NOTE: DHS updated this eList announcement to add information about edit 951 in the system updates section.

DSD eList announcement

Date: Dec. 28, 2020
To: Lead agency staff, service providers, advocates and people who access services through disability waivers
From: DHS Disability Services Division
Purpose: To announce:
1. Federal approval of BI, CAC and DD waiver amendment package
2. “All clear” to authorize streamlined services for BI, CAC and DD waivers in MMIS
3. Delay in CADI Waiver amendment approval
4. List of system changes, instructions for MMIS edit issues and policy changes
Effective: Jan. 1, 2021
Contact: Waiver.Reimagine@state.mn.us

“All clear” to authorize streamlined BI, CAC and DD service agreements after federal approval; still on hold for CADI authorizations

The federal Centers for Medicare & Medicaid Services (CMS) approved DHS’ waiver amendment package, which includes Waiver Reimagine streamlined service changes, effective Jan. 1, 2021, for the following waivers:

· Brain Injury (BI)

· Community Alternative Care (CAC)

· Developmental Disabilities (DD).

Lead agencies can begin to authorize BI, CAC and DD service agreements in MMIS (in response to the Dec. 23, 2020, eList announcement that asked lead agencies to wait).

CMS has not yet approved the amendments for the Community Access for Disability Inclusion (CADI) Waiver.

CADI Waiver amendment status

Because CMS has not approved the amendments for the CADI Waiver, lead agencies cannot authorize Waiver Reimagine streamlined services for people on the CADI Waiver.

DHS will be monitoring service authorizations to ensure lead agencies follow this direction. We will send an eList announcement when we receive CMS approval for the CADI Waiver amendments to provide instruction for implementation.

Note: The CADI Waiver renewal is separate from the CADI Waiver Reimagine streamlined service amendments. DHS must renew the CADI Waiver every five years, as explained in the Dec. 10, 2020, eList announcement. The CADI Waiver plan is effective Oct. 1, 2020, to Sept. 30, 2025.

Policy not approved for BI, CAC and DD waiver amendments

CMS did not approve the following changes in the BI, CAC and DD waiver amendments:

1. Remote support:

· We proposed adding remote support as an alternative service delivery option across the waivers through many services. CMS did not approve the expansion of remote support in this package of amendments. This does not change the existing policy for billable indirect time, per RMS User Manual – Quick reference guide on billable indirect time.

· DHS has temporary federal approval to use remote support as an alternative to in-person service delivery, through an Appendix K. The Appendix K for temporary remote support is effective until March 31, 2021. On Dec. 20, 2020, CMS released guidance allowing Appendix Ks to be extended for 6 months after the COVID-19 public health emergency. For more information, review Trump Administration Issues Guidance to Help State Medicaid and CHIP Programs Return to Routine Operations when the COVID-19 Public Health Emergency Ends (govdelivery.com) and Bulletin #20-56-02 Amended: Temporary expansion of remote support for home and community-based services (HCBS) waivers (PDF).

2. Prevocational services:

· We proposed modifying the service description for prevocational services to add a requirement that people receiving prevocational services must also receive an employment service or day support services. CMS did not approve this amendment, which means people new to receiving prevocational services do not need to also receive an employment service or day support services.

Approved BI, CAC and DD waiver amendments

The approved BI, CAC and DD waiver amendments give DHS the authority to implement the streamlined service menu as part of the first phase of the Waiver Reimagine project. Starting Jan. 1, 2021, a person on the BI, CAC or DD waiver who receives a service affected by the streamlined service changes will receive the streamlined service during a service change or at their annual reassessment. For more information about changes to service names, updated HCPCs and frameworks, see CBSM – Waiver Reimagine streamlined service crosswalk.

The approved amendments also address the intent of the HCBS settings standards more fully to support community inclusion and expand services to create more options for people. These changes are effective starting Jan. 1, 2021.

System updates

The following changes involve many system updates, including updates to the Rate Management System (RMS), MnCHOICES Assessment and Support Plan, MMIS and new HCPCs. At this time, we expect all updates to be complete by Dec. 31, 2020.

Currently, systems will allow lead agencies to authorize Waiver Reimagine streamlined services for people on the BI, CAC and DD waivers. The HCPC codes and modifiers are available in the MnCHOICES Support Plan, as communicated in the Dec. 1, 2020, eList announcement. For additional rates information, review DHS – FAQs: Jan. 2021 DWRS implementation of Waiver Reimagine.

Edit 632 and 951 issue

We are aware the MMIS service agreement edits 632 and 951 are posting when authorizing the streamlined services. We are actively working to include the streamlined services into edit 632 and 951 programming. Lead agencies can force these edits when the person’s service plan meets either:

· The habilitation requirements listed on CBSM – Habilitation

· The service requirements for waiver case management and an approved waiver service listed on CBSM – Waiver, AC and ECS case management.

Edit 413 issue

We also are aware the MMIS service agreement edit 413 may post for some providers. We are actively working to resolve this issue to support the auto-enrollment updates.

Summary of BI, CAC and DD changes

The following tables summarize the policy changes and clarifications included in the BI, CAC and DD Waiver Reimagine amendment package. The DHS Disability Services Division will send eList announcements as it updates the Community-Based Services Manual (CBSM) and MMIS to implement these federally approved amendments.

