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Day Training and Habilitation (DT&H)

Revised: 06-16-2011

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When counties determine the need for DT&H services under MS 252.28, the county must contract with licensed providers as specified in MS 256B.092. Services must be provided in accordance with MS 252.40 to 252.47 and standards promulgated under these statutes. Following is a description of the available funding sources to pay vendors of DT&H services: (revised 3/19/04)

Medical Assistance (MA) funding covers individuals who are MA eligible and reside in an ICF-DD or are MA eligible and on a home and community based waiver program for persons with developmental disability or related conditions (DD/RC waiver).

• MA payment for DT&H services must not replace the Minnesota Division of Vocational Rehabilitation money for sheltered work or work activity services.
• MA reimbursable day training and habilitation services must not exceed the number of days per calendar year as provided by MS 256B.501, subd. 5(e). Day training and habilitation services must not include:
• Special education and related services which otherwise are available through a local educational agency; or
• Vocational services which are otherwise available from a local vocational rehabilitation agency.

The Children and Community Services Act replaces the Community Social Services Act (CSSA) Chapter 256E, which was repealed as of July 1, 2003. The bill can be viewed at 256M.01-256M.80.

• The new law requires that counties assess the needs of the people they serve, prioritize the services they will provide over a two year period, meet with local constituents to review their plans, and then submit a plan to DHS of how they intend to best meet the needs of their residents with the funds available. The county and the DHS Children and Family Services Division then enter into a biennial service agreement.
• To the extent provided in the county service agreement, and in the Individual Service Plan (ISP), the county is responsible for providing DT&H services or alternative habilitation services during the day for persons with developmental disabilities. See Bulletin #03-68-10, pages 4 & 5.

DT&H Services are services related to a person's employment or work, self-care, communication skills, socialization, community orientation, transportation needs, emotional development, development of adaptive behavior, cognitive development, and physical mobility. Includes training, supervision assistance, and other support activities designed and implemented in accordance with a person’s individual service plan to help that person attain and maintain the highest level of independence, productivity, and integration into the community where the person lives and works. The ISP for each person requiring a 24-hour plan of care must provide services during the day outside the residence unless otherwise specified in their plan. (revised 3/19/04)

Intermediate Care Facility for Persons with Developmental Disability or Related Conditions (ICF/DD): The provider of a program licensed to serve persons who are developmentally disabled under MS 252.282; and a physical plant licensed as a supervised living facility under MS 144, which together are certified by the MDH as an intermediate care facility for persons with developmental disability or related conditions. Unless otherwise indicated, the term ICF-DD includes state-operated and community-based facilities.


Requirements for MA Reimbursement
Licensure under MS 245B (Consolidated Standards) and Minnesota Rules 9525.1580 and 9525.1600: Requirements for reimbursement include licensure under MS 252.40 to 252.47 and standards promulgated under these statutes.

• MA will directly reimburse vendors of DT&H services provided to residents of an ICF-DD when payment is authorized by the ICF-DD in accordance with procedures established in MS 256B.5015.
• Other conditions for provider enrollment in the MA program must be met.

Record Keeping and Retention
The vendor must maintain program records, fiscal records, and supporting documentation identifying the items below:

• Authorization from the county of financial responsibility, as provided by Minnesota Rules 9525.1250, subp. 2, for each recipient for whom service is billed;
• Attendance sheets and other records documenting that the recipient received the billed services from the vendor; and
• Records of all bills and, if applicable, all refunds to and from other sources for DT&H services.
• Vendor records shall be subject to the maintenance schedule, audit availability requirements, and other provisions in Minnesota Rules 9505.2160 to 9505.2245.
• Vendor financial records must be available, on request, to the commissioner and the United States Department of Health and Human Services.
• The vendor shall retain a copy of the records required as listed under Record Keeping and Retention above, for five years from the date of the bill unless an audit in process requires a longer retention period.
• The day service vendor shall maintain such records as may be necessary to submit the annual report by March 1, as provided by MS 256B.501, subd. 9.

Two-Party Agreement and Assignment of Payment
Federal regulations stipulate that an ICF-DD whose residents receive licensed DT&H services outside the facility must have a two-party agreement with the vendor of services.

