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Day Training and Habilitation (DT&H) Day Services

Revised: 11-17-2016

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Noncovered Services
  • Record Keeping and Retention
  • Two-Party and Three-Party Agreements
  • Authorization
  • Billing and Rates
  • Special Needs Rate Exceptions for ICF-DD Residents
  • Special Needs Rate Exceptions for Persons on the DD Waiver
  • Services Provided for Recipients age 21 and under
  • Guidelines for Full Day, Partial Day, and Transportation
  • Submitting Claims
  • Legal References
  • Provider Type Home Page Links
    Review related Web pages for the latest news and additions, forms, and quick links

    Overview

    Review the Day Training and Habilitation (DT&H) section of the Community Based Services manual (CBSM) for information about DT&H services including federal and state guidelines.

    DT&H day services are provided on a scheduled basis for periods of less than 24 hours each day.

    Eligible Providers

    Providers eligible to provide, bill and receive payment from Minnesota Health Care Programs (MHCP) for providing DT&H day services must:

  • • Be an enrolled MHCP provider and maintain 245D license
  • • Have an approved developmental disabilities (DD) waiver service authorization (SA) to provide services for the recipient
  • Counties must provide DT&H services and only provide these services through the Department of Human Services (DHS) licensed DT&H day service providers.

    MHCP Enrollment

    MHCP requires each DT&H satellite location to have its own NPI or UMPI number. To enroll to provide DT&H day services and transportation follow the instructions in the HCBS Waiver and Alternative Care (AC) Provider Enrollment section of the MHCP Provider manual.

    Contact DHS Licensing at 651-431-6500 or the DHS Licensing web page for Home and Community-Based Services (HCBS) for People with Disabilities and Age 65 or Older – 245D for information on how to get a 245D license.

    MN–ITS

    MHCP requires those who provide services to register their MN–ITS account.

    Eligible Recipients

    DT&H day services are available to people who:

  • • Are 18 years old or older and have a diagnosis of developmental disability or related condition
  • • Receive a screening for HCBS DD waiver services or reside in an Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD)
  • • Have their health and safety in the community addressed in their plan of care
  • • Make an informed choice to receive DT&H as part of their coordinated service and support plan (CSSP)
  • Counties must determine the need for DT&H day services according to requirements in Minnesota Statutes. Lead agencies must immediately contact DHS DSD Response Center at DSD.ResponseCenter@state.mn.us when their proposed actions seek to increase, grow or expand DT&H day services.

    Verify program eligibility for each recipient, each month through the MHCP phone eligibility verification system (EVS) or MN–ITS before providing services.

    Lead Agency Responsibilities

    For DT&H services identified in a CSSP, counties are responsible to:

  • • Authorize the delivery of services according to the CSSP and individual habilitation plans (required as part of the county’s provision of case management services)
  • • Develop a CSSP
  • • Ensure that transportation is provided or arranged by the vendor in the most efficient and reasonable way possible
  • • Set payment rates
  • County case managers (CM) are responsible for:

  • • Coordinating services
  • • Completing any necessary screenings
  • • Updating coordinated service and support plan changes
  • • Entering a service authorization (SA) to authorize the DT&H provider to bill DHS for services
  • Covered Services

    Use the codes in the following table to bill for services provided. DT&H transportation can be used only for DT&H services.

    Services and procedure codes

    Service Description

    Procedure Code and modifier

    DT&H – Daily (6 hours or more)

    T2020

    DT&H – Partial Day (Less than 6 hours)

    T2020 U5

    DT&H – 15 min

    T2021

    DT&H Transportation – Daily

    T2002

    Noncovered Services

    When Medical Assistance (MA) funding covers DT&H day services for people who are MA eligible and reside in an ICF-DD or are MA eligible and receive home and community-based waiver services for persons with developmental disabilities or related conditions (DD waiver), then MA funding for DT&H day services must not pay for either of the following:

  • • Special education and related services that are available through public education
  • • Vocational services that are available from the Minnesota Department of Employment and Economic Development – Division of Vocational Rehabilitation
  • Waiver Transportation
    Do not use extended transportation to supplement the DT&H transportation rate. Minnesota statutes and the federal DD waiver plan prohibit additional payment for transportation when it is included in the established rate.

    Record Keeping and Retention

    Maintain service records, fiscal records and supporting documentation identifying the items below:

  • • Service authorization (SA) from the county of financial responsibility for each recipient for whom service is billed
  • • Attendance sheets and other records documenting that the recipient received the billed services from the provider
  • • Records of all bills and, if applicable, all refunds to and from other sources for DT&H day services
  • In addition, the following requirements apply:

  • • Provider records are subject to the maintenance schedule, audit availability requirements, and other provisions in Minnesota Rules 9505.2160 to 9505.2245.
  • • Provider financial records must be available, on request, to the Minnesota Department of Human Services and the United States Department of Health and Human Services.
  • • Providers must retain a copy of the records required for five years from the date of the bill unless an audit in process requires a longer retention period.
  • • Day service providers must maintain records as necessary to submit the annual report by March 1 of each year.
  • Two-Party and Three-Party Agreements

    DHS requires two-party agreements to be completed between each ICF/DD and the DT&H day service provider that is providing residents with services. Parties need to complete these agreements only once unless there is a change in training and habilitation agencies.

    Three-party agreements between the training and habilitation agency, ICF/DD, and the county are required annually. 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. However, CMS does not recognize them 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.

    Two-Party Agreement and Assignment of Payment

    Federal regulations require that an ICF/DD whose residents receive licensed DT&H day services outside the facility must have a two-party agreement with the provider of those services.

  • • The ICF/DD and the DT&H provider must sign the two-party agreement ICF/DD Training and Habilitation Agreement (DHS-4224) (PDF). The ICF/DD completes an Assignment of Payment for Day Training and Habilitation Services (DHS-4223) (PDF) that lists all DT&H providers providing services and with whom they have an agreement. This form allows DHS to pay the DT&H day services provider. All paper invoices signed by the DT&H day services provider must also be signed by authorized personnel of the ICF/DD.
  • • All parties must retain copies of the signed agreement (DHS-4224) and assignment (DHS-4223) and a copy must be faxed to DHS Provider Enrollment at 651-431-7462.
  • • The DT&H provider must comply with the standards in the Code of Federal Regulations, title 42, sections 483.410(d) and 483.440.
  • Three-Party Agreement

    The ICF/DD, the county in which it is located, and the DT&H vendor must sign a three-party agreement Day Training and Habilitation Service Agreement (DHS-2638) (PDF), which spells out the responsibilities of each party, along with the rates, days of service and operating months.

  • • The county, the ICF/DD and the DT&H providers must retain a copy of the form, and one copy must be faxed to DHS Provider Enrollment at 651-431-7462.
  • • Counties must also send a copy of this agreement to DHS when there is a rate change or cost of living adjustment (COLA).
  • When MA funds are used to pay for DT&H day services for a person living in an ICF/DD, the county case manager:

  • • Coordinates services
  • • Completes any necessary screenings
  • • Updates coordinated service and support plan changes
  • • Contacts the county financial worker if there is a change in the recipient’s living arrangement
  • 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 the DT&H provides the required services to its residents regardless of whether the ICF/DD has given the DT&H power of attorney to act on its behalf. As stated in the Two-Party Agreement section above, when ICF/DD personnel sign, 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.

    Authorization

    Waiver services require approval from a case manager or service coordinator in the form of a completed service authorization or service agreement (SA). The SA allows the provider to bill MHCP and receive payment after the DT&H provides the services. Only services approved on the SA can be paid; however, the recipient must maintain both MA and waiver eligibility for the authorization to be valid. The case manager or service coordinator enters the SA into the DHS system (MMIS). The provider is responsible for ensuring the SA is accurate when they receive the authorization letter.

