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About the service agreement

Page posted: 8/3/26

Service agreements are located in the prior authorization subsystem. A service agreement:

1. Creates a service prior authorization for people on the following programs:

· Alternative Care (AC).

· Brain Injury – Nursing Facility (BI-NF) Waiver.

· Brain Injury – Neurobehavioral (BI-NB) Waiver.

· Community Alternative Care (CAC) Waiver.

· Community Access for Disability Inclusion (CADI) Waiver.

· Essential Community Supports (ECS).

· Moving Home Minnesota (MHM).

2. Creates a service prior authorization for people on the Elderly Waiver (EW) who are not enrolled in Minnesota Senior Health Options (MSHO) or Minnesota Senior Care Plus (MSC+) managed care products.

3. Allows a provider to bill DHS and receive payment for authorized services.

4. Identifies the services, time period, number of units, provider and approved rate.

For program-specific information, refer to:

· DD Screening Document Codebook: Information about authorizing services under the Developmental Disabilities (DD) Waiver.

· CFSS Policy Manual: Information about personal care assistance (PCA) and Community First Services and Supports (CFSS).

· MHM Program Manual: Information about eligibility for and authorization of available through MHM, including prior authorization of MHM services in combinations with waiver services under the home and community-based services (HCBS) programs listed above.

Service Agreement, DHS-3070 (PDF) is a fillable form that mirrors the fields in the MMIS service agreement screens.

Long-term services and supports (LTSS) program eligibility

You must establish and document a person’s eligibility for HCBS programs in MMIS before you enter a service agreement. The long-term care (LTC) screening document documents a person’s eligibility for the AC, BI-NF, BI-NB, CAC, CADI, ECS and EW programs.

The service agreement authorization period cannot fall outside of an established eligibility period (also called an eligibility span) created with the LTC screening document. The eligibility span:

· Identifies the program type.

· Controls the dates of service you are allowed to include on a service agreement.

· Determines which service agreement type you can use to authorize services.

For more information about eligibility spans, refer to MMIS LTSS Manual – LTC screening documents and HCBS program eligibility spans.

An individual service agreement authorization period (i.e., start and end dates or from-through period) cannot be longer than 12 months.

View and verify program eligibility

DHS strongly recommends you complete an LTC screening document inquiry to verify the person has an approved LTC screening document that establishes or continues HCBS program eligibility. For steps to complete an inquiry, refer to MMIS LTSS Manual – Use inquiry mode with LTC screening documents.

You can also find HCBS program eligibility information in the recipient subsystem. After you enter the recipient subsystem from the main menu:

· Waivers: Go to the RWVR screen for information about the program type, service agreement type and eligibility span information.

· AC: Go to the RELG screen for information about the AC eligibility span. The AC program is represented by AC-AC.

· ECS: Go to the RWVR screen for information about the program type, service agreement type and eligibility span information. You can also go to the RELG screen, where the ECS program is represented by UN-EC.

For more information, refer to MMIS LTSS Manual – Recipient screen descriptions.

Service agreement type by program type

Each HCBS program type uses a specific service agreement type identified by letter. You can only use the service agreement type associated with the person’s program type to authorize services for that person:

· F for CADI conversion.

· G for CADI diversion.

· H for CAC conversion.

· I for CAC diversion.

· J for EW conversion.

· K for EW diversion.

· L for BI-NF conversion.

· M for BI-NF diversion.

· N for AC conversion.

· O for AC diversion.

· P for BI-NB conversion.

· Q for BI-NB diversion.

· R for DD conversion.

· S for DD diversion.

· Y for ECS.

· Z for MHM.

For each service agreement type, MMIS will control the type and amount of service you can authorize, allowable service combinations, rates you can approve and the total dollar amount available for all services on the service agreement.

Note: “Conversion” refers to the use of HCBS to support a person as they return to the community at discharge from an institutional setting. “Diversion” refers to the use of HCBS to prevent or delay the use of institutional LTC.

Service agreement exception codes related to the LTC screening document

MMIS might post service agreement exception codes (i.e., edits) that are related to the LTC screening document. Before you can approve a service agreement, you must create a waiver, AC or ECS eligibility period with an opening, reopening or reassessment screening document for the same program type. If there is not a compatible eligibility period or if the service agreement starts before or after this period ends, MMIS will post exception codes to prevent you from approving the service agreement.

