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Waiver and Alternative Care programs overview

Page posted: 10/1/03

Page reviewed: 9/28/18

Page updated: 9/28/18

Legal authority

Federally approved BI, CAC, CADI, DD and EW waiver plans, 42 C.F.R. 440.180, Minn. Stat. §256B.092; Minn. Stat. §256B.49; Minn. Stat. §256B.0915, Minn. Stat. §256B.0913

Overview

Waiver and Alternative Care (AC) programs provide home and community-based services (HCBS) to meet the needs of people with disabilities and older adults. People must be Minnesota residents and meet eligibility requirements specific to each waiver/AC program.

Waiver/AC programs must meet federal and other guidelines, which include:

  • • Eligibility requirements
  • • Funding parameters and limits
  • • County, tribal nation and/or state policies
  • • Services available.
  • Each waiver/AC program is based on an agreement between DHS and the federal government (Centers for Medicare & Medicaid Services [CMS]). These agreements are called waiver plans or AC protocols. They:

  • • Define populations served
  • • Define services and provider standards
  • • Describe how rates are determined
  • • Describe how DHS manages the waiver/AC program.
  • While DHS manages the waiver/AC programs, lead agencies administer the programs. Lead agencies include counties, tribal nations and managed care organizations (MCOs).

    Programs

    People with disabilities or older Minnesotans who need certain levels of care may qualify for waiver/AC programs. These programs are available to people who choose to reside in the community and meet eligibility criteria:

  • Alternative Care (AC): For older Minnesotans who require the level of care provided in a nursing facility and who are not yet eligible for Medical Assistance
  • Brain Injury (BI) Waiver: For people with a traumatic, acquired or degenerative brain injury who require the level of care provided in a nursing facility that provides specialized services for people with BI, or who require the level of care provided in a neurobehavioral hospital
  • Community Alternative Care (CAC) Waiver: For people who are chronically ill or medically fragile and require the level of care provided in a hospital
  • Community Access for Disability Inclusion (CADI) Waiver: For people with disabilities who require the level of care provided in a nursing facility
  • Developmental Disabilities (DD) Waiver: For people with developmental disabilities or related conditions who require the level of care provided in an intermediate care facility for persons with developmental disabilities (ICF/DD)
  • Elderly Waiver (EW): For older Minnesotans who require the level of care provided in a nursing facility.
  • Services

    There are certain services available on each waiver/AC program. For specific information, see each waiver/AC CBSM page.

    Services under all waiver/AC programs must:

  • • Be authorized within allowable rates (see CBSM – Disability-specific financial management and CBSM – Rate methodologies for AC, ECS and EW service authorization)
  • • Be authorized by the lead agency before services are delivered
  • • Be for the direct benefit of the person, with exception of services that provide relief or training for caregivers (e.g., respite, homemaker, chore, family training and counseling [disability waivers], family caregiver services [EW and AC])
  • • Be related to a person's disability (for BI, CAC, CADI and DD)
  • • Be the least costly alternative to meet the person's needs
  • • Be within the allowable budget of the county/tribal nation for BI, CAC, CADI and DD waivers (see CBSM – Financial management of the waivers – Overview) or within the case mix cap for EW and AC (see Long-Term Services and Supports Service Rate Limits, DHS-3945 [PDF])
  • • Ensure the person's health, safety and well-being
  • • Help the person avoid institutionalization
  • • Help the person function with greater independence in the community
  • • Meet the person's assessed needs and be the person's choice of service to meet his/her assessed needs
  • • Not duplicate other services available
  • • Not be available through another funding source (e.g., Medical Assistance state plan services, long-term care insurance)
  • • Support the person's desires, needs and preferences
  • • Not substitute for parental responsibility
  • • Not substitute for informal supports that appropriately meet the person's needs
  • • Meet all program and service guidelines in the federally approved waiver plan or AC protocol.
  • State and lead agency responsibilities

    State responsibilities

    DHS is responsible to:

  • • Design and develop waiver programs, policies and services that meet federal guidelines and DHS goals
  • • Submit reports to CMS on the quality, performance and financial management of waiver/AC programs
  • • Renew waiver programs every five years as required by CMS
  • • Respond to the state legislature about development of and changes to waiver/AC programs and services
  • • Monitor waiver/AC program activity to ensure the integrity of services and standards
  • • Establish rate methodologies for waiver/AC services
  • • Delegate certain activities to lead agencies (see lead agency responsibilities list below)
  • • Manage lead agency administration of the programs for statewide consistency and compliance with federal standards
  • • Ensure people have the right to make choices and live in the most integrated setting of their choice
  • • Act as a policy and technical resource for lead agencies.
  • Lead agency responsibilities

