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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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BI, CAC, CADI and DD waiver general process and procedures

Effective Date: 10/1/03

Page Reviewed: 10/11/11

Page Updated: 3/28/14

Legal authority

Federally approved BI, CAC, CADI and DD waiver plans

Out of state services

Lead agencies may only authorize services outside of Minnesota when the waiver recipient remains a resident of Minnesota and meets one or more of the following situations:

1. Provider is located within the waiver recipient’s local trade area in the states of North Dakota, South Dakota, Iowa or Wisconsin and the service is provided in accordance with state and federal laws and regulations or
2. Waiver recipient is temporarily traveling outside of Minnesota, but within the United States, and services are limited to direct care staff services authorized in the individual's support plan.
Waiver plan requirements apply to services provided outside of Minnesota and include:

  • • Prior authorization
  • • Provider standards
  • • Recipient health and safety assurances
  • Temporary travel outside of Minnesota has a limit of 30 days per calendar year. There is an exception for emergencies. In emergencies, case managers/service coordinators will:

  • • Be notified when temporary travel may exceed 30 days as soon as possible prior to the thirtieth day
  • • Determine the legitimacy of the emergency and
  • • Determine whether waiver services are necessary
  • The waiver does not pay for travel expenses for waiver recipients and their companions. This includes paid and non-paid caregivers.

    Access

    Anyone may apply for waiver services. Lead agencies may receive referrals from a variety of sources such as discharge planners, schools, health care providers, other lead agencies.

    Designated lead agencies assign case managers/service coordinators to begin the assessment process. Case managers/service coordinators also verify the county of financial responsibility. See: Health Care Programs Manual Chapter 13 (click 13 State and County Responsibility, then 13.25 County Residence).

    Assessment process

    The assessment process includes screening for services to meet technical or procedural requirements for program eligibility. Use the LTCC assessment process to determine program eligibility for the BI, CAC and CADI waiver. Use the DD screening process to determine program eligibility for the DD Waiver.

    If people are ineligible for a waiver program, case managers/service coordinators:

  • • Communicate the ineligibility to the person
  • • Coordinate access to services and supports
  • • Send a Notice of Action Home and Community Based Waiver Services (DHS-2828)
  • Apply the conversion or diversion definitions to determine waiver type each time a person opens or reopens to a waiver program. If a person opens to a waiver as a conversion but then exits the waiver, the person may not be a conversion when reopened to the waiver.

    Service planning

    The assessment process also includes service planning. Case managers/ service coordinators create service plans in partnership with recipients and/or their representatives. Service plans document informed choice around choice of program, choice of provider and choice of services. The term community support plan may be interchangeable with:

  • • Individual service plan
  • • Plan of care/care plan
  • • Service plan
  • Service plan formats

    For the BI, CADI and DD waivers, lead agencies may use DHS approved service plan formats or develop service plans in formats of their choice. Service plans developed by lead agencies must include the following information:

  • • Amount, frequency and duration of each service provided
  • • Documentation of back-up and emergency plans which includes addressing such issues as handling medical emergencies and accessing emergency care, provision of back-up care if the scheduled caregiver does not arrive, and special considerations for weather conditions
  • • Documentation of services being provided in integrated settings
  • • Documentation that health and safety needs are met
  • • Documentation the person has freedom of choice
  • • Informal supports
  • • Types of providers to furnish each service
  • • Types of services to be provided (waiver, state-plan, other)
  • • Other waiver-specific information
  • For the CAC Waiver, lead agencies must use DHS approved service plan format.

    Other support systems

    Lead agencies plan for home care and waiver services in the context of other support systems that are or may be in place. Other support systems may include:

  • Adult mental health and child mental health
  • Group residential housing
  • • Natural supports (family, friends)
  • School-based services
  • • Services for the blind, deaf and hard of hearing
  • • Title IV-E
  • • Vocational rehabilitation services
  • Authorization

    Case managers/service coordinators:

  • • Authorize the type and amount of waiver services (see HCBS Model Contract)
  • • Assure parameters of the agreed upon service plan are implemented
  • • Only issue service authorizations to qualified providers
  • Lead agencies enter service authorizations into the Medicaid Management Information System (MMIS) as service agreements. Counties of financial responsibility approve the authorizations for waiver services.

