Yes. However, the exception request must meet the same criteria as any other exception. For more information, review the CBSM- DWRS exceptions requests page.
No. Lead agencies cannot make exception requests for historic "banded" rates. Exception requests are available only for new service recipients with needs that cannot be met by the framework-produced rates.
No. Only lead agencies can submit an exception request.
No, lead agency staff may authorize 1 to 1 DT and H without an exception request when appropriate.
Banding creates limits to changes in framework service payment rates that would otherwise change because of the system implementation. A 0.5 percent rate stabilization adjustment (band) applying to the unit rate is in effect for all of 2014. This 0.5 percent band will take effect when you create a new waiver span or renew a waiver span. This means that in 2014, existing payment rates for framework services will not increase or decrease by more than 0.5 percent.
Historic rates are rates authorized in MMIS prior to Jan. 1, 2014. There is no plan to update historic rates in the system.
A weighted average is defined as an average in which each quantity to be averaged is assigned a weight. These weightings determine the relative importance of each quantity on the average. Weightings are the equivalent of having that many like items with the same value involved in the average.
No. Banding does not apply to new residential services that are added to a consumer's service plan after Jan. 1, 2014.
For all day services, banding is applied at no more than plus or minus 0.5 percent of the weighted average authorized rate for each provider in the county of residence effective Dec. 1, 2013.
For all unit-based services, banding is applied at no more than plus or minus 0.5 percent of the weighted average authorized rate for each provider in the county of residence effective Dec. 1, 2013.
If you have a service agreement initiated for an individual who was receiving a residential service in December 2013, but the individual changes their provider for the same residential service, the Rate Management System will not automatically band the service. In these situations, lead agency staff will need to:
1. Complete the appropriate framework
2. Complete the non-framework rate information section
3. Choose the "residential change in service plan" for type
4. Fill in a unit rate for the service as determined by the lead agency.
This rate should be set within county aggregate budgets using the old methodology, which was in effect Dec. 1, 2013, for determining provider rates for a similarly situated recipient served by the new provider.
The rate for ILS and other day and unit-based services will be the weighted average for that service with the new provider in the specific county on Dec. 1, 2013, plus or minus up to 0.5 percent of the framework rate.
Yes. DHS will audit MMIS authorizations to assure that they match Rate Management System calculations.
If the record is not yet locked, the lead agency can edit the existing record.
For records that are locked in the Rate Management System, the lead agency will create a new service record.
No. You need only enter changes into the Rate Management System when they affect the rate calculation.
It is important to lock records. If records are not locked in the system, they will not match records in MMIS, which could trigger an audit.
No. Please use the procedure code including modifiers exactly as indicated in the blue bar in RMS. The ONLY exception to this is when you select the "partial day" non-framework rate for 15-minute DT and H, in which case you should use T2020 U5 in MMIS (not T2021).
The utility of many HCPCS modifiers changed with the implementation of the new DWRS. Please use the procedure codes and modifiers that the RMS produces.
These designations are intended to reference the license, and "corporate" is the default. So, if the license is for "family foster care" (which happens when the foster care home is the primary residence of the license holder), then you would select the "family" option. In all other cases use the "corporate" option, even if the services do not appear to be provided by a corporation.
People did not automatically get a new rate on Jan. 1, 2014. The rate system has rolling implementation as follows. Beginning Jan. 1, 2014:
By Dec. 31, 2014, all service authorizations for framework services must use the Rate Management System.
The provider, using information from the community support plan, generates the initial recommendation of service levels needed to determine rates. If the lead agency agrees with the information provided, they enter it into the Rate Management System to calculate a rate. If the lead agency does not agree, they continue negotiations with the provider to reach agreement on a service plan.
If the lead agency does not agree with the information provided on the RMS worksheets DHS-6790 (PDF), they should:
Minn. Stat. section256B.4914 states the following:
Subd. 4. Data collection for rate determination.
(a) Rates for applicable home and community-based waiver services, including rate exceptions under subdivision 12, are set by the rates management system.
(b) Data for services under Minn. Stat. section256B.4913, subd. 4a, shall be collected in a manner prescribed by the commissioner.
(c) Data and information in the rates management system may be used to calculate an individual's rate.
(d) Service providers, with information from the community support plan and oversight by lead agencies, shall provide values and information needed to calculate an individual's rate into the rates management system.
No. There are no worksheets for unit-based services because they do not require inputs to determine the rate.
If a county has not made arrangements for submitting worksheets, providers may complete the worksheets found by searching DHS Forms (eDocs) for the term "RMS Worksheets" and then send the forms to the lead agency.
No. The system uses the Rate Management System in place of the customized living tool.
The lead agency enters the agreed upon average daily amount of time for each service.
As an example, for a service in which three episodes of 30 minutes are planned each week, you calculate the average daily amount (1.5 hours/7 days) for an average daily amount of 0.21.