    Each line item on the SA lists the following:

  • • Minnesota Health Care Programs (MHCP) enrolled provider who is authorized to provide the needed services
  • • The rate of payment for the service
  • • The number of units approved
  • • Date or date span of authorization of service
  • • The approved procedure code(s)
  • Billing and Rates

    DT&H Day Services HCBS Waiver Rate Determination

    The Disability Waiver Rates Management System (DWRS) determines DT&H day services HCBS waiver rates according to Minnesota Statutes. After the lead agency conducts the needs assessment and community support plan to determine the recipient’s needs, the DWRS will be used to establish individual rates.

    ICF/DD MA Payment Rates for DT&H Day Services Providers

    DT&H day services must meet a minimum of 195 available service days. Bill DT&H services to MHCP that were provided to a resident of an ICF/DD only if DT&H day services are not included in the ICF/DD DHS approved rate. Three ICF/DD MA payment rates exist for providers of DT&H day services. The ICF/DD MA payment rates are:

  • • Full day service rate or payment for a full day of DT&H services. The contract between the DT&H provider and the county defines the numbers of hours that constitute a full day. 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.
  • MA will directly reimburse vendors of DT&H day services provided to residents of an ICF/DD when payment is authorized by the ICF/DD according to Minnesota Statutes.

    Special Transportation

    DT&H providers are responsible for arranging, providing, and 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 special transportation providers if those providers accept the DT&H transportation rate as payment in full. Trips to and from DT&H service sites are not eligible for payment as special transportation. Counties and county social workers or case managers may not authorize MHCP payment for special transportation to or from DT&H day services.

  • • MHCP reimburses DT&H providers a separate transportation rate, which is payment in full.
  • • Additional MHCP payment to a DT&H provider for transportation cannot be made unless a special needs rate has been authorized under Rule 186 and Minnesota Statutes 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 DT&H provider pay for transportation.
  • • 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 day 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. The special transportation provider must bill for this transportation and may not include billing for special transportation between the recipient’s residence and the DT&H site.

    Special Needs Rate Exceptions for ICF/DD Residents

    Minnesota Rules govern the authorization of special needs rate exceptions for very dependent people with special needs residing in an ICF/DD. The lead agency sends the request for a SA to DHS. DHS sends the approval letter through MN–ITS to the provider. Review the 186 Special Needs Funding section of the CBSM for more information.

    The approved service agreement indicates the following procedure codes and rates:

  • • X7010 – Direct care staff
  • • X7020 – Equipment
  • • X5628 – Professional/practitioner consultant
  • DT&H Day Services Special Needs Rate Exceptions for Persons on the DD Waiver

    The DWRS determines the DT&H day services rates according to Minnesota Statutes, including any DT&H day services rate exceptions.

    The Disability Services Division (DSD) at DHS grants final approval and will override the rate file on the SA for a person who receives the special needs rate exception. Counties do not have the ability to override the rate file in the MMIS system. Lead agencies can complete and submit the Disability Waiver Rates System Exception Request Application (DHS-5820) (PDF).

    Services for Recipients 21 Years Old or Under

    The school district must pay for DT&H day services provided to recipients 21 years old or under unless the Individual Education Plan team determines that the recipient has met educational goals and will graduate. For DHS to pay for services provided to a recipient 21 years old or under, the county case manager must send the following information to the DHS DT&H policy person before the provider bills:

  • • A copy of the recipient's diploma
  • • Recipient’s name and PMI number
  • • Date of graduation (diploma date)
  • • Site where the recipient will receive DT&H day services
  • • Begin date of services
  • If the recipient resides in an ICF/DD, bill the DT&H day services with a copy of the DHS letter as an attachment. Review Electronic Claim Attachments.