• The ICF-DD and DT&H sign the Two-Party Agreement (ICF-DD Training and Habilitation Agreement form). The ICF-DD completes an Assignment of Payment form that lists all DT&H vendors providing services and with whom they have an agreement. This form allows DHS to pay the DT&H services vendor. All paper invoices signed by the DT&H services vendor must also be signed by authorized personnel of the ICF-DD.
• Paper copies of the Assignment of Payment form and the Two-Party Agreement form are available from DHS Provider Enrollment. Copies of the signed agreements and arrangements must be retained by all parties and sent to DHS Provider Enrollment.
• The DT&H vendor must be in compliance with the standards in the Code of Federal Regulations, title 42, sections 483.410(d) and 483.440.
• DT&H vendors using MN-ITS must enter information in the Other Provider Types dropdown on the Provider tab.

Three-Party Agreement
The ICF-DD, the county in which it is located, and the DT&H vendor sign a Three-Party Agreement (DHS-2638) which spells out the responsibilities of each party along with the rates, days of service and operating months.

• The county, the provider (ICF-DD) and the vendor (DT&H) retain a copy of the form, and one copy must be sent to DHS - Disability Services Division (DSD). (revised 3/19/04)
• Counties must also send a copy of this agreement to DHS when there is a rate change or provider rate increase (Cost of Living Adjustment [COLA]).

When MA funds are used to pay for DT&H services for individuals living in an ICF-DD, the county case manager coordinates services, completes any necessary screenings, and Individual Service Plan changes. The case manager contacts the county financial worker if there is a change in the recipient’s living arrangement.


Differences Between Two and Three-Party Agreements
Three-Party Agreements between the training and habilitation agency, ICF-DD, and the county are required annually in accordance with Minnesota Rules 9525.1240. These agreements outline the responsibilities of each party and reflect the current approved MA reimbursement rates, service hours, days of service, and operating months. Three-Party Agreements are necessary to comply with county contracting requirements found in statute and rule, even though they are not recognized by CMS as evidence of compliance with 42 CFR 447.10 (e) which requires the ICF-DD to have a separate written agreement with each training and habilitation agency providing services to residents. DHS requires that a Two-Party Agreement be completed between each ICF-DD and the DT&H service vendor providing residents with services. These agreements are completed only once unless there is a change in training and habilitation agencies. Parties to the agreement should keep a copy and submit a copy to the DHS - DSD.

DT&H Services for Waivered Program Recipients

The county case manager coordinates services, completes any necessary screenings, and Individual Service Plan changes. The county case manager enters a service agreement that will authorize the DT&H vendor to bill DHS for services.

Other Possible Service Options for DT&Hs

Vendors who wish to provide waivered services that are different than DT&H bundled services can be licensed and enrolled with DHS as a waivered services provider.

Changes in the statute allow the same provider to provide both DT&H and residential services to a recipient, if certain conditions are met (MS 256B.092, subd. 5[b]).

• Work with your host county to determine need for services.
• Contact DHS Provider Enrollment by telephone at (651) 431-2700 or 1-800-366-5411, option 5, for a Home and Community Based Services Provider Enrollment Application (or online at http://edocs.dhs.state.mn.us/lfserver/public/DHS-4015-ENG).
• Contact DHS Licensing at (651) 296-3971 to obtain an application to become licensed as a 245B-WS (waiver services) provider.
• You must obtain a separate license for each county in which services will be provided. The waivered services license is specific to the county where services are provided. The license allows you to provide waivered services to persons of any age, with no more than four persons at any one site at a time.
• If recipients who are supported through the waiver services license will be provided services at the DT&H site, these services are subject to the terms of the waivered services license, including the capacity limit of no more than four persons at any one site. If the DT&H site is a location where waivered services are provided, the physical plant must have current (at the time of waivered services licensure) building inspector and fire marshal approvals for this intended use.
• In some instances, the DT&H vendor for a recipient may also provide waivered services to that recipient. At the time the recipient begins receiving licensed waivered services, s/he is considered a new service initiation under the waivered services license. All consolidated standards and other applicable licensing requirements pertaining to service initiation apply to this consumer.
• Any staff person who provides services under a DT&H license, and then provides services under one or more waivered services licenses held by the DT&H provider, will be considered a newly-hired staff person under the waivered services license(s). All consolidated standards and other applicable requirements pertaining to staff orientation will apply to this staff person.

