Enter the provider’s National Provider Identifier (NPI) or Unique Minnesota Provider Identifier (UMPI). Do not enter the lead agency’s UMPI.

Information you need

Provider’s NPI or UMPI

Enter the start date and end date to match the MMIS service agreement line.

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Day service starts and ends

Enter the total units.

If adult day daily or prevocational services daily are not provided at least 6 hours per day (not including transportation to/from), use adult day 15-minute or prevocational 15-minute instead.

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Number of units inclusive of service start and end date the person is authorized to receive the service

Select the staffing ratio from the drop-down menu.

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Average daily ratio of direct care staff to people who receive services

Enter the amount of time the service will be provided during a unit.

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Assessment and treatment provided on a 1:1 basis by a licensed practical nurse (LPN) during a unit of service

Enter the amount of time the service will be provided during a unit.

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Assessment and treatment provided on a 1:1 basis by a registered nurse (RN) during a unit of service

Enter the number of meals per unit of service.

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Number of meals per day

Enter the number of AM snacks per unit.

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Number of morning snacks per day

Enter the number of PM snacks per unit.

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Number of afternoon snacks per day

Use the drop-down menu to choose from the following options:

Note: To apply the deaf/hard of hearing (DHOH) customization in RMS, the following criteria must be met:

For specific eligibility criteria, refer to RMS User Manual – Quick reference guide on deaf/hard-of-hearing customization in the RMS.

Information you need

Determination of whether the person meets the criteria for deaf/hard of hearing customization

Enter whether the person requires a vehicle lift for transport.

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Information from the assessment

Enter whether the person uses a vehicle with a lift for transport.

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Information from the service provider

Enter the number of shared trips the person takes per day.
Note: It cannot be more than two.

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Information from the service provider

Enter the number of individual trips the person takes per day.
Note: It cannot be more than two.

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Information from the service provider

If the person shares transportation, enter the average number of miles for the person’s most direct route.

To determine this number, use an internet mapping application or information derived from transportation provider’s odometer. In many cases, the number of miles traveled will be higher than the most direct route. Enter information for the most direct route.

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Information from the service provider

If the person uses individual transportation, enter the average number of miles for person’s most direct route.

To determine this number, use an internet mapping application or information derived from transportation provider’s odometer.

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Information from the service provider

Enter the average number of riders with whom the person travels per day.

For public transportation, enter “99” as the average number of riders.

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Information from the service provider

Enter the non-framework rate amount. Only use this field if the person has a DHS-approved rate exception.

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Non-framework rate requested

Select the radio button for exception – Requires DHS approval.