MMIS field name

MnCHOICES field name

Description

DOCUMENT NBR

Not a field on the LTC screening document printout

This field is system-entered. MMIS assigns a document number to each screening document.

Found at the top of DHS-3427 but no field number assigned

DOC STATUS

Not a field on the LTC screening document printout

This field is system-entered. MMIS assigns a status to the document when saved. The status MMIS assigns (e.g., S for suspended or A for approved) is based on other data within the document.

Not a field on DHS-3427

CURR LOC/DT

Not a field on the LTC screening document printout

If the screening document has been routed to DHS or a county/Tribal Nation for action, this field records:

Not a field on DHS-3427

OVERRIDE LOC

Not a field on the LTC screening document printout

This field sends a suspended screening document from county/Tribal Nation staff to other county/Tribal Nation staff or DHS when you enter a routing queue code.

Not a field on DHS-3427

VERIFICATION CODE

Not a field on the LTC screening document printout

This field is system-entered. MMIS assigns a verification code on the first assessment screening document entered with activity type 02 or 04.

Before Aug. 1, 2024, this code was used for people seeking admission to an assisted living setting.

The number MMIS assigns does not change over time.

Not a field on DHS-3427

CLIENT NAME/ID

Person last name

This field is system-entered based on the RECIPIENT ID (PMI) entered on the SCRNG key panel screen.

1

CLIENT NAME/ID

Person first name

This field is system-entered based on the RECIPIENT ID (PMI) entered on the SCRNG key panel screen.

2

CLIENT NAME/ID

Person middle name

This field is system-entered based on the RECIPIENT ID (PMI) entered on the SCRNG key panel screen.

3

CLIENT NAME/ID

Not a field on the LTC screening document printout

This field is system-entered based on the RECIPIENT ID (PMI) entered on the SCRNG key panel screen.

4

REF NBR

Reference number

This field is optional. Lead agencies can use it to identify the person.

5

AGE

Not a field on the LTC screening document printout

This field is system-entered based on the date of birth and activity date used in ACT DT field on the ALT4 screen.

Not a field on DHS-3427

LA

Not a field on the LTC screening document printout

This field is system-entered based on the living arrangement information in the recipient subsystem in the RLVA screen.

Not a field on DHS-3427

DATE SUB

Date submitted

This field is system-entered. It is the date the screening document is entered and saved in MMIS.

6

DOB

Birth date

This field records the person’s date of birth in DD/MM/YYYY format. You must always enter it on the ALT1 screen.

This field must match the date of birth listed in the recipient subsystem. The date is tied to the date of birth in the MAXIS/PMIN system when the PMI was created.

7

SEX

Sex

This field is system-entered based on information in the recipient subsystem. The date is tied to the date of birth in the MAXIS/PMIN system when the PMI was created.

8

REF DATE

Referral date

This field records the date of the referral/request.

9

NEXT NF VISIT

Next NF visit

This field is system-entered. It indicates the date of the next required visit for a person younger than age 65 in a nursing facility (NF) when they refuse an annual visit after the initial NF visit.

The person may waive the annual assessment for no more than two consecutive years. The next required visit date is delayed for three years, as calculated by MMIS. For more information, refer to CBSM – Choice to waiver annual assessment.

10

ACTIVITY TYPE

Activity type

This field records the type of assessment or administrative activity the lead agency completed.

11

ACT DT

Activity type date

This field records the date the lead agency performed an assessment or administrative activity.

MMIS also calculates and shows the age of the person as of the activity date.

12

COS

County of service

This field records the county/Tribal Nation that provides eligibility worker services, as identified by the worker ID listed on the case number in the recipient subsystem.

Note: For people on the AC and ECS programs, use the county of residence (COR) for this field. People on these programs do not have an eligibility worker.

13

COR

County of residence

This field records the county where the person resides, as identified by the county listed on the residential address in the recipient subsystem.

13A

CFR

County of financial responsibility

This field records the county or Tribal Nation financially responsible for the person's Medical Assistance or other Minnesota Health Care Programs, as identified by the CFR listed on the major program span in the recipient subsystem.

