Temporary waiver exits and restarts: MMIS actions

Page updated: 2/25/26

Introduction

This page outlines MMIS actions taken for people on a home and community-based services (HCBS) waiver or AC program who enter the following settings:

· Institutions.

· Residential treatment settings for behavioral health or substance abuse.

· Intermediate care facilities for persons with developmental disabilities (ICFs/DD).

· Incarceration.

This page includes instructions for:

· Policy for admissions to certain settings for 30-121 days.

· Exits on Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Elderly Waiver (EW) programs.

· Exits on Alternative Care (AC) program.

· Exits on Developmental Disabilities (DD) Waiver.

· Reason codes used on service agreements (all programs).

Policy for admissions to certain settings for 30-121 days

People who enter certain settings for 121 or fewer days and were receiving HCBS may return to the community with HCBS waiver services without needing an assessment, as explained in the following sections.

Lead agencies cannot use the MMIS actions to restart a person’s waiver after admission for 30-121 days in a hospital, nursing facility or residential treatment setting if the person’s annual reassessment would have otherwise been due during the admission. In this situation, lead agencies must complete an initial assessment to reopen the person to a waiver. Lead agencies must continue to use the LTSS Recipient Report to track when reassessments are due.

Note: The MMIS actions to restart a waiver after admissions between 30-121 days do not apply to people on the AC or Essential Community Supports (ECS) program. For AC information, refer to the exits on AC program section. For ECS policy, refer to CBSM – ECS.

Exits on BI, CAC, CADI and EW programs

Institutions

These settings include:

· Hospitals.

· Nursing facilities (NFs).

Situation	Action needed
Person enters a hospital or NF for fewer than 30 days	Service agreement: · Close all line items effective the date of admission. · Enter new line items or a new service agreement after discharge. Screening document: · Do not enter an exit document to close the waiver.
Person enters a hospital or NF for 30-121 days (For BI, CAC and CADI, include days in a hospital prior to hospital discharge when admitted directly from the hospital to the NF)	Service agreement: · Close all line items and close the service agreement effective the date of admission. Screening document: · Enter an exit document using activity type 07 to close the waiver effective the date of admission using assessment result 53. To restart waiver: · Enter a screening document using activity type 07 and an assessment result 54 effective the date of discharge. · Enter a new service agreement to use the remaining waiver span.
Person enters a hospital or NF for 122 or more days (For BI, CAC and CADI, include days in a hospital prior to hospital discharge when admitted directly from the hospital to the NF)	Screening document: · The person was previously exited due to hospital or NF stay for 30-121 days effective the date of admission. · Complete an initial assessment to access a waiver at discharge.

Residential treatment settings for psychiatric, behavioral health or substance abuse

These settings include:

· 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).

· Regional treatment centers (RTCs).

· Community behavioral health hospitals (CBHHs).

· Children’s residential facilities (CRFs).

Note about IMD admissions: Service agreement/authorization dates cannot overlap with an IMD major program type. The effective date range of the IMD major program type may be verified in the MMIS recipient subsystem.

Situation	Action needed
Person enters a residential treatment setting for fewer than 30 days	Service agreement: · Close all line items effective the date of admission. · Enter new line items or a new service agreement after discharge. Screening document: · Do not enter an exit document to close the waiver.
Person enters a residential treatment setting for 30-121 days (For BI, CAC and CADI, include days in a hospital prior to hospital discharge when admitted directly from the hospital to the residential treatment setting)	Service agreement: · Close all line items and close the service agreement effective the date of admission. Screening document: · Enter an exit document using activity type 07 to close the waiver effective the date of admission using assessment result 53. To restart waiver: · Enter a screening document using activity type 07 and an assessment result 54. · Enter service agreement to use remaining waiver span.
Person enters a residential treatment setting for 122 or more days	Screening document: · The person was previously exited due to residential treatment stay for 30-121 days effective the date of admission. · Complete an initial assessment to access the waiver at discharge.

