Relocation Service Coordination (RSC): Learning the Basics

Welcome to Relocation Service
Coordination (RSC): Learning the Basics. A case management policy
training, brought to you by the Disability
Services Division of the Minnesota Department of
Human Services. Today’s video will cover a high-
level overview of Relocation Service Coordination. Our agenda for today’s training
includes: Learning Objectives, What is Relocation Service
Coordination? How would a person obtain
Relocation Service
Coordination? What is the role of a Relocation Service Coordination
Case Manager? and how can others support to
support relocation? Lastly, we have resources to
assist you in your work. After this session, learners
will be able to: Summarize Relocation Service
Coordination and how this program can assist
people in institutions with returning to
the community; Define the process of connecting
a person with Relocation Service Coordination
services; Recognize the role of Relocation Service Coordination
Case Managers; Apply best practices when
working with Relocation Service Coordination
Case Managers; and, Describe how to ensure a a successful transition for the
person receiving Relocation Service
Coordination. Our first section will cover “What is Relocation Service
Coordination,” or, RSC. Relocation Service Coordination
is a type of Medical Assistance reimbursed
case management. It is designed to help people
who want to move out of certain institutions
to move back into the community. Relocation Service Coordination
helps people plan and arrange for the services and supports they may need to live in the
community. The person must be receiving
inpatient care in an eligible institution in
order to access RSC. Medical Assistance Eligible
Institutions are defined in statute as: Hospitals;
Nursing Facilities, or NF including certified boarding
care facilities; Intermediate Care Facilities for persons with Developmental
Disabilities, or ICF/DD’s; And Regional Treatment Centers, providing inpatient services to
persons currently receiving Medical
Assistance. Relocation Service Coordination Case Management helps to
coordinate activities designed to help a
person who resides in an eligible institution
to gain access to: medical services, social
services, educational services, financial services, and
housing services. In order to receive Relocation Service Coordination
(RSC), a person much choose to receive
RSC, and choose to live in the
community. The person has to be eligible
for and receiving medical assistance and must reside in an eligible
institution during the time of service. A person’s home and community-
based services waiver must also be closed while they reside in an eligible
institution. The following people cannot use Relocation Services Coordination
(RSC): Persons living in the community
or an ineligible institution; Persons receiving another
type of Targeted Case Management,
including: Mental Health Targeted Case
Management, Vulnerable Adults with
Developmental Disabilities Targeted Case Management, or Behavioral Health Home
Services, to avoid duplication of Targeted
Case Management services. We’ll speak to this in greater
detail a bit later in this training. A person receiving Home and
Community Based Service (HCBS), waivers also cannot use RSC. The person’s HCBS
waiver programs should always be suspended while
in an institution. In order to access RSC services a person’s HCBS waiver program
must be closed and exited during the
duration of accessing RSC. Relocation Service Coordination
(RSC) is limited to 180 consecutive
days. This 180 consecutive day limit
is “per admission,” meaning that a person may
receive 180 days of RSC for each admission to an
eligible institution after a stay in the community. The stay in the community is
defined as at least “one full day in the community between
discharge and the next eligible admission, as updated by the person’s
financial worker.” In addition to RSC,
the use of any one of the following case management types will begin the 180 day
eligibility period, and will exhaust the benefit
after 180 days. Mental Health Targeted Case
Management, and Vulnerable Adults with
Developmental Developmental Disabilities
Targeted Case Management. The institution and person’s
supports should work together to update the county
or tribal financial worker to ensure proper eligibility for
new RSC access. Later in this video we will share best practices
when the individual receives other targeted case
management services. The services provided by Relocation Service Coordination
include, but are not limited to:
Develop a budget, review services that could
support the person in the community,
researching housing options Develop and updating a
relocation plan, based on the person’s needs and
preferences; Monitoring the implementation of
the relocation plan; Routine communication with the
individual, their team and service
providers; Referrals and assisting the
person with accessing services; Collaboration with the discharge planner and other care team
members. In addition, RSC Case managers
must also complete administrative functions such as
the completion and maintenance of required
documentation. Services NOT provided by
Relocation Service Coordination include, but are not limited to: Eligibility determinations and
re-determinations for medical assistance or a medical
assistance-funded benefit. Individuals must be medical
