Additional long-term care (LTC) screening document information

Page posted: 8/3/26

This page includes information to help you understand and code assessment information correctly in the LTC screening document for:

· Case mix classification.

· Mini-Cog field.

· Alternative Care (AC) and Essential Community Supports (ECS) citizenship requirement.

Case mix classification

Case mix refers to a classification used in home and community-based services (HCBS) programs to establish or contribute to the establishment of budgets and/or rate limits for some services. Case mix classification is based on a subset of assessment items, as described in AC, BI, CADI, EW Case Mix Classification Worksheet, DHS-3428B (PDF). The certified assessor calculates and identifies case mix in the MnCHOICES assessment. MMIS also reviews and posts exception codes for case mix based on the assessment data entered in the screening document.

Assessment for ventilator dependency

A person is ventilator-dependent if they meet both of the following criteria:

· Receive mechanical ventilation for life support at least six hours per day.

· Are expected to be or have been dependent on a ventilator for at least 30 consecutive days.

Intermittent or PRN use of oxygen, oxygen monitor only, apnea monitor only, nebulizer treatments or CPAP devices for snoring or sleep apnea do not meet the definition of mechanical ventilation for life support.

The assessor completes an assessment of ventilator dependency based on a review of a formal written treatment and clinical monitoring plan and/or review of the medical record.

The valid values used for ventilator-related need are:

· 00: Not applicable.

· 01: Intermittent: Not six hours per day or not expected to be/has not been dependent for 30 consecutive days.

· 02: Intermittent: At least six hours per day and expected to be/has been dependent for 30 consecutive days.

· 03: Continuous: Expected to be/has been dependent for 30 consecutive days.

People who are on or will access the Elderly Waiver (EW) and are ventilator-dependent are assigned case mix V. If you enter 02 or 03 in the vent dependency field, MMIS will classify the EW person as case mix V.

Mini-Cog field

Lead agencies use the Mini-Cog as a screening tool for the possible presence of dementia or other memory issues. The Mini-Cog is part of the MnCHOICES assessment. It replaces the mental status evaluation screening tool. The MEN STAT EVAL field in MMIS is protected, and you can leave it blank.

You must complete the Mini-Cog field on the ALT3 screen in MMIS when all of the following are true:

· The assessment is completed in MnCHOICES.

· The person is age 30 or older as of the activity type date.
Note: The field is protected for people younger than age 30.

· The activity type is 02, 04, 06, 08, 09 or 10.

· The program type is 00–12, 19, 22, 29 or 30; or the program type is 18 and the assessment result is not 35 (health risk assessment).

The valid values for the Mini-Cog field on the ALT3 screen are:

· 00–05: Score based on completion of the Mini-Cog screening.

· 06: Person chose not to complete.

· 07: Screening not indicated.

· 08: Additional screening not necessary.

· 09: The test is not accessible to person.

The Mini-Cog field is protected for activity types 01, 03, 05 and 07.

AC and ECS citizenship requirement

Some people are not eligible for the AC or ECS program if they are not citizens. People who apply for AC and ECS must attest to their citizenship or immigration status. For more information and links to applicable eligibility worksheets, refer to CBSM – AC and CBSM – ECS.

You must verify the AC or ECS applicant’s status electronically if you do not obtain it through other means, such as Medicare enrollment. For more information about methods to verify citizenship and/or immigration status, refer to Eligibility Policy Manual.

The ALT6 screen records the person’s citizenship status. The field is mandatory when all of the following are true:

· The effective date is equal to or greater than July 1, 2015.

· The program type is 09, 10, 22 or 29.

· The assessment result is 01, 10, 11 or 13.

The valid values for this field are:

· 1: Person is a US citizen.

· 2: Citizenship is pending.

· 3: Person is not a US citizen.

Note that these values do not have a preceding zero.

Exception codes related to citizenship

Exception code 279: Citizenship is pending

When the value is 2 (citizenship is pending), the AC major program eligibility span or the unknown major program/waiver type Y eligibility span for ECS is limited to 90 days.

Exception code 278: Citizenship field is missing or invalid

You must complete the citizenship field with a valid value.

When you exit a person from AC or ECS due to their inability to confirm citizenship (value 2) within 90 days (i.e., the time period allowed for value 2), use exit reason 22 to avoid this exception code.

Exception code 280: Citizenship not valid for program

When the value is 3 (person is not a US citizen), the person is not eligible for AC or ECS. You must:

1. Enter an exit screening document.

2. Change the assessment result to exit reason 22.

If the person reapplies for citizenship, you can reopen to the program and use value 2 in the citizenship field for a 90-day eligibility period.

If the person submits additional documentation to prove citizenship, you can reopen the program and use value 1 in the citizenship field.

Update the citizenship status

You can update the person’s citizenship status using activity type 07 when their citizenship status was initially pending (value 2) and you receive documentation within the reduced 90-day eligibility span.

To update the citizenship status:

1. Select screenings on the main menu to open the ASCR screening document key panel screen.

2. Enter the following information on the ASCR screen:

· Action code A (add).

· Document type L.

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

3. Press the transmit key to open a copy of the last approved screening document at the ALT1 screen.
Note: Because you are using a copy of the last screening document, nearly all fields will be populated. Most fields are protected using activity type 07. The fields you can change will appear as green fields, and protected fields will appear as white.

4. Enter following information on ALT1 screen:

· Person’s birth date in the DOB field.

· Activity type 07 in the ACTIVITY TYPE field.

· Activity type date associated with the case manager activity in the ACT DT field.

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

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

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

· Assessment result 49 to indicate citizenship is confirmed. You can only use this assessment result if citizenship was pending (value 2) on the previous document. MMIS will post exception codes if you use assessment result 49 for any program type other than 09, 10 or 29, or if the activity type is not 07.

· The effective date as the date you received citizenship documentation.

8. Press the transmit key to move to the ALT5 screen and update services, if needed.

9. Press the transmit key to move to the ALT6 screen, change the citizenship value to 1 and complete the mandatory fields.

10.Press F9 to display exception codes.

11. Resolve exception codes.

12. Press F3 to save the document.

When the document is saved and approved in MMIS, MMIS extends the program eligibility span as follows:

· For AC, MMIS extends the eligibility span to 365 days from the effective date on the last opening, reopening or reassessment screening document with assessment result 01, 11 or 13, respectively.

· For ECS, MMIS extends the eligibility span to the end of the 12th month from the effective date on the last opening, reopening or reassessment screening document with assessment result 01, 11 or 13, respectively.

Exit after 90 days

If the person does not or cannot confirm their citizenship status after 90 days, you must exit the person from the program using assessment result 22: person exited because they no longer meet other eligibility criteria. For instructions, refer to MMIS LTSS Manual – Close an HCBS program.

If the person becomes become eligible for MA LTC and meets nursing facility level of care criteria after exiting, they need another assessment using activity type 02 or 04 to reopen to a program.

Additional resources

CBSM – AC
CBSM – ECS
Eligibility Policy Manual
MMIS LTSS Manual – Close an HCBS program