2007 Minnesota Statutes

256B.0621 COVERED SERVICES: TARGETED CASE MANAGEMENT SERVICES.
    Subdivision 1.[Repealed, 2002 c 375 art 2 s 56]
    Subd. 2. Targeted case management; definitions. For purposes of subdivisions 3 to 10, the
following terms have the meanings given them:
(1) "home care service recipients" means those individuals receiving the following services
under sections 256B.0651 to 256B.0656: skilled nursing visits, home health aide visits, private
duty nursing, personal care assistants, or therapies provided through a home health agency;
(2) "home care targeted case management" means the provision of targeted case management
services for the purpose of assisting home care service recipients to gain access to needed services
and supports so that they may remain in the community;
(3) "institutions" means hospitals, consistent with Code of Federal Regulations, title 42,
section 440.10; regional treatment center inpatient services, consistent with section 245.474;
nursing facilities; and intermediate care facilities for persons with developmental disabilities;
(4) "relocation targeted case management" includes the provision of both county targeted
case management and public or private vendor service coordination services for the purpose of
assisting recipients to gain access to needed services and supports if they choose to move from an
institution to the community. Relocation targeted case management may be provided during the
last 180 consecutive days of an eligible recipient's institutional stay; and
(5) "targeted case management" means case management services provided to help recipients
gain access to needed medical, social, educational, and other services and supports.
    Subd. 3. Eligibility. The following persons are eligible for relocation targeted case
management or home care targeted case management:
(1) medical assistance eligible persons residing in institutions who choose to move into the
community are eligible for relocation targeted case management services; and
(2) medical assistance eligible persons receiving home care services, who are not eligible
for any other medical assistance reimbursable case management service, are eligible for home
care targeted case management services beginning July 1, 2005.
    Subd. 4. Relocation targeted county case management provider qualifications. (a) A
relocation targeted county case management provider is an enrolled medical assistance provider
who is determined by the commissioner to have all of the following characteristics:
(1) the legal authority to provide public welfare under sections 393.01, subdivision 7; and
393.07; or a federally recognized Indian tribe;
(2) the demonstrated capacity and experience to provide the components of case management
to coordinate and link community resources needed by the eligible population;
(3) the administrative capacity and experience to serve the target population for whom it will
provide services and ensure quality of services under state and federal requirements;
(4) the legal authority to provide complete investigative and protective services under
section 626.556, subdivision 10; and child welfare and foster care services under section 393.07,
subdivisions 1 and 2 ; or a federally recognized Indian tribe;
(5) a financial management system that provides accurate documentation of services and
costs under state and federal requirements; and
(6) the capacity to document and maintain individual case records under state and federal
requirements.
(b) A provider of targeted case management under section 256B.0625, subdivision 20, may
be deemed a certified provider of relocation targeted case management.
(c) A relocation targeted county case management provider may subcontract with another
provider to deliver relocation targeted case management services. Subcontracted providers must
demonstrate the ability to provide the services outlined in subdivision 6, and 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 provider also provides, or will provide, the
recipient's services and supports. Counties must require that contracted providers must provide
information on all conflicts of interest and obtain the recipient's informed consent or provide the
recipient with alternatives.
    Subd. 5. Specific provider qualifications. Providers of home care targeted case management
and relocation service coordination must meet the qualifications under subdivision 4 for county
vendors or the qualifications and certification standards under paragraphs (a) and (b) for private
vendors.
(a) The commissioner must certify each provider of home care targeted case management
and relocation service coordination before enrollment. The certification process shall examine
the provider's ability to meet the requirements in this subdivision and other state and federal
requirements of this service.
(b) Both home care targeted case management providers and relocation service coordination
providers are enrolled medical assistance providers who have a minimum of a bachelor's degree
or a license in a health or human services field, comparable training and two years of experience
in human services, or who have been credentialed by an American Indian tribe under section
256B.02, subdivision 7, and have been determined by the commissioner to have all of the
following characteristics:
(1) the demonstrated capacity and experience to provide the components of case management
to coordinate and link community resources needed by the eligible population;
(2) the administrative capacity and experience to serve the target population for whom it will
provide services and ensure quality of services under state and federal requirements;
(3) a financial management system that provides accurate documentation of services and
costs under state and federal requirements;
(4) the capacity to document and maintain individual case records under state and federal
requirements;
(5) the capacity to coordinate with county administrative functions;
(6) have no financial interest in the provision of out-of-home residential services to persons
for whom home care targeted case management or relocation service coordination is provided; and
(7) if a provider has a financial interest in services other than out-of-home residential
services provided to persons for whom home care targeted case management or relocation service
coordination is also provided, the county must determine each year that:
(i) any possible conflict of interest is explained annually at a face-to-face meeting and in
writing and the person provides written informed consent consistent with section 256B.77,
subdivision 2 , paragraph (p); and
(ii) information on a range of other feasible service provider options has been provided.
