Recuperative Care
Providing Crucial Support for MHCP Members
Recuperative care services play a vital role in aiding eligible Minnesota Health Care Programs (MHCP) members experiencing homelessness. ¨Recuperative care” means a model of care that prevents hospitalization or that provides post-acute medical care and support services for recipients experiencing homelessness who are too ill or frail to recover from a physical illness or injury while living in a shelter or are otherwise unhoused but who are not sick enough to be hospitalized or remain hospitalized or to need other levels of care.
Eligibility Criteria for Recuperative Care Services
To be eligible for recuperative care services, a recipient must:
- Not be a child: 21 years or older (if covered under Medical Assistance) or 19 years or older (if covered under MinnesotaCare);
- Be experiencing homelessness;
- Be in need of short-term acute medical care for a period of no more than 60 days;
- Meet clinical criteria, as established by the commissioner, that indicate that the recipient needs recuperative care; and
- Not having behavioral health needs that are greater than what can be managed by the provider within the setting.
Provider Requirements
Eligible Providers for Recuperative Care Services include:
- Registered Nurse
- Licensed Practical Nurse
- Case Manager
- Mental Health Counselor
- Social Worker
- Community Health Worker
Providers must submit a Recuperative Care Provider Assurance Statement (DHS-8486) to attest to meeting all conditions for reimbursement.
Recuperative Care Facility Requirements
Recuperative care can be administered in any setting, including homeless shelters, congregate care settings, single-room occupancy settings, or supportive housing, provided that the designated provider offers the following essentials to MHCP members:
- 24-hour access to bathroom facilities, encompassing a shower, sink, and toilet.
- Continuous access to a bed throughout the day and night.
- Access to three meals daily, integrated into the per diem rate.
- Availability of environmental services to maintain cleanliness and hygiene.
- Access to a telephone for communication needs.
- Secure storage facilities for the belongings of MHCP members.
- Presence of staff within the facility to conduct wellness checks as required, with a minimum frequency of once every 24 hours.
Covered Services under Recuperative Care
Covered services encompass a range of essential care including:
- Basic nursing care including monitoring physical health and pain level
- Wound care
- Medication support
- Patient education
- Immunization review and update
- Clinical goals development for the recuperative care period and discharge plan
- Care coordination including initial assessment of medical, behavioral, and social needs
- Care plan development
- Support and referral assistance for legal, housing, transportation, case management, and community social services
- Support and referral assistance for health care benefits, health, and other eligible benefits
- Care plan implementation follow-up and monitoring
- Medical, social, and behavioral (counseling and peer support) services that can be provided in the recuperative care setting
- Community health worker services (Minnesota Statutes, 256B.0625, 43.25 subdivision 49. 43.26)
Services Not Covered
Providers must carefully evaluate their program’s capabilities. It’s essential to ensure that the member’s behavioral health needs do not exceed what the provider can manage within the setting. Members should be independent with activities of daily living and not require a higher level of care. For instance, while a member may have a temporary cast on their arm, needing assistance to stand or access the bathroom surpasses the level of care offered in the recuperative care setting.
Billing & Discharge
Total payment rates for recuperative care consist of the recuperative care services rate and the recuperative care facility rate. The recuperative care services rate is for the services provided to the recipient and must be a bundled daily per diem payment of at least $300 per day. The recuperative care facility rate is for facility costs and must be paid from state money in an amount equal to the medical assistance room and board rate at the time the recuperative care services were provided. The eligibility standards in Chapter 256I do not apply to the recuperative care facility rate. The recuperative care facility rate is only paid when the recuperative care services rate is paid to a provider. Providers may opt to only receive the recuperative care services rate.
Before a recipient is discharged from a recuperative care setting, the provider must ensure that the recipient’s medical condition is stabilized or that the recipient is being discharged to a setting that is able to meet that recipient’s needs.
If a recipient requires care exceeding the 60-day limit described in Subdivision 3, the provider may request in a format prescribed by the commissioner an extension to continue payments until the recipient is discharged.
Additional Factors
Navigating the intricacies of providing recuperative care services requires a thorough understanding of eligibility criteria, service delivery, and billing processes. An attorney can assist in providing dedicated support to providers interested in offering high-quality care to MHCP members experiencing homelessness, ensuring compliance with DHS regulations and financial sustainability for all stakeholders involved.