Ecs Nforce2-m Manual

Ecs Nforce2-m Manual 7,2/10 2549 reviews

Revised: 05-15-2018

  • • Overview
  • • Eligible Providers
  • • Eligible Recipients
  • • Covered Services
  • • Noncovered Services
  • • Authorization Requirements
  • • Billing
  • • Legal References

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    Overview

    The Essential Community Supports (ECS) program will provide community based supports for recipients who do not meet the revised nursing facility level of care criteria.

    Services will support recipients with an assessed need for one of the Essential Community Supports to maintain their community living. Essential Community Supports will include service coordination plus one or more of the following services needed to maintain independence in the community:

  • • Personal Emergency Response System (PERS)
  • • Homemaker Services
  • • Chore Services
  • • Caregiver Support and Education (Family Caregiver Training & Education or Family Caregiver Coaching & Counseling)
  • • Home Delivered Meals
  • • Community Living Assistance (CLA)
  • • Adult day service

    • Eligible Providers

    Providers eligible to provide, bill and be reimbursed by MHCP for providing Essential Commuity Supports (ECS) services must:

  • • Be an enrolled MHCP provider and continuously maintain qualifications to provide the Essental Community Supports services
  • • Be selected by the service recipient,or case management/service coordinator of the lead agency (county/tribe/manged care organization (MCO))
  • • Have a DHS approved service authorization (SA) to provide services for the recipient

    • To enroll to provide ECS services, follow the instructions on the Home and Community-Based Services Programs Provider Enrollment section. If you are currently enrolled to provide any of the ECS services through an HCBS waiver programother than Community Living Assistance (CLA), you are already enrolled to provide these same services for people through the ECS program.

    MN–ITS

    MHCP requires providers to register their MN–ITS account. Registration information is included in your MHCP welcome letter upon completion of enrollment.

    MN–ITS is an internet based application you will use to:

  • • Important notices
  • • Verification of enrollment status
  • • Other enrollment information
  • • Service authorization letters
  • • Check recipient eligibility
  • • Submit claims
  • • Reconcile claims

    • MHCP encourages all providers to allow user access to anyone in the agency who may have a need to receive any of the information above.

    To learn more information about MN–ITS, review MN–ITS and Electronic Billing

    Eligible Recipients

    The lead agency (county, tribe or managed care organization) will do an assessment through the Long-Term Care Consultation (LTCC) or MnCHOICES to determine the need for ECS services.

    Recipients with an assessed need for at least one of the ECS services to maintain their community living, as outlined in Minnesota Statutes.

    Providers must verify program eligibility for each recipient, each month, through phone or MN–ITS eligibility verification. You may not be paid for services you provide if you do not confirm the recipient is eligible.

    Use MN–ITS Eligibility Request (270/271) to review information for each recipient before providing services. Look at the response to determine the following for the recipient:

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  • • MA eligibility
  • • Waiver eligibility
  • • Enrollment with a managed care organization (MCO)
  • • Other insurance (third party liability, private insurance coverage)
  • • Medicare coverage
  • • MA spenddown

    • Two groups of recpients may be eligible for ECS:

    The first group includes people who meet all of the following:

    Manual
  • • No longer meet nursing facility level of care (NF LOC) criteria
  • • Are not eligible for MA
  • • Are age 65 or older
  • • Meet Alternative Care (AC) financial eligibility criteria
  • • Can benefit from one or more ECS service

    • The second group includes people who meet all of the following:

  • • Were receiving Elderly Waiver (EW), Brain Injury (BI), Community Access for Disability Inclusion (CADI), or nursing facility services and lose MA eligibility for those services at reassessment on or after Jan. 1, 2015, due to changes in NF LOC criteria
  • • No longer meet the nursing facility level of care (NF LOC) criteria
  • • Are age 21 or older
  • • Meet Alternative Care (AC) financial eligibility criteria if not on MA
  • • Are not eligible for state plan (MA) Personal Care Attendant (PCA) services
  • • Can benefit from one or more ECS service

    • Covered Services

    Refer to the following for more information about each service.

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  • • Service Coordination (Case Management)
  • • Personal Emergency Response System
  • • Homemaker Services
  • • Chore Services
  • • Caregiver Training and Education (Family Caregiver)
  • • Home Delivered Meals
  • • Community Living Assistance
  • • Adult Day Services

    • Covered ECS services are limited to the following:

  • • $428 monthly maximum services budget
  • • Required service coordination and monitoring, limited to $600 annually
  • • For the second eligibility group (under Eligible Recipients, above), an additional $600 for service coordination is available one time to assist in transition planning.

    • Noncovered Services

    Recipients who retain MA eligibility and who are assessed to need help with acivities of daily living (ADLs) are not eligible for ECS. These recipients must use state plan PCA services.

    Authorization

    ECS services require approval from a case manager or service coordinator in the form of a completed service agreement (SA). The SA allows the provider to bill MHCP and receive payment after services are provided. MHCP will pay only services approved on the SA. The case manager or service coordinator enters the SA into the DHS MMIS system. When you receive the authorization letter, you must ensure that the SA is accurate.

    Each line item on the SA lists the following:

  • • MHCP Enrolled provider who is authorized to provide the needed services
  • • Rate of payment for the service
  • • Number of units authorized
  • • Date or date span of authorization of service and
  • • The authorized procedure code(s)

    • Billing

    For all ECS services, including CLA submit claims as follows:

  • • Bill MHCP directly for services incurred on or after Jan. 1, 2015, for FFS MHCP and MCO recpients
  • • Enter service agreement type
  • • Use the 837P format
  • • Use the HCPC codes approved on the Service Agreement
  • • For Community Living Assistance Services only, use HCPC codes H2015 and H2016

    • Submitting Claims for ECS Services:

  • • Use MN–ITS Direct Data Entry (DDE) or your own X12 compliance software (batch billing system)
  • • Use the Professional (837P) claim bill only for services already provided
  • • Bill only for services that are approved on the authorization
  • • Enter a diagnosis code. You must use the most current, most specific diagnosis code when submitting claims. MHCP will display the diagnosis code of the recipient in the service agreement letter.
  • • Use the information listed on your service agreement
  • • Use date spans only when you have provided services for all dates in the span

    • Refer to the Billing Policy section for more information about MHCP billing guidelines.

    Managed Care Enrollees

  • • Managed Care Organizations with no lead agency delegates using MMIS will send service agreements to DHS; DHS staff will enter them into MMIS
  • • Bill MHCP directly for services you provide for recipients on a prepaid health plan

    • Legal References

    Minnesota Statutes, section 256B.0922

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