Waiver Reimagine streamlined service changes

Topic	Waiver(s)	Changes
24-hour emergency assistance	BI, CAC, DD	Updates the service limitation section to exclude authorization of 24-hour emergency assistance when a person receives community residential services, family residential services or integrated community supports
Caregiver living expenses	BI, CAC, DD	· Updates the service definition to include individualized home supports without training and individualized home supports with training · Updates the service limitation section to identify that caregiver living expenses are not covered when a person receives community residential services, family residential services or integrated community supports
Chore services	BI, CAC, DD	Updates the service limitation section to exclude authorization of chore services when a person receives community residential services, family residential services or integrated community supports
Community residential services	BI, CAC, DD	Adds community residential services to the waiver
Family residential services	BI, CAC, DD	Adds family residential services to the waiver
Day support services	BI, CAC, DD	Adds day support services to the waiver
Home-delivered meals	BI, CAC, DD	· Updates the service limitation section to exclude authorization of home-delivered meals when a person receives community residential services or family residential services · Updates the service limitation section to identify that home-delivered meals may be authorized with integrated community supports when services are provided by different providers (BI only)
Homemaker	BI, CAC, DD	· Updates the service limitation section to exclude authorization of homemaker when a person receives community residential services or family residential services · Updates the service limitation section to identify that homemaker may be authorized with integrated community supports when services are provided by different providers (BI only)
Housing access coordination	BI	Updates the service definition to include integrated community supports
Individualized home supports	BI, CAC, DD	· Creates three service options of individualized home supports: individualized home supports without training, individualized home supports with training and individualized home supports with family training (BI, CAC and DD) · Moves the previous definition of individualized home supports, which did not include three service options, to the individualized home supports with training option (BI & CAC only) · Consolidates six services into three service options, retains all existing service activities and uses the existing service definitions
Integrated community supports	BI	Adds integrated community supports to the waiver
Night supervision	BI, CAC, DD	Updates the service limitation section to exclude authorization of night supervision when the person receives community residential services, family residential services or integrated community supports
Respite	BI, CAC, DD	Updates the service limitation section to exclude authorization of respite when a person receives community residential services, family residential services with shift staff or integrated community supports
Transitional services	BI, CAC, DD	Updates the eligible move locations to include integrated community supports

Fiscal policy

Topic	Waiver(s)	Changes
New service rates	BI, CAC, CADI, DD	Adds new services to corresponding categories for rate determination

HCBS settings standards changes

Topic	Waiver(s)	Changes
Adult day services	BI, CAC, DD	Adds language that allows people of any age who currently receive adult day services to continue receiving this service and limits new people to only start receiving adult day services if they are age 55 or older
Day training and habilitation	DD	Removes the transition plan that shifted employment from day training and habilitation services to employment development, employment exploration and employment support services
Customized living	BI	· Updates the service limitation section to limit new customized living settings to people age 55 and older and adds size requirements related to the HCBS settings rule for settings operating before Dec. 31, 2020 · Updates the service limitation section to exclude authorization of customized living when a person receives community residential services, family residential services or integrated community supports
Prevocational services	BI, CAC, DD	· Refines the definition to differentiate prevocational services from other day and employment services · Clarifies prevocational services limitations in relation to other day and employment support services · Clarifies prevocational transportation standards and moves information from the service definition into service limitations · Identifies that people receiving prevocational services prior to Jan. 1, 2021, can continue to receive services indefinitely and people who are new to prevocational services on or after Jan. 1, 2021, can receive prevocational services for 3 years or 36 months

Other waiver policy changes

Topic	Waiver(s)	Changes
Shared staffing ratios	BI, CAC, DD	Adds community residential services, family residential services and day support services to the shared staffing ratios
Temporary out-of-state travel	BI, CAC, DD	Adds community residential services and family residential services to the list of services eligible for temporary out-of-state travel
Residential habilitation	DD	Adds individualized home supports with training, individualized home supports with family training, community residential services and family residential services to the list of services that meet the habilitation requirement
Background studies	BI, CAC, DD	Updates the list of services that require a background study
Independent living skills (ILS) therapies	CAC, DD	Adds ILS therapies to align with BI and CADI
Participant safeguards – medication management and administration	CAC	Adds new services to the list of services that require a 245D license in Appendix G-3: Participant Safeguards

Transition plans

Topic	Waiver(s)	Changes
Housing access coordination	BI, CAC, DD	Removes housing access coordination as a service under the waiver to facilitate transition to the new Housing Stabilization Services benefit
Waiver Reimagine	BI, CAC, DD	· Identifies the services ending, being added or being modified · Identifies the timeline of the transition plan · Identifies how people affected by the changes will be notified by DHS

Waiver Reimagine resources

For more information, see:

· CBSM – Waiver Reimagine streamlined service crosswalk for information about changes to service names, updated HCPCs and frameworks

· DHS – FAQs: January 2021 DWRS implementation of Waiver Reimagine for information about Waiver Reimagine and DWRS

· DHS – Waiver Reimagine for general information about the project

· DHS – Waiver Reimagine FAQs for general questions and answers about the project

Previous eList announcements

DSD LEAD AGENCY ARCHIVE | DSD STAKEHOLDER ARCHIVE