Generally, individuals with banded rates are not eligible for exceptions. Banding is intended to protect providers’ rates from drastic changes and to ensure continued access to services for individuals.
However, you may complete a service intensity change for individuals with a banded rate who experience a change in service need. If the change in the individual’s need is so significant that the service intensity still does not meet an individual’s need, an exception may be appropriate. For more information, see the RMS training modules page.
An exception may be appropriate:
No. The lead agency must submit all exception requests on the Disability waiver rates system exception request application, DHS-5820 (PDF). Even if a lead agency is aware of the request and agrees with it, a provider must submit documentation to the lead agency for the lead agency to submit. This ensures that the lead agency is aware and is in agreement with an individual’s extraordinary needs and the cost drivers behind an increased rate.
If DHS receives an exception request directly from a provider, DHS will notify the provider, and copy the lead agency, that all exception requests must be routed through the lead agency for submission to DHS. DHS will not review the request unless submitted by the lead agency.
Yes, a lead agency should deny an exception request if:
A lead agency must inform DHS of its denial. DHS will document the denial and will only conduct further review if the conditions above were present and the lead agency did not comply with Minn. Stat. §256B.4914, subd. 14.
The component values in the RMS are not reflective of nor are they direction on what a provider pays its staff. Staff wages are a provider’s business practice and the RMS is a tool to calculate what an entire service costs.
During the banding period, DHS will continue to analyze all component values used in RMS and make changes as necessary and/or required by legislation.
At this time, minimum wage is not an eligible reason for an exception as it is not directly related to the needs of the individual.
We understand this time of change can be difficult for providers and lead agencies. However, ultimately, the goal of HCBS services is to provide the most meaningful, appropriate service for individuals with a disability to help them to live the most independent, integrated, meaningful lives possible.
A service rate cannot be the sole reason for demission of a person from service.
DHS developed the statewide rate-setting methodology (DWRS) because CMS cited Minnesota as being out of compliance with federal law in 2007. CMS deemed the pre-DWRS rate-setting methods (negotiating rates at a provider-lead agency level) to be inconsistent with the requirement for “efficiency, economy, and quality of care” standards in section 1902(a)(30)(A) of the Social Security Act. CMS directed Minnesota to implement a uniform statewide rate process. If Minnesota fails to comply with this federal mandate, we are at risk of losing federal waiver funding.
Minn. Stat. §245D.10, subd. 3 and 3a, identify how and when services may be disrupted and what is required when a provider determines it can no longer serve an individual. DHS encourages providers and lead agencies to work together to best meet the needs of the individual and to involve DHS as necessary before demitting a person.