Federally approved BI, CAC, CADI, DD and EW plans, Minn. Stat. § 256.01, subd.2(a)(7), Minn. Stat. §256B.02 subd. 7(c); Minn. Stat. §256B.0913, Minn. Stat. §256B.0922, Executive Order 13-10 (PDF), 42 USC §1396j, 42 CFR 431.110,

Tribal administration and management of home and community-based services (HCBS) programs: Option that allows DHS to contract with federally recognized tribal nations that have a reservation in Minnesota to operate a federally approved program or other DHS program.

Federally recognized tribal nations have the right to govern themselves. In Minnesota, there are 11 federally recognized tribal nations:

The following tribal nations currently administer and manage HCBS and long-term services and supports:

As dual citizens, tribal members have a choice between tribal management and county/health plan management of HCBS.

The tribal health care system is an important part of the health care system in Minnesota. DHS developed a contract model that supports the tribal authority to administer and manage HCBS programs in an effort to coordinate HCBS services and services available within the tribal health care systems, as well as recognize and act on tribal sovereignty.

This contract is referred to as a tribal “lead agency” contract because, under the contract, the tribal nation performs most of the activities outlined in Minn. Stat. §256B.0911 governing long-term care consultation. Within that statute, tribal nations are defined as lead agencies.

At a tribal nation’s request, DHS works with the tribal nation to develop a contract to administer DHS programs (e.g., waiver programs, Alternative Care and Essential Community Supports) and to provide case management services.

As a result, access to HCBS services for tribal community members and coordination between HCBS and tribal health care systems has improved.

Tribal leadership defines the HCBS programs to be included under the contract and the populations they will serve, which can be broader than tribal members.

Managed care organizations (MCOs) and counties that geographically overlap with the tribal service area are responsible to offer eligible people (as defined in the contract) the choice to receive tribal, county or MCO management of their HCBS at the initial assessment and annual reassessment.

MCOs also are responsible to:

DHS has a contract with the Leech Lake Band of Ojibwe to administer the following programs and services:

Eligible populations

The Leech Lake Band of Ojibwe has elected to serve Leech Lake households living on the Leech Lake Reservation and/or within the entire boundaries of the following counties (on which the reservation resides):

DHS has a contract with the Red Lake Band of Chippewa Indians to administer the following home and community-based programs and services:

Eligible populations

The Red Lake Band of Chippewa Indians has elected to serve people living in households within the geographic boundary of the Red Lake Band of Chippewa Indians who either:

Additionally, the Red Lake Band of Chippewa Indians elects to serve eligible people whom the tribal nation refers for long-term services and supports in other counties.

DHS has a contract with the White Earth Nation to administer the following programs and services:

Eligible populations

The White Earth Nation has elected to serve all households living on the White Earth Reservation and/or within the entire boundaries of the following counties (on which the reservation resides):

Transfer of administration and management

People who are eligible to choose tribal administration and management of their HCBS can choose to transfer their lead agency case management at any time (e.g., from county to tribal nation, tribal nation to MCO, etc.). The method of allocation and funding of waiver resources for a person transferring between lead agencies follows the same process for a county-to-tribal-nation change as a county-to-county change.

CFRs

When people transfer from county to tribal nation or tribal nation to county, their county of financial responsibility (CFR) typically remains the same, regardless of their choice to transfer. For more information, see CBSM – Minnesota Unitary Residency and Financial Responsibility Act.

Partnering with county financial workers

All eligible tribal members whose tribal nations contract with DHS as a lead agency have a county financial worker, except White Earth Nation. White Earth Nation has its own financial workers.

The county financial worker is responsible to communicate with the tribal nation when the tribal nation assesses, coordinates care or provides case management to the person. For more information, see:

Tribal nations can enroll to provide any service covered under any HCBS program for which the provider is qualified. Enrollment as a provider of HCBS or other long-term services and supports does not require a tribal administration and management contract.

Tribal nations that contract with DHS as a lead agency may develop alternative provider qualifications for waiver services, according to Minn. Stat. §256B.02, subd. 7c.

A tribal nation that plans to implement alternative standards must submit the standards to DHS, along with evidence of meeting, exceeding or being exempt from corresponding state standards.

To submit the standards, send them via secure fax to 651-431-7597 or by mail to:

HCBS Waivers
Minnesota Department of Human Services: Aging and Adult Services Division or Disability Services Division
P.O. Box 64967
St. Paul, MN 55164-0967