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Rate methodologies for AC, ECS and EW service authorization

Page posted: 11/2/16

Page reviewed:

Page updated:

Legal authority

Federally approved Elderly Waiver (EW) Plan, Alternative Care (AC) program (Minn. Stat. §256B.0913), Minn. Stat. §256B.0915, Essential Community Supports (ECS) program (Minn. Stat. §256B.0922)

Overview

The lead agency uses one of the following methods to determine rates for services it authorizes under the Alternative Care (AC), Essential Community Supports (ECS) and Elderly Waiver (EW) programs:

For specific AC, ECS and ECS service rate limits and monthly budget caps, see Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF).

State-established rates

DHS establishes rates for most AC, ECS and EW services.

AC and EW services

The lead agency authorizes the following AC and EW services at the state-established rate:

  • Adult companion services
  • Adult day services
  • Adult day services bath
  • Case management (see the case management note for more information)
  • Case management / conversion (AC only)
  • Case management aide
  • CDCS background study
  • CDCS required case management
  • Chore services
  • Extended state plan, home health services (including HHA, LPN, PCA and RN) (EW only)
  • Family adult day services
  • Family caregiver coaching and counseling (with assessment)
  • Family memory care
  • Home health services (including HHA, LPN, PCA and RN) (AC only)
  • Home-delivered meals
  • Homemaker / assistance with activities of daily living (ADLs)
  • Homemaker / home management
  • Individual community living supports
  • Nutrition services (AC only)
  • Respite / in-home and out-of-home
  • Transportation / mile (see the transportation section for more information).
  • ECS services

    The lead agency authorizes the following ECS services at the state-established rate:

    A note about case management

    The case management service follows the state-established rate only when it is provided by a county or tribe. If the lead agency contracts with another agency to provide this service, it may pay the contracted agency at a lower rate.

    Market rates

    The lead agency authorizes some AC, ECS and EW services at market rates. A market rate is the typical price charged for a service in the community market. Market-rate services:

  • • Have rate limits, which are published in Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF)
  • • Include services and goods purchased infrequently or one time from vendors on a retail basis and reimbursed based on receipts.
  • AC and EW services

    The lead agency authorizes the following AC and EW services at the market rates, up to the published rate maximums:

  • • AC discretionary services (See Minn. Stat. §256B.0913, subd. 5(19))
  • Environmental accessibility adaptations
  • Family caregiver training and education
  • Homemaker / cleaning
  • • PERS / Installation and testing, monthly service fee and purchase
  • Specialized equipment and supplies
  • Transitional services (EW only)
  • Transportation / trip (see the transportation section for more information).
  • ECS services

    The lead agency authorizes the following ECS services at the market rates, up to the published rate maximums:

  • Family caregiver training and education
  • Homemaker / cleaning
  • • PERS / installation and testing, monthly service fee and purchase.
  • Residential Services Tool

    The lead agency uses the Residential Services Tool (RS Tool) to determine rates for the following EW residential services:

    For more information, see DHS – EW residential services.

    Consumer directed community supports (CDCS)

    DHS establishes individual budget caps for people who use CDCS under the AC and EW programs, which are published in Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF).

    For more information about CDCS, see CDCS Lead Agency Operations Manual, DHS-4270 (PDF).

    Transportation

    The lead agency authorizes transportation at either the:

  • • State-established rate, per mile
  • • Market rate, per one-way trip (up to the state-established, one-way trip rate limit).
  • Use the following guidance to authorize mileage and trip rates:

  • • A provider may not bill at the mileage rate and trip rate for the same trip.
  • • Do not use the mileage rate when the provider transports more than one person at a time. Instead, use the one-way trip rate, up to the one-way trip rate limit.
  • • Do not authorize the mileage rate for travel time when the person is not in the vehicle.
  • • Do not authorize payment for transportation that duplicates transportation provided as part of another AC or EW service. (Exception: The lead agency may authorize mileage simultaneously with adult companion services.)
  • • When there is a choice between authorizing the trip rate or the mileage rate, the lead agency should chose the rate that ensures the person has access to the transportation service.
  • Additional resources

    CBSM – Alternative Care (AC)
    CBSM – Essential Community Supports (ECS)

    CBSM – Elderly Waiver (EW)

    DHS – EW residential services

    Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF)

    MHCP Provider Manual – Elderly Waiver and Alternative Care (AC) Program

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