Developmental Disabilities (DD) Waiver scenarios

Page posted: 6/26/19		Page reviewed: 10/17/23	Page updated: 2/10/26
Overview	This page contains sequencing charts for: 1. DD diversion/conversion to community intermediate care facility for persons with developmental disabilities (ICF/DD) 2. DD diversion/conversion to Family Support Grant (FSG) 3. DD diversion/conversion to ICF/DD short-term admission to DD diversion/conversion 4. DD diversion/conversion to semi-independent living services (SILS) 5. DD diversion/conversion to adoption, name/person master index number (PMIN) change 6. DD diversion/conversion annual reassessment and remaining on DD Waiver 7. DD diversion/conversion exit for reasons other than an institutional stay 8. DD diversion/conversion exit for a hospital or residential treatment settings admissions of up to 121 days 9. DD diversion/conversion – Person dies in a community setting 10. DD diversion/conversion – Person dies in an institution 11. DD diversion/conversion case manager change and/or change in current or planned services Notes Current services are attached to the action date. Planned services are attached to the effective date. MMIS automatically routes some documents to DHS to review. Lead agencies are no longer required to route documents manually to DHS.
Waiver exits	When a person exits the waiver, the lead agency can only update the following screening document fields: · Action date (field 23) · Action type (field 24) · Planned services (field 42 a-p) · Final action planned (field 46) · Assessment result (field 47a) · Exit reason (field 47b) · Effective date (field 48) · Case manager comments. The lead agency cannot alter any other fields in a waiver exit screening document.
Additional resources	DD Screening Document Codebook – Scenarios CBSM – DD Waiver CBSM –FSG CBSM – SILS

1. Scenario: DD diversion/conversion to community ICF/DD

County/tribal nation-entered fields	1st sequence	2nd sequence
(23) Action date	Waiver exit date (date prior to ICF/DD admission)	ICF/DD admission date
(24) Action type	03	03
(39) Level of care	01	01
(41) Current services	01, waiver service codes, residential code, other	19, 28, other
(42) Planned services	19, 28, other	19, 28, other
(44) Waiver need index	004	005
(46) Final action planned	07	07
(47a) Assessment result	05 – Waiver out	16 – Facility stay
(47b) Exit reason	16 – Facility stay	N/A
(48) Effective date	Waiver exit date (date prior to ICF/DD admission)	ICF/DD admission date
(49) Current Medical Assistance (MA) program	01 or 02	04
Nursing facility (NF) begin and through dates	Delete dates previously entered	N/A
Time-limited payment	N	N
Payment authorized	01	01
Case manager comments	Comments as needed	Comments as needed

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2. Scenario: DD diversion/conversion to FSG

County/tribal nation-entered fields	1st sequence
(23) Action date	Waiver exit date (date prior to FSG start date)
(24) Action type	03
(39) Level of care	01
(41) Current services	01, waiver service codes, residential code, other
(42) Planned services	19, 23, residential code, other
(44) Waiver need index	004
(46) Final action planned	03
(47a) Assessment result	05 – Waiver out
(47b) Exit reason	14 – Community with services – Not DD Waiver
(48) Effective date	Waiver exit date (date prior to FSG start date)
(49) Current MA program	01 or 02
NF begin and through dates	Delete dates previously entered
Time-limited payment	N
Payment authorized	01
Case manager comments	Comments as needed

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3. Scenario: DD diversion/conversion to ICF/DD short-term admission to DD diversion/conversion

County/tribal nation-entered fields	1st sequence	2nd sequence	3rd sequence
(23) Action date	Date action was taken	ICF/DD admission date	ICF/DD out date
(24) Action type	03	03	03
(39) Level of care	01	01	01
(41) Current services	01, waiver service codes, residential code, other	19, 26, other	01, waiver service codes, residential code, other
(42) Planned services	19, 26, other	01, waiver service codes, residential code, other	01 waiver service codes, residential code, other
(44) Waiver need index	004	005	004
(46) Final action planned	04	04	04
(47a) Assessment result	05 – Waiver out	16 – Facility stay	04 – Waiver in
(47b) Exit reason	16 – Facility stay	N/A	N/A
(48) Effective date	Waiver exit date (date prior to ICF/DD admission)	ICF/DD admission date	Waiver in date
(49) Current MA program	01 or 02	04	01 or 02
NF begin and through dates	Delete dates previously entered	N/A	N/A
Time-limited payment	N	N	N
Payment authorized	01	01	01
Case manager comments	Comments as needed	Comments as needed	Comments as needed

