Legal authority

Minn. Stat. §256B.5013, subd. 1

Definition

Variable rate adjustment: Person-specific rate to support the intermediate care facility for persons with developmental disabilities (ICF/DD) to meet the person’s documented, increased needs. DHS pays the variable rate in addition to the standard, facility-specific ICF/DD daily rate.

Eligibility

A person is eligible for a variable rate adjustment if they meet one of the following criteria.

Retirement from day training and habilitation (DT&H)

The person either fully or partially ends participation in a DT&H service, and the ICF/DD now has a need for additional resources. The person must meet all of the following requirements:

Preparing to move to a more integrated setting

The person has a need for additional resources for intensive, short-term programming within their current ICF/DD that is necessary before the person’s move to a less restrictive, more integrated setting.

Demonstrated medical, behavioral or cognitive need

The person has a demonstrated medical, behavioral or cognitive need that significantly affects the type or amount of services they need.

Need for staff assistance

One of the following is true:

Documentation

If the lead agency case manager identifies the person’s need for a variable rate request, the case manager must do one of the following:

Then, the ICF/DD must complete ICF/DD Variable Rate Recommendation Form, DHS-4677A and submit it to the county of financial responsibility (CFR). The CFR reviews DHS-4677A and submits it to DHS.

Timeline

The CFR must act on variable rate requests within 30 days and notify the requestor of the CFR’s recommendation in writing.

DHS will act upon variable rate recommendations no later than 30 days after receipt of a request with complete information.

Duration

Once approved, variable rate adjustments continue in place unless the person has an identified change in need.

At the person’s annual reassessment and support plan meeting, the case manager and support team must complete a review of their needed resources, including their variable rate need.

After initial approval, the ICF/DD and CFR must complete and submit ICF/DD Variable Rate Recommendation Form, DHS-4677A annually, even if the variable rate has not changed.

Changes in condition

The lead agency case manager and/or ICF/DD must use the DSD Contact Form to notify DHS of changes in the person’s condition that may result in a change to an existing service authorization with a variable rate. The submitter must include the following information:

Example

A person has a service authorization with a variable rate because they have behavioral needs that significantly impact the amount of services they need. After staff implement a positive supports plan, the person’s behavior changes, and the person no longer needs the variable rate.

Billing

The ICF/DD bills for approved dollars for appropriate dates and dollar amounts that match the service authorization by submitting the HCFA-1500 form to DHS.

Contact the MHCP Provider Resource Center with questions about completing the HCFA-1500 form.

Additional resources

ICF/DD Variable Rate Recommendation Form, DHS-4677A
MHCP Provider Resource Center