Family/own home/foster care (without support services) scenarios
Page posted: 6/26/19 | Page reviewed: 10/17/23 | Page updated: 10/17/23 | |
Overview | This page contains sequencing charts for: 3. Family home or foster care (without support services) to community ICF/DD 4. Family home or foster care (without support services) to Family Support Grant (FSG) 5. Family home to ICF/DD respite temporary care to family home 6. Family home or foster care (without support services) to DD diversion 8. Family home or foster care (without support services) to semi-independent living services (SILS) 11. Own home, family home or foster care to DD diversion when waiver start date is unknown 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: Family home or foster care to adoption, name/PMIN change, same CFR (non-waiver DD case management only)
County/tribal nation-entered fields | 1st sequence | 2nd sequence |
(23) Action date | Last date of current name and PMIN | First date of new name and PMIN |
(24) Action type | 03 | 01 |
(39) Level of care | Applicable level of care | Applicable level of care |
(41) Current services | 19, residential code, other | 19, residential code, other |
(42) Planned services | 19, residential code, other | 19, residential code, other |
(44) Waiver need index | N/A | N/A |
(46) Final action planned | Corresponds with field 42 planned services | Corresponds with field 42 planned services |
(47a) Assessment result | 14 – Community with services – Not DD Waiver | 14 – Community with services – Not DD Waiver |
(47b) Exit reason | 10 – Exit – Other (specify) | N/A |
(48) Effective date | Current name and PMIN on last date | New name and PMIN on first date |
(49) Current Medical Assistance (MA) program | 00 or 06 | 00 or 06 |
Nursing facility (NF) begin and through dates | Delete dates previously entered | N/A |
Time-limited payment | N | N |
Payment authorized | 07 | 07 |
Case manager comments | Adoption with name and PMIN change | Comments as needed |
2. Scenario: Family home or foster care to adoption, name/PMIN change, change in CFR (non-waiver DD case management only)
County/tribal nation-entered fields | 1st sequence | 2nd sequence (use appropriate scenarios if moving to another program) |
(23) Action date | Last date of current name and PMIN | New CFR in-person assessment date |
(24) Action type | 03 | 01 |
(39) Level of care | Applicable level of care | Applicable level of care |
(41) Current services | 19, residential code, other | As appropriate |
(42) Planned services | 19, residential code, other | As appropriate |
(44) Waiver need index | N/A | As appropriate |
(46) Final action planned | Corresponds with field 42 planned services | Corresponds with field 42 planned services |
(47a) Assessment result | 14 – Community with services – Not DD Waiver | Result based on assessment |
(47b) Exit reason | 10 – Exit – Other (specify) | N/A |
(48) Effective date | Current name and PMIN last date | Assessment result effective date |
(49) Current MA program | 00 or 06 | As appropriate |
NF begin and through dates | Delete dates previously entered | N/A |
Time-limited payment | N | N |
Payment authorized | 07 | As appropriate |
Case manager comments | Adoption with name and PMIN change | Comments as needed |
3. Scenario: Family home or foster care (without support services) to community ICF/DD
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 | 19, residential code, other |
(42) Planned services | 19, 28, other |
(44) Waiver need index | 005 |
(46) Final action planned | 07 |
(47a) Assessment result | 16 – Facility stay |
(47b) Exit reason | N/A |
(48) Effective date | ICF/DD admission date |
(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 |
4. Scenario: Family home or foster care (without support services) to FSG
County/tribal nation-entered fields | 1st sequence |
(23) Action date | In-person assessment date |
(24) Action type | 01 |
(39) Level of care | As appropriate |
(41) Current services | 19, 34, other |
(42) Planned services | 19, 23, 34, other |
(44) Waiver need index | Use DHS-7209 (PDF) to determine |
(46) Final action planned | 03 |
(47a) Assessment result | 14 – Community with services – Not DD Waiver |
(47b) Exit reason | N/A |
(48) Effective date | FSG 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 | Comments as needed |
5. Scenario: Family home to ICF/DD respite temporary care to family home
County/tribal nation-entered fields | 1st sequence | 2nd sequence |
(23) Action date | In-person assessment date | ICF/DD discharge date |
(24) Action type | 01 | 03 |
(39) Level of care | 01 | As appropriate |
(41) Current services | 19, 26, residential code, other | 19, residential code, other |
(42) Planned services | 19, 26, residential code, other | 19, 26, residential code, other |
(44) Waiver need index | 005 | 001, 002, 003 or 005 |
(46) Final action planned | 02 | 02 |