    Submitting Claims

    Bill DT&H day services electronically using the SA number if the recipient is on a DD waiver. Follow these guidelines to submit claims for full day, partial day and transportation:

  • • Use MN−ITS Direct Data Entry (DDE) or your own X12 compliance software (batch billing system).
  • • Use the Professional (837P). View the MN-ITS User Manual for DT&H Claims.
  • • When you provide services to a waiver service program recipient, a SA number is required in the Prior Authorization Number field on the Claim Information screen in MN-ITS DDE. Bill only for services already provided.
  • • Bill only for services approved on the SA. Note: Services that require a SA cannot be billed on the same claim as services that do not require a SA.
  • • If the SA 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 SA adjusted to include additional partial days.
  • • Enter a diagnosis code when submitting claims for all services. You must use the most current, most specific diagnosis code when submitting claims. MHCP will display the diagnosis code of the recipient in the service authorization letter.
  • • Submit your usual and customary charges for the service.
  • • Bill only one calendar month on each claim submission.
  • • Bill each date on a separate line.
  • Additional Billing Instructions for Recipients in an ICF/DD

    Use the codes in the following table to bill for services provided to a recipient in an ICF/DD. These services do not require a SA.

    Procedure codes for recipients in an ICF/DD

    Service Description

    Procedure code

    Full date rate (6 or more hours)

    T2020

    Partial day rate (less than 6 hours)

    T2020 with modifier U5

    Transportation

    T2002


  • • A diagnosis code is required for billing. Contact the ICF/DD or the county case manager/ service coordinator for diagnosis code.
  • • Enter the ICF/DD’s NPI or UMPI in the Claim Information-Other Providers (Claim Level) Accordion or the X12 Loop & element equivalent, when billing for DT&H day services for a recipient who lives in an ICF/DD.
  • • The DWRS does not set rates for recipients in the ICF/DD who are receiving DT&H services and transportation or ICF/DD services during the day. Provider specific service and transportation rates still apply.
  • • DT&H Day services can only be billed at a maximum of 23 days per calendar month.
  • 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 you do not provide a full day of service.
  • • If a recipient stays home because of illness or inclement weather, do not bill for DT&H day services.
  • • 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 you do not provide a full day of service.
  • Multiple Providers of DT&H Day Services for the Same Recipient on the Same Day

    Waiver SAs must include separate line items for each provider if the service is rendered on the same day by more than one agency. More than one provider 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 provider of service, services need to be coordinated and the providers must bill only the actual dates of service.

    Legal References

    Minnesota Statutes 252.28 (Commissioner of Human Services; Duties)
    Minnesota Statutes 256B.092
    (Services for Persons with Developmental Disabilities)
    Minnesota Statutes 252.41
    (Definitions)
    Minnesota Statutes 252.42
    (Service Principles)
    Minnesota Statutes 252.43
    (Commissioner’s Duties)
    Minnesota Statutes 252.44
    (County Board Responsibilities)
    Minnesota Statutes 252.45
    (Vendor’s Duties)
    Minnesota Statutes 252.46
    (Payment Rates)
    Minnesota Statutes 256B.501
    (Rates for Community-Based Services for Disabled)
    Minnesota Statutes 252.282
    (ICF/DD Local System Needs Planning)
    Minnesota Statutes 144
    (Department of Health)
    Minnesota Statutes 245D
    (Home and Community-Based Services Standards)
    Minnesota Statutes 256B.5015
    (Pass-through of Other Services Cost)
    Minnesota Rules 9525.0036
    (Determination of Need)
    Minnesota Rules 9525.1240
    (Day Training and Habilitation Agreement)
    Minnesota Rules 9525.1250
    (Reimbursable Services)
    Minnesota Rules 9505.2160
    (Scope and Applicability)
    Minnesota Rules 9505.2245
    (Appeal of Department Action)
    42 CFR 483.410(d)
    42 CFR 483.440
    42 CFR 447.10(e)

    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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