Minnesota Minnesota

Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


Alternative Care (AC) fees

Page posted: 2/6/20

Page reviewed: 5/1/26

Page updated: 5/1/26

Legal authority

Federally approved AC 1115 demonstration, Minn. Stat. §256B.0913, subd. 12

Definition

AC monthly fee: A monthly fee required for most people on the AC program to help pay for the cost of services provided under the program. People on AC pay cost-sharing fees that range from 5% to 30% of the average monthly cost of their AC services, unless they are exempt from paying a fee.

Overview

The lead agency determines a person’s monthly fee amount based on their income, assets and support plan. Then, the lead agency uses financial data from AC Program Client Disclosure Form, DHS-3548 and one of the following AC program eligibility forms:

  • · AC Program Eligibility form in the MnCHOICES application.
  • · AC Program Eligibility Type A form in the MnCHOICES application.
    Note: For instructions, refer to Practice Guide – AC Program Eligibility Instructions in the MnCHOICES Help Center.

    • For more information, refer to the process and procedure section on this page.

    The lead agency should share AC Program Monthly Fee and Payment Information, DHS-4639 (PDF) with people on AC.

    DHS bills for AC monthly fees the month after services are delivered. People who receive AC services (or their authorized representatives) receive a monthly invoice in the mail that indicates the monthly fee owed and how to submit the payment. The DHS Health Care Recipient Billing team is only able to communicate with the person receiving services, unless they give DHS permission to speak with their authorized representative.

    The lead agency emails the DHS Health Care Recipient Billing team at dhs.made@state.mn.us to:

  • · Obtain history of a person’s AC fee payments received by DHS.
  • · Report a change of address or update the billing address.
  • · Inform DHS about fee changes, including partial payments.
  • · Inform DHS about retroactive fee changes.
  • · Inform DHS about fee adjustments for services that were not used or were under-used.

    • Process and procedure

    At reassessment or whenever the person experiences a change in the service plan, the lead agency determines AC monthly fees based on the person’s:

  • · Adjusted monthly income and gross assets.
  • · Average monthly amount of services authorized.

    • The average monthly amount of services includes the cost of all services authorized for a person in a month, including case management.

    Note: A person’s budget does not include CFSS consultation services, so their AC fee does not include the cost.

    Instructions

    The lead agency:

    1. Sends AC Client Disclosure Form, DHS-3548 to the person to complete and return to lead agency before the reassessment meeting or when the person has a financial change.

    2. Uses the information from DHS-3548 to complete either the AC Program Eligibility form or AC Program Eligibility Type A form in the MnCHOICES application.

    3. Determines the person’s adjusted income and gross assets from their AC Program Eligibility form in the MnCHOICES application.

    4. Compares the information from step 1 to the fee schedule.

    5. Calculates the monthly fee by multiplying the cost of the average monthly amount of services by the fee percentage (i.e., 0.05 for 5%, 0.15 for 15% or 0.30 for 30%).

    6. Enters the dollar amount of the monthly fee on “AC required fee amount” and “AC partial payment” (when applicable) and enters the upcoming month’s date on the ASA2 screen of the MMIS service agreement. If the effective date of the AC fee has passed, the lead agency also must email the DHS Health Care Recipient Billing team at dhs.made@state.mn.us to manually create the retroactive bills.

    7. Notifies the DHS Health Care Recipient Billing team by email at dhs.made@state.mn.us of the AC fee so they can update their billing system (must be done by lead agency). The DHS Health Care Recipient Billing team verifies information from the ASA2 screen and from the email request to generate invoices.

    8. Emails all AC fee billing requests to dhs.made@state.mn.us with the following format:

  • · To add an invoice for a new participant opening to the AC program:
    Subject line: Participant initials, person master index (PMI) number, adding service agreement, mm/dd/yyyy (date email sent)
    Body of the email:
    Participant initials
    PMI number
    AC fee details: If the AC fee is the same each month, list the start month, fee amount and the word “ongoing” (i.e., mm/yyyy, fee amount, ongoing). If the AC fee varies, list each month and its corresponding fee (i.e., mm/yyyy, fee amount).
  • · To change an AC fee:
    Subject line: Participant initials, PMI number, changing AC fee, mm/dd/yyyy (date email sent)
    Body of the email:
    Participant initials
    PMI number
    AC fee details: If the AC fee is the same each month, list the start month, fee amount and the word “ongoing” (i.e., mm/yyyy, fee amount, ongoing). If the AC fee varies, list each month and its corresponding fee (i.e., mm/yyyy, fee amount).
  • · To end an AC fee:
    Subject line: Participant initials, PMI number, ending service agreement, mm/dd/yyyy (date email sent)
    Body of the email:
    Participant initials
    PMI number
    AC fee details: Last AC fee billing month (i.e., mm/yyyy) and corresponding fee amount
  • · To submit retroactive fees:
    Subject line: Participant initials, PMI number, retroactive fees, mm/yyyy (date email sent)
    Body of the email:
    Participant initials
    PMI number
    AC fee details: If the AC fee is the same each month, list the start month, fee amount and the word “ongoing” (i.e., mm/yyyy, fee amount, ongoing). If the AC fee varies, list each month and its corresponding fee (i.e., mm/yyyy, fee amount).
  • · To adjust fee for services that were not used or were under-used:
    Subject line: Participant initials, PMI number, AC fee correction mm/dd/yyyy (date email sent)
    Body of the email:
    Participant initials
    PMI number
    AC fee details: If the AC fee is the same each month, list the start month, fee amount and the word “ongoing” (i.e., mm/yyyy, fee amount, ongoing). If the AC fee varies, list each month and its corresponding fee (i.e., mm/yyyy, fee amount).
  • · To change the address:
    Subject line: Participant initials, PMI number, AC fee address change, mm/dd/yyyy (date email sent)
    Body of the email:
    Participant initials
    PMI number
    Updated address
    Authorized representative (AREP) name (if applicable)