(47a) Assessment result | 16 – Facility stay | 14 – Community with services – Not DD Waiver |
(47b) Exit reason | N/A | N/A |
(48) Effective date | ICF/DD admission date | ICF/DD discharge date |
(49) Current MA program | 04 | 00 |
NF begin and through dates | Delete dates previously entered | N/A |
Time-limited payment | N | N |
Payment authorized | 01 | 07 |
Case manager comments | ICF/DD for respite | Comments as needed |
6. Scenario: Family home or foster care (without support services) to DD diversion
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 service codes, residential code, other |
(42) Planned services | 01, waiver service codes, residential code, other |
(44) Waiver need index | 004 |
(46) Final action planned | Corresponds with field 42 planned services |
(47a) Assessment result | 04 – Waiver in |
(47b) Exit reason | N/A |
(48) Effective date | 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 | Comments as needed |
7. Scenario: Family home or foster care (without support services) to RTC to family home or foster care
County/tribal nation-entered fields | 1st sequence | 2nd sequence |
(23) Action date | In-person assessment date | RTC discharge date |
(24) Action type | 01 | 03 |
(39) Level of care | 01 | As appropriate |
(41) Current services | 19, 53, 41, other | 19, residential code, other |
(42) Planned services | 19, residential code, other | 19, residential code, other |
(44) Waiver need index | 005 | 001, 002, 003 or 005 |
(46) Final action planned | 98 | 02 |
(47a) Assessment result | 16 – Facility stay | 14 – Community with services – Not DD Waiver |
(47b) Exit reason | N/A | N/A |
(48) Effective date | RTC admission date | RTC discharge date |
(49) Current MA program | 00 or 06 | 00 |
NF begin and through dates | Delete dates previously entered | Delete dates previously entered |
Time-limited payment | N | N |
Payment authorized | 02 | 07 |
Case manager comments | Comments as needed | Comments as needed |
8. Scenario: Family home or foster care (without support services) 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 |
(44) Waiver need index | 005 |
(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 or 06 |
NF begin and through date | Delete dates previously entered |
Time-limited payment | N |
Payment authorized | 05 |
Case manager comments | Comments as needed |
9. Scenario: Own home, family home or foster care to DD diversion using an eligibility update when waiver start is unknown
Note: If the county or tribal nation completes the diagnostic review process, they must add case manager comments to inform the reviewer.
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, residential code, other | 19, residential code, 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 and 007 or 008 | 001 and 007 or 008 | 004 |
(46) Final action planned | 01 or 04 | 01 or 04 | 01 or 04 |
(47a) Assessment result | Either: | Either: | 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 | 00 | 00 | 01 |
NF begin and through dates | Delete dates previously entered | N/A | N/A |
Time-limited field | N/A | N/A | N/A |
Payment authorized | 01 | 01 | 01 |
Case manager comments | Comments as needed | Comments as needed | Comments as needed |
10. Scenario: Own home, family home or foster care to DD diversion using an eligibility update when waiver start date is known
Note: If the county or tribal nation completes the diagnostic review process, they must add case manager comments to inform the reviewer.
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, residential code, 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 and 007 or 008 | 004 |
(46) Final action planned | 01 or 04 | 01 or 04 |
(47a) Assessment result | Either: | 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 | 00 | 01 |
NF begin and through dates | Delete dates previously entered | N/A |
Time-limited field | N/A | N/A |
Payment authorized | 01 | 01 |
Case manager comments | Comments as needed | Comments as needed |
11. Scenario: Own home, family home or foster care to DD diversion when waiver start date is unknown
County/tribal nation-entered fields | 1st sequence | 2nd sequence – Completed within 60 days of the in-person assessment |
(23) Action date | In-person assessment date | Current date |
(24) Action type | 01 | 03 |
(39) Level of care | 01 | 01 |
(41) Current services | 19, residential code, 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 and 007 or 008 | 004 |
(46) Final action planned | 01 or 04 | 01 or 04 |
(47a) Assessment result | Either: | 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 | 00 | 01 |
NF begin and through dates | Delete dates previously entered | N/A |
Time-limited field | N/A | N/A |
Payment authorized | 01 | 01 |
Case manager comments | Comments as needed | Comments as needed |
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