Route the long-term care (LTC) screening document for additional approval
Page posted: 8/3/26
In most cases, you can enter and approve the LTC screening document if you have resolved all suspended and denial exception codes (i.e., edits). However, there are some circumstances in which you must route the LTC screening document to DHS staff or another lead agency for approval. This page provides instructions for those circumstances.
In general, you use the OVERRIDE LOC field on the ALT1 screen to send a suspended screening document for additional approval. The document routes to a queue based the number you enter in this field before saving the document. In some cases, MMIS auto-populates the field when you save the suspended document.
Instructions for Elderly Waiver (EW) conversion rate
A person returning to the community from a nursing facility (NF) stay of at least 30 days may be eligible for an EW conversion rate if the proposed cost of the support plan is greater than the person’s case mix budget.
In this situation, you can increase the case mix amount or consumer directed community supports (CDCS) amount on the LTC screening document, up to the NF’s payment rate at discharge. CBSM – EW hospital high-needs budget exception and NF conversion budget includes information about how to calculate the monthly budget requested and other policy and process information.
The following steps apply only to people who will open to fee-for-service EW. For people enrolled in managed care, contact the person’s managed care organization (MCO) for instruction to complete the request.
The county or Tribal Nation submits a request for a fee-for-service EW conversion rate using these steps:
1. Enter an LTC screening document using activity type 04. For instructions, refer to MMIS LTSS Manual – Enter an LTC screening document.
2. Manually update the case mix amount field (and the CDCS amount field, if applicable) on the ALT4 screen to the proposed cost of the support plan. This cost cannot exceed the NF rate.
3. Complete the remainder of the LTC screening document.
4. On the ALT4 screening, enter:
5. Press F9 to display exception codes.
6. Resolve all exception codes except exception code 784, which posts due to the change in dollar amount(s) in step 2.
7. Press F3 to save the screening document as suspended. MMIS will post exception code 784 and route the screening document to DHS staff.
8. Complete and submit a request for approval of the screening document by following instructions on CBSM – EW hospital high-needs budget exception and NF conversion budget.
Note: Previously, county/Tribal Nation staff used EW CDCS Conversion Rate Request, DHS-3956A to request approval of a suspended screening document with an increase to the CDCS allowable budget. Since the case mix budgets and the CDCS budgets are now equal for EW, DHS-3956A is now obsolete and no longer in use.
Once DHS staff receive other documentation related to the person’s support plan, DHS will approve, deny or amend the case mix amount and or the CDCS amount (if applicable) in MMIS by placing N or Y in the case mix approval/CDCS amount fields on the screening document, changing the dollar amount on the case mix/CDCS fields or request additional information from the case manager as recorded on the screening document.
After DHS staff approve the screening document, the case manager can complete the service agreement. For instructions, refer to MMIS LTSS Manual – Create a new service agreement.
You must repeat this process each year if the person continues to need the higher budget amount.
CDCS and personal care assistance (PCA) enhanced budget for Alternative Care (AC) and EW
In MMIS, the enhanced budget is called “PCA complex.” When a person on AC or EW is eligible for PCA complex, you may need to increase the CDCS amount field to support higher costs to support a higher rate for a qualified worker. For instructions, refer to MMIS LTSS Manual – CDCS screening documents.
CFSS Manual – PCA, CFSS and CSG enhanced rate/budget provides information about requesting DHS approval for additional funding when needed to support PCA enhanced budgets.
County of financial responsibility (CFR)
MMIS will post exception code 697 on an LTC screening document if both of the following are true:
To route this document to the CFR for approval:
1. Resolve or force all other suspended and denial status exception codes before routing.
2. Enter the county/Tribal Nation CFR code in the OVERRIDE LOC field on the ALT1 screen of the suspended screening document.
3. Press F3 to save the document in suspended status.
MMIS will route the document to the CFR’s queue the following day.
NF admissions for people younger than age 21
DHS must approve all NF admissions of people younger than age 21. If you enter an assessment or preadmission screening (PAS) for a person younger than age 21 with assessment result 04, 05, 07 or 08 (admission to an institution), MMIS will post exception code 655.
The exception code text for exception code 655 includes instructions for DHS review and approval of the NF stay. If instructed to route a suspended screening document:
1. Resolve or force all other suspended and denial status exception codes before routing.
2. Enter the routing code provided by DHS in the OVERRIDE LOC field on the ALT1 screen of the suspended screening document.
3. Press F3 to save the document in suspended status.
MMIS will route the document to the identified queue for DHS review and approval.
NF admissions for people with a developmental disability
If a person is on the Developmental Disabilities (DD) Waiver, Minnesota Aging Pathways staff will enter the PAS because the DD Waiver relies on a different institutional level of care. Minnesota Aging Pathways staff will determine NF LOC via their PAS process and tool.
Minnesota Aging Pathways staff will forward the PAS information to the county/Tribal Nation for DD Waiver work and the OBRA II screening. For additional information about NF admissions, refer to:
Verify routing
After routing a screening document, use inquiry mode the following day to verify that it routed properly. Do not use change mode to check these documents. Change mode will pull the documents out of the queues.
The ALT1 screen shows the CURR LOC/DT (current location/date) fields typically completed with the following codes:
For instructions about inquiry mode, refer to MMIS LTSS Manual – Use inquiry mode with LTC screening documents.
Additional resources
CBSM – EW hospital high-needs budget exception and NF conversion budget
CBSM – OBRA Level II evaluative report for people with developmental disabilities
CFSS Manual – PCA, CFSS and CSG enhanced rate/budget
DD Screening Document Codebook – OBRA Level II evaluative report scenarios
Minnesota Aging Pathways – Provider resources
MMIS LTSS Manual – CDCS screening documents
MMIS LTSS Manual – Create a new service agreement
MMIS LTSS Manual – Enter an LTC screening document
MMIS LTSS Manual – Exception codes in the LTC screening document
MMIS LTSS Manual – Use inquiry mode with LTC screening documents
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