CurrentUCarePolicy N/A

Relocation Service Coordination - Targeted Case Management

Governs UCare care coordinator responsibilities and member eligibility for DHS Relocation Service Coordination - Targeted Case Management to support transition from eligible institutions to the community; applies to members receiving UCare CT/CT+MED and MSC+/MSHO products in NC.

Policy Summary

PayerUCare

PolicyRelocation Service Coordination - Targeted Case Management

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionAssign an RSC-TCM to an eligible member within 20 days of the request and ensure MnCHOICES assessment is current within 365 days.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

180Benefit duration (days)

20Assignment timeframe (days)

365Assessment recency (days)

Activity 07 / Prog 19 / Result 18MMIS coding

Relocation Service Coordination (RSC-TCM) Coverage Criteria

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ALL of the following

ALL of the following
- Eligible for Medical Assistance (MA)
- Resides in an eligible institution at the time the member receives RSC-TCM
- Closed to any Home and Community-Based Services (HCBS) waiver due to a stay in an eligible institution
- Chooses to move into the community
- Chooses to receive RSC-TCM services
- Not duplicative of the institution's discharge planning services
- Has a MnCHOICES assessment documenting eligibility for RSC-TCM
- RSC-TCM 180-day benefit is not exhausted (service limited to the last 180 days of institutionalization)

ALL of the following

Included (not limited to)
- Develop, implement, update and monitor a relocation plan with the member
- Communicate with member, legal representative, informal supports, service providers and others as necessary to implement the relocation plan
- Coordinate referrals and assistance to access services and housing
- Coordinate efforts with the institution discharge planner
- Travel to visit the member and others as necessary to develop and implement the relocation plan

ALL of the following

Transition assistance when a member moves from one institution to another (not community relocation)
Administrative functions such as MA intake, eligibility determinations/re-determinations, appeals or conciliation activities
Direct treatment, therapy, habilitation or rehabilitative services
Payments for rental deposits, household items, moving expenses, or lease agreement fees

ALL of the following

No prior authorization required; the initial date of referral begins the 180-day RSC-TCM benefit
For MSC+/MSHO members, RSC-TCM providers must enroll with UCare's claims payment system to bill for services
Care coordinators must ensure MnCHOICES assessment is current (assessment within 365 days of referral) and avoid duplication or exceeded limits
Service may be discontinued by the member at any time or ends upon discharge from the eligible institution; if 180 days are exhausted consider referral to other supports

MMIS Coding and Assessment Requirements

MMIS activity/program/result codes for RSC-TCM eligibilitymixed

Activity type 07	MMIS activity type to use when assessment within 365 days
Program type 19	MMIS program type to use when assessment within 365 days
Assessment result 18	Assessment result code referenced

MnCHOICES assessment recency

RequirementMember must have a MnCHOICES assessment completed within 365 days of the RSC-TCM referral.

MMIS timingRSC-TCM may not begin until MMIS is updated to reflect the assessment recency.

MMIS coding when within 365 daysUse Activity type 07, Program type 19, and Assessment result 18 in MMIS.

Assignment timeframeA member eligible for RSC-TCM must be assigned an RSC-TCM worker within 20 days of the request for services.

Provider Actions, Billing, and Authorization

Billing Rule

Provider enrollment required to bill

Provider enrollment for billing: For MSC+ and MSHO members, RSC-TCM providers must enroll with UCare's claims payment system in order to bill for RSC-TCM services.

Affected members: MSC+, MSHO
Action: Enroll with UCare claims payment system before submitting RSC-TCM claims

Prior Authorization

Prior authorization not required

Prior authorization not required: Because RSC-TCM is paid for by the member's MA, prior authorization is not required. The initial date of referral begins the 180-day RSC-TCM benefit.

Do not submit a prior authorization request for RSC-TCM services
Benefit period: 180 days starting on the initial date of referral

Definitions and Eligibility

Eligible institution

DefinitionEligible institutions include hospitals; intermediate care facilities for persons with developmental disabilities (ICF/DDs); institutions for mental disease (IMDs), including RTCs licensed as hospitals or nursing facilities; nursing facilities (including skilled nursing and certified boarding care); and regional treatment centers (RTCs) that provide inpatient services to current MA recipients.

ExclusionIntensive residential treatment services (IRTS) licensed as board and lodging or supervised living are NOT eligible institutions for RSC-TCM.

ContextMember must reside in one of these eligible institutions at the time they receive RSC-TCM services.

Member eligibility

MA eligibilityMember must be eligible for Medical Assistance (MA).

Residence at time of serviceMember must reside in an eligible institution when receiving RSC-TCM.

Waiver statusMember must be closed to any HCBS waiver due to the institutional stay.

Choice and intentMember must choose to move into the community and choose to receive RSC-TCM services.

Assessment and benefit limitsMember must have a MnCHOICES assessment documenting eligibility and must not have exhausted the 180-day RSC-TCM benefit.

Exclusions (duplication)Members receiving Mental Health TCM, VA/DD TCM, or Behavioral Health Home services are ineligible due to duplication of services.

Policy Summary

PayerUCare

PolicyRelocation Service Coordination - Targeted Case Management

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionAssign an RSC-TCM to an eligible member within 20 days of the request and ensure MnCHOICES assessment is current within 365 days.

SourceLink

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