Day Training and Habilitation (DT&H) Day Services

Revised: September 16, 2024

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Record Keeping and Retention

· Two-Party and Three-Party Agreements

· Authorization

· Billing and Rates

· Special Needs Rate Exceptions for ICF-DD Residents

· Special Needs Rate Exceptions for Persons on the DD Waiver

· Services for Members 21 Years Old or Under

· Submitting Claims

· Guidelines for Full Day, Partial Day, and Transportation

· Legal References

Overview

Review the Day Training and Habilitation (DT&H) section of the Community-Based Services Manual (CBSM) for information about DT&H services including federal and state guidelines.

Minnesota Health Care Programs (MHCP) covers DT&H day services provided on a scheduled basis for periods of less than 24 hours each day.

This service is changing during the rolling implementation of the Waiver Reimagine streamline services for disability waiver services that began January 2021. Starting Jan. 1, 2021, a person on the developmental disability (DD) waiver program who receives DT&H services will receive the streamline service, known as day support services during a service change or at their annual reassessment.

For more information about day support services and the Waiver Reimagine Project, see the HCBS Waiver Services MHCP Provider Manual.

Eligible Providers

Providers eligible to provide, bill and receive payment from MHCP for providing DT&H day services must:

· Be an enrolled MHCP provider and maintain a 245D license.

· Have an approved developmental disabilities (DD) waiver service authorization (SA) to provide services for the member.

Counties must provide DT&H day services and the DT&H day service providers must be licensed through the Minnesota Department of Human Services (DHS).

MHCP Enrollment

MHCP requires each DT&H satellite location to have its own National Provider Identifier (NPI) or Unique Minnesota Provider Identifier (UMPI) number. To enroll to provide DT&H day support services and transportation, follow the instructions in the Day Training and Habilitation for ICF/DD Enrollment Criteria and Forms section of the MHCP Provider Manual.

Contact DHS Licensing at 651-431-6500 or the DHS licensing webpage for Home and Community-Based Services (HCBS) for People with Disabilities and Age 65 or Older – 245D for information on how to get a 245D license.

MN–ITS

MHCP requires those who provide services to register their MN–ITS account.

Eligible Members

DT&H day support services are available to members who:

· Are 18 years old or older and have a diagnosis of developmental disability or related condition.

· Receive a screening for HCBS DD waiver services or reside in an Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD).

· Have their health and safety in the community addressed in their plan of care.

· Make an informed choice to receive DT&H as part of their coordinated service and support plan (CSSP).

Counties must determine the need for DT&H day services according to requirements in Minnesota Statutes. Lead agencies must immediately contact DHS Disability Services Division (DSD) Response Center at DSD.ResponseCenter@state.mn.us when their proposed actions seek to increase, grow or expand DT&H day services.

Verify program eligibility for each member, each month through the MHCP Provider Resource Center eligibility verification system (EVS) or MN–ITS before providing services.

Lead Agency Responsibilities

For DT&H services identified in a CSSP, counties are responsible to:

· Authorize the delivery of services according to the CSSP and individual habilitation plans (required as part of the county’s provision of case management services).

· Develop a coordinated service and support plan (CSSP).

· Ensure that transportation is provided or arranged by the vendor in the most efficient and reasonable way possible.

County case managers (CM) are responsible for:

· Coordinating services

· Completing any necessary screenings

· Updating coordinated service and support plan changes

· Entering a service authorization (SA) to authorize the DT&H provider to bill DHS for services

Covered Services

Use the codes in the following table to bill for services provided. DT&H transportation can be used only for DT&H services.

Services and procedure codes

Service Description	Procedure Code and modifier
DT&H – Daily (6 hours or more)	T2020
DT&H – Partial Day (Less than 6 hours)	T2020 U5
DT&H – 15 min	T2021
DT&H Transportation – Daily	T2002

Noncovered Services

When members are eligible for or receive Medical Assistance and reside in an ICF-DD, they are not eligible to receive home and community-based waiver services. An ICF-DD is an institutional setting and for members who reside in an institutional setting, MA will not cover:

· Special education and related services that are available through public education, or

· Vocational services that are available from the Minnesota Department of Employment and Economic Development – Division of Vocational Rehabilitation.

Waiver Transportation
Minnesota statutes and the federal DD waiver plan prohibit additional payment for transportation when it is included in the established rate.

