DSD eList announcement
Date: July 5, 2023
To: Lead agencies and customized living (CL) providers
From: DHS Disability Services Division
Purpose: To inform lead agencies and CL providers of the Medicaid Management Information System (MMIS) claims edit to address the CL age limitation for the Brain Injury (BI) and Community Access for Disability Inclusion (CADI) waivers
Effective: July 1, 2023
Contact: Minnesota Health Care Programs (MHCP) Provider Resource Center
MMIS claims edit to address CL age limitation for BI and CADI waivers
To ensure ongoing compliance with the federally approved home and community-based services (HCBS) waiver plans, DHS will deny claim payments for CL settings where the BI and CADI CL age limitation is not met.
Effective July 1, 2023, MMIS claims edit 801 will post to deny payment for BI and CADI CL services to people younger than age 55 authorized in CL settings subject to the age limitation.
Age limitation for BI and CADI waivers
All CL or 24-hour CL settings developed and operational on or after Jan. 11, 2021, are limited to serving people on the BI and CADI waivers who are age 55 or older.
Lead agencies cannot authorize CL for people younger than age 55 on BI and CADI in settings that are subject to the CL age limitation. For a list of these settings, refer to CBSM – CL provider settings only allowed to serve people on the BI and CADI waivers who are age 55 and older.
Provider attestation
Providers are required to attest to compliance with the CL age limitation requirements as a condition of enrollment through CL Provider Assurance Statement, DHS-6189X (PDF). A provider’s enrollment with MHCP may be at risk if the provider fails to uphold the terms of their provider agreement and addendums (including service-specific assurance statements).
Additional information
For more information about the CL setting location and age limitations, refer to CBSM – CL (including 24-hour CL).
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