Note: For people on the AC and ECS programs, use the COR for this field. People on these programs do not have an eligibility worker.

13B

LTCC CTY

LTCC county

This field records the lead agency that completed the assessment or administrative activity.

For applicable values, refer to CBSM – Minnesota county, Tribal Nation and managed care organization codes.

Minnesota Aging Pathways (formerly Senior LinkAge Line) staff enter their information in this field for preadmission screenings.

14

LEGAL REP STAT

Legal representative status

This field records whether a person has a guardian or other legal representative status as determined by a court.

15

PRIMARY DIAG

Primary diagnosis

This field is required. It records the person’s primary diagnosis, which is often related to their need for services and care. If you move the cursor to any of the diagnosis fields and press F4, MMIS will show the name of the condition and other information represented by the diagnostic code.

Assessors may use the following diagnosis codes when a diagnosis from a qualified diagnosing provider is unavailable:

This field is required because providers receive the primary diagnosis code on the service agreement letter. They will use the code on their claim form if they do not have another diagnostic code from a diagnosing provider. All claims require a diagnostic code.

16

SECONDARY DIAG

Secondary diagnosis

This field is optional. It records the person’s secondary diagnosis that may affect their need for care or services.

17

DD DIAGNOSIS HISTORY

Is there a history of a DD diagnosis?

This field records if the person has a history of a DD or related condition diagnosis. Use Y for yes or N for no.

This field is related to when a person needs an OBRA level II evaluation.

18

DD DIAGNOSIS

If so, what is the DD diagnosis?

This field records the developmental disabilities (DD) diagnosis or determination of a related condition. This field is required if the DD DIAGNOSIS HISTORY field is Y.

Use the applicable ICD-10 DD diagnosis code:

18A

MI DIAGNOSIS HISTORY

Is there a history of an MI diagnosis?

This field records if the person has a history of a mental illness (MI) diagnosis. Use Y for yes or N for no.

This field might indicate the person needs an OBRA Level II evaluation if the assessment result is admission to a nursing facility.

19

MI DIAGNOSIS

If so, what is the MI diagnosis?

This field records the MI diagnosis. Use diagnosis codes obtained from medical records. This field is required if the MI DIAGNOSIS HISTORY field is Y.

19A

BI DIAGNOSIS HISTORY

Is there a history of a BI diagnosis?

This field records if the person has a history of a brain injury (BI) diagnosis. Use Y for yes or N for no.

20

BI DIAGNOSIS

If so, what is the BI diagnosis?

This field records the BI diagnosis. Use diagnosis codes from the person’s medical records. This field is required if the BI DIAGNOSIS HISTORY field is Y.

20A

CM/HP/CA NAME

Certified assessor/care coordinator name

This field is system-entered based on the CM/HP/CA NBR field.

22

MMIS field name

MnCHOICES field name

Description

PRESENT AT SCRNG

Present at assessment (12 fields) on the LTC screening document printout

These fields record who was present at the assessment. You can enter up to 12 values. You cannot enter duplicate codes.

24

INFORMAL CAREGIVER

Informal caregiver

This field records if the person has an informal caregiver who provides regular services or support. Use Y for yes or N for no.

24A

MARITAL STATUS

Marital status

This field records the person’s legal marital status.

25

REASONS FOR REF-1

Reasons for referral

This field records why someone made a request or referral for an assessment.

26

REASONS FOR REF-2

Reasons for referral secondary

This field records if there was secondary reason for a request or referral. You cannot enter duplicate codes.

26A

CURRENT LA

Current living arrangement

This field records the person’s current living arrangement.

27

PLANNED LA

Planned living arrangement

This field records the person’s planned living arrangement.

28

TEAM

Assessment team

This field records who completed the assessment. Use value 04 if the person will use or currently uses the Community Alternative Care (CAC) Waiver program.

29

HOSP TRNF

Hospital transfer

This field records if the person transferred from an acute hospital to the community or to a long-term care facility (nursing or certified boarding care facility). Use Y for yes or N for no.

