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: 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 6. BI, CAC or CADI to DD diversion NoteMMIS 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 | ||
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 |
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 |
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 |
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 |
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 |
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 |
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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