Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
Definitions.
The terms used in this part have the meanings given them in
items A to G and in part
9505.0370.
A. "Clinical supervision" has the meaning
given in Minnesota Statutes, section
245.462, subdivision
4a, for case management services to an adult, or section
245.4871, subdivision
7, for case management services to a child.
B. "Face-to-face" means the recipient is
physically present with the case manager.
C. "Mental health case management service" or
"case management service" means a service that assists a person eligible for
medical assistance in gaining access to needed medical, social, educational,
and other services necessary to meet the person's mental health needs and that
coordinates and monitors the delivery of these needed services.
D. For purposes of this part, "recipient"
means a person who has been determined by the local agency to be eligible for
the medical assistance program, who has a serious and persistent mental illness
or severe emotional disturbance as determined by a diagnostic assessment, and
who has been determined eligible for case management services by the local
agency.
E. "Serious and persistent
mental illness" means the condition of an adult as specified in Minnesota
Statutes, section
245.462, subdivision
20, paragraph (c).
F. "Severe
emotional disturbance" means the condition of a child as specified in Minnesota
Statutes, section
245.4871, subdivision
6.
G. "Updating" or "updated" has
the meaning given in Minnesota Statutes, section
245.467,
subdivision 2, for an adult, or section
245.4876,
subdivision 2, for a child.
Subp.
2.
Determination of eligibility to receive case management
services.
The local agency must determine whether a person is eligible
for case management services. The determination must be based on a diagnostic
assessment of the person as a person with a serious and persistent mental
illness or a severe emotional disturbance or on a determination according to
subpart
4.
Subp. 3.
Required contents of a
diagnostic assessment.
To be eligible for medical assistance payment, the diagnostic
assessment required for a determination of a recipient's eligibility to receive
mental health case management services must comply with the requirements of
parts
9505.0370 to
9505.0372. Additionally, the
diagnostic assessment must identify the needs that must be addressed in the
recipient's individual treatment plan if the recipient is determined to have a
serious and persistent mental illness or a severe emotional disturbance.
Subp. 4.
Eligibility if
person does not have a current diagnostic assessment.
Medical assistance payment is available for case management
services provided to a medical assistance eligible person who does not have a
current diagnostic assessment if all of the following criteria are met:
A. the person requests or is referred for and
accepts case management services;
B. the diagnostic assessment is refused at
the time of the person's referral or request for case management services by:
(1) an adult for reasons related to the
adult's mental illness;
(2) a child
for reasons related to the child's emotional disturbance who meets a criterion
specified in part
9505.0371, subpart
6; or
(3) the parent of a child;
C. the case manager determines
that the person is eligible for case management services; and
D. the person obtains a new or updated
diagnostic assessment within four months of the day the person first receives
case management services.
Subp.
5.
Determination of recipient's continued eligibility for
case management services.
A recipient's continued eligibility for case management
services under this part and parts
9520.0900 to
9520.0926 must be determined every
36 months by the local agency. The determination of whether the recipient
continues to have a diagnosis of serious and persistent mental illness or
severe emotional disturbance must be based on updating the recipient's
diagnostic assessment or on the results of conducting a complete diagnostic
assessment because the recipient's mental health status or behavior has changed
markedly. Unless a recipient's mental health status or behavior has changed
markedly since the recipient's most recent diagnostic assessment, only updating
is necessary. If the recipient's mental health status or behavior has changed
markedly, a new diagnostic assessment must be completed.
Subp. 6.
Eligible provider of case
management services.
A local agency, or an entity under contract to a local agency
to provide case management services, is eligible to enroll as a provider of
case management services.
Subp.
7.
Condition to receive medical assistance payment; case
manager qualifications.
To be eligible for medical assistance payment, a case
management service must be provided by a case manager who is qualified under
Minnesota Statutes, section
245.462, subdivision
4, for services to an adult, or section
245.4871, subdivision
4, for services to a child.
Subp.
8.
Condition to receive medical assistance payment; clinical
supervision required.
To be eligible for medical assistance payment for a case
management service provided to a recipient by a mental health practitioner, the
mental health practitioner must receive clinical supervision according to the
requirements of Minnesota Statutes, section
245.462, subdivision
4a, for an adult, or section
245.4871, subdivision
7, for a child.
Subp. 9.
Case management services eligible for medical assistance payment.
Case management services provided to a recipient that are
eligible for medical assistance payment are:
A. face-to-face contact between the case
manager and the recipient;
B.
telephone contact between the case manager and the recipient; the recipient's
mental health provider or other service providers; the recipient's family
members, legal representative, or primary caregiver; or other interested
persons;
C. face-to-face contacts
between the case manager and the recipient's family, legal representative, or
primary caregiver; mental health providers or other service providers; or other
interested persons;
D. contacts
between the case manager and the case manager's clinical supervisor about the
recipient;
E. individual community
support plan and assessment development, review, and revision required under
Minnesota Statutes, section
245.4711,
subdivision 4, for an adult, or section
245.4881,
subdivision 4, for a child;
F.
travel time spent by the case manager to meet face-to-face with the recipient
who resides outside of the county of financial responsibility; and
G. travel time spent by the case manager
within the county of financial responsibility to meet face-to-face with the
recipient or the recipient's family, legal representative, or primary
caregiver.