30

OBRA LVL 1 SCR

OBRA screening level I

This field records if the person received an OBRA level I screening. Use Y for yes or N for no.

If the person is starting a waiver or currently on a waiver, this field must be Y.

31

DENTAL CONCERNS

Not a field on the LTC screening document printout

This field records dental concerns for MSHO, MSC+ and SNBC health risk assessments. Use Y for yes, N for no or C for chose not to answer. Otherwise, leave this field blank.

Only on DHS-3427H (form discontinued Oct. 1, 2024)

HAVE DENTIST

Not a field on the LTC screening document printout

This field records if the person has a dentist for MSHO, MSC+ and SNBC health risk assessments only. Use Y for yes, N for no or C for chose not to answer. Otherwise, leave this field blank.

Only on DHS-3427H

(form discontinued Oct. 1, 2024)

CURR HOUSING

Current housing type

This field records the type of setting where the person lives.

32

PLANNED HSNG

Planned housing type

This field records the type of setting where the person will live.

33

OBRA LVL 2 REF MI DX

OBRA level 2 referral – MI

This field records whether a referral was required and made as determined through the OBRA level I screening, or when an OBRA level II screening has been previously completed. Use Y for yes or N for no.

Use the following rules for this field:

36 MI

OBRA LVL 2 REF DD DX

OBRA level 2 referral – DD

This field records whether a referral was required and made as determined through the OBRA level I screening, or when an OBRA level II screening has been previously completed. Use Y for yes or N for no.

If the DD history field is Y, the OBRA level II referral for DD DX must be Y.

36A DD

MMIS field name

MnCHOICES field name

Description

DRESSING

Dressing

This field records the value based on the assessment response.

38

GROOMING

Grooming

This field records the value based on the assessment response.

39

BATHING

Bathing

This field records the value based on the assessment response.

40

EATING

Eating

This field records the value based on the assessment response.

41

BED MOB

Bed mobility/positioning

This field records the value based on the assessment response.

42

TRANSFER

Transferring

This field records the value based on the assessment response.

43

WALKING

Walking/mobility

This field records the value based on the assessment response.

44

BEHAVIOR

Behavior

This field records the value based on the assessment response.

45

TOILETING

Toileting

This field records the value based on the assessment response.

46

SPC TRMT

Special treatments

This field records the value based on the assessment response.

47

CL MONITOR

Clinical monitoring

This field records the value based on the assessment response.

48

NEURO DX

Neuromuscular diagnosis

This field records the value based on the assessment response.

49

CASE MIX

Case mix

This field records the person’s case mix. MMIS checks this value by comparing data included in other fields on this screen. For more information about coding this field, refer to MMIS LTSS Manual – Additional LTC screening document information.

50

ORIENT

Orientation

This field records the value based on the assessment response.

51

SLF PRES

Self-preservation

This field records the value based on the assessment response.

52

DIS CERT

Disability certification source

This field records the value based on the assessment response.

53

SLF EVAL

Self-evaluation

This field records the value based on the assessment response.

54

HEARING

Hearing

This field records the value based on the assessment response.

55

COMM

Communication

This field records the value based on the assessment response.

56

VISON

Vision

This field records the value based on the assessment response.

57

MENT ST EV

Not a field on the LTC screening document printout

This field previously recorded the early dementia screening, but this requirement was replaced by the MINI COG field (described below). You do not need to enter information in this field.

58

TEL ANS

Telephone answering

This field records the value based on the assessment response.

59

TEL CALL

Telephone calling

This field records the value based on the assessment response.

60

SHOPPING

Shopping

This field records the value based on the assessment response.

61

PREP MLS

Preparing meals

This field records the value based on the assessment response.

62

LT HOUSE

Light housekeeping

This field records the value based on the assessment response.

63

HY HOUSE

Heaving housekeeping

This field records the value based on the assessment response.

64

LAUNDRY

Laundry

This field records the value based on the assessment response.

65

MGMT MEDS

Medication management

This field records the value based on the assessment response.

66

INSULIN

Insulin

This field records the value based on the assessment response.

67

MONEY MT

Money management

This field records the value based on the assessment response.

