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Banding scenarios

Banding creates limits for changes in framework service payment rates that are affected by DWRS implementation. For more information, please see the section on banding in the Rate Management System page in the CBSM.

Non-framework rates processes

In rare situations, the RMS does not correctly band to historic rates and/or a user may need to enter a non-framework rate and manually band the rate for RMS to reflect an appropriate final rate. Below are situations that explain the processes needed to determine rates for current year services when the RMS does not correctly calculate or band for:

  • • DHS-approved exception
  • • Residential change in a service plan
  • • Historic rate not available
  • • Partial day DT&H
  • • Service intensity
  • • MAPCY reduction
  • Please note: Although the system does not show the calculation, the RMS automatically calculates and applies regional variance factors, cost of living adjustments and banding percentages. You should never manually band for these reasons.

    A. DHS-approved exception

    Situation

    You must first submit an exception request via the DHS 5820 form. DHS will send an approval email if/when we approve the exception rate. You will then need to:

    1. Complete the appropriate framework

    2. Enter the approved exception rate in the non-framework section of RMS

    3. Choose the "DHS-approved exception" reason in the drop-down menu

    4. Enter a narrative in the box stating the date DHS approved the exception rate

    5. Hit calculate for the non-framework (exception) rate

    6. Authorize the non-framework (exception) rate in MMIS

    Service and unit types

  • • Residential
  • • Day
  • • Unit-based with and without programming
  • Training

    For additional training, see the module on DWRS exceptions on the RMS User Manual Training Modules page.

    B. Residential change in service plan

    Situation

    If a person received a residential service in December 2013 and changed residential providers after Jan. 1, 2014, he or she is eligible for a residential change in service option. You will need to:

    1. Complete the appropriate framework

    2. Determine the service rate using the lead agency's historic method of rate-setting

    3. Enter the rate in the non-framework section of RMS

    4. Choose the "Residential change in service plan" reason in the drop-down menu

    5. Hit calculate for the non-framework rate

    6. Authorize the non-framework rate in MMIS

    Service and unit types

  • • Residential
  • Training

    For additional training, see the module on residential change in service plan on the RMS User Manual Training Modules page.

    C. Historic rate not available

    Situation

    The RMS pulls the banding file on a certain date in December each year. If the service was not in approved status in MMIS on that date, it will not pull to the current year banding file. A historic rate may also be missing if the lead agency did not match the HCPC and modifier of the previously authorized service. If you know the person had an individual rate authorized in December 2013, but the system did not pull the rate from the previous year, you should manually band to the individual's historic rate. You will need to:

    1. Complete the appropriate framework

    2. Enter the correct rate in the non-framework section of RMS

    3. Choose the "Historic rate not available" reason in the drop-down menu

    4. Enter a narrative in the box stating the correct historic rate, why the individual should be banded to the historic rate and any banding adjustments that need to be made

    5. Hit calculate for the non-framework rate

    6. Authorize the non-framework rate in MMIS

    Service and unit types

  • • Residential
  • • Day
  • • Unit-based with and without programming
  • Training

    For additional training, see the modules on banding on the RMS User Manual Training Modules page.

    D. Partial day DT&H

    Situation

    People who received any DT&H services in 2013 are eligible to receive partial-day DT&H. DHS provided lead agencies with a rate file sheet with rates for all eligible individuals' specific partial-day rates. Only those individuals may use the partial-day DT&H rate. These rates will remain the same even if the individual changes day provider. If you are completing a service agreement renewal for a person who is authorized to receive partial-day DT&H, you will need to:

    1. Complete the DT&H 15-minute framework

    2. Enter the individual's partial-day rate from the rate file sheet in the non-framework rate section of RMS

    3. Choose the “DT&H Partial Day” reason from the drop-down menu

    4. Enter a narrative stating that this is the individual's approved partial-day rate

    5. Hit calculate for the non-framework (partial day) rate

    6. Authorize the non-framework (partial day) rate in MMIS

    Service and unit types

  • • DT&H partial days
  • Training

    For additional training, see the module on partial-day DT&H scenario on the RMS User Manual Training Modules page.

    D. Service intensity

    Situation

    For people who have had an increase or decrease in service intensity with the same provider, complete the steps below:

    1. Complete the appropriate framework to reflect the service intensity before the change

    2. Complete the appropriate framework to reflect the new service intensity

    3. Calculate the difference between the two RMS framework rates

    4. Add to or subtract that difference from the rate currently authorized in MMIS

    5. Enter the final amount in the non-framework section of the RMS

    6. Choose the “Service intensity" reason in the drop-down menu

    7. Enter a narrative showing the calculation

    8. Hit calculate for the non-framework rate

    9. Authorize the non-framework rate in MMIS

    Service and unit types

  • • Residential
  • • Day
  • • Unit-based with and without programming
  • Training

    For additional training, see the modules on service-intensity change scenarios on the RMS User Manual Training Modules page.

    E. MAPCY reduction (available December 2016)

    Situation

    When a child receives foster care or supported living services waiver service in a setting eligible for Title IV-E funds, you might need to adjust the waiver funds. See the Quick Reference Guide and CBSM page for more detail on how and when you should do this calculation. Once the waiver rate is determined, you will need to:

    1. Complete the appropriate framework

    2. Enter the calculated rate in the non-framework section of the RMS

    3. Choose the "MAPCY reduction" reason in the drop-down menu

    4. Enter a narrative in the box showing the calculation of the waiver service, minus the MAPCY supplemental level

    5. Hit calculate for the non-framework rate

    6. Authorize the non-framework rate in MMIS

    Service and unit types

  • • Foster care
  • • Supported living services
  • Training

    For additional training, see the modules RMS User Manual Training Modules page

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