Close a home and community-based services (HCBS) program

Page posted: 8/3/26

When closing an HCBS program, you use MMIS to document the closure (also called an “exit”). You can close a program using activity type 06 (reassessment) or activity type 07 (administrative activity).

MMIS LTSS Manual – Exit reasons includes more detailed information about activity types, exit reason codes and other MMIS rules when closing a program.

General rules for closing a program

Sequence

When you intend to close a program, you must close the service agreement before you enter a screening document to close a program. For instructions, refer to MMIS LTSS Manual – Close a service agreement.

Activity type and exit reason

The activity type you use to close the program will limit the exit reasons you can use. When you use any exit reason as the assessment result on a screening document, the document must also include an additional assessment result that indicates what will happen next for the person upon closing the program. For more information, refer to fields 75A and 75B (ALT4 screen) on MMIS LTSS Manual – LTC screening document fields.

Effective date

The effective date of an exit:

· Cannot be before the end date entered on the service agreement header.

· Cannot be before the activity type date of the reassessment for activity type 06.

· May be retroactive in some cases when using activity type 07.

· Must adhere to and reflect advance notice requirements.

· Is limited to the last day of the month that follows the current month when there is no advance notice requirement.

Notice

You must always provide notice to a person when closing their program, even if advance notice is not possible.

Advance notice, when required for purposes of MMIS exception codes, means:

· The effective date of the exit must be at least 10 days and no more than 60 days from the activity type date.

· For exit reason 21 (no longer meets any level of care), the effective date of the exit must be at least 30 days and no more than 60 days from the activity type date.

Close at reassessment

You can use the following exit reasons to close a program based on reassessment only:

· Exit reason 21: The person no longer meets any institutional level of care. The person must exit their current program.

· Exit reason 20: The person meets an institutional level of care other than the level of care associated with their current program. The person must exit their current program. They will change to a different program.
Example: A person on the Brain Injury – Neurobehavioral (BI-NB) Waiver no longer meets neurobehavioral hospital level of care, but they do meet nursing facility level of care.

You cannot use the following exit reasons to close a program at reassessment:

· Exit reason 24: Other reason.

· Exit reason 25: Services never used.

· Exit reason 53: Temporary waiver exit.

You must always provide advance notice if you close a program based on reassessment.

For additional information, refer to MMIS LTSS Manual – Record a reassessment.

Close using activity type 07: Administrative activity

When you use activity type 07 to close a program, you:

· Can use exit reasons 17, 19, 22–25, 31, 33, 34 or 53.

· Cannot use exit reasons 20 or 21.

The effective date can be retroactive in some cases. You must always provide notice if you close a program using activity type 07. Sometimes, advance notice is required. For more information, refer to MMIS LTSS Manual – Exit reasons.

Close after admission to an institution or residential treatment setting

CBSM – Temporary waiver exits and restarts: MMIS actions includes the policy and process for closing HCBS programs due to admission to an institution or residential treatment setting. All programs except Essential Community Supports (ECS) can remain open during admissions of less than 30 days.

When you close a program after admission to an institution or residential treatment setting:

1. Use activity type 07 to close the program.

2. Use the date of admission to the setting as the effective date for admissions longer than 29 days.

3. Use the applicable exit reason:

· Exit reason 53 (temporary waiver exit) when a person on a waiver has been admitted to an institution or residential treatment setting for 30 days or more.

· Exit reason 22 to close the Alternative Care (AC) program when a person on AC has been admitted to an institution or residential treatment setting for 30 days or more.

· Exit reason 24 to close the ECS program effective the date of admission. There is no short-stay period (i.e., 30 days) in which ECS may remain open. This policy allows Minnesota Aging Pathways to complete the person’s preadmission screening for nursing facility admission.

For information about people returning to the community with HCBS, refer to MMIS LTSS Manual – Relocation and transition assistance.

Reopen a closed program for appeal

If the person appeals the closing of their HCBS program and has requested HCBS to continue during the appeal, you must take additional steps to ensure services will continue.

If the person had a reassessment entered into MMIS that closed their HCBS program, you can use activity type 07 within 60 days of the activity type date of the reassessment (activity type 06) to change the assessment result and reopen the program to continue the person’s services.

Screening document instructions

To use activity type 07 to continue the person’s services:

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

2. Use:

· Action code A (add).

· Document type L.

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

3. Press the transmit key to open the ALT1 screen of the last saved screening document. This should be the exit document from the reassessment.

4. Enter the following information on the ALT1 screen:

· Person’s birth date in the DOB field.

· Activity type 07 in the ACTIVITY TYPE field.

· Activity type date in the ACT DT field. Use the day after the effective date on the exit document.

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

5. Press the transmit key to move to the ALT2 screen. Most fields are protected on the ALT2 screen when using activity type 07. Make the following changes:

· Enter 19 (appeals authorization) in the REASONS FOR REF field.

· Review and change other information on the ALT2 screen, as needed and allowable.

6. Press the transmit key to move to the ALT3 screen. Review and change information on the ALT3 screen, as needed and allowable.

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

· Enter assessment result 11 (reopen program) in the ASSESSMENT RESULTS field.

