Note: DHS corrected the date we received approval to Jan. 17, 2024, and removed the Developmental Disabilities Waiver from the waivers affected by the changes to specialized equipment and supplies.
DSD eList announcement
Date: Jan. 25, 2024
To: Lead agency staff and other interested parties
From: DHS Disability Services Division
Purpose: To announce federal approval of disability waiver amendments
Effective: Implementation timelines vary
Contact: DSD Contact Form
Waiver amendments approved by CMS
The federal Centers for Medicare & Medicaid Services (CMS) approved DHS’ waiver amendment package on Jan. 17, 2024. The amendment package affects the following waivers:
· Brain Injury (BI).· Community Alternative Care (CAC).· Community Access for Disability Inclusion (CADI).· Developmental Disabilities (DD).CMS also approved a waiver amendment for the Elderly Waiver (EW). We will send a separate eList announcement about the EW amendment.
Implementation of changes and clarifications
DHS has not implemented the changes and clarifications in this eList yet. First, we must update our policy manuals and MMIS. DHS will send eList announcements and/or update CBSM – What’s new when we implement the changes and clarifications. This includes information about consumer directed community supports (CDCS) policy changes.
CMS required Disability Waiver Rate System (DWRS) rate inflationary changes to be effective Jan. 31, 2024. This change will require lead agencies to modify January DWRS authorizations. DHS will contact rate mentors in early February to provide instructions.
The change in the DWRS effective date only affects the following services:
· Adult day services.· Community residential services.· Day support services.· Employment development services.· Employment exploration services.· Employment support services.· Family residential services.· Individualized home supports with family training.· Individualized home supports with training.· Individualized home supports without training.· Integrated community supports.· Night supervision.· Positive support services analyst.· Positive support services professional.· Positive support services specialist.· Prevocational services.· Specialized equipment and supplies.Other rate changes remain effective Jan. 1, 2024.
Summary of changes and clarifications
The following sections summarize the policy changes and clarifications included in this waiver amendment package.
Topic | Waiver(s) | Changes |
24-hour emergency assistance | · BI· CAC· CADI· DD | · Clarified services that are not covered based on existing policies |
Adult day services | · BI· CAC· CADI· DD | · Updated remote support requirements to be consistent with EW · Clarified that remote support is not available when the provider delivers adult day in a family foster care setting· Clarified services that are not covered based on existing policies |
Adult day services bath | · BI· CAC· CADI· DD | · Clarified services that are not covered based on existing policies |
Case management | · BI· CAC· CADI· DD | · Added reference to Minnesota’s informed choice policy outlined in Minn. Stat. §256B.4905· Updated informed choice language to reflect the current criteria, forms and process· Updated references to “lead agency” with “county and tribal nation” where appropriate |
Chore | · BI· CAC· CADI· DD | · Clarified services that are not covered based on existing policies |
Community residential services | · BI· CAC· CADI· DD | · Clarified services that are not covered based on existing policies |
CDCS | · BI· CAC· CADI· DD | · Updated references to “face-to-face” and “in-home” with “in-person” where appropriate · Added 2024 and 2025 yearly percentage changes for CDCS budgets · Clarified terms used to reference legal guardians and conservators paid to provide personal assistance · Changed the number of hours parents of minors and spouses can be paid to provide personal assistance · Updated references to “lead agency” with “county and tribal nation” where appropriate |
Customized living | · BI· CAC· CADI· DD | · Clarified services that are not covered based on existing policies |
Fair hearing | · BI· CAC· CADI· DD | · Added “MnCHOICES Assessment Summary” where appropriate · Clarified that the county or tribal nation must provide notice of action forms when they issue a denial, decrease or termination of the person’s services · Clarified that people have a right to continue receiving services during an appeal until the human services judge makes a decision |
Family residential services | · BI· CAC· CADI· DD | · Clarified services that are not covered based on existing policies |
Fiscal policy: Rates, allocations and financial management | · BI· CAC· CADI· DD | · Changed respite (15-minute) from a framework service to a market rate service · Added shared staffing ratios for homemaker, chore and night supervision · Changed shared staffing ratio for individualized home supports· Updated the schedule for automatic inflationary adjustments for certain waiver services · Updated references to “lead agency” with “county and tribal nation” where appropriateChange during CMS’ review periodDuring its review period, CMS directed DHS to: · Revise the waiver application to restore the text that was removed from Appendix I-2-a (relative to previously approved waiver language).· Revise Appendix I-2-a to list the changes specific to this amendment, including the ending and effective dates for changes to rate methodologies and to include shared staffing rations for chore, homemaker, individualized home supports and night supervision services.· Update Appendix J-2-C to include waiver year effective dates growth rates will be applied and to specify services that are affected by the DWRS rate increases.· Update Appendix J-2-D to align with CDCS estimates in J-2-C.· Update Appendix J-2-D to remove the term “decremental” in unit descriptors. |
Homemaker | · BI· CAC· CADI· DD | · Clarified services that are not covered based on existing policies |
Individualized home supports | · BI· CAC· CADI· DD | · Updated the statutory reference for “community living setting” under Minn. Stat. §256B.492, subd. 1 and 3 |
Integrated community supports | · BI· CAC· CADI· DD | · Clarified services that are not covered based on existing policies |
MnCHOICES: Waiver eligibility, assessment and support planning | · BI· CAC· CADI· DD | · Updated “Qualifications of Individuals Performing Initial Evaluations” as required by CMS during the recent CAC renewal · Updated training requirements for certified assessors |
Prevocational services | · BI· CAC· CADI· DD | · Clarified services that are not covered based on existing policies |
Respite | · BI· CAC· CADI· DD | · Clarified services that are not covered based on existing policies |
Specialized equipment and supplies | · BI· CAC· CADI | · Increased the annual service limit from $3,909 per year to $10,000 per year Change during CMS’ review periodDuring its review period, CMS directed DHS to: · Retain language regarding coverage for thickening agents, which are covered under Minnesota’s Medicaid state plan if they are determined to be medically necessary. |
Previous eList announcements
DSD LEAD AGENCY ARCHIVE | DSD STAKEHOLDER ARCHIVE
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