Minnesota Minnesota

DD Screening Document Codebook

DD Screening Document Codebook

BI, CAC and CADI waiver scenarios

Page posted: 6/26/19

Page reviewed: 10/17/23

Page updated: 10/17/23

Overview

This page contains sequencing charts for:

1. Brain Injury (BI), Community Alternative Care (CAC) or Community Access for Disability Inclusion (CADI) to semi-independent living services (SILS)

2. Person with developmental disability (DD) or related condition receiving BI, CAC or CADI and not requesting nursing facility (NF) placement

3. Person with DD or related condition applying for BI, CAC or CADI and not requesting NF placement

4. Person on DD Waiver applying for BI, CAC or CADI and not requesting NF placement

5. Person with DD or related condition receiving Family Support Grant (FSG) and requesting BI, CAC or CADI

6. BI, CAC or CADI to DD diversion

7. BI, CAC or CADI to FSG

Note

MMIS automatically routes some documents to DHS to review. Lead agencies are no longer required to route documents manually to DHS.

Additional resources

DD Screening Document Codebook – Scenarios
CBSM – BI Waiver
CBSM – CAC Waiver
CBSM – CADI Waiver
CBSM – Family Support Grant (FSG)

1. Scenario: BI, CAC or CADI to SILS

County/tribal nation-entered fields

1st sequence

2nd sequence (only use if SILS start date was unknown in 1st sequence)

(23) Action date

In-person assessment date

SILS start date

(24) Action type

01

03

(39) Level of care

02

03

(41) Current services

19, 33, residential code, other

19, 24, residential code, other

(42) Planned services

19, 24, residential code, other

19, 24, residential code, other

(46) Final action planned

05

05

(47a) Assessment result

14 – Community with services – Not DD Waiver

14 – Community with services – Not DD Waiver

(48) Effective date

SILS start date or, if unknown, action date

SILS start date

(49) Current Medical Assistance (MA) program

06

06

Nursing facility (NF) begin and through dates

Delete dates previously entered

N/A

Time-limited payment

N

N

Payment authorized

06

05

Case manager comments

Comments as needed

Comments as needed

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2. Scenario: Person with DD or related condition receiving BI, CAC or CADI and not requesting NF placement

County/tribal nation-entered fields

1st sequence

(23) Action date

In-person assessment date

(24) Action type

01

(39) Level of care

02

(41) Current services

19, 33, residential code, other

(42) Planned services

19, 33, residential code, other

(44) Waiver need index

005

(46) Final action planned

Corresponds with field 42 planned services

(47a) Assessment result

14 – Community with services – Not DD Waiver

(48) Effective date

Start date, renew date or assessment date

(49) Current MA program

00

NF begin and through dates

Delete dates previously entered

Time-limited payment

N

Payment authorized

06

Case manager comments

Receiving BI, CAC or CADI

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3. Scenario: Person with DD or related condition applying for BI, CAC or CADI and not requesting NF placement

County/tribal nation-entered fields

1st sequence

(23) Action date

In-person assessment date

(24) Action type

01

(39) Level of care

02

(41) Current services

19, 33, residential code, other

(42) Planned services

19, 33, residential code, other

(46) Final action planned

01 or 04

(47a) Assessment result

14 – Community with services – Not DD Waiver

(48) Effective date

BI, CAC or CADI start date

(49) Current MA program

00

NF begin and through dates

Delete dates previously entered

Time-limited payment

N

Payment authorized

06

Case manager comments

Applying for BI, CAC or CADI, not NF placement

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4. Scenario: Person on DD Waiver applying for BI, CAC or CADI and not requesting NF placement

County/tribal nation-entered fields

1st sequence

2nd sequence

(23) Action date

In-person assessment date

Waiver exit date

(24) Action type

01

03

(39) Level of care

01 or 02

01 or 02

(41) Current services

01, waiver service codes, residential code, other

19, 33, residential code, other

(42) Planned services

19, residential code, other

19, 33, residential code, other

(46) Final action planned

01 or 04

01 or 04

(47a) Assessment result

05 – Waiver out

14 – Community with services – Not DD Waiver

(47b) Exit reason

14 – Community with services – Not DD Waiver

N/A

(48) Effective date

Waiver exit date

BI, CAC or CADI start date (must be later than the waiver exit date)

(49) Current MA program

01 or 02

00

NF begin and through dates

Delete dates previously entered

Delete dates previously entered

Time-limited payment

N

N

Payment authorized

01

06

Case manager comments

Comments as needed

Applying for BI, CAC or CADI, not NF placement

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5. Scenario: Person with DD or related condition receiving FSG requesting BI, CAC or CADI

County/tribal nation-entered fields

1st sequence

(23) Action date

In-person assessment date

(24) Action type

01

(39) Level of care

02

(41) Current services

19, 23, residential code, other

(42) Planned services

19, 33, residential code, other

(46) Final action planned

01 or 04

(47a) Assessment result

14 – Community with services – Not DD Waiver

(48) Effective date

BI, CAC or CADI start date

(49) Current MA program

00

NF begin and through dates

Delete dates previously entered

Time-limited payment

N

Payment authorized

06

Case manager comments

Applying for BI, CAC or CADI, not NF placement

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6. Scenario: BI, CAC or CADI to DD diversion

In this scenario, the person is no longer at risk of nursing facility level of care but at risk of intermediate care facility for persons with developmental disabilities (ICF/DD) level of care, and the person’s DD Waiver services will start within 60 days of the action date.

County/tribal nation-entered fields

1st sequence

(23) Action date

In-person assessment date

(24) Action type

01

(39) Level of care

01

(41) Current services

01, waiver services codes, residential code, other

(42) Planned services

01, waiver services codes, residential code, other

(44) Waiver need index

004

(46) Final action planned

01 or 04

(47a) Assessment result

04 – DD Waiver in

(48) Effective date

DD Waiver start date

(49) Current MA program

01

NF begin and through dates

Delete dates previously entered

Time-limited payment

N

Payment authorized

01

Case manager comments

Explain level of care change

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7. Scenario: BI, CAC or CADI to FSG

County/tribal nation-entered fields

1st sequence

2nd sequence (only use if FSG start date was unknown in 1st sequence)

(23) Action date

In-person assessment date

FSG start date

(24) Action type

01

03

(39) Level of care

01 or 02

01 or 02

(41) Current services

19, 33, residential code, other

19, 23, residential code, other

(42) Planned services

19, 23, residential code, other

19, 23, residential code, other

(46) Final action planned

03

03

(47a) Assessment result

14 – Community with services – Not DD Waiver

14 – Community with services – Not DD Waiver

(48) Effective date

FSG start date or, if unknown, action date

FSG start date

(49) Current MA program

00

00

NF begin and through dates

Delete dates previously entered

Delete dates previously entered

Time-limited payment

N

N

Payment authorized

06

06

Case manager comments

Explain level of care change

Comments as needed

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