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Transitional Services Referral

  1. Please complete all sections. Incomplete referrals may be delayed. The online form has some required fields, and all of the required fields need to be completed in order for the form to be submitted. If the required fields are not entered, the form will not be submitted.
  2. Case Manager signature on the last page is required for authorization.
  3. Eligibility Info
    1. Age 18 or older
    2. Moving from an eligible setting to their own home (a person’s own home is a setting they own, rent or lease that is not operated, owned or leased by a provider of services or supports)
    3. Moving to a setting where these items and expenses are not normally furnished
    4. Transitional services can be authorized for up to 45 days after an individual’s move
    5. Individual cannot receive transitional services if they have already had them in the last 3 years
  1. MCIL does not work directly with individuals receiving services. MCIL will communicate with the case manager making the referral. Case managers are expected to communicate any necessary information directly to the individual who is moving. Individuals contacting us will be referred back to their case managers.

Please allow 7-10 days for processing referrals

MCIL requires a service agreement prior to us providing services.

Household Items

  • Provider Name: MCIL
  • NPI Number: A994520200
  • Procedure Code: T2038-U2
  • Maximum Amount: $500.00

Furniture

  • Provider Name: MCIL
  • NPI Number: A994520200
  • Procedure Code: T2038-U1
  • Maximum Amount: $1,500.00

Moving Services, Delivery,
Damage Deposit, Application Fee, Mileage & Labor

  • Provider Name: MCIL
  • NPI Number: A994520200
  • Procedure Code: T2038
  • Maximum Amount: $3,000.00

MCIL adheres to the Minnesota Department of Human Services Community Based Services Manual on Market Rate for Transitional Services, basing our rates on wage and expertise of the person providing the service, the number of people sharing the service, administrative and indirect costs associated with providing the service, program or facility costs, local rates for comparable services not provided through Medical Assistance. Current rates for services range from $300-600 depending on the number and complexity of services authorized, except in the event that only a damage deposit is needed, which is $150. Please contact us with any questions.

If you have any questions, call Monica at 651-964-3143

MCIL Transitional Services Referral Form