(c) The state of Minnesota, a county board, or agency acting on behalf of a county board
shall not be liable for damages, injuries, or liabilities sustained because of services provided to a
client by a private service coordination vendor.
    Subd. 6. Eligible services. (a) Services eligible for medical assistance reimbursement as
targeted case management include:
(1) assessment of the recipient's need for targeted case management services and for persons
choosing to relocate, the county must provide service coordination provider options at the first
contact and upon request;
(2) development, completion, and regular review of a written individual service plan, which
is based upon the assessment of the recipient's needs and choices, and which will ensure access to
medical, social, educational, and other related services and supports;
(3) routine contact or communication with the recipient, recipient's family, primary caregiver,
legal representative, substitute care provider, service providers, or other relevant persons identified
as necessary to the development or implementation of the goals of the individual service plan;
(4) coordinating referrals for, and the provision of, case management services for the recipient
with appropriate service providers, consistent with section 1902(a)(23) of the Social Security Act;
(5) coordinating and monitoring the overall service delivery and engaging in advocacy as
needed to ensure quality of services, appropriateness, and continued need;
(6) completing and maintaining necessary documentation that supports and verifies the
activities in this subdivision;
(7) assisting individuals in order to access needed services, including travel to conduct a
visit with the recipient or other relevant person necessary to develop or implement the goals
of the individual service plan; and
(8) coordinating with the institution discharge planner in the 180-day period before the
recipient's discharge.
(b) Relocation targeted county case management includes services under paragraph (a),
clauses (1), (2), and (4). Relocation service coordination includes services under paragraph (a),
clauses (3) and (5) to (8). Home care targeted case management includes services under paragraph
(a), clauses (1) to (8).
    Subd. 7. Time lines. The following time lines must be met for assigning a case manager:
(a) For relocation targeted case management, an eligible recipient must be assigned a county
case manager who visits the person within 20 working days of requesting a case manager from
their county of financial responsibility as determined under chapter 256G.
(1) If a county agency, its contractor, or federally recognized tribe does not provide case
management services as required, the recipient may obtain relocation service coordination from a
provider qualified under subdivision 5.
(2) The commissioner may waive the provider requirements in subdivision 4, paragraph
(a), clauses (1) and (4), to ensure recipient access to the assistance necessary to move from an
institution to the community. The recipient or the recipient's legal guardian shall provide written
notice to the county or tribe of the decision to obtain services from an alternative provider.
(3) Providers of relocation targeted case management enrolled under this subdivision shall:
(i) meet the provider requirements under subdivision 4 that are not waived by the
commissioner;
(ii) be qualified to provide the services specified in subdivision 6;
(iii) coordinate efforts with local social service agencies and tribes; and
(iv) comply with the conflict of interest provisions established under subdivision 4,
paragraph (c).
(4) Local social service agencies and federally recognized tribes shall cooperate with
providers certified by the commissioner under this subdivision to facilitate the recipient's
successful relocation from an institution to the community.
(b) For home care targeted case management, an eligible recipient must be assigned a case
manager within 20 working days of requesting a case manager from a home care targeted case
management provider, as defined in subdivision 5.
    Subd. 8. Evaluation. The commissioner shall evaluate the delivery of targeted case
management, including, but not limited to, access to case management services, consumer
satisfaction with case management services, and quality of case management services.
    Subd. 9. Contact documentation. The case manager must document each face-to-face and
telephone contact with the recipient and others involved in the recipient's individual service plan.
    Subd. 10. Payment rates. The commissioner shall set payment rates for targeted case
management under this subdivision. Case managers may bill according to the following criteria:
(1) for relocation targeted case management, case managers may bill for direct case
management activities, including face-to-face and telephone contacts, in the 180 days preceding
an eligible recipient's discharge from an institution;
(2) for home care targeted case management, case managers may bill for direct case
management activities, including face-to-face and telephone contacts; and
(3) billings for targeted case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.
    Subd. 11. Notice of relocation assistance. The commissioner shall establish a process with
the Centers for Independent Living that allows a person residing in a Minnesota nursing facility
to receive needed information, consultation, and assistance from one of the centers about the
available community support options that may enable the person to relocate to the community, if
the person: (1) is under the age of 65, (2) has indicated a desire to live in the community, and
(3) has signed a release of information authorized by the person or the person's appointed legal
representative. The process established under this subdivision shall be coordinated with the
long-term care consultation service activities established in section 256B.0911.
History: 1Sp2001 c 9 art 2 s 39; art 3 s 20-28; 1Sp2003 c 14 art 3 s 17,18; 2005 c 56 s 1;
1Sp2005 c 4 art 7 s 6-12; 2007 c 147 art 6 s 17