Skip To: Main content|Subnavigation|
Minnesota Department of Human Services Community-Based Services Manual (CBSM)
DHS Home CountyLink Home Manuals Home Bulletins
Advanced Search
Show/Hide Table of Contents  

Waiver and Alternative Care (AC) case management

Page posted: 10/01/03

Page reviewed: 9/28/18

Page updated: 9/28/18

Legal authority

Federally approved BI, CAC, CADI, DD and EW waiver plans, Minn. Stat. §256B.49, Minn. Stat. §256B.915, Minn. Stat. §256B.092, Minn. R. 9525.0004 to 9525.0036, Minn. Stat. §256.012

Applicability

The information on this page applies to case management provided under the following programs:

  • • Brain Injury (BI) Waiver
  • • Community Alternative Care (CAC) Waiver
  • • Community Access for Disability Inclusion (CADI) Waiver
  • • Developmental Disabilities (DD) Waiver
  • • Elderly Waiver (EW)
  • • Alternative Care (AC) program.
  • Definition

    Waiver/Alternative Care (AC) case management: A service that provides a person and his/her family with access to assessment, person-centered planning, referral, linkage, support plan monitoring, coordination and advocacy related to waiver services, resources and informal supports that are not necessarily funded through the waiver.

    Care coordination: A service for people enrolled in Minnesota Senior Health Options (MSHO) and/or Minnesota Senior Care Plus (MSC+). It provides assessment and coordination of the delivery of all health and long-term care services among different health and social service professionals and across settings of care. Care coordination also includes the waiver case management responsibilities identified above.

    Case manager/care coordinator: The professional who assists with access to and navigation of social, health, educational, vocational and other community and natural supports and services based on the person’s values, strengths, goals and needs. This professional is responsible to provide the person with information necessary for him/her to make informed choices.

    Covered services

    Waiver case management includes the following activities:

    1. Plan:

  • • Develop the support plan with the person, his/her parents or legal representative and/or anyone else the person wants to invite (e.g., informal caregivers, friends, family members, etc.)
  • • Ensure the support plan identifies the person's options and choices of services and providers, including case management and services provided in a non-disability-specific setting
  • • Provide the person with a copy of his/her support plan
  • • Review and update the support plan annually with the person
  • 2. Refer and link:

  • • Work with the person to connect with providers and services
  • • Assist the person with the appeal process
  • 3. Coordinate:

  • • Communicate with the person's team to ensure all of the person's needs are addressed
  • • Organize services and supports based on the person's needs and preferences
  • • Ensure services are not duplicated
  • 4. Monitor:

  • • Ensure providers deliver services as written in the person's plan
  • • Continually evaluate whether the support plan meets the person's needs
  • • Update the support plan as needed
  • 5. Advocate:

  • • Encourage and empower the person to make informed choices
  • • Promote health, safety, wellbeing and independence
  • • Support and respect the person's right to take risks.
  • Non-covered services

    Waiver case management cannot duplicate other Minnesota state plan or waiver services.

    Administrative activities are not billable under any waiver. Administrative activities include:

  • • Diagnosis
  • • Intake
  • • Initial determination and ongoing review of eligibility for programs and services (including Medical Assistance [MA] eligibility and disability certification)
  • • Service authorization and screening document entry into MMIS
  • • Transportation of the person
  • • Determination of financial eligibility
  • • Responding to requests for conciliation conferences and appeals in certain circumstances
  • • Job duties not directly related to the person's plan and delivery of services based on the person's individual need (e.g., training time, filing relevant documents/materials and obtaining technical assistance).
  • Service requirements and exceptions

    BI, CAC and CADI waivers

    People on BI, CAC and CADI waivers must receive another waiver service in addition to waiver case management.

    The lead agency may authorize waiver case management without another waiver service for a maximum of 60 calendar days. During this timeframe, the case manager must check in with the person at least monthly (e.g., phone calls or in-person visits).

    If the lead agency does not authorize an additional waiver service during the 60-day timeframe, the person must exit the waiver until he/she becomes eligible and the lead agency can authorize additional waiver services.

    Exception

    If the reason for not authorizing additional waiver services is that the person is transitioning between providers, services or settings, DHS allows an additional 60 days to authorize an additional waiver service. During this timeframe, the case manager must check in with the person at least monthly (e.g., phone calls or in-person visits).

    If the lead agency does not authorize services during the additional 60 days (120 days total), the person must exit the waiver until he/she becomes eligible and the lead agency can authorize additional waiver services.

    DD Waiver

    People on the DD Waiver must receive waiver case management and a residential habilitation service (see CBSM – Habilitation services – residential).

    Starting DD Waiver

    When a person starts the DD Waiver, the lead agency may authorize a support plan that does not include a residential habilitation service for a maximum of 90 calendar days. The case manager must:

  • • Document in the support plan what residential habilitation service will be in place within the 90-day timeframe
  • • Document in MMIS the reason a residential habilitation service was not authorized
  • • Contact the DSD Resource Center for help approving the service authorization (see CBSM – DSD Resource Center)
  • • Authorize a residential habilitation service within 90 days of a person starting the DD Waiver (see CBSM – Habilitation services – residential).
  • If the lead agency does not authorize a residential habilitation service during the 90-day timeframe, the person must exit the waiver until he/she becomes eligible and the lead agency can authorize additional waiver services.

    Loss of habilitation services while currently on DD Waiver

    People currently on the DD Waiver must receive waiver case management and a residential habilitation service.

    The lead agency may authorize waiver case management without a residential habilitation service for a maximum of 60 calendar days. During this timeframe, the case manager must check in with the person at least monthly (e.g., phone calls or in-person visits).