Services DT&H Vendors May Provide Through Waivers
See Home and Community Based Waivered Services for a detailed description of who can provide the services, and related billing information.

Rate Determination

Regardless of the funding source, the county board in which an approved vendor is located recommends all service payment rates for approval by the Commissioner in accordance with MS 252.40 to 252.47 and standards promulgated thereafter.

At the county's request, a program may be granted a rate variance if it meets specific eligibility criteria detailed in MS 252.46, subd. 6. The formal appeal process for DHS denial of a rate change request is described in MS 252.46, subd. 19.

All DT&H vendors submit rate increase recommendations to the host-county for approval on forms issued in a DHS bulletin. DHS enters the new rate into the claims processing and payment system and counties make appropriate changes to service agreements.

Payment Rates

DT&H services must meet a minimum of 195 available service days. Services provided to a resident of an ICF-DD can be billed to MHCP only if DT&H services are not included in the ICF-DD DHS approved rate. Minnesota statutes establish three payment rates for providers of DT&H services, and one optional rate including:

• Full day service rate or payment for a full day of DT&H services. The numbers of hours that constitute a full day are defined in the contract between the DT&H provider and the county. A full day must include six or more program hours, including the time it takes to transport the recipient to and from the service site.
• Partial day service rate or payment for less than a full day of DT&H services. This rate is for services provided less than six hours a day or less than the full day established in the agreement between the ICF-DD and the county. This rate must not exceed 75% of the full day rate.
• Transportation rate or payment for transportation from the recipient's residence to the service site and back home. Except in unusual circumstances, the license holder must not transport the recipient for longer than 90 minutes per one-way trip.

Special Transportation
DT&H providers are responsible for arranging, providing, and/or paying for transportation of a recipient to and from the recipient’s residence and the DT&H service site. DT&H providers can subcontract with specials transportation providers if those providers accept the DT&H transportation rate as payment in full. Relevant laws include MS 252.45, 252.46, and 252.44, and Minnesota Rules 9505.0315 and 9525.1200. Trips to and from DT&H service sites are not eligible for payment as special transportation. Counties and county social workers/case managers may not authorize MHCP payment for special transportation to or from DT&H services.

• MHCP reimburses DT&H providers a separate transportation rate, which is to be considered payment in full.
• Additional MHCP payment to a DT&H for transportation cannot be made unless a special needs rate has been authorized under Rule 186 and MS 256B.501, subd. 8.
• When other MHCP-covered services are provided to a recipient in a DT&H setting, those services are considered secondary to the DT&H service and do not alter the requirement that the payment for transportation must be made by the DT&H provider.
• The Special Transportation providers must determine whether a trip is eligible for Special Transportation payment.

Exception for Special Transportation
The only circumstance under which MHCP special transportation may be billed for a trip to or from a DT&H site for a recipient receiving DT&H services at that site is when a recipient is being transported from the DT&H site to a site providing MHCP-covered services that are not DT&H services. This transportation must be billed by the special transportation provider and may not include billing for special transportation between the recipient’s residence and the DT&H site.

Pilot Rates
Pilot rates (formerly titled Hourly rates), with the HIPAA code changes, went from 60 minutes to 15 minute codes

This information pertains to vendors and host counties who participate in a pilot rate payment system. The pilot rate system will not be implemented statewide. If desired, providers and counties can work with DHS to develop a revenue-neutral transition to the site based rate structure. Pilot payment rates and procedures are determined by DHS. Fifteen (15) minute services are authorized by counties and billed by providers using the following codes for both ICF-DD and waiver recipients:

Billing Rate Hourly Billing Codes (for Service dates prior to 9/30/06) 15 Minute Billing Codes (for Service dates on/after 10/1/06)
A rate (1:1 services) Units capped per year X5296 T2020 with modifier TG
B rate (*Level 1) X5297 T2020 with modifier TF
C rate (*Level 2) X5298 T2002 with modifier UB
D rate (*Level 3) X5299 T2021
*Service Authorization level

Counties must authorize and complete the service agreement for all waiver recipient services and one-to-one services for ICF-DD residents. Payment for rates B-D corresponds to the level of service authorized in box 43 of the Screening Document for Persons with Developmental Disabilities.

