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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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Waiver Rates and Billing

Page posted: 10/01/03

Page reviewed: 8/17/10

Page updated: 1/27/15

Legal Authority

Minn. Stat. §256B.0625, Minn. Stat. §256B.0627, Minn. Stat. §256B.092 and Minn. Stat. §256B.49

Definitions

Rate: Fixed charge per unit of a commodity or service.

Background

DHS uses rate-setting methodologies to determine waiver rates. DHS has a range of rate methodologies to assist lead agencies to calculate rate amounts for services.

Service Rates

DHS publishes new HCBS waiver program service rates with instructions for lead agencies. For HCBS waiver program services DHS publishes these rates as a reference file rate limit.

Lead agencies use rate limits as a guide to determine what a reasonable rate should be when negotiating service rates with providers. View complete sets of rates, codes and rate maximums on the Continuing care and other provider rate changes page.

Lead Agency Contracts

Counties and tribes were directed to terminate contracts with waiver service providers effective Jan. 1, 2014, with the following exceptions:

  • • Case management
  • • Home or vehicle modifications for a participant
  • Lead agencies may negotiate rates with providers for some waiver services at higher rates than the maximum rates listed in the current reference file rate limits.

    However, lead agencies are responsible to keep within their resource limit set by DHS.

    Alternative Pricing Method

    Lead agencies may price some waiver services using the alternative pricing method. By using this method, the provider has more flexibility in billing DHS for services rendered or for items purchased.

    To price an item using this method, place the total amount of the service or item in the "REQ TOT AMT" field, leaving the "REQ RATE" and "UNIT" fields blank.

    Waiver Rate Management System

    The disability waiver rate system (DWRS) determines individualized payment rates for certain BI, CAC, CADI and DD waiver services.

    Lead agency workers use the Rate Management System (RMS) tool to calculate payment rates for specific authorized services, which are then entered into Medicaid Management Information Systems (MMIS). The RMS User Manual provides operational information to help them lead agencies effectively use this tool.

    Related Policies

    Financial Management of CAC, CADI and BI Waivers
    Financial Management of DD Waiver
    Financial Management of the Waivers - Overview

    Rates

    Additional Resources

    HCBS provider enrollment and provider standards CBSM page
    MHCP Provider Manual, Chapter 1
    (billing claims information)

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    © 2017 Minnesota Department of Human Services Updated: 1/27/15 9:48 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 1/27/15 9:48 AM