    • Note: An email is not required to change partial payments. Instead, the lead agency updates “AC partial payment” on the ASA2 screen of the MMIS service agreement. AC fee invoices will continue to be billed at the full AC fee dollar amount and will not note the partial payment. There is no minimum amount for partial payments. The case manager must explain to the person that they will still owe the full amount of overdue fees, but partial payments allow them to continue to be eligible for AC.

    9. Sends the person or their authorized representative a notice of action or the lead agency’s own AC fee letter with information about the fee, cost of service and how they determined the fee. For more information, refer to CBSM – Notice of action.

    Fee exclusions

    A person is excluded from paying an AC monthly fee if they:

  • · Live in a nursing facility and only receive case management services.
  • · Are eligible for AC but are not yet receiving services.
  • · Have income/assets below the minimum amounts.
  • · Receive temporary AC.
  • · Participate in the consumer directed community supports (CDCS) option.

    • Non-payment of fees

    People become ineligible for AC when their fees are 60 days past due. Lead agencies should use the overdue fees report to monitor AC fee payments. For more information, refer to the InfoPac reports section on this page.

    A person can remain eligible for AC by making arrangements with the lead agency, which may include:

  • · Making partial payments.
  • · Appointing a representative payee.
  • · Making a one-time or recurring online payment from a financial account.
  • · Establishing more family involvement to help the person manage payments.
  • · Using another method that ensures prompt payments and is acceptable to the lead agency.

    • The lead agency can extend the person’s eligibility, as necessary, while making arrangements to correct non-payment of past-due amounts and ensure future payments.

    If the person and lead agency do not resolve non-payment of fees, the lead agency sends the person a notice of action to explain that the person will be disenrolled from AC. For more information, refer to CBSM – Notice of action.

    The person may appeal the disenrollment under the state’s standard fair hearing process. For more information, refer to CBSM – Appeals.

    After a person is disenrolled due to nonpayment of a monthly fee, the lead agency must wait 30 days before reinstating the person’s eligibility.

    InfoPac reports

    InfoPac allows lead agencies to view and print reports, versions and sections to which they have been given access. Each lead agency has an InfoPac liaison who can give staff access to reports.

    InfoPac includes the following reports related to AC:

  • · AC Overdue Fees: Monthly report that provides information about people with overdue fees, sorted by county of service and case manager. DHS updates this report every two weeks.
  • · AC Client Information: Monthly report that provides detailed information of people obligated to pay a fee.
  • · AC Cumulative Service Encumbrance and Payments: Monthly report that provides the total of all people, units and amounts encumbered and used for the lead agency.

    • For additional information about InfoPac reports, refer to Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF).

    Estate claims

    The AC program has the same estate claim policy as Medical Assistance. DHS or the lead agency may try to recover the cost of services paid by the AC program, including overdue AC fees, by submitting an estate claim.

    Lead agencies should share AC Program Recovery Information, DHS 5186 (PDF) with people on the AC program.

    Additional resources

    AC Client Disclosure Form, DHS-3548
    AC Program Monthly Fee and Payment Information, DHS-4639 (PDF)
    AC Program Recovery Information, DHS 5186 (PDF)
    CBSM – AC
    CBSM – Notice of action
    MHCP Eligibility Policy Manual – Estate Claims
    Referral for an AC Estate Claim, DHS-4801 (PDF)
    Instructions for Completing and Entering the LTCC Screening Document and Service Agreement Into MMIS, DHS-4625 (PDF)

    Resource: Monthly fee amounts

    For the current Federal Poverty Guidelines (FPG) amounts, refer to Practice Guide – AC Program Eligibility Instructions in the MnCHOICES Help Center.

    Person’s income

    Gross assets

    Monthly fee

    Income <100% FPG, and

    <$10,000

    $0

    Income >100% FPG but <150% FPG, and

    <$10,000

    5% cost of AC services

    Income >150% FPG but <200% FPG, and

    <$10,000

    15% cost of AC services

    Income >200% FPG, or

    >$10,000

    30% cost of AC services

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