Minnesota Minnesota

DSD MMIS Reference Guide

DSD MMIS Reference Guide


Finalize a Type B Service Agreement for CSG and CSG with FSG

Note: DHS will keep this page for historical reference during the transition from personal care assistance (PCA) and the Consumer Support Grant (CSG) to Community First Services and Supports (CFSS). For more information, refer to DSD MMIS Reference Guide – MMIS transition from PCA and CSG to CFSS.

Page posted: 5/20/11

Page reviewed:

Page updated: 9/30/24

Transition from CSG to CFSS

DHS is in the process of replacing personal care assistance (PCA) and the Consumer Support Grant (CSG) with Community First Services and Supports (CFSS). For more information about this transition, refer to CFSS Manual – Transition from PCA and CSG to CFSS.

DHS must update the Medicaid Management Information System (MMIS) to allow counties/tribal nations to enter a CFSS service agreement (SA). Some fields have minor changes. For more information, refer to DSD MMIS Reference Guide – MMIS transition from PCA and CSG to CFSS.

During the transition from CSG to CFSS, the county/tribal nation follows the instructions below to enter a new SA in MMIS:

  • · Conducts the assessment.
  • · Enters three months of CSG services with the CSG procedure code (T2025).
  • · Enters a line for the county/tribal nation administrative fee with the CSG procedure code (T2025).
  • · Enters a line for consultation services. For more information, refer to DSD MMIS Reference Guide – ASA3 screen for consultation services (T1023).

    • AGMT STAT field

    The status of the service agreement, referred to as the header status, is indicated by a code displayed in the AGMT STAT field located at the top left of MMIS screens.

    Suspended status

    The header status is S (suspended) when a service agreement is first created. Service agreements remain in suspended status when routing to DHS for review or routed to the county of residence (COR) for finalization.

    Approved status

    The worker or DHS reviewer must change the SA status to A (approved) to finalize the service agreement. SA must have approved status before provider may render services. MMIS will not pay claims for services provided outside prior authorization service dates.

    Denied status

    The worker uses denied status to deny PCA services when the person does not meet PCA access criteria or when the person declines PCA services following an initial assessment. The DHS reviewer enters D (denied) status in specific circumstances.

    Pended status

    DHS uses the status code P (pended) in specific circumstances, such as when the person has not chosen PCA provider.

    Line STAT CD/DATE fields

    MMIS also displays a status code in the STAT CD field located at the end of each line on the ASA3 screen. The DATE field is auto-populated by MMIS to indicate the entry date of the status.

    Suspended status

    The line status code is S (suspended) until the status is updated by the worker. DHS cannot pay claims for services on lines with suspended status.

    Approved status

    Lines with A (approved) status mean the provider may render this service and submit claims for it.

    Denied status

    Lines with D (denied) status means the provider may not render the service nor submit claims for it.

    Navigation

    Part of the finalization process is to resolve posted exception codes when applicable. There are two ways to navigate to a desired screen in the service agreement queue to resolve an error:

    1. Press a transmit key to advance from screen to screen in queue order.

    2. Enter the acronym for the desired screen in the NEXT field to advance to the desired screen. The NEXT field is located in the upper left corner of the screen.

    Finalize SA for CSG

    The steps to finalize CSG service agreements varies depending on the scenario.

    End FSG line on CSG service agreement

    1. Enter end date on T2025 UD (FSG with CSG) line. The end date cannot extend beyond July 31, 2012.

    2. Press F9 key to trigger the MMIS exception control function.

    CSG with PCA assessment

    1. Press F9 function key to trigger the MMIS exception control function.

    2. Go to the AHC1 screen and confirm that MMIS posted the anticipated home care rating.

    3. Resolve exception codes with status of 3 (deny) or 4 (suspend) that are not DHS reviewer codes. Press the F9 key to clear resolved codes. Resolve exception code 140 last. Exception code 948 posts when the person does not meet PCA access criteria.

    4. Type an A over the S in the STAT CD field on lines. MMIS auto-populates the STAT DATE field after F9 key is used.

    5. Type an A over the S in the AGMT STAT field at the top left of any screen.

    6. Press the F9 key again to clear the 140 exception codes.

    7. Press function key F3 to save entries and exit.

    8. DHS makes all changes to a finalized SA in approved or denied status.

    Cashing a current PCA service agreement

    Final review by county worker

    1. Press function key F9 to trigger the MMIS exception control function.

    2. Go to the AHC1 screen and confirm that MMIS posted the anticipated home care rating. HOME CARE RATING and TOTAL TIME fields are not auto-populated by MMIS when SA date span is less than 46 days.