Record Keeping and Retention

Maintain service records, fiscal records and supporting documentation identifying the following information:

· Service authorization (SA) from the county of financial responsibility for each member for whom service is billed

· Attendance sheets and other records documenting that the member received the billed services from the provider

· Records of all bills and, if applicable, all refunds to and from other sources for DT&H day services

In addition, the following requirements apply:

· Provider records are subject to the maintenance schedule, audit availability requirements, and other provisions in Minnesota Rules, 9505.2160 to 9505.2245.

· Provider financial records must be available, on request, to the Minnesota Department of Human Services and the United States Department of Health and Human Services.

· Providers must retain a copy of the records required for five years from the date of the bill unless an audit in process requires a longer retention period.

· Day service providers must maintain records as necessary to submit the annual report by March 1 of each year.

Two-Party and Three-Party Agreements

DHS requires each ICF/DD and the DT&H day service provider that is providing residents with services to complete two-party agreements. Parties need to complete these agreements only once unless there is a change in training and habilitation agencies.

DHS requires the training and habilitation agency, ICF/DD, and the county to complete three-party agreements annually. These agreements outline the responsibilities of each party and reflect the current approved MA reimbursement rates, service hours, days of service and operating months. Three-party agreements are necessary to comply with county contracting requirements found in state statutes and rules. However, The Centers for Medicare & Medicaid Services (CMS) does not recognize them as evidence of compliance with title 42 of the Code of Federal Regulations, section 447.10 (e), which requires the ICF/DD to have a separate written agreement with each training and habilitation agency providing services to residents.

Two-Party Agreement and Assignment of Payment

Federal regulations require that an ICF/DD whose residents receive licensed DT&H day services outside the facility must have a two-party agreement with the provider of those services.

· The ICF/DD and the DT&H provider must sign the two-party agreement ICF/DD Training and Habilitation Agreement (DHS-4224) (PDF). The ICF/DD completes an Assignment of Payment for Day Training and Habilitation Services (DHS-4223) (PDF) that lists all DT&H service providers with whom they have an agreement. This form allows DHS to pay the DT&H day services provider. The DT&H day support services provider and an authorized person of the ICF/DD must sign all paper invoices.

· All parties must retain copies of the signed agreement (DHS-4224) and assignment (DHS-4223) and upload it in the Minnesota Provider Screening and Enrollment (MPSE) portal or fax it to DHS at 651-431-7493.

· The DT&H provider must comply with the standards in the Code of Federal Regulations, title 42, sections 483.410(d) and 483.440.

Three-Party Agreement

The ICF/DD, the county in which it is located, and the DT&H vendor must sign the three-party agreement Day Training and Habilitation Service Agreement (DHS-2638) (PDF), which spells out the responsibilities of each party, along with the rates, days of service and operating months.

· The county, the ICF/DD and the DT&H providers must retain a copy of the form, upload it in the MPSE portal or fax it to DHS at 651-431-7493

· Counties must also fax a copy of this agreement to Provider Eligibility and Compliance at 651-431-7462 when there is a rate change or cost of living adjustment (COLA).

When a person living in an ICF/DD uses MA funds to pay for DT&H services, the county case manager:

· Coordinates services

· Completes any necessary screenings

· Updates coordinated service and support plan changes

· Contacts the county financial worker if there is a change in the member’s living arrangement

DT&H and ICF/DD Signature Requirements

The DT&H and ICF/DD may make any legal arrangement to secure authorized signatures on billing invoices. Each ICF/DD is responsible for ensuring that the DT&H provides the required services to its residents regardless of whether the ICF/DD has given the DT&H power of attorney to act on its behalf. As stated in the previous Two-Party Agreement section, when ICF/DD personnel sign, they are accepting responsibility for the accuracy and legitimacy of the bills they authorize for submission to DHS. This means they are verifying the accuracy of the stated charges, days of service, and transportation provided for each member who is a resident of the ICF/DD. The two-party agreement also states that the DT&H accepts responsibility for the accuracy and legitimacy of bills it submits to the ICF/DD for signature.

Authorization

Waiver services require a case manager or service coordinator to approve a completed service authorization (SA). The SA allows the provider to bill MHCP and receive payment after the DT&H provides the services. Only services approved on the SA can be considered for payment. Services on approved SA are not a guarantee of payment. The member must maintain both MA and waiver eligibility for the authorization to be valid. The case manager or service coordinator enters the SA into the DHS system (MMIS).