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4. Scenario: DD diversion/conversion to SILS

County/tribal nation-entered fields	1st sequence	2nd sequence
(23) Action date	Waiver out date	In-person assessment date
(24) Action type	03	01
(39) Level of care	01	03
(41) Current services	01, waiver service codes, residential code, other	19, 24, residential code, other
(42) Planned services	19, 24, residential code, other	19, 24, residential code, other
(44) Waiver need index	004	005
(46) Final action planned	05	05
(47a) Assessment result	05 – Waiver out	14 – Community with services – Not DD Waiver
(47b) Exit reason	Applicable waiver exit reason	N/A
(48) Effective date	Waiver exit date	SILS start date
(49) Current MA program	01 or 02	06
NF begin and through dates	N/A	N/A
Time-limited payment	N	N
Payment authorized	01	05
Case manager comments	Comments as needed	Comments as needed

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5. Scenario: DD diversion/conversion to adoption, name/PMIN change

County/tribal nation-entered fields	1st sequence	2nd sequence
(23) Action date	Last date of old name/PMIN	Adoption date with new name/PMIN
(24) Action type	03	01
(39) Level of care	01	01
(41) Current services	01, waiver service codes, residential code, other	01, waiver service codes, residential code, other
(42) Planned services	19, residential, other	01, waiver services, residential code, other
(44) Waiver need index	004	004
(46) Final action planned	98	04
(47a) Assessment result	05 – Waiver out	04 – Waiver in
(47b) Exit reason	10 – Exit – Other	N/A
(48) Effective date	Last date of old name/PMIN	Waiver in date
(49) Current MA program	01 or 02	01 or 02
NF begin and through dates	Delete dates previously entered	N/A
Time-limited payment	N	N
Payment authorized	01	01
Case manager comments	Adoption, name and PMIN change	Comments as needed

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6. Scenario: DD diversion/conversion annual reassessment remaining on DD Waiver

MMIS will not allow lead agencies to use assessment result 15 (i.e., remain on the DD Waiver) with an effective date that is not within the current DD Waiver span. If the effective date (field 48) is not within the current DD Waiver span, MMIS will produce a “no matching waiver segment” error.

Instructions

To extend a person’s DD Waiver span at reassessment, lead agencies must follow these instructions:

· If the first date of a person’s new service authorization is within the previous waiver span, use a date within the previous waiver span as the effective date.

· If the first date of a person’s new service authorization is not within the previous waiver span, use the last date of the previous waiver span as the effective date.

Then, the lead agency can authorize services using the updated waiver span.

The lead agency does not need to make changes to the person’s current service authorization period.

Example

A person’s current service authorization span is Aug. 1, 2018, through July 31, 2019. The lead agency completes the reassessment and enters an action type 01 (i.e., face-to-face assessment) into MMIS. The effective date for this document will be July 31, 2019. This document extends the waiver span through Aug. 31, 2020, and allows the lead agency to authorize services for Aug. 1. 2019, through July 31, 2020.

County/tribal nation-entered fields	1st sequence
(23) Action date	In-person assessment date
(24) Action type	01
(39) Level of care	01
(41) Current services	01, waiver service codes, residential code, other
(42) Planned services	01, waiver service codes, residential code, other
(44) Waiver need index	004
(46) Final action planned	01 or 04
(47a) Assessment result	15 – Remain in community with DD Waiver services
(47b) Exit reason	N/A
(48) Effective date	Waiver service agreement span start date
(49) Current MA program	01 or 02
NF begin and through dates	Delete dates previously entered
Time-limited payment	N
Payment authorized	01
Case manager comments	Comments as needed

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7. Scenario: DD diversion/conversion exit for reasons other than an institutional stay

County/tribal nation-entered fields	1st sequence
(23) Action date	Waiver exit date
(24) Action type	03
(39) Level of care	01
(41) Current services	01, waiver service codes, residential code, other
(42) Planned services	19, other
(44) Waiver need index	004
(46) Final action planned	Corresponds with field 42 planned services
(47a) Assessment result	05 – Waiver out
(47b) Exit reason	Enter appropriate exit reason
(48) Effective date	Waiver exit date
(49) Current MA program	01 or 02
NF short-term approval begin and through date	Delete dates previously entered
Time-limited payment	N
Payment authorized	01
Case manager comments	Comments as needed

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8. Scenario: DD diversion/conversion exit for a hospital or residential treatment settings admissions of up to 121 days

These settings include:

· Acute hospital.