68

TRANSP

Transportation

This field records the value based on the assessment response.

69

FALLS

Falls

This field records the value based on the assessment response.

70

HOSP

Hospitalizations

This field records the value based on the assessment response.

71

ER VISITS

ER visits

This field records the value based on the assessment response.

72

NF STAYS

NF stays

This field records the value based on the assessment response.

73

VENT DEP

Vent dependent

This field records the value based on the assessment response. For more information about coding this field, refer to MMIS LTSS Manual – Additional LTC screening document information.

74

MINI COG

Early dementia screening

This field records the value based on the assessment response. For more information about coding this field, refer to MMIS LTSS Manual – Additional LTC screening document information.

74a

FAMILY PLN

Not a field on the LTC screening document printout

This field was previously completed for SNBC health risk assessments.

Only on DHS-3427H (form discontinued Oct. 1, 2024)

MMIS field name

MnCHOICES field name

Description

ASSESSMENT RESULTS/EXIT RSNS

Assessment results and exit reasons

These two fields record the outcome of the assessment or administrative activity.

You only use the second field when the assessment result is an exit (i.e., when the person’s program is being closed).

The assessment result or exit reason you can use depends on the activity type on the screening document, as well as the person’s sequence of screenings in MMIS history. For detailed information, refer to MMIS LTSS Manual – LTC screening document activity type and assessment result combinations.

For more information about exit codes and advance notice requirements, refer to MMIS LTSS Manual – Exit reasons.

75A (first field)

75B (second field only used in combination with an exit reason in 75A)

EFFECTIVE DT

Effective date

This field records the effective date of the assessment result/exit reason. MMIS uses the effective date to:

76

INFORMED CHOICE

Informed choice

This field records that the person received required information to make an informed choice. Use Y for yes or N for no.

77

CLIENT CH

Person’s choice

This field records the person’s choice of services and setting. Use the assessment result/exit reason values.

78

GUARDIAN CH

Guardian’s choice

This field records the guardian’s choice of services and setting if the person has a guardian. Use the assessment result/exit reason values.

Leave this field blank if the person does not have a guardian.

79

FAM CH

Family’s choice

This field records the family’s choice of services and setting for the person. Use the assessment result/exit reason values.

Leave this field blank if the person’s family did not participate in the assessment.

80

LTCC/IDT RECMND

LTCC/multi-disciplinary team recommendation

This field records the assessor’s recommended services and setting for the person. Use the assessment result/exit reason values. You cannot use value 29 (undecided) in this field.

81

LVL OF CARE

Level of care

This field records the particular amount of care and services required to meet a person's needs, as determined during assessment or administrative activities. For more information about level of care, refer to CBSM – Level of care.

82

NF TRACK

Not a field on the LTC screening document printout

This field is optional. It is for telephone screenings. If you are not recording a telephone screening, leave this field blank.

Not a field on DHS-3427

CASE MIX AMT

Case mix amount

This field is system-entered based on the case mix value. This field records the monthly budget amount approved for AC, ECS or EW services.

83

CASE MIX APP (Y/N)

Not a field on the LTC screening document printout

This field is DHS-entered for lead agency requests to exceed the case mix dollar amounts. For more information, refer to MMIS LTSS Manual – Route an LTC screening document for additional approval.

Not a field on DHS-3427

REASON FOR NF CONT STAY/CDCS ENDING

Reasons for NF continued stay/CDCS ending secondary

These two fields record either:

You can use up to two different values.

84

84A

REL TO COMM

Not a field on the LTC screening document printout

This field was only completed for SNBC health risk assessments recorded in MMIS.

Only on DHS-3427H (form discontinued Oct. 1, 2024)

ADL COND

IADL COND

COMP COND

COGNITION

BEHAVIOR

Not fields on the LTC screening document printout

MMIS still displays these fields in this section of the ALT4 screen. Data in these fields may be carried over from historical screening documents. You can delete data in these fields.

Not fields on DHS-3427

HYG/SAFETY

The person has not or may not ensure his/her own care, hygiene, nutrition or safety

This field records the assessor’s professional conclusion about the person's needs/conditions.