· Enter the effective date in the EFFECTIVE DT field for assessment result 11. This must be the day after the effective date of the exit. This should be the same date as the activity type date for activity type 07.

· Do not change the previous program type from the exit document.

8. Press the transmit key to move to the ADHS screen and add comments to document that the reason for reopening the program was due to appeal. Include the appeal docket number.

9. Press F9 to display exception codes. Note:

· This activity may generate various exception codes, such as exception code 179 (level of care does not match the program type).

· Fee-for-service Elderly Waiver (EW) only: If a person was previously receiving services under a 24-hour customized living (CL) rate and no longer meets the criteria for a 24-hour CL rate, MMIS will post exception code 520 if you indicate 24-hour CL on the ALT5 screen using service codes 58, 59, 60 or 86. If MMIS posts this exception code on a document being submitted for appeals, the DHS Service Agreement and Screening Document (SASD) Support Team must resolve this exception code.

10. Resolve exception codes, when possible.

11. Take the appropriate action:

· If all exceptions codes are resolved, press F3 to save and exit. This document will extend the program eligibility span to support continuation of services. You can stop at this step.

· If there are remaining exception codes that prevent approval of the document in MMIS, continue to the next step.

12. Save the document in MMIS as suspended with the remaining exception codes by pressing F3 to save and exit.

13. Request approval of the suspended screening document via the SASD Support Team Portal, DHS-3754. Complete the form and include:

· The document number (found at the top of the screening document suspended in MMIS).

· The exception codes that need to be forced to allow services to continue during an appeal in the comments section of the form.

SASD Support Team staff will force exception codes when:

· The activity type is 07 (case management administrative activity).

· The assessment result is 11 (reopening a person to the same program).

· The reason for referral is 19 (appeals authorization).

· The program type is the same as the previous program type.

· The effective date used to reopen the program is the day following the effective date of the exit.

· The person remains eligible for the program in other respects (e.g., remains eligible for Medical Assistance [MA] or for payment of long-term care under MA).

If the request does not meet the above requirements, SASD Support Team staff will return the request with instructions about the issues you need to resolve.

SASD Support team staff will email you when the screening document is approved in MMIS. This screening document will extend the program eligibility span to support continuation of services. SASD Support Team staff may also email you to provide additional instruction or request additional information.

For people on EW, approval of the screening document to reopen the program will continue EW capitation payments to managed care organizations (MCOs) to support the continuation of services during an appeal for people on Minnesota Senior Health Options (MSHO) or Minnesota Senior Care Plus (MSC+), subject to existing capitation cut-off dates.

Service agreement instructions

When the screening document in MMIS is approved to reopen the program:

1. Create a new service agreement using the appropriate service agreement type. For instructions, refer to MMIS LTSS Manual – Create a new service agreement.

2. Authorize services included in the previously approved support plan.

3. Use the effective date to reopen to the program as the header and line item begin date(s).

4. Generate service agreement letters to the provider and person, using applicable reason codes if desired.

MCOs must provide timely information to providers about the reinstatement of service authorizations using their current prior authorization processes, communication and tools.

Instructions when the appeal is final

Person prevails

If the person’s appeal is successful:

1. Enter a screening document using activity type 05 and assessment result 98.

2. Enter the activity date and assessment result date (i.e., effective date), which can be the date the screening document was updated with this information.

3. Enter a comment in the case manager comment screen with the appeal docket number that indicates the appeal has been heard and the person prevailed.

No other action is needed. The person will continue on the program with authorized services in place. The lead agency must complete a timely reassessment as required.

Person does not prevail

If the person’s appeal is not successful, you must take the following steps with the service agreement:

1. Close the service agreement, if any, at the header and line items. For instructions, refer to MMIS LTSS Manual – Close a service agreement.

2. Use a date for the end date for the header and line items that is 10 days after the date the lead agency received the appeal determination.

3. Resolve any exception codes and save the service agreement. This action will generate notices about the end of the authorization. Use applicable reason codes if desired.

MCOs must provide timely information to providers about the discontinuation of service authorizations using their current prior authorization processes, communication and tools.

Then, you must:

1. Enter a screening document using activity type 07 to close the program.

2. Use the date the lead agency received the appeal determination as the activity type date.

3. Exit the person from the waiver, AC or ECS program using:

· Exit reason 22 (person exited – no longer meets other eligibility criteria).

· Applicable secondary assessment result as required for all exits (e.g., 03 – in community with no services).

4. Use an effective date for the exit that is 10 days after the activity type date. This date will end the eligibility span in the recipient subsystem and will also end EW capitation payments to MCOs.

5. Enter a comment in the case manager comment screen with the appeal docket number that indicates the appeal has been heard and the person did not prevail.

6. Send a notice of action, as required, to the person and legal representatives. For more information, refer to CBSM – Notice of action.

Additional resources

CBSM – Notice of action
CBSM – Temporary waiver exits and restarts: MMIS actions
MMIS LTSS Manual – Close a service agreement
MMIS LTSS Manual – Create a new service agreement
MMIS LTSS Manual – Exit reasons
MMIS LTSS Manual – LTC screening document fields
MMIS LTSS Manual – Record a reassessment
MMIS LTSS Manual – Relocation and transition assistance
SASD Support Team Portal, DHS-3754