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Coverage criteria policies

Home care services, waivered services – Minnesota Health Care Programs

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Home Care Waivered Services requires prior authorization.

Coverage

Home Care services, Waivered Services is generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

Home and community-based waiver programs available to people who meet the eligibility criteria include:

  1. Alternative Care, a program that supports certain home and community-based services for older Minnesotans, age 65 years and over, who are at risk of nursing home placement and have low levels of income and assets.
  2. Brain Injury (BI) Waiver for people with acquired or traumatic brain injuries who need the level of care provided in a nursing facility that provides specialized (cognitive and behavioral supports) services for people with brain injury or neurobehavioral hospital level of care.
  3. Community Alternative Care (CAC) Waiver for chronically ill and medically fragile people who need the level of care provided in a hospital.
  4. Community Access for Disability Inclusion (CADI) Waiver for people with disabilities who require the level of care provided in a nursing facility.
  5. Developmental Disabilities (DD) Waiver for people with developmental disability or related condition who need the level of care provided in an Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD).
  6. Elderly Waiver (EW) for people over the age of 65 years who require the level of care provided in a nursing facility.

Definitions

Waivered Services - Services that normally would not be covered or reimbursed under Minnesota MA. These services have received federal approval for expanded coverage beyond the normal parameters of the Minnesota MA program.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

Portions of the contents of these coverage criteria relating to Minnesota Public Programs medical coverage criteria are taken directly from the Minnesota Health Care Programs Provider Manual at:
http://mn.gov/dhs/people-we-serve/people-with-disabilities/services/home-community/programs-and-services/hcbs-waivers.jsp

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Policy activity

  • 10/31/1994 - Date of origin
  • 05/01/2017 - Effective date
Review date
  • 05/2017

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