Use Y for yes or N for no.

90

NEG/ABUSE

The person has been or may be neglected, abused or exploited by another person

This field records the assessor’s professional conclusion about the person's needs/conditions related to neglect, abuse or exploitation by another person.

Use Y for yes or N for no.

91

FRAILITY

INST STAYS

HEARING IMP

REST/REHAB

UNSTABLE

SPEC TREAT

CMPLX CARE

VISUAL IMP

Not fields on the LTC screening document printout

MMIS still displays these fields in this section of the ALT4 screen. Data in these fields may be carried over from historical screening documents. You can delete data in these fields.

Not fields on DHS-3427

TOL ASSIST

The person needs constant supervision and/or assistance of another to begin and complete toileting

This field records the assessor’s professional conclusion about the person's needs/conditions related to the constant supervision and/or assistance of another person to begin and complete toileting.

Use Y for yes or N for no.

100

PCA COMPLEX

The person is eligible for 10 or more hours of CFSS services per day

This field records if the person’s assessment shows eligibility for 10 hours or more of personal care assistance (PCA)/Community First Services and Supports (CFSS) services per day.

Use Y for yes or N for no.

When you press F9 to display exception codes, MMIS automatically populates this field as follows:

MMIS will post exception code 163 if this field is left blank. You must enter Y or N for case mix E through K.

100A

REQUIRES AC/WVR SVC

The person requires one or more AC, ECS or waiver services to delay or prevent institutionalization

This field records whether the person requires one or more AC, ECS or waiver service to delay or prevent institutionalization.

Use Y for yes or N for no.

101

SAFE/COST EFFECTIVE

The person’s needs can be met in the community in a satisfactorily safe and cost-effective manner

This field records whether the person’s needs can be met in the community in a satisfactorily safe and cost-effective manner by using waiver/AC/ECS services.

Use Y for yes or N for no.

102

NO OTHER PAYOR IS RESP

It has been determined that the AC, ECS or waiver program is the appropriate payer for these services

This field records whether the AC, ECS or waiver program is the appropriate payer for the services.

Use Y for yes or N for no.

103

PROGRAM TYPE

Program type

This field records which AC, ECS, or waiver program, if any, will fund planned services.

104

MHM IND

Moving Home MN

This field records if the person chose Moving Home Minnesota (MHM) services.

Use Y for yes or N for no.

105

CDCS

CDCS

This field records if the person chose the consumer directed community supports (CDCS) option for AC and EW.

Use Y for yes or N for no.

For additional instructions, refer to MMIS LTSS Manual – Work with CDCS.

106

CDCS AMOUNT

CDCS amount

This field records the monthly dollar cap for CDCS services.

MMIS automatically enters this amount for AC and EW program types if the CDCS value is Y when you save the screening document in MMIS.

If the person needs a higher CDCS amount due to an enhanced budget or approved higher case mix, refer to MMIS LTSS Manual – Route an LTC screening document for additional approval and MMIS LTSS Manual – Work with CDCS.

107

SERVICES

Not a field on the LTC screening document printout

Previously, this field was used to support evaluation of certain services. You may see data in this field carried over from historical screening documents.

This field is no longer required but still appears on the ALT4 screen.

Not a field on DHS-3427

PROV NPI

Not a field on the LTC screening document printout

Previously, this field was used to support evaluation of certain services. You may see data in this field carried over from historical screening documents

This field is no longer required but still appears on the ALT4 screen.

Not a field on DHS-3427

MMIS field name

MnCHOICES field name

Description

CODE (Service code)

IND (Source code)

DESCRIPTION

Service code 1-18

Source code 1-18

These fields record services reviewed or recommended by the certified assessor. MMIS allows up to 18 different selections without duplicates.

You must use the following source codes:

MMIS will automatically populate the DESCRIPTION of the service when you press F9 to display exception codes or press the transmit key to move to another screen.

111

DHS-3427 includes a list of service codes used here, as well as a description of the source code choices to be paired with each service code.

