two consecutive months without a face-to-face contact with the adult or
the adult's legal representative, family, primary caregiver, or other relevant persons identified as
necessary to the development or implementation of the goals of the personal service plan.
(b) Payment for targeted case management provided by county staff under this subdivision
shall be based on the monthly rate methodology under section
256B.094, subdivision 6
(b), calculated as one combined average rate together with adult mental health case management
256B.0625, subdivision 20
, except for calendar year 2002. In calendar year 2002,
the rate for case management under this section shall be the same as the rate for adult mental
health case management in effect as of December 31, 2001. Billing and payment must identify the
recipient's primary population group to allow tracking of revenues.
(c) Payment for targeted case management provided by county-contracted vendors shall be
based on a monthly rate negotiated by the host county. The negotiated rate must not exceed
the rate charged by the vendor for the same service to other payers. If the service is provided
by a team of contracted vendors, the county may negotiate a team rate with a vendor who is a
member of the team. The team shall determine how to distribute the rate among its members.
No reimbursement received by contracted vendors shall be returned to the county, except to
reimburse the county for advance funding provided by the county to the vendor.
(d) If the service is provided by a team that includes contracted vendors and county staff, the
costs for county staff participation on the team shall be included in the rate for county-provided
services. In this case, the contracted vendor and the county may each receive separate payment for
services provided by each entity in the same month. In order to prevent duplication of services,
the county must document, in the recipient's file, the need for team targeted case management
and a description of the different roles of the team members.
(e) Notwithstanding section
256B.19, subdivision 1
, the nonfederal share of costs for
targeted case management shall be provided by the recipient's county of responsibility, as defined
, from sources other than federal funds or funds used to match
other federal funds.
(f) The commissioner may suspend, reduce, or terminate reimbursement to a provider that
does not meet the reporting or other requirements of this section. The county of responsibility, as
defined in sections
, is responsible for any federal disallowances. The county
may share this responsibility with its contracted vendors.
(g) The commissioner shall set aside five percent of the federal funds received under this
section for use in reimbursing the state for costs of developing and implementing this section.
(h) Payments to counties for targeted case management expenditures under this section shall
only be made from federal earnings from services provided under this section. Payments to
contracted vendors shall include both the federal earnings and the county share.
(i) Notwithstanding section
, county payments for the cost of case management
services provided by county staff shall not be made to the commissioner of finance. For the
purposes of targeted case management services provided by county staff under this section, the
centralized disbursement of payments to counties under section
consists only of federal
earnings from services provided under this section.
(j) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for targeted case
management services under this subdivision is limited to the last 180 days of the recipient's
residency in that facility and may not exceed more than six months in a calendar year.
(k) Payment for targeted case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.
(l) Any growth in targeted case management services and cost increases under this section
shall be the responsibility of the counties.
Subd. 7. Implementation and evaluation.
The commissioner of human services in
consultation with county boards shall establish a program to accomplish the provisions of
subdivisions 1 to 6. The commissioner in consultation with county boards shall establish
performance measures to evaluate the effectiveness of the targeted case management services.
If a county fails to meet agreed upon performance measures, the commissioner may authorize
contracted providers other than the county. Providers contracted by the commissioner shall also
be subject to the standards in subdivision 6.
History: 1Sp2001 c 9 art 2 s 44; 2002 c 277 s 18; 2002 c 375 art 2 s 31; 2002 c 379 art 1 s
113; 2003 c 112 art 2 s 50; 2005 c 56 s 1; 1Sp2005 c 4 art 3 s 9