    If the lead agency does not authorize a residential habilitation service during the 60-day timeframe, the person must exit the waiver until he/she becomes eligible and the lead agency can authorize a residential habilitation service.

    Exception

    If the reason for not authorizing a residential habilitation service within 60 days is that the person is transitioning between providers, services or settings, DHS allows an additional 60 days to authorize a residential habilitation service. During this timeframe, the case manager must check in with the person at least monthly (e.g., phone calls or in-person visits).

    If the lead agency does not authorize a residential habilitation service during the additional 60 days (120 days total), the person must exit the waiver until he/she becomes eligible and the lead agency can authorize a residential habilitation service.

    EW and AC

    The exceptions listed above do not apply to EW and AC. People on EW or AC must receive another waiver service in addition to waiver case management.

    Secondary information

    Additional types of case management

    Some people who receive waiver case management also may be eligible for other types of case management (e.g., mental health case management). In these situations, DHS recommends the waiver case manager:

  • • Ensures effective communication and coordination of supports
  • • Defines roles and responsibilities clearly to ensure supports are not duplicated.
  • If the person has more than one type of case manager (e.g., person also has a mental health case manager), the waiver case manager is responsible for all covered waiver case management services.

    Excluded types of case management

    People who receive waiver case management are not eligible for the following types of case management:

    For more information about types of case management, see CBSM – Case management/care coordination.

    Provision of case management

    People may request to receive waiver case management services from a lead agency other than the lead agency responsible for managing the person's waiver. If a lead agency subcontracts with a qualified provider, choice of provider should be given to the person.

    BI, CAC, CADI and DD

    Waiver case management for people on BI, CAC, CADI and DD waivers is arranged by the county or tribal nation of financial responsibility (CFR).

    EW and AC

    For people who receive EW or AC waiver case management, the county or tribal nation of service is responsible to provide access to and arrange for the provision of case management services. For people enrolled in MSHO and MSC+, the managed care organization is responsible to provide waiver case management services.

    Financial interest

    The case manager or case management aide cannot have a personal financial interest in the services provided to the person.

    Additionally, case management or case management aide services cannot be provided by a private agency that has a financial interest in the services provided to the person.

    Frequency

    The timelines below represent the minimum required frequencies for face-to-face visits. The frequency of face-to-face visits should increase based on the person's needs.

    BI, CAC, CADI and DD

    The waiver case manager must conduct a minimum of two face-to-face visits with the person in a 12-month period. One of the visits can be included as part of the person's annual reassessment if the assessor is also the case manager.

    EW and AC

    The case manager must conduct at least one face-to-face visit per 12-month period. This visit can be included as part of the person's annual reassessment if the assessor is also the case manager.

    Provider standards and qualifications

    BI, CAC, CADI, EW and AC

    The lead agency may employ or contract with the following people to provide case management:

  • • Public health nurse
  • • Registered nurse
  • • Social worker.
  • Public health nurse and registered nurse

    A public health or registered nurse providing case management must be licensed under Minn. Stat. §148.171148.285.

    Social worker

    A social worker providing case management must either:

  • • Be a graduate from an accredited four-year college with a major in social work, psychology, sociology or a closely related field
  • • Be a graduate from an accredited four-year college with a major in any field and one year of experience as a social worker/case manager/care coordinator in a public or private social service agency.
  • For lead agencies that use the Minnesota Merit System or a county civil service system, social workers must:

  • • Apply to the Merit System to be considered for an open social worker position and put on an eligible employment list
  • • Meet the minimum qualifications of a social worker under Minn. R. 9575 or the county civil service system.
  • For more information, see DHS – About the Merit System.

    DD Waiver

    A case manager must have:

  • • A bachelor's degree (at minimum) in social work, special education, psychology, nursing, human services or other fields related to the education or treatment of people with developmental disabilities or related conditions
  • • One year of experience in education or treatment of people with developmental disabilities or related conditions, or a minimum of one course that specifically focuses on developmental disabilities
  • • 20 hours per year of training in the area of case management or developmental disabilities (the lead agency must document training and keep it on file).
  • Registered nurse requirement

    A registered nurse must be designated as either the case manager or the qualified developmental disability professional (QDDP) for people who are both:

  • • Determined to have overriding healthcare needs
  • • Seeking admission to a nursing facility or intermediate care facility for persons with developmental disabilities (ICF/DD), or accessing home and community-based waiver services.
  • Tribal nations (all waivers and AC)

    For services provided by tribal governments, alternative credentialing standards can be applied under Minn. Stat. §256B.02, subd. 7. For more information, see CBSM – Tribal administration of HCBS programs.

    Billing

    The waiver case manager must plan and deliver services based on the person's individual needs and submit claims based on case management services actually delivered. The case manager cannot bill services based on an average of billable units provided to a person, nor the average billable units provided to all people on waivers.

    Provider payment information

    DHS will not pay for waiver case management services provided by more than one provider on the same day. DHS pays the provider as indicated on the service agreement.

    Additional resources

    CBSM – Case management aide
    CBSM – Case management and travel time

    CBSM – Case management/care coordination

    CBSM – Alternative Care conversion case management

    CBSM – DSD Response Center

    CBSM – Guide to encouraging informed choice and discussing risk

    CBSM – Support planning

    DHS – About the Merit System

    DHS – Person-centered practices

    DHS – TrainLink

    DSD MMIS Reference Guide

    MHCP Provider Manual – Billing for Waiver and Alternative Care (AC) Program

    Rate/Report this pageReport/Rate this page

    © 2018 Minnesota Department of Human Services Updated: 12/12/18 8:43 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 12/12/18 8:43 AM