2004 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 Repealed, 2002 c 375 art 2 s 56 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 section 256B.0627:  
 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 mental retardation; 

    (4) "relocation targeted case management" means the 
 provision of targeted case management 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 January 1, 2003.

    Subd. 4.    Relocation targeted case management provider 
 qualifications.  (a) A relocation targeted 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 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.  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.    Home care targeted case management provider 
 qualifications.  The following qualifications and 
 certification standards must be met by providers of home care 
 targeted case management. 

    (a) The commissioner must certify each provider of home 
 care targeted case management 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) A home care targeted case management provider is an 
 enrolled medical assistance provider who has a minimum of a 
 bachelor's degree or a license in a health or human services 
 field, and is 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; and 

    (5) the capacity to coordinate with county administrative 
 functions. 

    Subd. 6.    Eligible services.  Services eligible for 
 medical assistance reimbursement as targeted case management 
 include: 

    (1) assessment of the recipient's need for targeted case 
 management services; 

    (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 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) traveling 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. 

    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 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 targeted relocation case 
 management services from an alternative provider of targeted 
 case management services enrolled by the commissioner. 

    (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. 

    HIST: 1Sp2001 c 9 art 2 s 39; art 3 s 20-28; 1Sp2003 c 14 art 
 3 s 17,18