    3. Resolve exception codes with status of 3 (deny) or 4 (suspend) that are not DHS reviewer codes. Press the F9 key again to clear resolved codes. Workers are not able to resolve the exception codes listed below on a CSG service agreement when cashing out current PCA service agreement:

  • · 140 – HEADER/ LINE ITEM STATUS SUSPENDED. DHS reviewer resolves 140 codes. Worker does not resolve exception code 140 on a PCA notice of termination SA. Leave header and lines in suspended status.
  • · 874 – DUPLICATE SVC AGMT ON FILE posts because another SA for PCA with overlapping date span exists in MMIS. MMIS routes SA to DHS.

    • 4. Press function key F3 to save entries and exit. MMIS automatically routes SA to DHS.

    Review process by DHS reviewer

    1. Adjust PCA units on existing PCA line(s) that overlap CSG line(s).

    2. End PCA line(s) with date span beyond CSG SA begin date.

    3. Close current PCA service agreement.

    4. Route the SA for CSG back to the County of Residence (COR) queue.

    Finalization process by county worker following DHS review

    1. Check COR queue for Type B service agreements ready for finalization.

    2. Open the SA in production region. Do not finalize SA while in the COR queue.

    3. Type an A over the S in the STAT CD field on lines.

    4. Type an A over the S in the AGMT STAT field at the top left of any screen.

    5. Press F9 to clear the 140 exception codes.

    6. Press F3 to save entries and exit.

    Notice of reduction and Notice of termination

    Final review by county worker

    1. Press function key F9 to trigger the MMIS exception control function.

    2. Go to the AHC1 screen and confirm that MMIS posted the anticipated home care rating. HOME CARE RATING and TOTAL TIME fields are not auto-populated by MMIS when SA date span is less than 46 days.

    3. Resolve exception codes with status of 3 (deny) or 4 (suspend) that are not DHS reviewer codes and press the F9 key again to clear resolved codes. Workers are not able to resolve the exception codes listed below on a notice of reduction or termination service agreement for CSG:

  • · 140 – HEADER/ LINE ITEM STATUS SUSPENDED. DHS reviewer resolves 140 codes. Worker does not resolve exception code 140 on a PCA notice of reduction or termination SA.
  • · 861 – HOME CARE RATING MISSING/INV posts when SA date span is 45 days or less.

    • 4. Manually route the notice of reduction or termination SA to DHS for finalization. To manually route the SA to DHS, go to the ASA2 screen and enter 510 in the OVR LOC field.

    5. Press function key F3 to save entries and exit.

    Review process by DHS reviewer

    1. Enter or confirm that the dollar amount documented on the AHC3 screen is on CSG and FSG lines.

    2. Enter OV in the HOME CARE RATING field on AHC1 to override the home care rating.

    3. Finalize SA by approving SA lines and header, saving entries and exiting MMIS.

    Finalization process by county worker following DHS review

    1. Take no further action for a notice of termination of CSG.

    2. Enter a second service agreement for the remainder of the year using the new CSG monthly budget amount (lower) when assessment results in a reduction of CSG monthly budget amount.

    Denial of CSG

    1. Press function key F9 to trigger the MMIS exception control function.

    2. Worker cannot resolve most of the exception codes that MMIS posts on a denial of CSG SA.

    3. Type a D (denied) over the S in the STAT CD field for CSG line.

    4. Type a D over the S in the AGMT STAT field at the top left of any screen.

    5. Press the F9 key again to clear the 140 exception codes. Exception code 861 and other exception codes will remain posted after pressing F9. MMIS will not route the SA to DHS for review because the SA header and line are in D (denied) status.