Intermediate care facilities for persons with developmental disabilities (ICF/DD)

Situation	Action needed
Person enters an ICF/DD facility	Service agreement: · Close all line items and close the service agreement effective the date of admission. Screening document: · Enter an exit document to close the waiver effective the date of admission. · Complete an initial assessment to access the waiver.

Incarceration

Note: Lead agencies cannot use assessment result 53 to exit a person from the waiver when they are incarcerated.

For the purposes of this page, “incarceration” refers to city, county, state and federal correctional and detention facilities. This includes people who are:

· In a work release program that requires they return to the facility during non-work hours.

· Sent by the court or penal institution to a chemical dependency residential treatment program while serving a sentence and are required to return to the correctional facility after completing treatment.

· In a juvenile facility licensed by the Department of Corrections (DOC) that is for holding, evaluation and detention purposes.

For more information, refer to MHCP Provider Manual – Health care programs and services.

Situation	Action needed
Person is incarcerated for fewer than 30 days	Service agreement: · Close all line items effective the date of incarceration. · Enter new line items or a new service agreement after incarceration. Screening document: · Do not enter an exit document to close the waiver.
Person is incarcerated for more than 30 days	Service agreement: · Close all line items and close the service agreement effective the date of incarceration. Screening document: · Enter an exit document to close the waiver effective the date of incarceration. · Complete an initial assessment to access the waiver after incarceration.

Exits on AC program

This section applies to the following settings:

· Hospitals.

· NFs.

· Rule 31 program settings (chemical dependency/SUD services).

· Rule 36 program settings (mental health/IRTS).

· PRTFs.

· IMDs.

· RTCs.

· CBHHs.

Situation	Action needed
Person enters an applicable setting for fewer than 181 days	Service agreement: · Close all line items effective the date of admission. · Add AC conversion case management to the service agreement. · End line items for AC conversion case management at discharge and add other service line items. Screening document: · Do not enter an exit document. · Perform the annual reassessment if due during the admission, as required to continue AC conversion case management.
Person enters an applicable setting for 181 or more days	Service agreement: · Applicable setting with no AC conversion case management: Close the service agreement effective the date of admission. · Applicable setting with AC conversion case management: Close the service agreement effective the 180th day. Screening document: · Applicable setting with no AC conversion case management: Enter an exit document to close the AC program effective the date of admission using assessment result 22. · Applicable setting with AC conversion case management: Enter an exit document to close the AC program effective the 180th day. To restart AC if exited: · Complete an initial assessment to reopen AC or change to EW at discharge.

Exits on DD Waiver

DHS implemented the MMIS changes for the DD Waiver. For more information, refer to the Oct. 17, 2023, eList announcement.

Hospitals

Situation	Action needed
Person enters a hospital for fewer than 30 days	Service agreement: · Close line items effective the date of admission. · Enter new line items or a new service agreement after discharge. Screening document: · Do not enter an exit document to close the waiver.
Person enters a hospital for 30-121 days	Service agreement: · Close all line items and close the service agreement effective the date of admission. Screening document: · Follow DD Screening Document Codebook – DD Waiver – Scenario 8 for next steps to close and subsequently reopen the waiver.
Person enters a hospital for 122 days or more	Screening document: · The person was previously exited due to hospital stay for 30-121 days. · Complete an initial assessment to access the waiver at discharge.

NFs

For people on the DD Waiver who enter an NF, a qualified developmental disability professional (QDDP) must complete OBRA Level II evaluative report for people with developmental disabilities, DHS-4248 (PDF) before the NF admission.

Situation	Action needed
Person enters an NF (Include days in a hospital prior to discharge to the NF)	Service agreement: · Close all line items and close the service agreement effective the date of admission. Screening document: · Follow DD Screening Document Codebook – OBRA scenarios and DD Screening Document Codebook – NF scenarios.

Residential settings for psychiatric, behavioral health or substance abuse

These settings include:

· Rule 31 program setting (chemical dependency/SUD).

· Rule 36 program setting (mental health/IRTS).

· PRTFs.

· IMDs.

· CBHHs.

· CRFs.

· RTCs.