Special Needs Rate Exceptions for ICF-DD Residents

Minnesota Rules 9510.1020 to 9510.1140 (Rule 186) DHS governs the authorization of special needs rate exceptions for very dependent persons with special needs residing in an ICF-DD. A vendor and recipient specific service agreement and approval letter are generated and sent to the provider when a request is approved.

The billing code and rate is indicated on the approved service agreement:

• X7010 - Direct care staff
• X7020 - Equipment
• X5628 - Professional/practitioner consultant

Special Needs Rate Exceptions for Persons on the DD/RC Waiver

The special needs rate exception for persons on the DD/RC waiver was first clarified in DHS Informational Bulletin #95-61A, dated April 20, 1995. The county cannot negotiate an individual rate for a recipient that is different from the established DT&H rates unless authorization is received from DHS in accordance with Rule 186 criteria. Recipients who receive a rate exception are considered to have the same level of need as recipients who reside in an ICF/DD. MS 256B.501, subd. 8, allows for additional dollars to be available a maximum of 12 months to allow a recipient to continue to receive DT&H services.

The following is the process for making the request:

• The provider submits a proposal to the CFR for the person. The proposal should be based on "above and beyond the current rate that they are receiving". This is what will be needed to continue to serve the person. The proposal is based on services, which are clearly special services not covered under the established rate.
• For example, the provider's current full time rate is $50.00 and they need _____ amount above this rate to serve a recipient due to medical or behavior issues. This could also be applied to just the transportation rate.
• Typically the provider comes up with a rate based on 1:1 staff serving the person. This may include wages and a benefit component.
• The case manager will verify that the person meets the eligibility criteria and is screened and authorized for DD/RC waivered services.
• The county then submits the rate exception proposal to the DHS-DSD DT&H policy person. In addition to the provider information. The case manager should include the ISP, which indicates a need for a habilitation component that cannot be met within the established rate of the DT&H.

The maximum approval period is 12 months and cannot be renewed except in exceptional circumstances. It is expected that the need for the rate exception will be eliminated in the 12 month period. The costs for the rate exception must be managed within the county waiver pool.

DHS-DSD grants final approval and will override the rate file on the service agreement for the person who receives the special needs rate exception. Counties do not have the ability to override the rate file in the MMIS system.

Services Provided to Recipients Under Twenty One Years of Age

DT&H services provided to recipients under the age of twenty-one must be paid by the school district unless the Individual Education Plan team determines that educational goals have been met and the recipient will graduate. In order for a vendor to bill and be paid by DHS for services provided to a recipient age 22 or under, the following steps must be taken:

• The recipient's county case manager must send the following information to the DHS DT&H policy person:
• A copy of the recipient's diploma
• Recipient name and MHCP ID number
• Date of graduation (diploma date)
• The site where the recipient will receive DT&H service
• Beginning date of service
• If the recipient resides in an ICF-DD, the DT&H services must be billed on a paper CMS-1500 with a copy of the DHS letter attached.
• If the recipient is on a DD/RC waiver, DT&H services can be electronically billed using the service agreement number.

Guidelines for Full Day, Partial Day, and Transportation

If a recipient is sent home because of a weather emergency or illness, bill for a partial day if a full day of service is not provided. If a recipient stays home because of illness or inclement weather, DT&H services cannot be billed.

If a recipient is transported only one way (either to or from the training site), bill the full transportation rate if transportation is provided, arranged, or contracted for at least one way.

If a recipient leaves early or arrives late because of a scheduled doctor or dentist appointment, bill for the partial day rate if a full day of service is not provided. All efforts should be made to schedule medical and dental appointments at times that do not interfere with required training and habilitation services. This also applies to a scheduled therapy, program, or vocational service that is not a DT&H service or included in the MA per diem but is scheduled in accordance with the ISP.


