Request to exceed the Alternative Care (AC) and Elderly Waiver (EW) budget caps
Page posted: 8/3/26
The budgets available to support AC and EW service authorizations are based on the person’s assessed case mix classification. Each case mix classification is attached to a monthly budget amount. MMIS populates this amount in the long-term care (LTC) screening document for the AC and EW program types in the case mix monthly amount field.
MMIS multiplies the case mix monthly amount by the number of months included on the service agreement using the header begin and end dates to calculate a total cap amount (CAP AMT). MMIS will populate the calculated total cap amount on the AC or EW service agreement. Typically, the cumulative total amount contained within all approved line items on the service agreement cannot exceed the total cap amount.
DHS can approve requests to exceed the AC and EW budget cap in the following circumstances:
1. The person’s eligibility span is reduced, and the service agreement header span must end to close the AC or EW program properly. This might happen when:
2. The cost of the service plan will exceed the CAP AMT when authorizing personal care assistance (PCA) complex services.
3. The person requests a conversion rate for EW.
For additional policy and process information related to exceeding AC and EW budget caps or to request a conversion rate for EW to support discharge from a nursing facility, refer to:
Reduce a service agreement header end date and close a program
When the AC or EW program must be closed because a person is living in a facility or treatment setting or has died, you must reduce the service agreement header and line item end dates to the last day of program eligibility. This date is also the last date the person can receive services. When the header end date is reduced, MMIS also reduces the total authorized cap amount (CAP AMT) based on the number of months left in the decreased service agreement period multiplied by the case mix budget amount.
Exception code 672
If the person has died or is living in an institution/treatment setting, the units and amount for services already delivered may exceed the total amount available when you shorten the header period to close the program.
MMIS will post exception code 672 (total cap exceeded) if the cost of all approved service line items now exceed the new total cap amount.
Force the exception code
If exception code 672 continues to post and the exit was due to death or living in an institutional/residential treatment setting, you can make exception code 672 forcible by completing these steps:
1. Access the service agreement you want to close in the change mode. For instructions, refer to MMIS LTSS Manual – Change an existing service agreement.
2. Change the header end date and line item end dates to the date of death or admission to an institutional/residential treatment setting.
3. Change the header status from A (approved) or T (partially approved) to S (suspended).
4. Add a message to the DHS comment screen with the date of death or date of admission to an institutional/residential treatment setting and a request to force exception code 672.
5. Press F3 to save the service agreement.
6. Use Service Agreement and Screening Document (SASD) Support Team Portal, DHS-3754 to submit a request with identifying information.
When the SASD Support Team receives the request, they will:
1. Check the DHS comment screen for the date of death or admission to an institutional/residential treatment setting.
2. Ensure the service agreement header end date matches the date of death or admission to an institutional/residential treatment setting.
3. Add reason code 672 to the ASA2 screen.
4. Force exception code 672.
5. Change the header status back to A (approved) or T (partially approved).
6. Email the case manager to notify them that they forced the exception code, or to provide additional steps the lead agency needs to take before the exception code can be forced.
The SASD Support Team will keep the service agreement in suspense, will not add reason code 672 and will not force exception code 672 if you do not add the correct message to the comment screen, still need to resolve other exception codes or need to address other problems.
Reason code 672
Reason code 672 means the service agreement was approved in MMIS to exceed the total cap for the current services up to the date of death or admission to an institutional/residential treatment setting. Using reason code 672 will:
If the person returns to the community after the institution stay, you must create a new service agreement to resume their services.
Exception codes 672 and 452 for a CDCS or CFSS service agreement
The total cap amount for service agreements that include CDCS or CFSS can be exceeded when AC or EW is closed for any reason. This is not limited to exits due to death or a person living in an institutional/residential treatment setting.
Service agreements that include a line item for T2028 (CDCS) or T1023 (CFSS) on the AC or EW service agreement allow budgets to be used flexibly during a 12-month period. MMIS will bypass the following exceptions codes so they do not post on the service agreement:
When you press F9 to display exception codes on a service agreement that includes CDCS or CFSS, MMIS automatically makes the following changes when the header end date is reduced and the total authorized amount now exceeds the total cap amount.
Note: This is the date the program ended.
You can add more units and total amounts to line items if additional service claims for dates of service occurred before the program end date. You also can add new line with end dates no later than the program end date.
If the person returns to the community within the previous eligibility span, you cannot extend the original service agreement. You must create a new service agreement for the new period in the community and not exceed the total cap.
Change to a new county of service or Tribal Nation for AC or EW when the program remains open
The information in this section will help you avoid exception code 672 (total authorized exceeds total cap) when a person moves to a new county of service or Tribal Nation. For more information about AC and EW transfers, refer to MnCHOICES Lead Agency Transfer and Communication Form, DHS-6037 (PDF) and CBSM – MnCHOICES lead agency transfer and communication form: Scenarios for people on AC, EW or ECS. In particular, note the scenarios when the transfer involves a Tribal Nation.
New agency is not completing a reassessment upon transfer
If the new agency is not completing a reassessment when the person transfers:
1. The previous agency does not enter an exit LTC screening document.
2. The new agency enters an LTC screening document using activity type 05 with assessment result 98 that identifies the new LTCC county and case manager.
3. The previous agency that created the service agreement leaves the service agreement open for the 12 months of eligibility and closes the line items they approved. The end date of the line items is the last day the previous agency is responsible for case management.
4. The new agency uses the same service agreement and adds line items for services they are authorizing through the end of the service agreement period.
New agency completes a reassessment upon transfer
If the new agency will complete a reassessment when the person transfers:
1. The new agency ends the existing service agreement with an end date one day before the reassessment effective date. For instructions, refer to MMIS LTSS Manual – Close a service agreement.
2.The new agency enters a screening document with activity type 06 and assessment result 13, then approves and saves it in MMIS.
3. MMIS extends the eligibility span for another 12 months.
4. The new agency authorizes their services on a new service agreement for the new 12-month period.
Exception code 672 for other exit reasons
If the reason for exiting from AC or EW is not due to death or admission to an institutional/residential treatment setting, you must resolve exception code 672. Exception code 672 posts when the approved service agreement line item amounts exceed the total cap available. In many cases, you can resolve exception code 672 by reducing the number of unpaid units and/or authorized amounts to reflect the discontinuation of services as of the date the program will close.
If MMIS still posts the exception code, use the SASD Support Team Portal, DHS-3754 and include the person master index (PMI) number, date of exit and reason for exiting.
Additional resources
Case Management Transfer Scenarios for People on AC, EW or ECS, DHS-6037A (PDF)
CBSM – AC and EW budgets and case mix caps
CBSM – EW hospital high-needs budget exception and nursing facility conversion budget
CDCS Manual – Enhanced budget
CFSS Manual – PCA, CFSS and CSG enhanced rate/budget
MMIS LTSS Manual – Change an existing service agreement
MMIS LTSS Manual – Close a service agreement
MnCHOICES Lead Agency Transfer and Communication Form, DHS-6037 (PDF)
SASD Support Team Portal, DHS-3754
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