Effective Date: 10/1/03
Page Reviewed: 10/11/11
Page Updated: 3/28/14
Federally approved BI, CAC, CADI and DD waiver plans
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
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:
The waiver does not pay for travel expenses for waiver recipients and their companions. This includes paid and non-paid caregivers.
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).
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:
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.
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:
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:
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:
Case managers/service coordinators:
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 is one piece of waiver case management/service coordination. Case managers are responsible to:
1. Initiate reassessments.
For people who have a developmental disability and receive BI, CAC or CADI waiver services, case managers are responsible to:
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.
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.
To transition from one waiver program to another, people must:
See the waiver slot allocations/funding section of the CBSM – Financial management of the waivers – BI, CAC, CADI.
Case managers must terminate waiver programs or services for people when:
When case managers terminate waiver programs: