DSD eList announcement
Date: Jan. 17, 2020
To: Lead agency staff and other interested stakeholders
From: DHS Disability Services Division
Purpose: To announce federal approval of a waiver amendment package that affects the BI, CAC, CADI and DD waivers
Effective date: Varies by service
Contact: DSD.ResponseCenter@state.mn.us
Waiver amendments approved by CMS
The federal Centers for Medicare & Medicaid Services (CMS) approved DHS’ waiver amendment package on Dec. 18, 2019. The amendment package affects the following waivers:
· Brain Injury (BI)· Community Alternative Care (CAC)· Community Access for Disability Inclusion (CADI)· Developmental Disabilities (DD).To implement these approved changes, we must update our policy manuals and MMIS. We will send eList announcements when we implement the changes.
The following sections summarize the policy changes and clarifications included in this waiver amendment package.
Fiscal policy: Rates, allocations and financial management
Topic | Waiver(s) | Changes |
Shared care | · BI· CAC· CADI· DD | Identifies which services allow shared care |
Allocation of resources to lead agencies | · BI· CAC· CADI· DD | · Updates the year-to-year percentage change (BI, CAC and CADI)· Adds reference to statutory authority that allows DHS to transfer funding between lead agencies (BI, CAC, CADI and DD) |
Rate determination method | · BI· CAC· CADI· DD | · Replaces references to the Disability Waiver Rate System (DWRS) with the Rate Management System (RMS)· Adds a competitive workforce factor· Updates the frequency of inflationary adjustments to every two years, beginning in 2022· Removes references to residential care and supported employment services, which have ended· Cleans up language for consistency |
Consumer directed community supports (CDCS)
Topic | Waiver(s) | Changes |
CDCS service definition | · BI· CAC· CADI· DD | · Adds language about shared services to the personal assistance service category· Adds clarifying language for services that support caregivers The following language was approved by CMS, with the additional changes noted as a result of the public comment period: “Shared services cannot be provided: · To more than three participants by one worker at one time;· When more than one worker is providing services [add] at the same time [end add] to participants who are sharing [add] personal assistance [end add] services; or· For a child care program licensed under Minnesota Statutes, chapter 245A or operated by a local school district or public school.” |
Limitations of CDCS | · BI· CAC· CADI· DD | · Allows people to use CDCS once they are no longer in the Minnesota Restricted Recipient Program (MRRP)· Clarifies language about CDCS availability by the type of living arrangement |
Involuntary exit | · BI· CADI· DD | Corrects involuntary exit language in BI, CADI and DD to align with CAC |
Required case management | · BI· CAC· CADI· DD | Clarifies oversight of budget and fiscal records in the list of required case management functions |
Remediation | DD | Corrects remediation language for financial management services (FMS) providers and support planners |
CDCS enhanced budget | · BI· CAC· CADI· DD | Updates the CDCS enhanced budget from 5% to 7.5% to align with the enhanced personal care assistance (PCA) changes |
Description of participant direction | · BI· CAC· CADI· DD | · Clarifies that CDCS participants must use an FMS provider· Removes employer-of-record language, which no longer applies· Adds the requirement for CDCS participants to use the same FMS provider in certain situations |
Transition plan | · BI· CAC· CADI· DD | Removes outdated language about a transition plan for replacing fiscal support entities (FSEs) with FMS providers, which has expired |
Home care
Topic | Waiver(s) | Changes |
Extended PCA | · BI· CAC· CADI· DD | Updates the frequency of verification of PCA provider qualifications for extended PCA services |
Private duty nursing | CADI | Replaces references to private duty nursing (PDN) with home care nursing (HCN) |
Extended home care nursing | · BI· CAC· CADI· DD | Updates provider qualifications for extended HCN services |
Electronic visit verification (EVV)
Topic | Waiver(s) | Changes |
Services required to use EVV | · BI· CAC· CADI· DD | Adds language that addresses the services required to use EVV |
Waiver case management
Topic | Waiver(s) | Changes |
MN Merit System | · BI· CAC· CADI | Removes the written exam requirement for the MN Merit System |
References to “county agency” | · BI· CAC· CADI· DD | Replaces references to “county agency” with “lead agency” |
Annual visits | · BI· CAC· CADI· DD | Adds language that addresses annual visits when the case manager is the assessor |
Waiver assessment and support planning
Topic | Waiver(s) | Changes |
Language updates | · BI· CAC· CADI· DD | Updates language in the following areas to reflect current practices: · Assessment (BI, CAC, CADI and DD)· Support planning (BI, CAC, CADI and DD)· Forms (BI, CAC, CADI and DD)· Department review of DD screening documents (DD)The following language was approved by CMS, with the additional change noted as a result of the public comment period: “Minnesota Statutes, section 256B.49, subd. 15 (a) requires that participants receive a copy of their written coordinated services and supports plan (CSSP). The CSSP is developed with the person and must: · Identify the person's long-term and short-term goals· Identify the person's preferences for services, including his/her choices for self-directed options and goals· Document that the person made an informed choice from all available options for [add] services and [end add] providers· Include a notice about the person's right to request a conciliation conference or appeal hearing · Describe the person's need for services (including needs met by relatives, friends and others, as well as community services used by the general public)· List specific services to be provided for the person, including the amount and frequency of the services, and relate the service to an assessed need, the person's preferences and available resources· Reasonably ensure the person's health and welfare, including personal risk strategies · Contain the authorized annual and monthly amounts for the services· Describe the provider's responsibility to implement and make recommendations about modifying the CSSP· Provide information that assists the provider with developing an individual service delivery plan, as required by the provider’s license· Address the person's assessed needs, his/her choices for long-term services and supports (including formal and informal services) and risk management strategies· Be reviewed by a health professional if the person has overriding medical needs that impact the delivery of services· Be agreed to and signed by the person, his/her legal representative (if applicable), authorized lead agency representative and providers of HCBS services.” |
Employment and day services
Topic | Waiver(s) | Changes |
Adult day services and adult day services bath | · BI· CAC· CADI· DD | · Adds language that addresses collocated settings and settings on or next to institutions· Updates the provider qualifications |
Day training and habilitation | DD | Adds language that addresses collocated settings and settings on or next to institutions |
Employment development, employment exploration and employment support | · BI· CAC· CADI· DD | · Includes technical and grammatical changes· Clarifies business ownership requirements for employment services providers· Adds language that addresses when providers can bill for indirect time· Adds language about how and where lead agencies keep documentation that funds for Vocational Rehabilitation Services (VRS) and Individuals with Disabilities Act (IDEA) are not available |
Prevocational services | · BI· CAC· DD | Adds language that addresses collocated settings and settings on or next to institutions |
Structured day | BI | · Replaces “maladaptive behavior” with “challenging behavior”· Adds language that addresses collocated settings and settings on or next to institutions |
Supported employment | · BI· CAC· CADI· DD | · Adds an end date of Aug. 31, 2018, to the service description· Removes outdated language about a transition plan, which has expired |
Crisis respite and positive supports
Topic | Waiver(s) | Changes |
Crisis respite services | · BI· CAC· CADI· DD | · Restores missing language in the crisis respite service definition (CADI)· Clarifies the size limits for foster care and community residential settings (BI, CAC, CADI and DD)· Updates the provider qualifications (BI, CAC, CADI and DD) |
Positive support services | · BI· CAC· CADI· DD | · Replaces “maladaptive behavior” with “challenging behavior”· Removes examples of positive support approaches· Adds language that addresses when providers can bill for indirect time· Updates whom positive support professionals and analysts can train and direct· Updates the provider qualifications for positive support professionals· Updates the provider qualifications for positive support analysts |
Other waiver services
Topic | Waiver(s) | Changes |
Adult companion | · BI· CAC· CADI | Corrects the provider qualifications |
Adult foster care | · BI· CAC· CADI | Adds community residential setting (CRS) to the definition |
Caregiver living expenses | · BI· CAC· CADI· DD | · Updates the list of approved services (BI, CAC and CADI)· Clarifies that this service cannot be provided by related people, per federal regulations (BI, CAC, CADI and DD)· Clarifies the documentation requirements (BI, CAC, CADI and DD) |
Customized living | · BI· CADI | Clarifies that this service is for adults |
Environmental accessibility adaptations | · BI· CAC· CADI· DD | · Adds language that allows an assessment provider to oversee the project to ensure Americans with Disabilities Act (ADA) requirements are met (BI, CAC, CADI and DD)· Clarifies when there can be an exception to modifying a primary vehicle (BI, CAC, CADI and DD)· Clarifies how to authorize multiple line items of home modifications to ensure service integrity (BI, CAC, CADI and DD)· Restores missing language that addresses cameras in bedrooms of minor children (DD)· Adds language that requires two comparison bids when requesting an exception to the annual limit (BI, CAC, CADI and DD)· Updates the provider qualifications for home modification assessment providers (BI, CAC, CADI and DD) |
