MMIS Long-Term Services and Supports Manual

The Medicaid Management and Information System (MMIS) Long-Term Services and Supports Manual is a resource for lead agency assessors, case managers and care coordinators. It helps staff work with long-term care (LTC) screening documents and service agreements in MMIS.

Other MMIS resources

MMIS User Manual for Minnesota Health Care Programs (MHCP) provides an overview of the MMIS subsystems used to maintain coverage and service delivery information for MHCP, including Medical Assistance (MA), MinnesotaCare, Medicare Supplement Programs (MSP) and processes related to premium billing for MinnesotaCare and Client Option Spenddown (COS). It supports county, Tribal Nation and state staff responsible to enter, update and maintain MHCP data in MMIS.

DSD MMIS Reference Guide is for assessors and case managers who work with Consumer Support Grant (CSG), personal care assistance (PCA), Community First Services and Supports (CFSS) and the Developmental Disabilities (DD) Waiver.

DD Screening Document Codebook is for lead agency workers who complete DD screening documents.

What is MMIS?

MMIS is a mainframe system designed to:

· Process health services claims.

· Detect and reduce fraud and abuse.

· Provide information for policy development, administrative decisions and reporting.

MMIS’ primary function is the appropriate payment of claims. To pay claims, MMIS verifies:

· The person’s health care or other program eligibility.

· The person’s enrollment in managed care, if applicable.

· Prior authorization of services, when needed.

· The provider’s enrollment and qualifications for services.

LTC screening documents and service agreements

Lead agencies primarily work with LTC screening documents and service agreements in MMIS. LTC screening documents and service agreements allow lead agencies to manage and administer the following home and community-based services (HCBS) programs:

· Long-term care consultation (LTCC), which provides assessment and support planning for any person requesting this help.

· Programs for people age 65 and older: Alternative Care (AC), Elderly Waiver (EW) and Essential Community Supports (ECS).

· Programs for people with disabilities: Brain Injury (BI) Waiver, Community Access for Disability Inclusion (CADI) Waiver and Community Alternative Care (CAC) Waiver.

Note: The Developmental Disabilities (DD) Waiver has its own screening document and service agreement. This manual does not include information about the DD Waiver screening document or service agreement type.

The LTC screening document:

· Captures information related to program eligibility.

· Establishes eligibility for HCBS programs within the recipient subsystem.

· Establishes HCBS service budgets for some programs.

· Collects information about people who receive assessments and their outcomes.

· Records lead agency activities.

The service agreement:

· Supports claims by identifying allowable services, approved services, dates of service, rates and providers.

· Generates authorization letters for the person, case manager and providers.

· Allows providers to be paid for services they deliver.

Subsystems

MMIS has 30 subsystems. These subsystems establish health care eligibility, approve payment for services, pay capitation to managed care organizations, enroll providers and pay claims. The following sections include brief descriptions of the commonly used subsystems. For full descriptions and information about other subsystems, refer to MMIS LTSS Manual – MMIS subsystems.

Prior authorization subsystem

LTC screening documents and service agreements are located in the prior authorization subsystem, which is a subsystem used for many services that must be approved in MMIS before claim payment. Lead agencies complete most of their work related to administration and management of HCBS programs in this subsystem.

Recipient subsystem

The recipient subsystem maintains information about health care eligibility. Eligibility workers (also called financial workers) develop and record information related to Minnesota Health Care Programs (MHCP) eligibility in the MAXIS system. Some information from MAXIS copies over to the MMIS recipient subsystem, including the person master index (PMI) number generated in MAXIS. For more information about MAXIS, refer to PartnerLink – MAXIS.

MMIS also uses eligibility information in the recipient subsystem to verify eligibility criteria for HCBS program eligibility and to pay claims accurately in MMIS.

Provider subsystem

The provider subsystem maintains information about providers and their qualifications to deliver services, including HCBS services. All providers delivering services covered under MHCP, including HCBS services, must be enrolled in MMIS via the DHS Medicaid Payments and Provider Services Division. For more information, refer to Minnesota Provider Screening and Enrollment (MPSE) Manual.

Resources

Policy information

The Community-Based Services Manual (CBSM) contains policy, procedure and system information related to the programs referenced in this manual. Lead agency staff who manage and administer those programs use the CBSM as a reference and policy guide.

DHS Service Agreement and Screening Document (SASD) Support Team

The SASD Support Team is a DHS help desk that provides technical assistance to lead agencies and DHS staff for MMIS, related specifically to screening documents and service agreements in the following areas:

· AC and ECS.

· BI, CAC, CADI, DD and EW.

· Home care services (type B service agreements) for personal care assistance (PCA), Community First Services and Supports (CFSS), home health aide (HHA), skilled nursing visit (SNV), home care nursing (HCN), Consumer Support Grant (CSG) and Family Support Grant (FSG).

· Assessment and screening documents, including LTCC, preadmission screening (PAS), DD screening and Omnibus Budget Reconciliation Act (OBRA) screening.

The SASD Support Team provides the following technical assistance:

· Adjusts service agreements as appropriate.

· Helps staff resolve exception codes (i.e., edits) and error messages on service agreements and screening documents entered into MMIS.

· Helps staff with MMIS entry and technical issues related to service agreements and screening documents.

· Processes and reviews home care service agreement requests.

· Processes screening document deletion requests.

SASD Support Team staff are available Monday through Friday from 8 a.m. to 4 p.m.

For more information and instructions to contact the SASD Support Team, refer to CBSM – SASD Support Team.

MMIS online training

DHS created MMIS online training to demonstrate how to work with LTC screening documents and service agreements in MMIS. For more information, refer to MMIS LTSS Manual – Training.