Minnesota Minnesota

DD Screening Document Codebook

DD Screening Document Codebook

Semi-independent living services scenarios

Page posted: 7/2/19

Page reviewed:

Page updated: 9/24/19

Overview

This page contains the more frequently used sequencing charts for:

1. Semi-independent living services (SILS) to community intermediate care facility for persons with developmental disabilities (ICF/DD)

2. SILS to crisis-only diversion to DD diversion

3. SILS to crisis-only diversion to SILS

4. SILS to regional treatment center (RTC) to SILS

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 – Relocation service coordination (RSC)
CBSM – Semi-independent living services (SILS)

1. Scenario: SILS 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, 28, residential code, other

(42) Planned services

19, 28, other

(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 Medical Assistance (MA) program

04

Nursing facility (NF) begin and through dates

Delete dates previously entered

Time-limited payment

N

Payment authorized

01

Case manager comments

Comments as needed

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2. Scenario: SILS 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

(46) Final action planned

Corresponds with field 42 planned services

(47a) Assessment result

04 – Waiver in

(47b) Exit reason

N/A

(48) Effective date

Date person will access the DD Waiver

(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

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3. Scenario: SILS to DD diversion to SILS

County/tribal nation-entered fields

1st sequence

2nd sequence

(23) Action date

In-person assessment date

In-person assessment date

(24) Action type

01

01

(39) Level of care

01

03

(41) Current services

01, waiver service codes, residential code, other

19, 24, residential code, other

(42) Planned services

01, waiver service codes, residential code, other

19, 24, residential code, other

(46) Final action planned

04

05

(47a) Assessment result

04 – Waiver in

05 – Waiver out

(47b) Exit reason

N/A

14- Community with services – Not DD Waiver

(48) Effective date

Waiver start date

Waiver end date

(49) Current MA program

01

00

NF begin and through dates

Delete dates previously entered

N/A

Time-limited payment

N

N

Payment authorized

01

05

Case manager comments

Comments as needed

Comments as needed

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4. Scenario: SILS to RTC to SILS

County/tribal nation-entered fields

1st sequence

2nd sequence

(23) Action date

In-person assessment date

In-person assessment date

(24) Action type

01

01

(39) Level of care

01

03

(41) Current services

19, 33, other

19, 24, residential code, other

(42) Planned services

As planned

19, 24, residential code, other

(46) Final action planned

Corresponds with field 42 planned services

Corresponds with field 42 planned services

(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

00

NF begin and through dates

Delete dates previously entered

N/A

Time-limited payment

N

N

Payment authorized

02

05

Case manager comments

Type of RTC services (mental health, chemical dependency)

Comments as needed

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