Use a functional needs update for Alternative Care (AC) and Elderly Waiver (EW)

Page posted: 8/3/26

A functional needs update (activity type 10) allows an assessor to update assessment and other information for a person on the AC or EW program during a service year (i.e., program eligibility span). The update can occur remotely, but it must be done in direct contact with the person.

An assessor typically uses a functional needs update when the person’s assessed needs change in a way that requires additional resources to implement the support plan, such as:

· Changes to the case mix that affect the monthly budget or consumer directed community supports (CDCS) cap.

· Changes that affect eligibility for 24-hour customized living rate limits.

You can only use a functional needs update when all of the following are true:

· The person is on AC or EW.

· The program eligibility span is open.

· The screening document uses assessment result 12: service change.

You cannot use a functional needs update to:

· Extend the program eligibility or service agreement span.

· Change the program type.

· Replace an annual reassessment.

For information about the policy and processes related to changes in need following an assessment, including a functional needs update, refer to CBSM – Assessment applicability and timelines.

Instructions

To document the functional needs update in MMIS:

1. Type X next to screenings on the main menu, then press the transmit key to open the key panel (ASCR) screen.

2. Use:

· Action code A (add).

· Document type L.

· Person’s person master index (PMI) number.

3. Press the transmit key to open a copy of the last LTC screening document.
Note: Because you are using a copy of the last screening document, nearly all fields will be populated, and you can update most fields using activity type 10. Fields you can change will appear green, and protected fields will appear white.

4. Enter the following information on the ALT1 screen:

· Person’s birthdate in the DOB field.

· Referral date in the REF DATE field.

· Activity type 10 in the ACTIVITY TYPE field.

· Activity type date that the assessment was completed in the ACT DT field.

· Code of the county, Tribal Nation or managed care organization that completed the screening activity in the LTCC CTY field.

· Certified assessor/case manager/care coordinator provider number in the CM/HP/CA NBR field.

· Updates to any other information on the ALT1 screen that may have changed since the last in-person assessment.

5. Press the transmit key to move to the ALT2 screen. Review and change information on the ALT2 screen, as needed, based on the functional needs update.

6. Press the transmit key to move to the ALT3 screen. Review and change information on the ALT3 screen, as needed, based on the functional needs update.

7. Press the transmit key to move to the ALT4 screen and enter:

· Assessment result code 12 in the ASSESSMENT RESULTS field.

· An effective date that is no sooner than the activity type date, no more than 60 days after the activity date and no later than the end of current eligibility span.

· Updates to any other information on the ALT4 screen that may have changed since the last in-person assessment.

Note: Do not change the program type.

8. Press the transmit key to move to the ALT5 screen and update the service plan summary information if needed.

9. Press the transmit key to move to the ALT6 screen, which will only appear if the person is on the AC program. Update the information as needed.

10. Press F9 to display exception codes.

11. Resolve exception codes.

12. Press F3 to save the document. This step is important. You must save the document even if exception codes remain. MMIS will save the completed data and allow you to return to the document for additional work.

13. Press F3 to return to the LTC screening document key panel.

14. Press F3 to return to the main menu.

15. Select prior authorization on the main menu to update the service agreement if needed. For more information, refer to MMIS LTSS Manual – Change an existing service agreement.

Exception codes

Unresolved exception codes will prevent MMIS from approving a screening document. For more information, refer to MMIS LTSS Manual – Exception codes in the LTC screening document.

Additional resources

CBSM – Assessment applicability and timelines
MMIS LTSS Manual – Change an existing service agreement
MMIS LTSS Manual – Exception codes in the LTC screening document