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Effective: December 1, 2006 |
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14.10 - Facility Living Arrangements |
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Residence in certain types of facilities or institutions may affect people’s eligibility for Minnesota Health Care Programs (MHCP). The distinction between community and facility living arrangements may be based on factors such as the specific type of facility, the size of the facility, or the length of the resident’s stay and the type of medical services provided.
Exception: People who meet all other eligibility requirements for Refugee Medical Assistance (RMA) are eligible for RMA regardless of their living arrangement. The Refugee Medical Assistance program, which is 100% federally funded, is not subject to living arrangement requirements.
To determine the living arrangements some facilities, it may be necessary to contact the facility and:
l Ask what services the facility is licensed for and under what authority.
l Obtain the provider number, if any, that the facility will be using to bill for services to the client.
l If it is a correctional facility for children, ask if the child is in a secure or non-secure unit.
Facility Living Arrangement Categories.
Public and Private Institutions.
Chemical Dependency Treatment.
Facility Living Arrangement Categories
Facilities or institutions fall within seven main categories:
l Institutions for Mental Diseases (IMDs).
l Residential Treatment Facilities.
l Long-Term Care Facilities (LTCFs).
l Group Residential Housing (GRH).
l Correctional Facilities.
l Battered Women’s Shelters.
l Non-Negotiated Rate Facilities.
There are specific codes for each category which are used to identify different living arrangements on the system. For further information, including system codes, for Institutions for Mental Diseases, long-term care facilities, and correctional facilities, see those sections of this chapter. Also see Children in Facilities. For residential treatment facilities, group residential housing, battered women’s shelters, and non-negotiated rate facilities, see Other Facilities.
Public and Private Institutions
People who live in public facilities or institutions may or may not be eligible for health care program coverage. Eligibility in public institutions is approved or denied according to federal regulations. Health care coverage for people who are enrolled in a managed care organization (MCO) and are placed by the MCO, or whose MCO coverage in an IMD is court-ordered, continues without interruption.
In general, people are not eligible for MHCP payment of facility treatment costs if their coverage is fee-for-service (FFS) and they meet one of the following:
l Reside in a public institution that has over 16 beds and whose main purpose is to treat mental illness (MI) or chemical dependency (CD). See Institutions for Mental Diseases (IMDs) for exceptions.
l Are incarcerated adults.
l Are children in certain publicly owned and operated correctional facilities.
Most clients who live in privately managed facilities or institutions (except for secure correctional facilities) and are otherwise eligible for health care program coverage will remain eligible.
People may be eligible for General Assistance Medical Care (GAMC) if they live in facilities. However, GAMC does not pay for the cost of care in a facility. GAMC will pay for medical care which is not provided by the facility. People in IMDs or non-IMD CD facilities may be eligible for MHCP coverage for medical services that are not part of the facility treatment regimen.
The Minnesota State Regional Treatment Centers (RTCs) have been undergoing (and continue to undergo) many changes to the services that they were originally established to provide. Some RTC campuses, like the former Cambridge and Moose Lake campuses, will no longer exist. Others will offer expanded services in selected areas.
The goal of these RTC changes is to transfer many of the programs and services to newly established community-based settings. In general, these new community-based facilities will not be Institutions for Mental Diseases (IMDs). This will enable residents to be potentially eligible for Medical Assistance (MA).
People placed in public institutions or other institutional settings for a temporary period while awaiting placement in a suitable setting appropriate to their needs are not considered to be residents of institutions. These people are potentially eligible for health care program coverage if they meet other eligibility requirements.
Example:
Alex is eligible for Medical Assistance (MA) and is to be placed in a foster home, but there are no openings available for two weeks. He is placed in a correctional facility in which permanent placements are not eligible for MA.
Action:
Alex remains MA-eligible during his temporary placement.
Crisis situations may occur in which an individual is unwilling to accept intervention or services due to the nature of his or her mental illness. In these situations, a hold may be placed on a person by a qualified examiner for 72 hours (excluding weekends and holidays). The person must "represent a risk of harm to self and others" because of mental illness, intoxication or mental retardation. The 72 hours provides necessary time to pursue a court order to continue holding the individual, if deemed necessary.
Mental health hold orders usually involve inpatient hospital treatment. All Minnesota Health Care Programs except GAMC cover inpatient hospital treatment if it is medically necessary.
If a 72-hour hold in any kind of facility is not medically necessary, the county is liable for 100 percent of the cost. The county and the facility negotiate the payment amount.
Many living arrangements are designed to meet clients' specific needs, including treatment for chemical dependency (CD). CD treatment may be provided in a variety of settings.
l Detoxification-Only Facilities - At a detox-only facility, no CD treatment is given; only detoxification services are provided. Payment for services is the responsibility of the county agency. People in a detox-only facility are considered to have a community living arrangement.
l Institutions for Mental Diseases (IMDs) - CD treatment may be provided in an IMD residential treatment facility or IMD psychiatric hospital. Such treatment, as well as room and board while in treatment, is covered by the Consolidated Chemical Dependency Treatment Fund (CCDTF). Health care programs can pay for medical services from outside providers.
l Residential Treatment Facility (Not IMD) - CD treatment in a residential treatment facility that is not an IMD is covered by the CCDTF. The CCDTF also covers room and board while in treatment. Health care programs can pay for medical services not included in the CD treatment.
l CD Halfway Houses - There are several types of halfway houses that provide CD treatment:
n If the halfway house is a standalone facility which offers no other treatment programs for CD recovery, residents are considered to have a community living arrangement and are potentially eligible for health care program coverage.
n If the halfway house is part of a facility that offers CD treatment and is an IMD, the resident is considered to be in an IMD.
n If the halfway house is publicly owned and operated and has over 16 beds, the resident is considered to be living in an IMD.