No eligibility span

MMIS will post exception codes 253 and 254 if the person does not have an eligibility span compatible with the service agreement type and authorization period on the service agreement. To resolve these exception codes:

1. Press F4 to navigate to the recipient subsystem from anywhere on the service agreement.

2. Take the appropriate action based on program:

· Waiver and ECS: Enter RWVR in the NEXT field and press the transmit key to show the dates and program type.

· AC and ECS: Enter RELG in the NEXT field and press the transmit key to show the dates of eligibility.

3. Press F3 to return to the service agreement and take the appropriate next step described below.

Incorrect/missing span

If the eligibility span is incorrect or missing:

1. Save the service agreement in suspended status.

2. Enter the missing or corrected screening document and approve it.

3. Use change mode to return to the service agreement and complete it. For instructions, refer to MMIS LTSS Manual – Change an existing service agreement.

4. Press F9 to display exception codes, resolve exception codes and press F3 to save.

Incorrect heading dates

If the service agreement header (i.e., start and end) dates are incorrect based on the eligibility span:

1. Correct the agreement start date and/or the agreement end date on the ASA1 screen to correspond to the eligibility span.

2. Press F9 to display exception codes, resolve exception codes and press F3 to save.

Many errors

If you have not already saved the service agreement and it contains many errors, press F6 to exit without saving. If you saved the service agreement in suspended status, you must change the status at the ASA1 screen to deny the service agreement. Press F3 to save the change and exit the service agreement.

More than one eligibility period

If there is more than one eligibility period (e.g., person was on a program, left and returned), the service agreement cannot overlap both periods. In this case, you must complete a service agreement for each eligibility span. For instructions, refer to MMIS LTSS Manual – Close a service agreement and MMIS LTSS Manual – Create a service agreement.

Service agreement type does not match the LTC program type

To approve the service agreement, you must ensure the service agreement type matches the screening document program type. MMIS will post exception codes 253 and 254 if the service agreement type does not match the program type on the most recent saved, approved screening document.

Service agreement type is incorrect

If you have not already saved the service agreement, press F6 to exit without saving it.

If you already saved the service agreement:

1. Use change mode to return to the service agreement. For instructions, refer to MMIS LTSS Manual – Change an existing service agreement.

2. Change the header status to D (deny) on the ASA1 screen.

3. Delete the provider number on each line item, if necessary, so the provider does not receive a denial letter.

4. Make sure the send recipient letter field on the ASA2 screen is N so the person does not receive a denial letter.

5. Enter a message on the comment screen or use reason code 834 on the ASA2 screen. For more information, refer to MMIS LTSS Manual – Service agreement reason codes.

Saved, approved screening document has an incorrect program type

You must contact the DHS Service Agreement and Screening Document (SASD) Support Team to request a deletion of the screening document. For more information, refer to MMIS LTSS Manual – Delete an LTC screening document.

Major program does not overlap

Waiver service agreements must fall within the MA eligibility period as shown on the RELG screen in the recipient subsystem. AC service agreements must fall within the AC major program eligibility span developed by the LTC screening document. ECS service agreements must fall within the MA or UN major eligibility program span.

If the major program is not open or the service agreement dates on the ASA1 screen start before or end after the major program eligibility span, exception code 271 will prevent you from approving the service agreement. If the major program MA eligibility span is not present or the dates are incorrect, you must ask the county or Tribal Nation eligibility worker (also called a financial worker) to make the corrections.

Recipient not on file

If you use an invalid person master index (PMI) number on the ASA1 screen, MMIS will post exception codes 129 and/or 251. These exception codes prevent you from approving the service agreement. You must correct the PMI field.

Living arrangement is not correct

The line item dates cannot overlap with an institution living arrangement period, except for the following situations:

· The date of admission and date of discharge can overlap with service agreement dates.

· AC case management, paraprofessional case management and AC conversion case management services on an AC service agreement can overlap with a nursing facility institution period, but only for the purpose of providing conversion case management for up to 180 days.

If there is unallowable overlap within dates related to living arrangements in the recipient subsystem, MMIS will post exception code 375. The RLVA screen in the recipient subsystem shows the living arrangement periods and types at the bottom of the screen. It includes dates of admission, dates of discharge (if any) and the provider ID of the provider associated with the admission. If the data on the RLVA screen is incorrect, you must ask the eligibility worker to correct it.

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MMIS Long-Term Services and Supports Manual