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Minnesota Department of Human Services Provider Manual
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HCBS Waiver Services

Revised: 01-23-2017

  • Eligible Providers
  • Enrollment
  • MN–ITS
  • Training Requirements
  • Eligible Recipients
  • Covered and Noncovered Services
  • Service Authorization
  • Billing
  • Void (“Take-Back”) Waiver and Alternative Care (AC) Service Claims
  • Specialized Supplies & Equipment Authorization & Billing Responsibilities
  • Review EW-AC section for specific information about the Elderly Waiver (EW) and Alternative Care (AC) programs and services through the programs.

    Overview

    Review the Waiver Program Overview for information about the Home and Community Based Services (HCBS) waiver programs including background, federal and state guidelines, state, county and tribe responsibilities and specific information about each waiver program.

    Eligible Providers

    For providers to provide services and be eligible to receive payment from MHCP, they must meet the following criteria:

  • • Be an enrolled MHCP provider
  • • Maintain licensure or documentation supporting their qualifications to provide waiver services
  • • Obtain a DHS approved service authorization (SA) to provide services for the recipient
  • For information on limitations to paying relatives and legally responsible individuals, review the Community-Based Services Manual (CBSM).

    MHCP Enrollment

    To enroll in MHCP to provide waiver or AC program services, follow the instructions in the Home and Community Based Services (HCBS) Waiver and Alternative Care Provider Enrollment section.

    Providers must determine which HCBS program services they want and are qualified to provide. Use the Waiver and Alternative Care (AC) Programs Service Request Form (DHS-6638) (PDF) to report the service(s) you want to provide and the qualifications you have to provide the service(s) to a recipient receiving services through waiver programs.

    For more information regarding licensures, certifications or registrations needed to provide the waiver service, refer to one or more of the following:

  • • Lead agency where you will provide services. Lead agencies include:
  • • Human Service office in each county or tribe. Review the Minnesota Tribal and County Health Care Directory
  • Managed care organization (MCO)
  • DHS Licensing
  • Minnesota Department of Health
  • MN–ITS

    MHCP requires those who provide services through waiver and AC programs to register for a MN–ITS account. You will receive a welcome letter with your MN–ITS registration information once you are approved as an MHCP enrolled provider.

    Eligible Recipients

    The lead agency determines the additional eligibility criteria for HCBS programs. Each waiver program has different application processes, eligibility requirements and covered services.

    Refer to the specific eligibility criteria for each of the following waiver programs:

    Brain Injury (BI)
    Community Alternative Care (CAC)

    Community Access for Disability Inclusion (CADI)

    Developmental Disabilities (DD)

    Providers must verify program eligibility for each recipient, each month through phone or MN–ITS eligibility verification. Use MN–ITS Eligibility Request (270/271) to review eligibility information for each recipient before providing services.

    Turning 65
    A recipient receiving waiver services before age 65, remains eligible for the respective waiver after the recipient’s 65th birthday if all other eligibility criteria are met. The case manager or service coordinator must inform a recipient nearing age 65 of the other community support options so that the recipient can choose which alternative will best meet his or her needs. Options may include the Elderly Waiver, remaining on the recipient’s current HCBS waiver or other alternatives that may meet the needs and preferences of the recipient.

    Covered and Noncovered Services

    Select the link below to view the Community Based Services Manual (CBSM) policy page for each service that includes the legal reference, service description, covered and noncovered services when applicable and provider standards and qualifications.

    Service

    BI

    CAC

    CADI

    DD

    24-hour Emergency Assistance

    X

    X

    X

    X

    Adult Companion Services

    X

    X

    Adult Day Care

    X

    X (FADS only)

    X

    X

    Adult Day Care Bath

    X

    X

    X

    Assistive Technology

    X

    Behavioral Support

  • • Behavior Professional
  • • Behavior Analyst
  • • Behavior Specialist
  • X

    X

    X

    Caregiver Living Expenses

    X

    X

    X

    X

    Case Management

    X

    X

    X

    X

    Case Management Aide (Paraprofessional)

    X

    X

    X

    Chore Services

    X

    X

    X

    X

    Consumer Directed Community Supports (CDCS)

    X

    X

    X

    X

    Crisis Respite

    X

    X

    X

    Customized Living

    X

    X

    Customized Living 24-hour

    X

    X

    Day Training and Habilitation (DT&H)

    Also see the MHCP Provider Manual Day Training & Habilitation (DT&H) section for additional information

    X

    Environmental Accessibility Adaptations

    X

    X

    X

    X

    Extended Personal Care Assistance (PCA)

    X

    X

    X

    X

    Extended Home Care Services

  • • Home Health Aide (HHA)
  • • Home Care Nursing (HCN)
  • • Therapies (physical, occupational, speech language- pathology, and respiratory)
  • X

    X

    X

    Family Training and Counseling

    X

    X

    X

    X

    Foster Care

    X

    X

    X

    Home Delivered Meals

    X

    X

    X

    X

    Homemaker Services

    X

    X

    X

    X

    Housing Access Coordination

    X

    X

    X

    X

    Independent Living Skills (ILS)Training

    X

    X

    X

    Independent Living Skills (ILS)Therapies

    X

    Night Supervision

    X

    X

    Personal Support

    X

    Prevocational Services

    X

    X

    Residential Care Services

    X

    X

    Residential Habilitation

  • • In-home Family Support Services
  • • Supported Living Services (SLS)
  • X

    Respite Care

    X

    X

    X

    X

    Specialist Services

    X

    Specialized Equipment and Supplies

    X

    X

    X

    Structured Day Program

    X

    Supported Employment Services

    X

    X

    X

    X

    Transitional Services

    X

    X

    X

    X

    Transportation

    X

    X

    X

    X


    Service Authorization

    Waiver services require approval from a case manager or service coordinator in the form of a completed service authorization (SA). The SA allows the provider to bill MHCP and receive payment after services are provided. Only services approved on the SA can be paid; however, the recipient must maintain both MA and waiver eligibility in order for the authorization to be valid. The case manager or service coordinator enters the SA into the DHS computer system (MMIS). Providers are responsible for ensuring the SA is accurate upon receipt of their service authorization letters (SAL) in their MN–ITS mailbox.

    Each line item on the SA lists the following:

  • • MHCP enrolled provider who is authorized to provide the needed services
  • • Rate of payment for the service
  • • Number of units approved
  • • Date or date span of authorization of service
  • • Approved procedure code(s)
  • The SA for BI, CAC, CADI, and DD Waivers may include the following:

  • • Medical Assistance (MA) home care services of SNV, HHA, HCN and PCA
  • • Waiver services consistent with the provider agreement
  • County Health and Human Service or Lead Agency Responsibilities
    County agencies acting as agents for the HCBS Program are responsible for providing program access and local program administration. Review the county or tribal responsibilities section of the Waiver Programs Overview in the Community-Based Services Manual (CBSM).

    After the needs assessment and support planning have occurred, the lead agency will use the Disability Waiver Rate System (DWRS) to price individual services and provide the amount to authorize individual services.

    Billing

    Follow the Billing for Waiver and Alternative Care (AC) Program instructions.

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    Updated: 1/23/17 1:42 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 1/23/17 1:42 PM