Home-delivered meals | · BI· CAC· CADI· DD | Updates the provider qualifications |
Independent living skills (ILS) training | · BI· CAC· CADI | Replaces “maladaptive behavior” with “challenging behavior” |
Night supervision services | · BI· CAC· CADI· DD | · Restores missing language that defines “own home” (BI and CADI)· Adds language that addresses what this service covers (BI, CAC, CADI and DD) |
Residential care | · BI· CADI | · Adds an end date of June 30, 2018, to the service description· Removes outdated language about a transition plan, which has expired |
Residential habilitation | DD | · Clarifies that caregiver living expenses are available to providers of supported living services (SLS) for adults· Clarifies where services can be provided· Replaces references to “daily staff intervention” with “daily staff support”· Adds language that addresses daily staff support related to the delivery of the SLS remote support option for adults living in their own home· Adds references to CRS where applicable· Replaces “maladaptive behavior” language with “challenging behavior” |
Respite | · BI· CAC· CADI· DD | · Includes a technical change in the service definition for hospitals and nursing facilities (BI, CAC and CADI)· Includes a technical change in the service definition for hospitals (DD)· Clarifies that respite for children younger than 18 years old must be provided in licensed settings unless exclusion criteria is met (BI, CAC, CADI and DD)· Adds intermediate care facilities for persons with developmental disabilities (ICFs/DD) as an available setting for people to receive respite (DD)· Adds a size limitation to unlicensed settings (excluding camps) (BI, CAC, CADI and DD)· Removes references to residential care, which ended June 30, 2018 (BI and CADI)· Updates the provider qualifications (BI, CAC, CADI and DD) |
Specialist services | · BI· CAC· CADI· DD | Adds language that addresses when providers can bill for indirect time |
Transitional services | · BI· CAC· CADI· DD | · Corrects the licensing reference for ICFs/DD · Aligns the “own home” definition with housing access coordination· Clarifies when transitional services can support a person to move into a customized living setting· Removes the 180-day limitation from the eligibility criteria The following language was approved by CMS, with the additional change noted as a result of the public comment period: “For purposes of this service, own home means a setting that a participant owns, rents, or leases that is not operated, owned or leased by a provider of services or supports, and the person has full control of their housing and full choice of service providers. For a participant who moves into a home where customized living services are available, transitional services are covered when the participant will reside in a self-contained living unit (e.g. apartment) with a bathroom, kitchen (or kitchenette), and sleeping area. Transitional services are covered when the home does not include the provision of these items or services [add], and [end add] when they are inherent to the service being provided.” |
Transportation | · BI· CAC· CADI· DD | · Adds language that addresses what this service covers (BI, CAC, CADI and DD)· Corrects the provider qualifications (BI and CADI) |
Waiver policies
Topic | Waiver(s) | Changes |
Background studies | · BI· CAC· CADI· DD | Updates the list of services that require a background study |
“Direct benefit” language | · BI· CAC· CADI· DD | Adds clarifying language for services that support caregivers |
Eligibility groups | · BI· CAC· CADI· DD | Updates eligibility groups to align with the state plan for Medical Assistance for Employed Persons with Disabilities (MA-EPD) |
Minimum age of staff | · BI· CAC· CADI· DD | Adds language that addresses the minimum age of staff members who provide waiver services |
Paying relatives | · BI· CAC· CADI· DD | · Updates the “paying relatives, legal guardians and conservators” section to provide clarity and consistency across waivers· Updates language about CDCS and payments to relatives and parents of minors who provide foster care |
People ages 65 and older returning to a disability waiver | · BI· CAC· CADI | Restores language that allows people ages 65 and older who exited their waiver due to an institutional stay to return to a disability waiver within 180 days without DHS approval |
Services covered/not covered | · BI· CAC· CADI· DD | · Clarifies that alternative therapies are only covered under CDCS· Clarifies the goods and services that are not covered |
Temporary out-of-state travel | · BI· CAC· CADI· DD | · Clarifies the language about temporary travel and local trade area· Removes the 30-day timeline for temporary travel |
Verification of provider qualifications | · BI· CAC· CADI· DD | · Updates the frequency of verification for all Chapter 245D-licensed services· Updates the frequency of verification for all services for which DHS Provider Enrollment completes the verification |
Quality assurance (QA) measures
Topic | Waiver(s) | Changes |
QA measures | · BI· CAC· CADI· DD | Updates QA measures to correct technical errors and be consistent across waivers |
Previous eList announcements
DSD LEAD AGENCY ARCHIVE | DSD STAKEHOLDER ARCHIVE
Report this page