· Rule 31 program settings (chemical dependency/Substance Use Disorder [SUD] services).

· Rule 36 program settings (mental health/Intensive Residential Treatment Services [IRTS]).

· Psychiatric residential treatment facilities (PRTFs).

· Institutions for mental disease (IMDs).

· Community Behavioral Health Hospitals (CBHHs).

· Children’s Residential Facility (CRF).

· Regional treatment center (RTC).

Note: People who are admitted to certain settings for 121 or fewer days and were receiving DD Waiver services before admission may return to the DD Waiver without an assessment, as long as the person’s annual reassessment would not have otherwise been due during the admission. In that situation, lead agencies must complete an assessment to reopen the person to the DD Waiver.

County/tribal nation-entered fields	1st sequence	2nd sequence
(23) Action date	Waiver exit date	Waiver in date
(24) Action type	03	03
(39) Level of care	01	01
(41) Current services	Leave previously entered values	01, waiver service codes, residential code, other
(42) Planned services	19, other	01, waiver service codes, residential code, other
(44) Waiver need index	004	004
(46) Final action planned	Corresponds with field 42 planned services	01 or 04
(47a) Assessment result	05 – Waiver out	18 – Restart waiver
(47b) Exit reason	17 – Temp waiver exit	N/A
(48) Effective date	Waiver exit date (date prior to admission)	Waiver service agreement span start date
(49) Current MA program	01 or 02	01 or 02 (must match previous program the person accessed)
NF short-term approval begin and through date	Delete dates previously entered	Delete dates previously entered
Time-limited payment	N	N
Payment authorized	01	01
Case manager comments	Comments as needed	Comments as needed

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9. Scenario: DD diversion/conversion – Person dies in a community setting

County/tribal nation-entered fields	1st sequence
(23) Action date	Date of death
(24) Action type	03
(39) Level of care	Leave previous level of care
(41) Current services	Leave previous current services
(42) Planned services	No planned services
(44) Waiver need index	Leave previous waiver need index
(46) Final action planned	Leave previously entered values or 98
(47a) Assessment result	05 – Waiver out
(47b) Exit reason	08 – Exit – Death
(48) Effective date	Date of death
(49) Current MA program	No change to current waiver program code
NF short-term approval begin and through date	Delete dates previously entered
Time-limited payment	N
Payment authorized	01
Case manager comments	Comments as needed

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10. Scenario: DD diversion/conversion – Person dies in an institution

In this scenario, there is no need to enter in a document that exits the person using exit reason 08 – Exit – Death. This information is captured elsewhere in MMIS.

County/tribal nation-entered fields	1st sequence
(23) Action date	Institutional admission date
(24) Action type	03
(39) Level of care	Leave previous level of care
(41) Current services	Leave previous current services
(42) Planned services	33 – Other
(44) Waiver need index	Leave previous waiver need index
(46) Final action planned	Leave previously entered values or 98
(47a) Assessment result	05 – Waiver out
(47b) Exit reason	16 – Facility stay
(48) Effective date	Waiver exit date
(49) Current MA program	No change to current waiver program code
NF begin and through dates	Delete dates previously entered
Time-limited payment	N
Payment authorized	01
Case manager comments	Comments as needed

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11. Scenario: DD diversion/conversion case manager change and/or change in current or planned services

County/tribal nation-entered fields	1st sequence
(23) Action date	Date of the change in case manager or service change
(24) Action type	03
(39) Level of care	01
(41) Current services	01, waiver service codes, residential code, other
(42) Planned services	01, waiver service codes, residential code, other
(44) Waiver need index	004
(46) Final action planned	01 or 04
(47a) Assessment result	15 – Remain in community with DD Waiver services
(47b) Exit reason	N/A
(48) Effective date	Date case manager or service change is effective
(49) Current MA program	01 or 02
NF begin and through dates	Leave blank
Time-limited payment	N
Payment authorized	01
Case manager comments	Comments as needed

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