Legal authority

Federally approved BI, CAC, CADI, DD and EW waiver plans, AC program (Minn. Stat. §256B.0913), 42 C.F.R. 440.180, Minn. Stat. §256S, Minn. Stat. §256B.092, Minn. Stat. §256B.49

Overview

A person’s individual CDCS budget amount is calculated using a formula developed by the state. DHS calculates budget amounts according to federal authority for each program and issues CDCS budgets at least annually.

Each person’s annual state-set budget amount is the amount available to them to purchase allowable goods and services. The individual CDCS budget must include the costs of all the person’s waiver services and Medical Assistance (MA) state plan home care services.

Assessment results

Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Developmental Disabilities (DD) waivers

The lead agency obtains the person’s CDCS budget through the Waiver Management System (WMS). The WMS calculates the CDCS budget amount using the person’s most recent MnCHOICES assessment information.

Alternative Care (AC) and Elderly Waiver (EW)

The person’s MnCHOICES assessment determines their case mix classification for AC and EW. The maximum CDCS budget amount is based on the person’s case mix classification.

Establishing CDCS budgets for BI, CAC, CADI and DD

The CDCS budget methodology is a formula that uses identified variables from the person’s assessment scores to calculate the budget. Each variable has a score reported on or derived from the assessment.

Budget methodology

The budget methodology is different based on the waiver. For more information, refer to the following resources.

BI, CAC and CADI

CDCS Manual – CDCS budget methodology for the BI, CAC and CADI waivers
CDCS Manual – Variables used in the CDCS budget methodology for the BI, CAC and CADI waivers

DD

CDCS Manual – CDCS budget methodology for the DD Waiver
CDCS Manual – Variables used in the CDCS budget methodology for the DD Waiver

Cost of living adjustments (COLA)

CDCS Manual – COLA for CDCS budgets – BI, CAC, CADI and DD

Establishing CDCS budgets for AC and EW

CDCS case mix budget caps are the same as traditional case mix budget caps. The CDCS budget amount is located on the MMIS screening document when the CDCS Y/N field indicator is “Y.” For more information about the budget cap amounts, refer to the CDCS budget caps section of Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

Procedure codes

There are three procedure codes to identify CDCS services:

For more information, refer to section 201.09 of Instructions for Completing and Entering the LTC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF).

Flexible use

People can use their AC/EW case mix budget flexibly. For more information, refer to section 301.03 of Instructions for Completing and Entering the LTC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF) and Instructions for Completing and Entering the LTCC Screening Document and Health Risk Assessment into MMIS for the MSC+ and MSHO Programs, DHS-4669 (PDF).

Communicating CDCS budget information

Lead agencies must provide CDCS budget information to the person and their legal representative. For more information, refer to CDCS Manual – Resource: Communicating CDCS budget information for people using waivers and AC.

Legislative budget changes

BI, CAC, CADI and DD

Legislative authority may adjust CDCS waiver budgets. The 2023 Minnesota Legislature authorized:

For details about the changes, refer to DHS – Long-term services and supports rate changes and Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

AC and EW

Legislative authority may adjust CDCS monthly budget caps. The 2023 Minnesota Legislature authorized:

For details about the changes, refer to DHS – Long-term services and supports rate changes and Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

Notification/calculation

For all legislative budget changes (i.e., AC, BI, CAC, CADI, DD and EW), lead agencies must:

People who use CDCS can use CDCS Community Support Plan (CSP) Addendum, DHS-6633A (PDF) to document changes to their plan.

Prorating budgets

When service plans will cover less than one year, the lead agency must prorate CDCS budgets. For more information, refer to:

Budget amount on the CDCS CSP

The person must include their budget amount on the CDCS CSP they develop. Each person’s annual state-set budget amount is the amount available to them. The person can only include costs in the CDCS CSP for allowable services and goods up to the annual CDCS budget amount.

The lead agency is responsible to review and approve final spending decisions in the person’s CDCS CSP. The state-set CDCS budget represents an “up to” amount available to purchase services. The amount the lead agency approves in the CDCS CSP is based on projected costs of services to address the person’s assessed needs, which may be less than the CDCS budget maximum.

The person can only spend their authorized budget within the service plan dates. They cannot carry over unexpended CDCS budget funds to the next service plan year.

Exception process for BI, CAC, CADI and DD

There is an exception that can increase individual CDCS budgets for people on disability waivers who meet the eligibility requirements. For more information about the exception, refer to:

Conversion rates for EW

When the monthly EW CDCS case mix budget caps cannot support the services the person needs to transition to community living from a nursing facility, the lead agency may request approval from DHS or the managed care organization (MCO) for a monthly conversion budget limit.

For information about the process to request a CDCS conversion budget limit, refer to CBSM – EW conversion rates.

Authorizing the budget (CDCS service authorizations and MMIS activity)

The lead agency authorizes CDCS as one service agreement line item. The lead agency must:

1. Enter the dates of the service span.

2. Use CDCS code T2028 (no modifier).

3. Enter the person’s approved budget amount as the requested total amount (no unit or rate).

Note: The individual CDCS budget amount the lead agency authorizes on the service agreement cannot exceed the state-set budget.

BI, CAC, CADI and DD budgets

For BI, CAC, CADI and DD waivers, the person’s annual budget information is in the WMS.

AC and EW budgets

For AC and EW, the person’s monthly budget information is on the screening document in the CDCS amount field.

Other service agreement lines

CDCS budgets can include payment for state plan home care services (BI, CAC, CADI, DD and EW), but the lead agency must authorize these services on a separate line item. For more information, refer to CDCS Manual – Purchasing home care services.

CDCS budgets cannot include payment for:

The lead agency must authorize these services on separate line items.

Reassessments and functional needs updates

The person’s CDCS budget might change based on a reassessment or an AC/EW functional needs update assessment (FNU).

When a budget change occurs:

1. The lead agency informs the person of the new budget amount. Depending on the situation, the person does one of the following:

2. The person works with the lead agency to revise their CDCS CSP to meet their current needs.

3. The person submits their updated CDCS CSP to the lead agency for approval and authorization.

Enhanced budget process

For information about the enhanced budget, refer to: