Case manager and care coordinator essentials

Information for case managers and care coordinators to help guide and fulfill their role. This includes information on policy, programs and system tools.

Policy
Programs
System tools

Policy

Each of these policies drive Minnesota’s current policies and practices for HCBS waivers and programs:
- Community-Based Services Manual (CBSM): The CBSM provides explanation and guidance on DSD and AASD policy. This resource is an essential tool for performing case management duties.
- Policy compliance / lead agency review: The overarching goal of the HCBS lead agency review is to determine how HCBS programs are operating and meeting the needs of the people they serve. This evaluation process helps DHS assure compliance by counties and tribal nations in the administration of HCBS programs, share performance on key measures and outcomes, identify best practices to promote collaboration between lead agencies and obtain feedback about DHS resources to prompt state improvements.
  - List of items reviewed (PDF)
  - HCBS reports and data
- HCBS settings rule: The settings rule requires providers to account for a person’s choice in their daily life experiences, in addition to location and its physical characteristics.
- Jensen settlement: The Jensen settlement agreement limits the seclusion of and restrictive practices for people with disabilities.
- Minnesota’s Olmstead Plan: The Olmstead Plan requires our state to ensure people with disabilities are living, learning, working and enjoying life in the most integrated setting.
- Person-Centered, Informed Choice and Transition Protocol: The protocol addresses the federal and state statutes, rules and court requirements related to person-centered practices and principles.
- 245D and positive supports: 245D provider standards improve the dignity, health and independence of people we serve. Positive supports is an individually designed, proactive plan to address challenging behaviors. Some resources:
Programs
- Consumer directed community supports (CDCS): CDCS gives a person flexibility in service planning and responsibility for self-directing his or her services, including hiring and managing support workers. This service option is available to people on the HCBS waivers and Alternative Care Program.
  - CDCS Manual: This is the primary source for CDCS policy.
  - Consumer directed community supports CBSM page
- Consumer Support Grant (CSG): CSG is a state-funded alternative to Medicaid home care services. CSG allows greater flexibility and freedom of choice in service selection, payment rates, service delivery specifications and employment of service providers.
- Essential Community Supports (ECS): Community-based services for people 65 years or older who do not meet nursing facility level of care criteria.
- Family Support Grant (FSG) : FSG provides state cash grants to families of children with certified disabilities to prevent or delay out-of-home placement.
- Medicare: A federal health insurance program that covers millions of older adults and people with disabilities. Medicare is composed of four main components: Parts A, B, C and D. Some resources:
  - Minnesota's Senior LinkAge Line can help by providing plan comparisons and enrollment information
  - Medicare savings programs help people who have low income pay the cost of their Medicare coverage.
- Minnesota Health Care Programs (MHCP): People with low incomes who meet eligibility rules may qualify for Minnesota Health Care Programs:
  - Medical Assistance (MA): Minnesota’s Medicaid program for people who are elderly or blind or disabled and have low income. People who receive waiver services must be eligible for MA.
  - Medical Assistance for Employed Persons with Disabilities (MA-EPD): Loss of Medical Assistance (MA) may prevent people with disabilities from working. With MA-EPD, people can work, earn, save money and still keep their MA.
  - MinnesotaCare: A health care program for Minnesotans with low incomes.
  - Minnesota Family Planning Program (MFPP): Covers only family planning services.
  - Managed care: DHS contracts with managed care organizations (MCOs) to coordinate health care while a person is enrolled in MHCP. Approximately two-thirds of MHCP members are enrolled in an MCO, while one-third receive services on a fee-for-service basis.
    - Care coordination: Provided for people enrolled in MSHO, MSC+ and SNBC to help coordinate the delivery of all health and long-term care services among different health and social service professionals and across settings of care.
    - Minnesota Senior Care Plus (MSC+): A mandatory prepaid Medical Assistance program for people age 65 and older.
    - Minnesota Senior Health Options (MSHO): A voluntary health care program for people age 65 and older who are enrolled in MA and Medicare parts A and B. Members enrolled in MSHO receive Medicare, Medicare Part D, and Medical Assistance services through the MSHO plan chosen.
    - Special Needs BasicCare (SNBC): A voluntary managed care program for people with a certified disability, ages 18 through 64, who are enrolled in MA.
- Personal care assistance (PCA): PCA services provide flexible in-home and community support to help a person maximize his or her independence. The Personal Care Assistance Program Manual is the primary source for PCA policy. The Personal care assistance webpage provides many resources to help someone choose and explore the PCA service. PCA options are:
  - Traditional: the person chooses an agency to hire, train and schedule their PCA
  - Choice: the person is responsible for hiring, training, scheduling their home PCA.
  - Extended: Additional PCA time beyond what state plan PCA allows based on need for increased duration or frequency. Lead agencies authorize additional units through a waiver program.
  - 45-day temporary start: Lead agencies use this process to begin PCA services temporarily until the lead agency assessor can schedule and complete a face-to-face assessment.
- Waiver and Alternative Care programs: Programs that have received federal approval for expanded coverage for services above and beyond those covered under MA. The following programs provide services in the community to meet the needs of people with disabilities and older adults:
System tools
- Medicaid Management Information System (MMIS): System for managing screening documents, service authorizations and eligibility information. MMIS online training is available on the Older Adult Programs Learning Center. Search the course catalog for “MMIS”
- MnCHOICES: A web-based application that integrates assessment and support planning for people who seek access to Minnesota’s long-term services and supports
- Rates tools:
  - Disability Waiver Rate System (DWRS): Determines individualized payment rates for certain BI, CAC, CADI and DD waiver services
  - Elderly Waiver Residential Services (EWRS) Rate Tool: Tool to develop service plans and determine rates for Elderly Waiver, customized living and adult foster care services
  - Rate Management System User Manual: Provides training and guidance
- Social Services Information Systems (SSIS): System for case management documentation and data collection.

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