Legal authority

Federally approved BI, CAC, CADI, DD and EW waiver plans, Alternative Care (AC) program (Minn. Stat. §256B.0913), 42 C.F.R. 440.180, Minn. Stat. §256S, Minn. Stat. §256B.092, Minn. Stat. §256B.49

Overview

A person’s individual CDCS budget amount is calculated using a formula developed by the state. DHS calculates budget amounts according to federal waiver authority for each program and issues CDCS budgets annually.

Each person’s annual state-set budget amount is the amount available to them to purchase eligible goods and services. The individual budget for a person using CDCS must include the costs of all waiver services and Medical Assistance (MA) state plan home care services.

Assessment results

The CDCS budget amount is obtained by using the person’s screening document and most recent assessment information (i.e., long-term care consultation [LTCC] or MnCHOICES assessment).

BI, CAC, CADI and DD waivers

The person’s individual assessment is used to determine their CDCS budget for Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Developmental Disabilities (DD) waivers.

AC and EW

The person’s individual assessment determines their case mix classification for Alternative Care (AC) and Elderly Waiver (EW). The maximum CDCS budget amount is based on the person’s case mix classification.

Establishing CDCS budgets (BI, CAC, CADI and DD)

The CDCS budget methodology is a formula that uses identified variables from the person’s assessment scores to calculate the budget. Each variable is given a score that is reported on or derived from the assessment during the face-to-face assessment process.

Budget methodology

Budget methodology differs depending on the program/waiver. For more information, refer to the following resources.

BI, CAC and CADI

CDCS budget methodology for the BI, CAC and CADI waivers
Variables used in the CDCS budget methodology for the BI, CAC and CADI waivers

DD

CDCS budget methodology for the DD Waiver
Variables used in the CDCS budget methodology for the DD Waiver

COLA

Cost-of-living adjustments (COLA) for CDCS budgets for BI, CAC, CADI and DD waivers

Establishing CDCS budgets (AC, EW)

The maximum CDCS budgets are based on case mix budget caps, which are established at the person’s assessment. CDCS case mix budget caps are the same as traditional case mix budget caps. The CDCS budget amount is located on the MMIS screening document when the CDCS Y/N field indicator is “Y.” For more information about the budget cap amounts, refer to the CDCS budget caps section of Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

Procedure codes

There are three procedure codes to identify CDCS services:

For more information, refer to section 201.09 of Instructions for Completing and Entering the LTC screening document and Service Agreement into MMIS, DHS-4625 (PDF).

Flexible use

People can use their AC/EW case mix budget flexibly. For more information, refer to section 301.03 of Instructions for Completing and Entering the LTC screening document and Service Agreement into MMIS, DHS-4625 (PDF) and Instructions for Completing and Entering the LTCC Screening Document and Health Risk Assessment into MMIS for the MSC+ and MSHO Programs, DHS-4669 (PDF).

Legislative budget changes

BI, CAC, CADI and DD

Legislative authority may adjust CDCS waiver budgets. The 2023 Minnesota Legislature authorized an 8.49% increase to CDCS disability waiver budgets effective Jan.1, 2024.

AC and EW

Legislative authority may adjust CDCS monthly budget caps. The 2023 Minnesota Legislature authorized an increase to AC and EW CDCS budgets to match traditional AC and EW case mix budgets effective Jan. 1, 2024.

For details about the changes, refer to DHS – Long-term services and supports rate changes and Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

Notification/calculation

For all legislative budget changes (i.e., BI, CAC, CADI, DD, AC and EW), lead agencies must:

To inform people of legislative changes to their budgets, lead agencies should use CDCS Community Support Plan Addendum, DHS-6633A (PDF). People who use CDCS can use DHS-6633A to document changes to their plan.

Prorating budgets

When service plans will cover less than one year, CDCS budgets need to be prorated. For more information, refer to the following resources:

Budget amount on the plan

The budget amount must be included on the CDCS community support plan (CSP) developed by the person. The person and the lead agency must compare the proposed cost of implementing the CDCS CSP to the total CDCS budget amount available to evaluate cost effectiveness and the likely success of the proposed plan, taking into consideration the person’s health and safety.

CSPs

The CDCS CSP can include costs for services up to the annual CDCS budget amount. Unexpended CDCS budget funds cannot be carried over to subsequent service plan years.

Like any other type of service budget maximum, the state-set CDCS budget represents an “up to” amount available to purchase services. The amount actually approved by the lead agency in the CSP is based on projected costs of services needed to address the person’s assessed needs, which may be less than the CDCS budget maximum.

The CSP can only include costs for allowable services and goods up to the annual CDCS budget amount.

Exceptions

All services must be provided within the budget amount, with the exception of:

Exception process (BI, CAC, CADI and DD)

There is an exception that can increase individual CDCS budgets for people on disability waivers who meet the eligibility requirements.

For more information on the exception, refer to:

Conversion rates (EW)

Counties and tribal nations

Counties and tribal nations may request approval from DHS for monthly conversion budget limits when the EW CDCS budget cap is not enough to support the services and supports needed for the person to return to the community from a nursing facility.

MCOs

If the person receives the EW from a managed care organization (MCO), the MCO must approve the request for monthly conversion budget limits.

Instructions

Refer to CBSM – EW conversion rates for information about the process to request a CDCS conversion budget limit. To determine the conversion budget limit, the case manager must complete EW CDCS Conversion Rate Request, DHS-3956 (PDF).

Authorizing the budget (CDCS service authorizations and MMIS activity)

CDCS is authorized as one service agreement line item. The lead agency must:

1. Enter the dates of the service span.

2. Use CDCS code T2028 (no modifier).

3. Enter the person’s approved budget amount as the requested total amount (no unit or rate).

Note: The individual CDCS budget amount the lead agency authorizes on the service agreement cannot exceed the state-set budget.

BI, CAC, CADI and DD

For BI, CAC, CADI and DD waivers, the person’s annual budget information is in the Waiver Management System (WMS).

AC and EW

For AC and EW, the person’s monthly budget information is on the screening document in the CDCS amount field.

Service agreement lines

A service agreement can contain separate line items that include:

Note

State plan services for AC that address chronic, long-term care needs are authorized under the CDCS code T2028 with no modifier.

Reassessments

Annual reassessments or assessments due to a change in condition might change the person’s CDCS budget. If a budget change occurs, the lead agency will inform the person of the new budget amount. Depending on the situation, the person does one of the following:

After the person updates their CSP, they must submit it to the lead agency for approval and authorization.

Enhanced budget process

For information about the enhanced budget, refer to: