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Banding scenarios

Banding limits changes in service payment rates that are caused by Disability Waiver Rates System (DWRS) implementation. For more information, please see the section on banding on the Rate Management System (RMS) page in the Community-Based Services Manual (CBSM).

Non-framework rates processes

In some situations, a user will need to manually band to a non-framework rate. This may happen in the following circumstances:

  • Exception approved by DHS
  • Change in residential service provider
  • Historic rate not available
  • Service intensity changed
  • MAPCY reduction.
  • Never manually band to account for regional variance factors, cost of living or banding adjustments. The RMS automatically calculates and applies these adjustments.

    Scenarios

    Exception approved by DHS

    Situation

    You must first submit an exception request via the DWRS Exception Request Application, DHS-5820 form. DHS will send an approval email if it approves the exception rate.

    Steps if DHS approves exception

    You will then need to:

    1. Complete the appropriate framework in the MnCHOICES Support Plan
    2. Enter the approved exception rate in the unit rate field in the non-framework rate information section
    3. Choose the exception approved by DHS option
    4. Enter a narrative in the box and the date DHS approved the exception rate
    5. Select the calculate & save button
    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 understanding the exception process module on the RMS User Manual Training Modules page.

    Change in residential service provider

    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 change in residential service provider rate calculation. You should determine the service rate using the lead agency's historic method of rate setting.

    Steps once you determine service rate

    You will need to:

    1. Complete the appropriate framework in the MnCHOICES Support Plan
    2. Enter the rate in the unit rate field in the non-framework rate information section
    3. Choose the change in residential service provider option
    4. Enter a narrative in the box to describe the change in residential service provider
    5. Select the calculate & save button
    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.

    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's banding file. A historic rate also may be missing if the lead agency did not match the Healthcare Common Procedure Code (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 person's historic rate.

    Steps to manually band

    You will need to:

    1. Complete the appropriate framework in the MnCHOICES Support Plan
    2. Enter the correct rate in the unit rate field in the non-framework rate information section
    3. Choose the historic rate not available option
    4. Enter a narrative in the box about the reason the person should be banded to the historic rate. Include the correct historic rate and any banding adjustments that need to be made
    5. Select the calculate & save button
    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 about banding and how to complete non-framework rates in the MnCHOICES Support Plan on the RMS User Manual Training Modules page.

    Service intensity changed

    Situation

    For people who had an increase or decrease in service intensity with the same provider:

    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 unit rate field in the non-framework rate information section
    6. Choose the service intensity changed option
    7. Enter a narrative to explain that a service intensity change has taken place and show the calculation
    8. Select the calculate & save button
    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 module about service-intensity change scenarios on the RMS User Manual Training Modules page.

    MAPCY reduction

    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 – Funding for children in foster care settings for detail on how and when you should do this calculation.

    Steps once you determine the waiver rate

    You will need to:

    1. Complete the appropriate framework in the MnCHOICES Support Plan
    2. Enter the calculated rate in the unit rate field in the non-framework rate information section
    3. Choose the MAPCY reduction option
    4. Enter a narrative in the box and show the calculation of the waiver service, minus the MAPCY supplemental level
    5. Select the calculate & save button
    6. Authorize the non-framework rate in MMIS.

    Service and unit types

  • • Foster care
  • • Supported living services.
  • Training

    For additional training, see the MAPCY reduction module on the RMS User Manual Training Modules page

    Temporary manual banding scenario for respite (daily)

    Background information

    The recently approved waiver amendment removes respite (daily) from the framework rate category of the Disability Waiver Rate System (DWRS). Lead agency staff no longer will use the Rate Management System (RMS) framework to determine rates for respite (daily) authorizations. Respite (daily) is now a market-rate service. For more information, see the April 6, 2018, eList.

    Note about respite (15-minute)

    Respite (15-minute) is still a DWRS framework service. You must use RMS within the MnCHOICES Support Plan Application to determine respite (15-minute) unit rates.

    Instructions for MnCHOICES Support Plan Application

    For new respite (daily) rate entries in the MnCHOICES Support Plan Application, lead agency staff needs to enter the market rate as a manually banded unit rate until the system is updated. On the RMS calculator screen for respite (daily), lead agency staff needs to:

  • • Complete the “customization” field in the “other” section
  • • Select “historic rate not available”
  • • Enter the market-rate in the “unit rate” field
  • • Type “market-rate service” in the required notes field
  • • Click on the “calculate and save” button.
  • Instructions for MMIS

    For existing MMIS disability waiver service agreements with respite (daily) authorizations, the lead agency does not need to update the rate until renewal.

    For new MMIS disability waiver service agreements that will have respite (daily) authorizations, the lead agency needs to enter the market rate for the service.

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    © 2018 Minnesota Department of Human Services Updated: 4/6/18 12:24 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 4/6/18 12:24 PM