Community ICF/DD scenarios
Page posted: 6/26/19 | Page reviewed: | Page updated: 2/21/20 | |
Overview | This page contains sequencing charts for: 2. Community ICF/DD to semi-independent living services (SILS) 3. Community ICF/DD to regional treatment center (RTC) to community ICF/DD 4. ICF/DD to DD diversion/conversion using an eligibility update when waiver start is unknown 5. ICF/DD to DD diversion/conversion using an eligibility update when waiver start date is known 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: Community ICF/DD to DD diversion/conversion
County/tribal nation-entered fields | 1st sequence | 2nd sequence |
(23) Action date | In-person assessment date | Waiver in date |
(24) Action type | 01 | 03 |
(39) Level of care | 01 | 01 |
(41) Current services | 19, 28, other | 01, waiver service codes, residential code, other |
(42) Planned services | 01, waiver service codes, residential code, other | 01, waiver service codes, residential code, other |
(44) Waiver need index | 001, 006 | 004 |
(46) Final action planned | 01 | 01 |
(47a) Assessment result | 16 – Facility stay | 04 – Waiver in |
(47b) Exit reason | N/A | N/A |
(48) Effective date | In-person assessment date | Waiver open date |
(49) Current Medical Assistance (MA) program | 04 | 01 or 02 |
Nursing facility (NF) begin and through dates | Delete dates previously entered | N/A |
Time-limited payment | N | N |
Payment authorized | 01 | 01 |
Case manager comments | Comments as needed | Comments as needed |
2. Scenario: Community ICF/DD to SILS
County/tribal nation-entered fields | 1st sequence |
(23) Action date | In-person assessment date |
(24) Action type | 01 |
(39) Level of care | 03 |
(41) Current services | 19, 24, residential code, other |
(42) Planned services | 19, 24, residential code, other |
(46) Final action planned | 05 |
(47a) Assessment result | 14 – Community with services – Not DD Waiver |
(47b) Exit reason | N/A |
(48) Effective date | SILS start date |
(49) Current MA program | 00 |
NF begin and through dates | Delete dates previously entered |
Time-limited payment | N |
Payment authorized | 05 |
Case manager comments | Comments as needed |
3. Scenario: Community ICF/DD to RTC to community ICF/DD
County/tribal nation-entered fields | 1st sequence | 2nd sequence |
(23) Action date | RTC in date | ICF/DD in date |
(24) Action type | 03 | 03 |
(39) Level of care | 01 | 01 |
(41) Current services | 19, 28, other | 19, 28, other |
(42) Planned services | 19, 33, other | As planned |
(46) Final action planned | 98 | 07 |
(47a) Assessment result | 16 – Facility stay | 16 – Facility stay |
(47b) Exit reason | N/A | N/A |
(48) Effective date | RTC admission date | ICF/DD admission date |
(49) Current MA program | 00 or 06 | 04 |
NF begin and through dates | Delete dates previously entered | N/A |
Time-limited payment | N | N |
Payment authorized | 02 | 01 |
Case manager comments | Type of RTC services (e.g., mental health, chemical dependency) | Comments as needed |
4. Scenario: ICF/DD to DD diversion/conversion using an eligibility update when waiver start is unknown
County/tribal nation-entered fields | 1st sequence | 2nd sequence – Completed within 60-90 days of the in-person assessment | 3rd sequence – Completed within 60 days of the eligibility update |
(23) Action date | In-person assessment date | Telephone assessment date | Waiver in date |
(24) Action type | 01 | 12 | 03 |
(39) Level of care | 01 | 01 | 01 |
(41) Current services | 19, 28, other | 19, 28, other | 01, waiver service codes, residential code, other |
(42) Planned services | 01, waiver service codes, residential code, other | 01, waiver service codes, residential code, other | 01, waiver service codes, residential code, other |
(44) Waiver need index | 001, 006 | 001, 006 | 004 |
(46) Final action planned | 01 or 04 | 01 or 04 | 01 or 04 |
(47a) Assessment result | 16 – Facility stay | 16 – Facility stay | 04 – Waiver in |
(47b) Exit reason | N/A | N/A | N/A |
(48) Effective date | In-person assessment date | Telephone assessment date | Waiver in date |
(49) Current MA program | 04 | 04 | 01 or 02 |
NF begin and through dates | Delete dates previously entered | N/A | N/A |
Time-limited payment | N | N/A | N/A |
Payment authorized | 01 | 01 | 01 |
Case manager comments | Comments as needed | Comments as needed | Comments as needed |
5. Scenario: ICF/DD to DD diversion/conversion using an eligibility update when waiver start date is known
County/tribal nation-entered fields | 1st sequence | 2nd sequence – Completed within 60-90 days of the in-person assessment |
(23) Action date | In-person assessment date | Telephone assessment date |
(24) Action type | 01 | 12 |
(39) Level of care | 01 | 01 |
(41) Current services | 19, 28, other | 01, waiver service codes, residential code, other |
(42) Planned services | 01, waiver service codes, residential code, other | 01, waiver service codes, residential code, other |
(44) Waiver need index | 001, 006 | 004 |
(46) Final action planned | 01 or 04 | 01 or 04 |
(47a) Assessment result | 16 – Facility stay | 04 – Waiver in date |
(47b) Exit reason | N/A | N/A |
(48) Effective date | In-person assessment date | Waiver start date |
(49) Current MA program | 04 | 01 or 02 |
NF begin and through dates | Delete dates previously entered | N/A |
Time-limited payment | N | N |
Payment authorized | 01 | 01 |
Case manager comments | Comments as needed | Comments as needed |
6. Scenario: ICF/DD – Person dies
County/tribal nation-entered fields | 1st sequence |
(23) Action date | Date of death |
(24) Action type | 03 |
(39) Level of care | 01 |
(41) Current services | 19, 28, other |
(42) Planned services | No planned services |
(44) Waiver need index | Leave previous waiver need index |
(46) Final action planned | 98 |
(47a) Assessment result | 16 |
(47b) Exit reason | 08 – Exit – Death |
(48) Effective date | Date of death |
(49) Current MA program | 04 |
NF begin and through dates | Delete dates previously entered |
Time-limited payment | N |
Payment authorized | 01 |
Case manager comments | Comments as needed |
Report this page