Note about IMD admissions: Service agreement/authorization dates cannot overlap with an IMD major program type. The effective date range of the IMD major program type may be verified in the MMIS recipient subsystem.

Situation	Action needed
Person enters a residential treatment setting for fewer than 30 days	Service agreement: · Close all line items effective the date of admission. Screening document: · Do not enter an exit document to close the waiver.
Person enters a residential treatment setting for 30 to 121 days	Service agreement: · Close all line items and close the service agreement. Screening document: · Follow DD Screening Document Codebook – DD Waiver – Scenario 8 to enter an exit document to close the waiver effective the date of admission.
Person enters a residential treatment setting for 122 days or more	Screening document: · The person was previously exited due to residential treatment setting stay for 30-121 days. · Complete an initial assessment to access the waiver at discharge.

ICFs/DD

Situation	Action needed
Person enters an ICF/DD for fewer than 30 days	Service agreement: · Close all line items during the stay and close the service agreement. Screening document: · Follow DD Screening Document Codebook – DD Waiver – Scenario 3 to enter an exit document to close the waiver effective the date of admission.
Person enters an ICF/DD facility for more than 30 days	Service agreement: · Close all line items during the stay and close the service agreement. Screening document: · Follow DD Screening Document Codebook – DD Waiver – Scenario 1 to enter an exit document to close the waiver effective the date of admission.

Incarceration

Note: Lead agencies cannot use assessment result 17 to exit a person from the waiver when they are incarcerated.

For the purposes of this page, “incarceration” refers to city, county, state and federal correctional and detention facilities. This includes people who are:

· In a work release program that requires they return to the facility during non-work hours.

· Sent by the court or penal institution to a chemical dependency residential treatment program while serving a sentence and are required to return to the correctional facility after completing treatment.

· In a juvenile facility licensed by the Department of Corrections (DOC) that is for holding, evaluation and detention purposes.

For more information, refer to MHCP Provider Manual – Health care programs and services.

Situation	Action needed
Person is incarcerated for fewer than 30 days	Service agreement: · Close all line items effective the date of incarceration. · Enter new line items or a new service agreement after incarceration. Screening document: · Do not enter an exit document to close the waiver.
Person is incarcerated for more than 30 days	Service agreement: · Close all line items and close the service agreement effective the date of incarceration. Screening document: · Enter an exit document to close the waiver effective the date of incarceration. · Complete a new assessment to access the waiver after incarceration.

Exits on ECS

Minn. Stat. §256B.0911 does not apply to ECS. For ECS policy, refer to CBSM – ECS.

Reason codes used on service agreements (all programs)

Reason codes add auto-populated text to service agreement letters that are generated for providers and people/legal representatives (as applicable). Reason codes describe actions taken or changes made to services.

The lead agency should:

· Use reason code 844 when closing the line items effective the date of admission but not entering a screening document to close the waiver/AC due to a facility stay where waiver/AC services may not be provided.

· Use reason code 961 when ending the service agreement and entering a screening document to close the waiver/AC due to a facility stay where the waiver/AC span cannot remain open.

When the information applies to all service line items within the service agreement, the lead agency should put the reason code on the ASA2 screen within the STAT RSN field.

When the information applies to individual service line items, the lead agency should put the reason code on the ASA3 screen within the RSN CD field.

Reason code text will continue to appear on future letters if the lead agency does not remove it when they make additional changes to the document. The lead agency must remove the reason code if it is no longer valid.

Additional resources

CBSM – ECS
CBSM – Notice of action
CBSM – Preadmission screening and OBRA
CBSM – Relocation service coordination targeted case management (RSC-TCM)
CBSM – Waiver, AC and ECS process and procedure – Out-of-state services section
DD Screening Document Codebook – Screening scenarios
Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF)
Instructions for Completing and Entering the LTCC Screening Document and HRA into MMIS for the MSC+ and MSHO Programs, DHS-4669 (PDF)
Lead Agency Assessor/Case Manager/Worker/LTC Communication Form, DHS-5181 (PDF)
Minnesota Aging Pathways – Providers and partners resources