For purposes of items F and G, if a case manager arrives on
time for a scheduled face-to-face appointment with a recipient, the recipient's
family, legal representative, or primary caregiver and the person fails to keep
the appointment, the time spent by the case manager in traveling to and from
the site of the scheduled appointment is eligible for medical assistance
payment.
Subp.
10.
Limitation on payments for services.
Payment for case management services shall be limited
according to items A to G.
A. Payment
for case management services is limited to no more than ten hours per recipient
per month, excluding time required for out-of-county travel under subpart
9, item F. The payment may be
for any combination of the services specified in subpart
9, except that payment for
telephone contact between a case manager and the recipient; the recipient's
family, legal representative, or primary caregiver; mental health provider and
other service providers; or other interested persons is limited to no more than
three hours per recipient per month.
B. When traveling with a recipient, a case
manager may not bill concurrently for both a face-to-face session with the
recipient and travel time.
C. An
assessment that duplicates an assessment eligible for payment under subpart
2 or
5 is not eligible for medical
assistance payment.
D. Payment for
case management services to a recipient is limited to the services of one case
manager per unit of time per recipient.
E. Time spent by the case manager in charting
and record keeping is not eligible for separate medical assistance payment as a
case management service.
F. Time
spent by the case manager in court during which the case manager is not
providing a case management service that would otherwise be eligible for
medical assistance payment is not a covered service.
G. Time spent in communication with other
case managers who are members of the recipient's case management team under
part
9520.0916 or
9520.0917 is not a covered service
unless the recipient is a face-to-face participant in the
communication.
Subp. 11.
Documentation of services.
To obtain medical assistance payment for case management
services, the case manager must document the recipient's case management
services according to the requirements of parts
9505.2175 and
9505.2180. Additionally, if a case
manager who provides other mental health services eligible for medical
assistance payment to a recipient who receives case management services from
the case manager and intersperses the recipient's case management service and
the other mental health services eligible for medical assistance payment within
the same session, the case manager must clearly document in the recipient's
record the intervals in which each service was provided.
Subp. 12.
Recovery of payment.
Medical assistance payments received by a case management
provider for case management services that are not documented as required in
subpart
11 are subject to recovery
under parts
9505.2160 to
9505.2245.
Subp. 13.
Excluded service.
Client outreach for the purpose of seeking persons who
potentially may be eligible for medical assistance and mental health case
management services under this part is not eligible for medical assistance
payment.
Subp. 14.
Coordination of case management services with other programs.
Case management services to recipients receiving case
management services through a program other than medical assistance shall be
coordinated as specified in items A to D.
A. Recipients who are receiving case
management services through the Veterans Administration are not eligible for
case management services under parts
9520.0900 to
9520.0926 and this part while they
are receiving case management through the Veterans Administration.
B. Persons receiving home and community-based
services under a waiver are not eligible for case management services under
parts
9520.0900 to
9520.0926 and this part if these
services duplicate each other. For purposes of this subpart, "home and
community-based services under a waiver" refers to services furnished under a
waiver obtained by the state from the United States Department of Health and
Human Services as specified in Code of Federal Regulations, title 42, sections
440.180 and 441.300 to 441.310.
C.
Except as provided in subpart
2, if a recipient has the
diagnosis of developmental disability and the diagnosis of mental illness or
emotional disturbance, the county shall assign the recipient a case manager for
services to persons with developmental disability according to parts
9525.0015 to
9525.0165 and shall notify the
recipient of the availability of case management services under parts
9520.0900 to
9520.0926. If the adult or the
adult's legal representative or, in the case of a child, the child's parent or
legal representative or, if appropriate, the child chooses case management
services under parts
9520.0900 to
9520.0926, the case manager
assigned under parts
9525.0015 to
9525.0165 and the case manager
chosen under parts
9520.0900 to
9520.0926 shall work together as a
team to ensure that the person receives services required under parts
9520.0900 to
9520.0926 and
9525.0015 to
9525.0165. The case manager under
parts
9520.0900 to
9520.0926 shall be responsible for
assuring that the requirements of parts
9520.0900 to
9520.0926 and
9525.0015 to
9525.0165 are met.
D. A recipient who has been assessed as
chemically dependent under parts
9530.6615 and
9530.6620 and who also is
determined to have a serious and persistent mental illness or a severe
emotional disturbance is eligible to receive case management services under
parts
9520.0900 to
9520.0926 and this part. The case
manager assigned under parts
9520.0900 to
9520.0926 must coordinate the
recipient's case management services with any similar services the person is
receiving from other sources.
E.
For purposes of this part, a recipient enrolled with a prepaid health plan
under a prepaid medical assistance plan established under Minnesota Statutes,
section 256B.031, is eligible for case management services as specified in this
part on a fee-for-service basis from a provider other than the prepaid health
plan.
Statutory Authority: MS s
245.484;
256B.04;
256B.0625
