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Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


AASD and DSD eList announcement

Date: Oct. 18, 2021
To: Lead agency staff and customized living service providers
From: DHS Aging and Adult Services and Disability Services divisions
Purpose: To announce temporary guidance to process a Medicaid Management Information System (MMIS) service agreement with edit 413 posting to customized living service line items
Effective: Immediately
Contact: For BI and CADI: DSD.WaiverPolicy@state.mn.us; for EW: DHS.AASD.HCBS@state.mn.us

Temporary guidance for customized living service authorizations in MMIS

DHS is working on an MMIS update to improve the efficiency of authorizing customized living services while continuing to ensure providers have and maintain the appropriate license(s) or credential(s) at the time of service authorization. We will send another eList when we implement the update. Until then, lead agencies can use the temporary guidance in this eList.

Background

On Sept. 13, 2021, DHS completed an MMIS programming change to service agreement (SA) authorizations and claim submissions for customized living services. The change ensures providers have and maintain the appropriate license(s) or credential(s) at the time of service authorization.

This change causes MMIS edit 413 to post to SA line items for customized living services when the provider listed on the SA line item has a license or credential end-date that occurs before the SA line end-date. For example, customized living provider Juniper Shores has an assisted living license end-date of July 31, 2022, on its DHS provider record. Edit 413 will post for an SA line item end-date with Juniper Shores listed as the provider after July 31, 2022.

Temporary guidance to authorize customized living services in MMIS

Lead agency staff have two temporary options to create customized living SA line items.

With either option, if the person changes providers or the provider does not renew their license, the lead agency can deny the pended line, if applicable, and create a new line for the appropriate service(s).

Option 1

The lead agency creates two line items:

  • · Approve one line item for the dates the provider’s license or credential does not end before the SA line end-date
  • · Pend the second line with the 858 reason code for the dates the provider does not have a current license or credential listed within the DHS MMIS provider file; edit 413 will post to this line item.

    • The lead agency can go back into the SA to edit or update the SA and approve the line item (as long as edit 413 resolves) when one of the following happens:

  • · After DHS implements the MMIS programming for the edit 413 update
  • · After the provider has renewed their license or credentials and DHS has updated their license information within the DHS MMIS provider file.

    • Note: Option 1 may result in the lead agency receiving an error message in the MnCHOICES Support Plan when the service span effective date starts on or after Jan. 1, 2022. This error message will occur because the mid-December rates release has not yet happened. DHS advises lead agencies to not enter rate information with an effective date of Jan. 1, 2022, until after that rate release has happened. This recommendation follows the typical process for when DHS releases rate updates.

    Option 2

    The lead agency creates one line item for only the dates the provider’s license or credential is active.

    The lead agency can go back into the SA to extend the original line item date span when one of the following happens:

  • · After DHS implements the MMIS programming for the edit 413 update
  • · After the provider has renewed their license or credentials and DHS has updated their license information within the DHS MMIS provider file.

    • More information

    To look up the provider’s license or credential effective date for customized living services, lead agencies can either:

  • · Go to Minnesota Department of Health – Health Care Provider Directory and select “Assisted Living Facilities” in step 1
  • · Review the provider’s approved license or credentials in MMIS on the PLIC screen of the provider file.

    • Lead agencies can refer to Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF) for more information about:

  • · Edit 413 (begins on page 140)
  • · Infopac report PWMW9332-R2086, which identifies service agreements for providers with category of service, specialty and/or license code errors (page 181).

    • Previous eList announcements

    AASD LEAD AGENCY ARCHIVE | DSD LEAD AGENCY ARCHIVE | DSD STAKEHOLDER ARCHIVE

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