Alternative Care (AC) fees and service agreements

Page posted: 8/3/26

People using the AC program may have a monthly fee to contribute to the costs of their AC services. The DHS Health Care Recipient Billing team uses information on the ASA2 screen to bill the person for their fees correctly. The accuracy and timing of the billing process depends on the information you enter on the service agreement in MMIS. For an overview of the fee policy and process, including communication with the DHS Health Care Recipient Billing team, refer to CBSM – AC fees.

The lead agency determines a person’s financial eligibility for the AC program using either:

· AC Program Eligibility Worksheet, DHS-2630 (PDF).

· AC Program Eligibility Worksheet Type A, DHS-2630A (PDF).

These worksheets also contain information to calculate the percentage applied to the average monthly cost of AC services to establish the AC fee amount, if any.

This page provides instructions for AC fee information in MMIS.

Complete fee information on the screening document

The long-term care (LTC) screening document has two fields on the ALT5 screen related to AC fees:

· Reasons for waiving a fee.

· Y/N field for AC fee assessed.

You must complete the AC fee waiver reasons field if the AC fee assessed field is N. Use the following reason codes:

· 03: Married couple requests an asset assessment under the spousal impoverishment provision.

· 04: Person resides in a nursing facility and receives AC conversion case management only.

· 05: Person is eligible for AC but is not yet receiving AC services.

· 06: Income/assets are below minimal amounts (from DHS-2630 or DHS-2630A).

· 08: Person receives temporary AC.

· 09: Person receives consumer directed community supports (CDCS) under AC.

You must update the AC fee information on the screening document if there is a change in the reason for waiving a fee or if the person now has a fee. You can make this update using activity type 05 or activity type 07, depending on the other fields you might need to change on the screening document.

Complete AC service agreement fields

You must complete the following fields on the ASA2 screen for an AC service agreement:

· AC fee payment method.

· AC partial payment.

· AC required fee amount.

· Current monthly fee, which is a dollar and cents amount or zero (0).

· AC fee effective date.

Table 1: AC fee fields

Field name	Description
AC fee payment method	The AC fee payment method field on the ASA2 screen records how the fee will be paid. It is a mandatory field. If left blank, the field will turn red and the message “correct highlighted fields” will appear at the bottom of the ASA2 screen when you press the transmit key or press F9 to display exception codes. You must use one of the following values: · 00: The person pays the monthly fee. · 01: The person appointed a representative payee. · 02: The fee is automatically withdrawn from a financial account (i.e., an online payment; not automatic withdrawal plan [AWP]). · 03: The person’s family is involved in the financial management of payments. · 04: The person uses another method acceptable to the lead agency to ensure prompt fee payments. · 05: The person makes partial payments. · 06: The person does not have a fee.
AC partial payment	If the AC payment method field is 05 (partial payment), you must complete the AC partial payment field. The dollar amount in this field is what the person has agreed to pay. This amount must be less than the AC required fee amount field. There is no minimum amount or percentage of fees required to establish a partial payment arrangement.
AC required fee amount	If the person has an AC fee, this field uses the amount that was calculated using the percentage and the monthly average cost of the AC services, including case management. If the person has no fee, enter zero (0).
AC fee effective date field	The AC fee effective date field records only the date of the upcoming month (i.e., the month following the current month. If you enter any other date, the field will turn red and a “correct highlighted fields” message will appear at the bottom of the ASA2 screen when you press the transmit key or press F9 to display exception codes. Use MM/YY format for the month and year.

Determine the AC fee amount

To determine the AC fee amount:

1. Finalize the AC support plan.

2. Identify the AC services to be included on the AC service agreement.

3. Use the percentage of AC costs to be paid, if any, as indicated on DHS-2630 or DHS-2630A, to calculate the dollar amount of the monthly fee by applying the relevant percentage to the average monthly cost of AC services. Include case management costs.

4. Enter the AC fee amount in the AC required fee amount field on the ASA2 screen. If the person is not required to pay any fee amount, enter zero (0).

5. Complete the AC fee effective date fields on the ASA2 screen using the upcoming month for the date.

6. Do not deduct the fee from the line item authorizations on the service agreement.

7. Notify the DHS Health Care Recipient Billing team of the AC fee using instructions on CBSM – AC fees so they can update their billing system and generate invoices for fee payment.
Note: This step must be done by the lead agency.

Update the AC fee information

You must update the AC fee amount and effective date fields whenever the fee amount changes. The fee may increase, decrease or no longer be required. A fee may change if:

· The person is no longer required to pay a fee.

· The percentage used to calculate the fee amount changes.

· The total average monthly dollar amount for authorized services changes.

· The person agrees to a partial payment plan.

You must communication with the DHS Health Care Recipient Billing team each time you enter or change AC fee information on the ASA2 screen, including when the effective date of an assigned AC fee has passed and billing will be retroactive. For more information, refer to CBSM – AC fees.

Instructions to update fee amounts or effective dates

New service agreements – Header begin date in past

When you add a service agreement with a header begin date in the past, the AC fee effective date will automatically be the current month plus one month. If you change the field to any other date, MMIS will change the date entered to the upcoming month date (i.e., the current month plus one) after you exit the ASA2 screen.

Example: You add a new service agreement in August with a header begin date in July. The AC fee effective date will have an effective date of September, even though the header begin date is before September.

To bill correctly for the months before the AC fee effective date on the new service agreement, you must submit a request to the DHS Health Care Recipient Billing team. For more information, refer to CBSM – AC fees.

New service agreements – Header begin date in future

When you add a service agreement with a header begin date in the future, the AC fee effective date will automatically match the header begin date. If you change the AC fee effective date field to any other date, MMIS will populate the header begin date after you exit the ASA2 screen.

Existing service agreements

The AC fee effective date field turns red when you make changes to other AC fee fields on the ASA2 screen of an existing AC service agreement. You must reenter the AC fee effective date. The AC fee effective date may remain the same as the previous date, or you can change it to a future month (i.e., the current month plus one).

Examples of changes that require you to reenter the AC fee effective date include:

· The required fee amount on the ASA2 screen changed based on changes to the support plan.

· The person agrees to a partial payment plan to remain on AC.
Note: You must update the AC payment method field to indicate a partial payment plan (05) before you enter a dollar amount in the partial payment amount field.

If a required fee amount or partial payment amount change is effective in the current month or a previous month, you must submit a request to the DHS Health Care Recipient Billing team to ensure correct billing. For more information, refer to CBSM – AC fees.

Additional resources

AC Program Eligibility Worksheet, DHS-2630 (PDF)
AC Program Eligibility Worksheet Type A, DHS-2630A (PDF)
CBSM – AC fees