Federally approved BI, CAC, CADI, DD and EW waiver plans, federally approved AC 1115 demonstration

Institution: For the purposes of this policy, an institution is a:

Unforeseen circumstance: For the purposes of this policy, an unforeseen circumstance is a death or a significant change in condition that occurs after the county/tribal nation completed a MnCHOICES assessment and expected the person to enroll in one of the following programs:

When the county/tribal nation determines a person is eligible for a waiver/AC program and expects them to be discharged from an institution, the county/tribal nation may approve the following services before the expected discharge:

These services must be necessary for the person to return to the community.

If an unforeseen circumstance prevents the person from enrolling in the waiver/AC program, the county/tribal nation may request reimbursement from DHS for expense(s) incurred in anticipation of the person’s enrollment.

The county/tribal nation may request reimbursement if all of the following are true:

Note: When a person enrolled in AC/EW exits AC/EW before the end of the service agreement, an exception process may allow the county/tribal nation to authorize payment for outstanding expenses. For more information, refer to the case mix budget exceptions section of CBSM – AC and EW budgets and case mix caps.

Timeline

The county/tribal nation can request reimbursement up to 12 months after they incurred an expense.

Request

To request reimbursement, the county/tribal nation must submit the following to DHS before the 12-month period ends:

An MCO cannot request reimbursement from DHS for unforeseen circumstances. If the person is/was enrolled in Minnesota Senior Care Plus (MSC+) or Minnesota Senior Health Options (MSHO), the case manager should contact the MCO about the procedures it needs to follow for reimbursement.