    Lead agencies are responsible to:

  • • Complete assessments to determine financial and program eligibility for people who request services and supports
  • • Enter screening documents into MMIS
  • • Help people access, coordinate and evaluate services
  • • Offer people choices of services to meet their assessed need(s)
  • • Inform people of the option to self-direct their own services
  • • Use required forms (see CBSM – Required waiver forms for home and community-based disability waivers and CountyLink – MnCHOICES forms for long-term services and supports assessment, eligibility and support planning [PDF])
  • • Monitor provider performance and the ongoing provision of services for effectiveness, person's satisfaction, health and safety and continued eligibility (i.e., make service adjustments as necessary)
  • • Provide case management/care coordination for people on waiver/AC programs, including assessment and support plan development (see CBSM – Waiver/AC case management)
  • • Prior authorize waiver/AC services
  • • Enter service authorizations into the appropriate system (counties and tribal nations use MMIS)
  • • Sign provider agreements with DHS and meet the provider qualifications when the lead agency is the provider of services
  • • Comply with DHS requirements if opting to review and approve non-enrolled providers as qualified to deliver waiver/AC services (see CBSM –Lead agency oversight of waiver/AC approval-option service vendors)
  • • Work in partnership with DHS and other organizations to provide resources about programs to people with disabilities or older Minnesotans.
  • For more information about managed care responsibilities, see DHS – MCO contract information, forms and resources.

    For more information about tribal nation responsibilities, see CBSM – Tribal administration of HCBS programs.

    Processes and procedures for disability waivers

    For information about how to administer BI, CAC, CADI and DD waiver programs, see CBSM – BI, CAC, CADI and DD waiver general processes and procedures.

    Provider enrollment and standards

    Waiver providers must meet the qualifications and standards for the service provided. Service-specific standards and qualifications are listed on each waiver service page in the CBSM.

    For more information, see CBSM – Waiver/AC provider enrollment and standards.

    MMIS codes for HCBS waiver/AC program eligibility

    Alternative Care

    Certified assessors/case managers enter the program eligibility for AC using the following long-term care (LTC) screening document fields:

  • • Program type
  • • Activity type
  • • Assessment result
  • • Effective dates.
  • The date will set the begin date of the eligibility span on the RELG screen in MMIS. The code displayed on the RELG screen for AC program eligibility is AC.

    BI, CAC, CADI, DD and EW

    Financial workers must enter a person's disability or other eligibility status on the RELG screen in MMIS. This documents part of waiver program eligibility. The following codes are the only codes financial workers may enter for program eligibility:

  • • BX: Blind
  • • DC: Disabled/child age 18 through 20
  • • DP: Employed disabled with premium
  • • DX: Disabled
  • • EX: Age 65 and over
  • • 15: 1619A
  • • 16: 1619B
  • • 09: IV-E Adoption Assistance
  • • 10: Minnesota Adoption Assistance
  • • 25: IV-E Foster Care.
  • Additional information about codes 09, 10 and 25

    Many children who are eligible for Title IV-E adoption assistance (09), MN adoption assistance (10) and Title IV-E foster care (25) also are certified disabled and receiving waiver services. The eligibility status for these children must remain coded with 09, 10 or 25 for funding purposes.

    Additional information for financial workers about "D" code

    Financial workers must add a “D” code to the indicator field in MMIS on the RELG screen to indicate "disabled" for purposes of waiver program eligibility. For more information, see the MMIS User Manual.

    Additional resources

    CBSM – Assessment and support planning
    CBSM – BI, CAC, CADI and DD waiver general process and procedures

    CBSM – Level of care

    CBSM – Lead agency oversight of waiver/AC approval-option service vendors

    CBSM – Paying relatives and legally responsible individuals

    CBSM – Required waiver forms for home and community-based disability waivers

    CBSM – Support planning

    CBSM – Waiver/AC service provider overview

    CountyLink – MnCHOICES forms for long-term services and supports assessment, eligibility and support planning (PDF)

    HCBS Waiver/AC Service Purchase Agreement template available for use/modification by county/tribal agencies (.DOC)

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

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