MMIS field name

MnCHOICES field name

Description

STREET ADDRESS

Street address

This field records the person’s address. It is also used for mailing service agreement letters and other DHS or lead agency correspondence to the person on AC or ECS.

You must always enter the first line of the address. Do not use colons, punctuation marks or other special characters in this address line.

This information will transfer to the RCAD screen of the person’s recipient case record in MMIS.

135

STREET ADDRESS

Additional address information

This field is optional. You can use it to add additional mailing criteria.

Do not use colons, punctuation marks or other special characters in this address line.

This information will transfer to the RCAD screen of the person’s recipient case record in MMIS.

135A

CITY

City

This field records the city of the person’s address.

Do not use colons, punctuation marks or other special characters in this field.

This information will transfer to the RCAD screen of the person’s recipient case record in MMIS.

135B

STATE

State

This field records the two-letter abbreviation of the state of the person’s address

Do not use colons, punctuation marks or other special characters in this field.

This information will transfer to the RCAD screen of the person’s recipient case record in MMIS.

135C

ZIP CODE

Zip code

This field records the zip code of the person’s address

Do not use colons, punctuation marks or other special characters in this field.

This information will transfer to the RCAD screen of the person’s recipient case record in MMIS

135D

CFR

County of financial responsibility (CFR)

This field records the CFR. The value in this field will populate the CFR field on the RELG screen for major programs AC, UN and ECS.

135E

AC/ECS GROSS INCOME

AC/ECS gross income

This field records the person’s gross income as calculated using the AC or ECS financial eligibility worksheets.

Enter the dollar value rounded to the nearest dollar from the applicable AC or ECS eligibility worksheet:

135F

AC/ECS GROSS ASSETS

AC/ECS gross assets

This field records the person’s gross assets as calculated using the AC or ECS financial eligibility worksheets.

Enter the dollar value rounded to the nearest dollar from the applicable AC or ECS eligibility worksheet:

135G

AC/ECS ADJUSTED INCOME

AC/ECS adjusted income

This field records the person’s adjusted income. Enter the dollar value rounded to the nearest dollar from the applicable AC or ECS eligibility worksheet:

135H

AC/ECS ADJUSTED ASSETS

AC/ECS adjusted assets

This field records the person’s adjusted assets. Enter the dollar value rounded to the nearest dollar from the applicable AC or ECS eligibility worksheet:

135I

MEDICARE/MBI ID NUMBER

Medicare/MBI ID number

This field records the person’s Medicare identification number.

The number in this field will update the RCIP screen of the recipient subsystem if an eligibility worker has not populated the RCIP screen.

135J

MEDICARE/MBI PART A BEGIN DT

Medicare/MBI Part A effective start date

This field records the effective date of Medicare part A eligibility. The date comes from the person’s Medicare ID card.

Use MM/DD/YY format.

The date in this field will update the RMCR screen of the recipient subsystem if an eligibility worker has not populated the RMCR screen.

135K

MEDICARE/MBI PART A END DT

Medicare/MBI Part A effective end date

This field is open-ended. Use 99/99/99 as the date. The person’s eligibility continues until death.

135L

MEDICARE/MBI PART B BEGIN DT

Medicare/MBI Part B effective start date

This field records the effective date of Medicare part B eligibility. The date comes from the person’s Medicare ID card.

Use MM/DD/YY format.

The date in this field will update the RMCR screen of the recipient subsystem if an eligibility worker has not populated the RMCR screen.

135M

MEDICARE/MBI PART B END DT

Medicare/MBI Part B end date

This field is open-ended. Use 99/99/99 as the date. The person’s eligibility continues until death.

135N

AC FEE WAIVER REASON

AC fee waiver reason

This field records the reason the person does not have an AC fee obligation.

136

MED ELIGIBLE

Medicare eligible

This field indicates if the person is eligible for Medicare.

Use Y for yes or N for no.

If you use Y in this field, the other Medicare fields on ALT6 are mandatory.

137

AC FEE ASSESSED

AC fee assessed

This field records whether the person will pay an AC fee.

Use Y for yes or N for no.

To calculate the fee, if any, refer to:

138