For the correct service name, procedure code and rate framework to populate MnSP, all technical changes must be in place and operational.
New component values will be implemented on a rolling basis throughout 2022, pending federal approval. This means new frameworks will not be used until a person’s 2022 annual renewal or if they have a service change that starts on, or after, Jan. 1, 2022.
DHS published CBSM – Waiver Reimagine streamlined service crosswalk to provide details about service name, HCPC and framework changes.
See CBSM – Resource: Waiver Reimagine streamlined service crosswalk for a complete list of frameworks used for each streamlined service.
There are no changes to the input fields used to calculate the rate because existing RMS frameworks are used for the streamline services, except integrated community supports. The only change will be to service names, so they reflect the new streamlined services.
If a previous service had a rate worksheet, the Rate management worksheets, DHS-6790 (PDF) will look the same.
Yes. Effective January 1, 2022, lead agencies may authorize remote services in MnSP and MMIS. DHS updated MnSP to support authorization of these remote services. Lead agencies should review Remote support in the CBSM to learn more. Some remote services have a different HCPC modifier combination. The Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945(PDF) document contains the service, HCPC and modifier combination to use for remote services.
No. Day support services are only available in a 15-minute unit. There is not a daily unit for day support services.
No. Adult day services are not an option for people younger than age 55 who are new to the services and who would not begin receiving the service until on or after Jan. 1, 2021. For more information, see CBSM – Adult day services.
A person in this situation could receive day support services.
Integrated community supports are services that provide support and training in community living service categories to adults ages 18 and older who reside in a living unit of a provider-controlled, integrated community supports setting (e.g., apartment in a multifamily housing building). Integrated community supports can be delivered up to 24 hours a day in the person’s living unit or in the community. For more information, see CBSM – Integrated community supports.
Integrated community supports are only available through the Brain Injury (BI) and Community Access for Disability Inclusion (CADI) waivers during the 2021 Waiver Reimagine implementation. A future waiver amendment will add this service to the Community Alternative Care (CAC) and Developmental Disabilities (DD) waivers in 2023.
Following federal approval, we posted the integrated community supports framework on DHS – Disability waiver rate system, under the frameworks tab.
For the input fields used to calculate the rate for this service, see RMS User Manual – Residential fields for integrated community supports. For additional information about the framework, see the integrated community supports framework on DHS – Disability waiver rate system, under the frameworks tab.
Yes. It is available through Rate management worksheets, DHS-6790 (PDF).
No. The base shared staffing hours is not an input field and cannot be adjusted. The base shared staffing value of 8 hours is set in Minn. Stat. §256B.4914, subd. 6(e)(1).
No. The hours a person needs should be provided on an individual basis and entered in the 1:1 hours input area in the RMS tool. The base shared staffing number of 8 hours is for the general oversight of the program. Integrated community supports is designed to meet the individual needs of a person and not a setting.
DHS has published guidance to confirm the number of DHS-approved provider-controlled units.
Use one-way waiver transportation (T2003 UC), which is a market rate service. For more information, see CBSM – Briefcase resource document: Transportation and day and employment services.
Yes. The rate authorized in MMIS must match the calculation in RMS. This is the rate calculated by the RMS, a DHS-approved rate exception, or a manually calculated rate due to a MAPCY reduction. DHS will audit MMIS authorizations to assure that they match RMS calculations.
The lead agency needs to enter the correct information into MnSP, calculate the rate and then enter the matching information into MMIS. When DHS notifies a lead agency that a line is noncompliant, it means that the final rate, NPI, procedure code, and/or modifier(s) for the line are not the same in MnSP and MMIS.
The provider, using information from the community support plan and the person requesting services, provides the initial recommendation of service levels needed to determine rates. If the lead agency agrees with the information provided, they enter that information into the RMS to calculate a rate. If the lead agency does not agree, it continues to work with the provider to reach an agreement on a service plan that meets the assessed needs of the person.
If the lead agency does not agree with the information provided on the RMS worksheets, DHS-6790 (PDF), it should discuss the differences, continue service planning and come to an agreement about what will be entered into RMS.
Ideally, what a person wants and needs will align with what the lead agency authorizes. If the lead agency and provider cannot reach an agreement, authorizations must match the person's needs.
Lead agencies are in the position to either:
Providers are in the position to:
See Minn. Stats. 256B.4914 for more information.
No. There are no 6790 worksheets for unit-based services because they do not require inputs to determine the rate.
Providers may complete the worksheets found by clicking the appropriate links in the Rate management worksheets, DHS-6790 (PDF). Send completed forms to the lead agency.
Lead agencies uses the Rate Management System. Providers should complete the Rate Management Worksheet - Customized Living Services and 24 Hour Customized Living Services, DHS-6790G (PDF) and send to the lead agency. The lead agency should review the 6790G and work with the provider to reach an agreement about the services needed to meet the assessed needs of the person served.
Effective 1/1/2022, certain service categories have a maximum number of staffing hours that can be entered into RMS.
For the following service categories, the combined number of staffing hours entered into RMS may not total more than 24 hours of staffing per day:
For the following service categories, maximum staffing hours are based on the person’s case mix:
If the person has an existing DWRS rate exception for the service, the lead agency should mark the application as a renewal. If there is a change in rate requested from the previous year, the lead agency must provide all appropriate cost driver documentation. For more information, see DHS – Disability waiver rate system, under the exceptions tab.
If the person has never had an exception for the service prior to the 2022 component value changes, the lead agency should mark the application as new. The lead agency must provide all appropriate cost driver information. For more information, see DHS – Disability waiver rate system, under the exceptions tab.
Yes. However, the exception request must meet the same criteria as any other exception. For more information, review the DWRS exceptions requests page in the Community-Based Services Manual (CBSM).
No. Only lead agencies may submit an exception request to DHS.
Recalculate rates if the waiver closes.