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Waiver programs overview

Page posted: 10/1/03

Page reviewed: 5/28/15

Page updated: 5/28/15

Legal authority

42 C.F.R. 440.180, Medicaid Waiver Plans, Minn. Stat. §256B.092; Minn. Stat. §256B.49; Minn. Stat. §256B.0915; Minn. Stat. §256B.0913

Background

Waiver programs meet the needs of targeted populations based on eligibility requirements specific to each waiver program. Waiver programs are not an entitlement.

Waiver plans:

  • • Define populations served
  • • Define services and provider standards
  • • Describe cost control formulas
  • • Describe how DHS manages waivers
  • While DHS manages the waiver programs, local agencies administer the programs. Lead agencies include counties, tribes and health plans.

    Federal guidelines

    Because each waiver program was written to meet federal guidelines, each includes:

  • • Eligibility requirements
  • • Funding parameters and limits
  • • Separate county and/or state policies
  • • Service menus.
  • Disability waiver service guidelines

    Services authorized under all disability waiver program plans must:

  • • Be within the allowable budget of the county
  • • Help a person avoid institutionalization
  • • Help a person function with greater independence in the community
  • • Meet authorization guidelines set by the federally approved state waiver plans
  • Each waiver program requires certain questions be asked about services:

  • • Are the services necessary to ensure the health, welfare and safety of the person?
  • • Are the services selected by the person as an alternative to institutionalization?
  • • Have all options been assessed and does this option meet the individual desires, needs and preferences of the person?
  • • Is the cost of the service considered reasonable and customary?
  • • Is the service covered by any other funding source?
  • For more information, see CBSM-page Financial Management of the Waivers – Overview.

    State, county or tribal responsibilities for waiver management

    State responsibilities

    DSD is responsible to:

  • • Act as a policy and technical resource for counties and tribes
  • • Assist CMS in audits of the programs prior to the five-year program renewal cycle
  • • Centrally manage county and tribal administration of the programs for statewide consistency and compliance with federal standards
  • • Design and develop services in order to obtain federal participation in the waiver programs
  • • Develop policy that expresses program and department goals
  • • Monitor program activity to assure the integrity of services and standards
  • • Provide annual reports to CMS on the performance of the waivers
  • • Renew waiver programs as required by CMS
  • • Respond to the State Legislature for development of waiver programs and services
  • County or tribal responsibilities

    Counties or tribal agencies acting as agents for the state Medicaid agency (DHS) must:

  • • Authorize and monitor services to reasonably assure health and safety
  • • Determine financial and program eligibility of persons for services and programs
  • • Enter screening document and service authorization into MMIS
  • • Help people access, coordinate and evaluate services
  • • Monitor provider performance systematically
  • • Monitor the on-going provision of services for efficacy, consumer satisfaction, continued eligibility and adjust as necessary
  • • Provide case management/service coordination for persons receiving services including assessment and service plan development
  • • Sign provider agreements with DHS to assure providers meet State standards for licensing or certification relevant to their area of service
  • • Exercise the option to enroll with DHS on behalf of market and receipt service vendors (as determined by DHS) in accordance with established state policy
  • • Work in partnership with DHS and other organizations to provide information, services and assistance to people with disabilities.
  • For a broader scope of lead agency responsibilities, reference CBSM-page State and lead agency oversight responsibilities.

    Waiver provider enrollment standards

    DHS has moved to a more centralized management of home and community-based services waiver and Alternative Care services.

    The CBSM-page Waiver/AC provider enrollment and standards provides an overview of standards for services included under the HCBS waiver and AC programs.

    MMIS codes for HCBS waiver eligibility

    County financial workers must enter disability status on the RELG screen in MMIS. This documents HCBS waiver eligibility. The following codes are the only codes county financial workers may enter for waiver eligibility:

  • • BX: Blind
  • • DC: Disabled/child age 18 through 20
  • • DP: Employed disabled with premium
  • • DX: Disabled
  • • EX: Age 65 and over
  • • 15: 1619A
  • • 16: 1619 B
  • • 09: IV-E Adoption Assistance *
  • • 10: Minnesota Adoption Assistance*
  • • 25 IV-E Foster Care*
  • *Many children who are eligible for Title IV-E adoption assistance (09), MN adoption assistance (10) and Title IV-E foster care (25) also are certified disabled and receiving HCBS waiver services. The eligibility status for these children needs to remain coded with 09, 10 or 25 for funding purposes.

    Additionally, county financial workers must add a “D”code to the indicator field in MMIS on the RELG screen to indicate disabled for purposes of waiver eligibility. See the MMIS User Manual for more information.

    Out of state services

    Services may be authorized and provided outside of Minnesota only in the certain situations. More information on out of state services.

    Waiver programs and Alternative Care

    Minnesota residents with disabilities or chronic illnesses who need certain levels of care may qualify for the Minnesota HCBS waiver programs. These programs are available to persons who choose to reside in the community and meet the eligibility criteria.

  • Alternative Care (AC) for people over age 65 years who are at risk of nursing home placement (DHS Aging and Adult Services Division administers the AC program)
  • Brain Injury (BI) Waiver for people with a traumatic, acquired or degenerative brain injury who require the level of care provided in a nursing facility that provides specialized services for persons with BI, or who require the level of care provided in a neurobehavioral hospital
  • Community Alternative Care (CAC) Waiver for chronically ill and medically fragile people who require the level of care provided in a hospital
  • Community Access for Disability Inclusion (CADI) Waiver for people with disabilities who require the level of care provided in a nursing facility
  • Developmental Disability (DD) Waiver for persons with developmental disabilities or a related condition who require the level of care provided in an Intermediate Care Facility for Persons with Persons with Developmental Disabilities (ICF/DD)
  • Elderly Waiver (EW) for people over the age of 65 years who require the level of care provided in a nursing facility and choose to reside in the community (DHS Aging and Adult Services Division administers the EW program)
  • Additional resources


    HCBS Waiver/AC Service Purchase Agreement template available for use/modification by County/Tribal Agencies (.DOC)

    Paying relatives and legally responsible individuals

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