Recuperative Care

Overview

Recuperative care services are available to eligible PrimeWest Health members experiencing homelessness to help prevent hospitalizations; or provide medical care and support services when they are unable to recover from a physical illness when living in a shelter or they are otherwise unhoused. PrimeWest Health members receive recuperative care services when they don’t need to be hospitalized or remain hospitalized, or don’t meet severity of illness for other levels of care.

PrimeWest Health members must have a referral from a hospital or clinic to receive recuperative care services.

Eligible Providers

The following providers may provide recuperative care services:

• Registered nurse
• Licensed practical nurse
• Case manager
• Mental health counselor
• Social worker
• Community health worker as defined under section MN Stat. 256B.0625, subd. 49
  • Community health workers must enroll as individual providers with Minnesota Health Care Programs (MHCP). Refer to the Recuperative Care Enrollment Criteria and Forms section under "Provider Basics" in the MHCP Provider Manual for complete enrollment information.

Supervision of Recuperative Care Health Services

Recuperative care health services must be supervised by an advanced practice provider enrolled with Minnesota Health Care Programs (MHCP). The following providers may supervise recuperative care health services:

• Advanced practice registered nurses (nurse practitioners and clinical nurse specialists)
• Physicians (MDs, DOs)
• Physician Assistants

If a recuperative care facility partners with a licensed, MHCP-enrolled health services group provider, the health services should be provided by the group of caregivers listed on the Recuperative Care Provider Assurance Statement (DHS-8486).

• These providers may be from a home care or public health services group that the recuperative care facility is partnering with to provide the health services. The affiliated health services group provider must have an established medical director.

Registered Nurses (RNs), Licensed Practical Nurses (LPNs), social workers, and case managers are not required to enroll with MHCP to provide recuperative care services.

Providers must self-attest that they meet all the conditions by completing and submitting a Recuperative Care Provider Assurance Statement (DHS-8486) to be eligible for reimbursement.

Eligible Members

To be eligible for recuperative care services, PrimeWest Health members must meet the following criteria:

• Be age 21 or over if they have Medical Assistance, or age 19 years or over if they have MinnesotaCare
• Experiencing homelessness or are unhoused
• In need of short-term medical care for fewer than 60 days
• In need of assistance with the covered services listed below

Covered Services

PrimeWest Health covers the following recuperative care services:

• 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 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 (MN Stat. sec. 256B.0625, subd. 49)

Recuperative Care Facility Requirements

Recuperative care may be provided in any setting, including, but not limited to, homeless shelters, congregate care settings, single room occupancy settings, or supportive housing, if the recuperative care or housing provider is able to provide the following to the PrimeWest Health member within the designated setting, at a minimum:

• 24-hour access to a bathroom (shower, sink, and toilet)
• 24-hour access to a bed
• Access to three meals per day (included in per diem)
• Availability to environmental services
• Access to a telephone
• Secure place to store the member’s belongings
• Staff available within the setting to provide a wellness check as needed (minimum of once every 24 hours)

Noncovered Services

The provider must evaluate their program’s capabilities.

• The member’s behavioral health needs cannot be greater than what can be managed by the provider within the setting.
• The member needs to be independent with activities of daily living and not need a higher level of care. For example, the member may have a temporary cast on their arm; however, needing assistance to stand or get to the bathroom is more than can be offered in the recuperative care setting.

Recuperative Care Extended Stay

Providers may request an extension if a member requires recuperative care services for more than 21 days. If the member is nearing the 21-day limit, providers should complete and submit a Recuperative Care Extended Stay Request (DHS-8513) along with relevant medical information to the medical reviewer. Extended stays are not expected to go past 60 days.

Readmissions

Any consecutive readmission to recuperative care services for the same diagnosis will continue the same 21-day limit. If the member is close to the 21 days, submit the Recuperative Care Extended Stay Request (DHS-8513) along with required medical information to ensure continued payment. Any readmission to recuperative care services for a new diagnosis starts a new 21-day coverage limit.

Discharge From Recuperative Care Services

Providers must ensure either one of the following before discharging a member from recuperative care services:

• The member’s medical condition has improved
• The member is being discharged to another setting that can meet their needs

Billing

Recuperative Care Services Rate

The recuperative care services rate is a bundled per diem payment of $300 per day for the services provided to the member. Services provided within the bundled payment may include, but are not limited to, the covered services.

For members with both Medicare and Medical Assisted coverage, providers must bill MHCP directly. Medicare does not cover the recuperative care health services rate (bundled payment).

Recuperative Care Facility Rate

The recuperative care facility rate includes the room and board daily 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. The eligibility standards in chapter 256I do not apply to the recuperative care facility rate.

Recuperative Care Services Claim

• Bill on 837P claim format. Refer to the MN–ITS 837P Professional User Guides.
• Bill CPT code T2033 for the recuperative care bundled payment.
• Bill all CPT or HCPCS codes on the same exact claim that describes the services rendered with a $0.00 charge (these will be zero pay).
• One of the ICD-10 diagnosis codes for homelessness will also need to be on the claim and condition code 17. It is the provider’s responsibility to determine the appropriate diagnosis code for the service that was provided

Recuperative Care Facility Claim

• 86X Residential Facility claim format. Refer to the MN–ITS 837P Professional User Guides.
• One of the ICD-10 diagnosis codes for homelessness will also need to be on the claim and condition code 17. It is the provider’s responsibility to determine the appropriate diagnosis code for the service that was provided.

Note: The recuperative care services professional claim must be submitted to and paid for by PrimeWest Health prior to submitting the recuperative care facility claim.

Recuperative Care Facility Rate

The recuperative care facility rate is approximately $34 per day. This includes the room and board daily rate. 

Managed Care Members

The recuperative care facility (room and board) rate is paid from State funds in an amount that equals the Medical Assistance room and board rate at the time the recuperative care services were provided.

These facility claims are covered through MHCP fee-for-service and should be billed directly to MHCP.

Recuperative care providers must contact PrimeWest Health for enrollment requirements and billing and coverage policies when providing services to PrimeWest Health members.

Updated_05/06/2026