assistance-eligible in order to receive RSC services; Direct services like treatment, therapy, or rehabilitative
services; Transition assistance when a
person moves from one institution to another, unless it is part of the overall
relocation plan; Services without proper
documentation in the member’s relocation plan; Services covered by another
funding source, such as Moving Home Minnesota. As with all case management
services, administrative functions, delivery of service prior to
authorization, appeals or conciliation
activities, outreach services and
marketing activities are not billable services. There are great benefits to
using Relocation Service Coordination
(RSC). RSC covers up to 40 hours
a week to support planning for community discharge. RSC case managers support
the person and chosen caregivers in developing
a plan for long term stability. RSC case managers are
knowledgeable in person-centered planning and offer a customized plan,
including housing, expungement, transportation, and community
resources. In addition, RSC case managers
have knowledge of geographical areas, including
housing resources and tools that can support a person’s plan for
stability after discharge. RSC case managers can coordinate
collaboration and hand-offs with other Targeted Case
Management services as well as managed care
organizations. RSC has simple and clear
eligibility requirements to access services. The next section of our training
explores how a person would obtain Relocation Service
Coordination. Prior to admission, or upon
admission to an institution, the person can obtain RSC by:
Receiving information at the time of the county or
tribal nation’s screening that must occur within 80 days
of admission. Or, the person, or someone
acting on their behalf may request to receive RSC by contacting the county or
tribal nation in which the person
permanently resides. Once a person or their chosen
support requests RSC, the person will have a MnCHOICES assessment,
if it has not already occurred. Once an assessment is completed
and eligibility has been determined, further collaboration
with county, tribal nation, or managed care staff may occur.
The person will choose an RSC case manager either with
their county, tribal nation, managed care organization,
or with a private RSC provider. The person should expect to
begin working with an RSC case manager within
20 days of the request. Following eligibility, if the person
chooses to access RSC, it is the responsibility of the
MnCHOICES assessor to determine if the person is
also receiving another form of Targeted Case Management
by reviewing the Medicaid Management
Information System, or MMIS . Communication between
all case managers is vital to determine how
billing will work to ensure that Targeted Case Management
services are not duplicated. Once a person is discharged
from an institution, Relocation Services Coordination Targeted Case Management
benefits end. If a person is on Minnesota
Senior Health Options or MSHO or Minnesota Senior Care Plus
or MSC+, a care coordinator would be
assigned to them. The care coordinator should be
contacted to ensure non-duplication of
services. The Care Coordinator supports the person to move out of the
facility. If the person is on Special
Needs Basic Care, the county or tribal nation is
responsible for determining eligibility and
authorization for RSC. If the person or their chosen
support are unaware of who the care coordinator is, they can contact the Managed
Care Organization and they would be able to
provide that information. The person, legal
representative, family, nursing facility or social
worker are all able to contact the Managed Care Organization for
that information. The person’s MnCHOICES assessor
and RSC Case manager are responsible to inform the
person of their appeal rights. A person receiving RSC has the
right to appeal a decision that: Denies the person is eligible
for RSC case management; Delays or suspends the persons
access to RSC case management; Reduces the amount or type of
RSC case management services; or, Terminates or ends a
person’s RSC case management services prior
to the 180 day limit. This section explores the role
of an RSC case manager. RSC case managers direct
activities designed to help a person who
resides in an institution to gain access to
supports and services necessary to help that person
move into the community. An RSC case manager has: Skills in identifying and
assessing a wide range of needs; Knowledge of local community
resources and how to use those resources
for the benefit of the person; and, a bachelor’s degree in
social work, nursing, psychology, sociology
or a closely related field or a bachelor’s degree and one
year of experience in the delivery of
social services. RSC providers consist of
individuals and organizations including county, tribal nation,
and private RSC providers. All RSC providers must be
contracted through a county or tribal nation,
or certified through the Minnesota Department of Human
Services. All RSC providers must be free
from conflict of interest in providing service support
and coordination. A conflict of interest is any
time a case manager or provider could
benefit from working with the person on their relocation
planning. For example, an RSC case manager
or the provider they work for also provides residential services
in the geographical area the person wishes to
relocate to. RSC providers must also be
trained in the delivery of person-centered