    Note: Institutional care is not an allowable residence in which to receive waiver services.

    Limitations in waiver authorization

    Authorized services cannot supplant or duplicate services available through other funding sources such as Medicare, private insurance and Medicaid.

    Items, adaptations or modifications purchased are the least costly to reasonably meet the need(s) of the person.

    Unless otherwise noted, spouses, parents of minors (related by blood, marriage or adoption), and professional guardians or conservators of a participant, may not be paid to provide waiver services for that recipient. A professional guardian or conservator is an individual, agency, organization or business entity that provides guardianship or conservator services for a fee. Legal representatives who are not otherwise responsible to provide a support service may be paid to provide waiver services when it is part of the participant’s community support plan.

    Waiver rates may not enhance reimbursement available to a person under the Medical Assistance State plan.

    Reassessment

    Reassessment is one piece of waiver case management/service coordination. Case managers are responsible to:

    1. Initiate reassessments.
    2. Review service plans annually or more often as necessary to meet the needs and preferences of the person.
    3. Complete and enter screening documents/service agreements into MMIS.
    4. Complete additional annual documentation if applicable.

    For people who have a developmental disability and receive BI, CAC or CADI waiver services, case managers are responsible to:

  • • Complete a new Service Agreement for input into MMIS, which reflects the care plan for the person.
  • • Complete both the LTC and DD Screening Document for input into MMIS annually.
  • • Include both the DD and LTCC case manager at the annual review
  • • Include both the DD and LTCC screening teams at the full team screening
  • 65 years of age

    People who receive disability waiver services may choose to stay on the waiver when they turn 65 years of age.

    BI, CAC and CADI waivers

    People may exit the waiver for institutional care or a trial of non-waiver home care and choose to return to the same waiver after age 65. They have up to 180 days from when they exited the waiver.

    People may not change waivers after age 65 except to go to the Elderly Waiver. People may not return to the BI, CAC or CADI waivers from the EW.

    For people turning age 65 in the community, lead agencies have a three-month window in which to conduct an in-person assessment and enter a new screening document into MMIS. Use an 08-activity type. The three-month window includes the one month before the birthday month and two months after the birthday month.

    DD Waiver

    The 180-day limitation does not apply to the DD Waiver. People over age 65 may return to the DD Waiver after exiting for institutional care or a trial of non-waiver home care.

    Person's own home

    Some of the waiver services can only be provided to a person living in his or her own home. For information about how to determine if a setting is considered a person's own home, see CBSM – Requirements for a person's own home.

    Changing waiver programs

    To transition from one waiver program to another, people must:

  • • Meet the level of care criteria required for the requested waiver
  • • Need the level of services offered under the requested waiver
  • See the waiver slot allocations/funding section of the CBSM – Financial management of the waivers – BI, CAC, CADI.

    Termination

    Case managers must terminate waiver programs or services for people when:

  • • Home and community-based services no longer reasonably assure the health and safety of the person
  • • Person chooses not to use waiver services
  • • Person has been admitted to an Institute for Mental Disease (IMD), Regional Treatment Center (RTC), or Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD)
  • • Person has been institutionalized for at least 30 consecutive days
  • • Person is no longer eligible for Medical Assistance
  • • Person no longer meets diagnostic criteria
  • • Physician certifies that the person requires continued institutionalization for an indefinite period of time
  • • Service coordinator determines, based on a reassessment, the person no longer requires waiver services or is no longer at risk for institutional level of care
  • When case managers terminate waiver programs:

  • • Communicate the termination action to the person
  • • Discuss alternative services and assist the person in transitioning to services meeting their needs
  • • Send a Notice of Action Home and Community Based Waiver Services DHS-2828 (PDF)
  • Temporary Waiver Exits (PDF)

    Additional resources

    CBSM – Forms
    CBSM – Required waiver forms

    CBSM – Financial management of the Waivers - DD

    CBSM – Requirements for a person's own home

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    © 2017 Minnesota Department of Human Services Updated: 4/19/16 2:26 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 4/19/16 2:26 PM