    6. Press function key F3 to save entries and exit.

    Cashing out current SA for HCN or HHA to CSG

    Final review by county worker

    1. Press function key F9 to trigger the MMIS exception control function.

    2. Resolve exception codes with status of 3 (deny) or 4 (suspend) that are not DHS reviewer codes and press the F9 key again to clear resolved codes. Workers are not able to resolve the exception codes listed below on a CSG service agreement when cashing out the current SA for HCN or HHA:

  • · 140 – HEADER/ LINE ITEM STATUS SUSPENDED. DHS reviewer resolves 140 codes. Worker must leave header and lines in suspended status.
  • · 861 – HOME CARE RATING MISSING/INV posts and indicates the Home Care Rating is missing.
  • · 887 – CSG NEEDS DENIED PDN/HHA LINE indicates a denied line for HCN is missing.

    • 3. Press function key F3 to save entries and exit. MMIS automatically routes the CSG SA to DHS for review.

    Review process by DHS medical review agent

    1. Adjust HCN or HHA line on current SA.

    2. Enter Home Care Rating on the AHC1 screen of the CSG SA.

    3. Enter a denied line for HCN or HHA with reason code 533 on the CSG SA.

    4. Route the CSG SA back to the County of Residence (COR) queue.

    Finalization process by county worker following DHS review

    1. Check COR queue for Type B service agreements ready for finalization.

    2. Open the SA in production region. Do not finalize SA while in the COR queue.

    3. Type an A (approved) over the S in the STAT CD field on lines.

    4. Type an A over the S in the AGMT STAT field at the top left of any screen.

    5. Press the F9 key again to clear the 140 exception codes.

    6. Press function key F3 to save entries and exit.

    CSG with combined PCA and HCN or HHA

    Final review by county worker

    1. Press function key F9 to trigger the MMIS exception control function.

    2. Resolve exception codes with status of 3 (deny) or 4 (suspend) that are not DHS reviewer codes and press the F9 key again to clear resolved codes. Workers are not able to resolve the exception codes listed below on a CSG service agreement with combined PCA and HCN or HHA:

  • · 140 – HEADER/ LINE ITEM STATUS SUSPENDED. DHS reviewer resolves 140 codes. Worker must leave header and lines in suspended status.
  • · 861 – HOME CARE RATING MISSING/INV posts and indicates the Home Care Rating is missing.
  • · 887 – CSG NEEDS DENIED PDN/HHA LINE indicates a denied line for HCN is missing.

    • 3. Press function key F3 to save entries and exit.
    4. MMIS automatically routes the CSG SA to DHS for review.

    Review process by DHS medical review agent

    The worker will send the HCN or HHA assessment received from the home health agency to medical review agent for approval. If the medical review agent denies the request, they will:

  • · Not enter a Home Care Rating on the AHC1 screen.
  • · Enter a denied line for HCN or HHA (without reason code 533).
  • · Route the SA to the COR queue.

    • The worker takes no further action on the CSG SA when the medical review agent denies the request for HCN or HHA.

    If medical review agent approves the request, they will

  • · Enter a Home Care Rating on the AHC1 screen.
  • · Enter a denied line for HCN or HHA with reason code 533.
  • · Route the CSG SA to the COR queue for finalization.

    • Finalization process by county worker following DHS review and approval of HCN or HHA by Medical Review Agent

    1. Check COR queue for Type B service agreements ready for finalization.

    2. Open the SA in production region. Do not finalize SA while in the COR queue.

    3. Enter dollar amount on CSG line(s) and FSG line (if needed) in the REQ TOT AMT field on the ASA3 screen. Go to HOME CARE RATING field on AHC1 for HCR determination by the medical review agent. Look up CSG monthly budget amount for HCR. Multiply the CSG monthly budget amount times the number of months on the line.

    4. If FSG field indicator is Y on the AHC2 screen, refer to notes on the AHC3 screen and enter dollar amount on FSG line in the REQ TOT AMT field on the ASA3 screen (if not previously entered).

    5. Press function key F9 to trigger MMIS exception control function and review exception codes.

    6. Do not resolve exception codes 241, 412 and 420 posted on a HCN or HHA denied line:

  • · 241 – PROVIDER TYPE/SERVICE CONFLICT
  • · 412 – THE CATEGORY OF SERVICE DOES NOT MATCH THE PROCEDURE REQUESTED
  • · 420 – PROV ENROLLED AS NO-PAY.

    • 7. Type an A (approved) over the S in the STAT CD field on lines.
    8. Type an A over the S in the AGMT STAT field at the top left of any screen.
    9. Press the F9 key again to clear the 140 exception codes.
    10. Press function key F3 to save entries and exit.

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