Each line item on the SA lists the following:

· Minnesota Health Care Programs (MHCP) enrolled provider who is authorized to provide the needed services

· The rate of payment for the service

· The number of units approved

· Date or date span of authorization of service

· The approved procedure code(s)

Billing and Rates

DT&H Day Services HCBS Waiver Rate Determination

The Disability Waiver Rates Management System (DWRS) determines DT&H day services HCBS waiver rates according to Minnesota Statutes. After the lead agency conducts the needs assessment and community support plan to determine the member’s needs, the lead agency will use the DWRS to establish individual rates.

ICF/DD MA Payment Rates for DT&H Day Services Providers

DT&H day services must provide a minimum of 195 available days of service. Bill DT&H services to MHCP that were provided to a resident of an ICF/DD only if DT&H day services are not included in the ICF/DD DHS approved rate. Three ICF/DD MA payment rates exist for providers of DT&H day services. The ICF/DD MA payment rates are:

· Full day service rate or payment for a full day of DT&H services. The contract between the DT&H provider and the county defines the number of hours that constitute a full day. A full day must include six or more program hours, including the time it takes to transport the member to and from the service site.

· Partial day service rate or payment for less than a full day of DT&H services. This rate is for services provided less than six hours a day or less than the full day established in the agreement between the ICF/DD and the county. This rate must not exceed 75% of the full day rate.

· Transportation rate. This is payment for transportation from the member's residence to the service site and back home.

MA will directly reimburse vendors of DT&H day services provided to residents of an ICF/DD when the ICF/DD authorizes the payment according to Minnesota Statutes.

Special Transportation

DT&H providers are responsible for arranging, providing, and paying for transportation of a member to and from the member’s residence and the DT&H service site. DT&H providers can subcontract with special transportation providers if those providers accept the DT&H transportation rate as payment in full. Trips to and from DT&H service sites are not eligible for payment as special transportation. Counties and county social workers or case managers may not authorize MHCP payment for special transportation to or from DT&H day services.

· MHCP reimburses DT&H providers a separate transportation rate, which is payment in full.

· MHCP cannot make additional payments to a DT&H provider for transportation unless a special needs rate has been authorized under Minnesota Rules, 186 and Minnesota Statutes, 256B.501, subd. 8.

· When other MHCP-covered services are provided to a member in a DT&H setting, those services are considered secondary to the DT&H service and do not alter the requirement that the DT&H provider pay for transportation.

· The special transportation providers must determine whether a trip is eligible for special transportation payment.

Exception for Special Transportation
The only circumstance under which MHCP special transportation may be billed for a trip to or from a DT&H site for a member receiving DT&H day services at that site is when a member is being transported from the DT&H site to a site providing MHCP-covered services that are not DT&H services. The special transportation provider must bill for this transportation and may not include billing for special transportation between the member’s residence and the DT&H site.

Special Needs Rate Exceptions for ICF/DD Residents

Minnesota Rules govern the authorization of special needs rate exceptions for very dependent people with special needs residing in an ICF/DD. The lead agency sends the request for a SA to DHS. DHS sends the approval letter through MN–ITS to the provider. Review the Minnesota Rules, 186 special needs rate exception section for more information.

The approved service authorization indicates the following procedure codes and rates:

· X7010 – Direct care staff

· X7020 – Equipment

· X5628 – Professional/practitioner consultant

Special Needs Rate Exceptions for Persons on the DD Waiver

The DWRS determines the DT&H day services rates according to Minnesota Statutes, including any DT&H day services rate exceptions.

The Disability Services Division (DSD) at DHS grants final approval and will override the rate file on the SA for a member who receives the special needs rate exception. Counties do not have the ability to override the rate file in the MMIS system. Lead agencies can complete and submit the Disability Waiver Rates System Exception Request Application (DHS-5820) (PDF).

Services for Members 21 Years Old or Under

The school district must pay for DT&H day services provided to members 21 years old or under unless the Individual Education Plan team determines that the member has met educational goals and will graduate. For MHCP to pay for services provided to a member 21 years old or under, the county case manager must send the following information to the DHS DT&H policy person before the provider bills:

· A copy of the members diploma

· Member’s name and PMI number (person master index – a unique identification number that MAXIS assigns to each person)

· Date of graduation (diploma date)

· Site where the member will receive DT&H day services

· Begin date of services

If the member resides in an ICF/DD, bill the DT&H day support services with a copy of the DHS letter as an attachment. Review Electronic Claim Attachments.

Submitting Claims

Bill DT&H day services electronically using the SA number if the member is on a DD waiver. Follow these guidelines to submit claims for full day, partial day and transportation:

· Use MN−ITS Direct Data Entry (DDE) or your own X12 compliance software (batch billing system).

· Use the Professional (837P). View the MN–ITS User Manual for DT&H Claims.

· When you provide services to a waiver services program member, a SA number is required in the Prior Authorization Number field on the Claim Information screen in MN-ITS DDE. Bill only for services already provided.

· Bill only for services approved on the SA. Note: Do not bill for services that require an SA on the same claim as services that do not require an SA.

· If the SA does not have an appropriate number of partial days, do not substitute and bill for a full day. Minnesota law defines this as a fraudulent billing practice. Contact the county case manager to have the SA adjusted to include additional partial days.

· Enter a diagnosis code when submitting claims for all services. You must use the most current, most specific diagnosis code when submitting claims. The SA will display the diagnosis code.

· Submit your usual and customary charges for the service.

· Bill only one calendar month on each claim submission.

· Bill each date on a separate line.

Billing Instructions for Members in an ICF/DD

Use the codes in the following table to bill for services provided to a member in an ICF/DD. These services do not require an SA.

Procedure codes for members in an ICF/DD

Service Description	Procedure code
Full date rate (6 or more hours)	T2020
Partial day rate (less than 6 hours)	T2020 with modifier U5
Transportation	T2002

· A diagnosis code is required for billing. Contact the ICF/DD or the county case manager or service coordinator for the diagnosis code.

· Enter the ICF/DD’s NPI or UMPI in the Claim Information-Other Providers (Claim Level) Accordion or the X12 Loop & element equivalent, when billing for DT&H day services for a member who lives in an ICF/DD.

· The DWRS does not set rates for members in the ICF/DD who are receiving DT&H services and transportation or ICF/DD services during the day. Provider specific service and transportation rates still apply.

· Providers can only bill for DT&H day services at a maximum of 23 days per calendar month.

Guidelines for Full Day, Partial Day and Transportation

· If you send a member home because of a weather emergency or illness, bill for a partial day if you do not provide a full day of service.

· If a member stays home because of illness or inclement weather, do not bill for DT&H day services.

· If a member is transported only one way (either to or from the training site), bill the full transportation rate if transportation is provided, arranged, or contracted for at least one way.

· If a member leaves early or arrives late because of a scheduled doctor or dentist appointment, bill for the partial day rate if you do not provide a full day of service.

Multiple Providers of DT&H Day Services for the Same Member on the Same Day

Waiver SAs must include separate line items for each provider if the provider renders the service on the same day by more than one agency. More than one provider may bill for approved partial day services provided on the same day. Only one provider may bill for daily service codes per day. If there is more than one provider of services, the case managers must document this information in the member’s support plan and give providers clear direction on how to bill for the services.

Legal References

Minnesota Statutes, 252.28 (Commissioner of Human Services; Duties)
Minnesota Statutes, 256B.092 (Services for Persons with Developmental Disabilities)
Minnesota Statutes, 252.41 (Definitions)
Minnesota Statutes, 252.42 (Service Principles)
Minnesota Statutes, 252.43 (Commissioner’s Duties)
Minnesota Statutes, 252.44 (Lead Agency Board Responsibilities)
Minnesota Statutes, 252.45 (Vendor’s Duties)
Minnesota Statutes, 252.46 (Payment Rates)
Minnesota Statutes, 256B.501(Rates for Community-Based Services for Disabled)
Minnesota Statutes, 252.282 (ICF/DD Local System Needs Planning)
Minnesota Statutes, 144 (Department of Health)
Minnesota Statutes, 245D (Home and Community-Based Services Standards)
Minnesota Statutes, 256B.5015 (Pass-through of Other Services Cost)
Minnesota Rules, 9525.0036 (Determination of Need)
Minnesota Rules, 9525.1240 (Day Training and Habilitation Agreement)
Minnesota Rules, 9525.1250 (Reimbursable Services)
Minnesota Rules, 9505.2160 (Scope and Applicability)
Minnesota Rules, 9505.2245 (Appeal of Department Action)
Code of Federal Regulations, title 42, section 483.410(d)
Code of Federal Regulations, title, 42, section 483.440
Code of Federal Regulations, title 42, section 447.10(e)

CPT codes, descriptions and other data only are copyright 2002 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.