Billing for Full Day, Partial Day, and Transportation
• Use the CMS-1500 claim form, or MN-ITS (837P in MN-ITS Interactive for individual claim entry or Batch for multiple claim submission) to bill for DT&H services. Bill only one calendar month on each claim.
• A diagnosis code is required when the recipient resides in an ICF-DD. Contact the ICF-DD or the county case manager/service coordinator for diagnosis code information. Diagnosis codes are required for billing services provided to a waivered service program recipient as of October 16, 2003, to comply with HIPAA regulations.
• When services are provided to a waivered service program recipient, a service agreement number is required in box 23 on the CMS-1500 claim form or in the Authorization Number field on the Claim Information tab in MN-ITS Interactive. A service agreement number is not required when the recipient resides in an ICF-DD. (See the DHS 837P training module for billing CMS-1500 claim forms and choose the Batch option.)
Use the following codes to bill for services provided to a recipient in an ICF-DD. These services do not require prior authorization (service agreement):

Service Description Billing codes for Service dates prior to 9/30/06 Billing codes for Service dates on/after to 10/1/06
Full date rate(6 or more hours) X7000 T2020
Partial day rate (less than 6 hours) X7001 T2020 with modifier U5
Transportation X7002 T2002

Use the following codes to bill for services provided to home and community based DD/RC waivered service program recipients. These services require prior authorization (service agreement) by the county case manager:

Service Description Billing codes for Service dates prior to 9/30/06 Billing codes for Service dates on/after to 10/1/06
Full date rate(6 or more hours) X5680 T2020
Partial day rate (less than 6 hours) X5679 T2020 with modifier U5
Transportation X5681 T2002

If the service agreement does not have an appropriate number of partial days, do not substitute and bill for a full day. This is considered a fraudulent billing practice. Contact the county case manager to have the service agreement adjusted to include additional partial days.

• Enter the ICF-DD’s National Provider Identifier (NPI) or Unique Minnesota Provider Identifier (UMPI) in box 24J, or the electronic equivalent, when billing for DT&H services for a recipient who lives in an ICF-DD.
• A partial day and a full day may be billed on the same CMS-1500 claim form using separate lines. Enter a "from" and "through" date if services are provided on consecutive days. The unit box must contain the day(s) the recipient was present in the day training program. The combined units of services must not exceed the monthly limitations. Daily attendance records must be kept on site and are subject to audit.
• Transportation cannot be billed using "from" and "through" dates of an entire month if a recipient resides in an ICF-DD and attends DT&H for some partial and some full days in that month. Bill transportation line by line to match partial and full days of service.
• Extended transportation billing code X5601 cannot be used to supplement the DT&H transportation rate. Minnesota statute and the federal DD/RC waiver plan prohibit additional payment for transportation when it is included in the established rate.

Multiple Providers of DT&H for the Same Recipient/Same Day
Waivered service agreements must include separate line items for each vendor if the service is rendered on the same day by more than one agency. More than one vendor may bill for approved partial day services provided on the same day. Only one provider may bill for daily service codes per day. If there is more than one vendor of service, services need to be coordinated and only the actual dates of service should be billed. Date spans can be used when services are provided on consecutive days.

DT&H and ICF-DD Signature Requirements

The DT&H and ICF-DD may make any legal arrangement to secure authorized signatures on billing invoices. Each ICF-DD is responsible for ensuring that required services are provided to its residents regardless of whether or not it has given the DT&H "power of attorney" to act on its behalf. As stated in the Two-Party Agreement section, when ICF-DD personnel sign the CMS-1500 claim form, they are accepting responsibility for the accuracy and legitimacy of the bills they authorize for submission to DHS. This means they are verifying the accuracy of the stated charges, days of service, and transportation provided for each recipient who is a resident of the ICF-DD. The Two-Party Agreement also states that the DT&H accepts responsibility for the accuracy and legitimacy of bills it submits to the ICF-DD for signature.

Legal References

MS 252.28
MS 256B.092
MS 252.40 to 252.47
MS 256B.501
Children and Community Services Act (256M.01-256M.80)
MS 252.282
MS 144
MS 245B
Minnesota Rules 9525.1580
Minnesota Rules 9525.1600
MS 256B.5015
Minnesota Rules 9525.1250
Minnesota Rules 9505.2160
Minnesota Rules 9505.2245
42 CFR 483.410(d)
42 CFR 483.440
Minnesota Rules 9525.1240
42 CFR 447.10(e)
MS 256B.092, subd. 5(b)

CPT codes, descriptions and other data only are copyright 2002 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.


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