approaches to planning. An RSC case manager’s
responsibilities include, but are not limited to: Developing and reviewing a
relocation plan with the person; Making referrals to needed
services and supports; Communicating with the person
and their chosen support to carry out the relocation
plan in the 180-day period before the person’s discharge; Coordinating, monitoring, and
supporting overall service delivery and
advocacy as needed to ensure quality of
services, appropriateness, and
continued need; and traveling and completing
documentation necessary to develop and carry out
the relocation plan. Individuals receiving RSC
must have a relocation plan. An RSC case manager develops,
monitors and reviews the plan using a person-centered process. At a minimum the service plan
must identify: The person and his or her
legal representative; All case managers
responsible for coordinating and planning
services; The person’s goals; The person’s needs and how
those needs will be met; The amount, duration and
frequency of the services; The anticipated service
outcomes; and the method and frequency
of monitoring the plan of care. If there are multiple
case managers, the service plan must identify
and attribute specific case management activities
to each case manager to demonstrate their differing
roles and responsibilities. People often ask what others
can do to support the person’s relocation. This section will help to
answer that question. Similar to other forms of
voluntary case management, RSC is dependent on
collaboration and cooperation to support the process. To assist in the relocation
process, the person can keep the
RSC case manager updated on changes in their
needs or preferences; Be open to discussing their
hopes and wishes for housing and services;
provide accurate information about past and current housing
history; Be proactive and a full
participant in the process, and responsive to
information requests; and be willing to explore
many housing options and opportunities. To support the person in
their relocation, inpatient care staff should
communicate and coordinate with the RSC case manager
throughout the 180-day period before the person is discharged. Communication is particularly
important for: Medical Assistance,
General Assistance, and disability certification
eligibility, if necessary; Confirmation and documentation of
support needs and preferences; Discharge planning, including necessary prescriptions,
supplies, and equipment, upcoming appointments and follow up
care that may be needed; and any changes involved in the
plan of care prior to discharge, for example, re-hospitalization
or unexpected discharges. Family, friends, guardians or legal
representatives, and others in the person’s life can support
the person’s relocation by: Supporting the person in
developing a plan that promotes their goals and
preferences; Understanding the balance
between what is important to as well as important for the
person, and how it relates to their plan; Recognizing the importance of
experiences for the person to understand
housing and support options; Assisting the person in making
an informed decision; and collaborating with
institutional staff and the RSC case manager as necessary and desired
by the person. In this section, we have provided
a few resources and tools to assist you in working with
Relocation Service Coordination. To receive communications
from DHS, sign up to receive bulletins and
e-list announcements. For policy questions and general
reference, check the CBSM, or Community-
Based Services Manual, and CountyLink. For Technical Assistance,
contact the DSD Response center. Lists of RSC Providers
can be found by accessing the DHS Certified
RSC Provider list, and the County and Tribal
Information Directory. For more specialized resources,
the Office of the Ombudsman, Disability HUB MN, Senior Linkage
Line, DB101, and are great resources for more
information. provides tools and
information on housing, planning tools to assist with
creating a path toward housing independence, supports and services. Information: Content covers a
wide range of topics, including information on
specific types of housing, services, and life situations. Learn about housing options,
how to pay for housing, and how to get services
no matter the setting. Tools: to help plan and organize
a relocation. Experts: The Get Help Now
feature connects users to experts who can answer questions
and help plan next steps. These experts come from the
Disability Hub MN, Senior Linkage Line,
Veteran’s Linkage Line, and United Way 211. The search function
is also used throughout HB101 to help find specific resources
in every community. Person-Centered Skills and Tools
are listed on this page for your information. The following websites are
included: Person Centered Thinking
Training, which is a link to sign up for live training about
Person Centered concepts; The Person Centered Practices
Webpage, which provides information regarding
Person Centered concepts; The Olmstead Plan Webpage; and the Positive Supports
Minnesota Webpage. Some helpful brochures and forms
are listed here. They include: DHS Form 3182,
Minnesota Health Care Programs; DHS Form 1941, Your Appeal
Rights; and DHS Form 4839E, Data Privacy Practices. Thank you so much for your time
and attention to this training. If you have any questions, please
email the DSD Response Center at [email protected]

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