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MMIS automation process for July 1, 2020

Lead agency (county and tribal nation) staff must refrain from adding or making changes to those Alternative Care (AC), Essential Community Supports (ECS) and Elderly Waiver (EW) service agreements with line items for home delivered meals (HDM) from June 11 to 12, or until DHS gives lead agencies the all-clear message. During this time, DHS will enter rates in MMIS and run the rate increase process on June 12, 2020.

Staff may enter screening documents during this time. This restriction does not include the EW, AC or ECS service agreements without home delivered meals or service agreements for the Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Developmental Disabilities (DD) waiver programs.

Please read these instructions carefully for the changes to the service agreements on June 12.

Affected Line Items

MMIS partially adjusts service agreement lines for HDM services for the AC, EW and ECS programs if the line item for S5170:

  • Includes the date of July 1, 2020, or later
  • Has a status of approved, pended or suspended.

Reports

After the automation process, lead agencies should use the following Infopac reports to identify service agreements to adjust:

  • MW2083A: Procedure Code Rate Increase Report LTC Waivers/AC Program
  • MW2083H: Procedure Code Rate Increase Report ECS Program (see note below).

If you need access to the Infopac reports, contact your lead agency MMIS security liaison who will request access.

Report PWMW941A-R2083H for Essential County Supports service agreements includes people enrolled with managed care. The managed care organization identified in the LTC screening document’s preadmission screening field as well as the REF PROV NBR field on the MMIS ASA1 screen receives its own page of this report. The MCO must review the report and contact the contracted lead agency to enter/change the service agreements in the MMIS to make the changes. If there is not a contracted lead agency, the MCO must contact dhs.mcoecs@state.mn.us with the service agreement number and instructions for changing each affected line item.

Automation Process for HDM Services for AC, ECS and EW programs

Line items that begin before July 1 and end on or after July 1 with unused units

Approved, pended, or suspended lines that begin before July 1, 2020 and end on or after July 1, 2020 with unused units MMIS will:

  • Change the line item end date to June 30, 2020
  • Reduce the units
  • Add reason code 499 to the line that explains that the line changes because of the rate increase. Any existing reason codes will now display after the 499
  • Post edit 380 (Automatic Line Adjustment)

MMIS creates a new line for the same procedure code beginning July 1, 2020. On the new line, MMIS will:

  • Use the same end date as the original line item
  • Use the same provider number
  • Add the new rate into the Requested and Approved Rate fields
  • Add reason code 499 (Any other reason codes that were displayed on the original line are moved to this line after the 499)
  • Suspend the new line
  • Change the service agreement (SA) header status to "T" (partially suspended) if it was originally approved
  • Post edit 380 (Automatic Line Adjustment) to route the service agreement to the lead agency for further adjustments.

Lead agencies must:

  1. Review the number of units for both line items for accuracy. Check if the number of units is sufficient based on the person's needs; adding or subtracting units as appropriate.
  2. Remove existing reason codes that are no longer needed (except the 499).
  3. Approve the new line.
  4. Change the header status to "A" (approved).

Line items that begin on or after July 1 with unused units

For lines that begin on or after July 1, 2020 with unused units, MMIS will:

  • Change the line item status to suspend (if previously approved or pended)
  • Post edit 380 (Automatic Line Adjustment)
  • Add reason code 499 to the line that explains the line was changed due to a rate change (Any existing reason codes will now display after the 499)
  • Add the new rate to the Requested and Approved Rate fields

Lead agencies must:

  1. Remove existing reason codes other than code 499.
  2. Approve the line.
  3. Change the header status to "A" (approved).

Line items that end on or after July 1 with no unused units remaining

Lines that end on or after July 1, 2020 with no unused units remaining or with no units left after performing the calculation to prorate the units MMIS will:

  • Change the line item end date to June 30, 2020
  • Add reason code 499.

Lead agencies must:

  1. Do nothing unless the service continues beyond June 30, 2020. If the service continues, lead agencies must enter a new line that begins July 1, 2020, with the correct rate and units.
  2. Approve the line.

Alternative Care, Elderly Waiver and Essential Community Supports Budget Cap Increases

Follow these instructions to increase the service agreement Total Cap Amount if needed to allow for the increased HDM costs.

A new AC, ECS, or EW screening document using activity type 05 and assessment result 98 or the next scheduled reassessment entered with an activity type date of July 1, 2020, or later will change the Total Cap Amount on the service agreement when the service agreement is entered and edited. Those months through June 2020 will use the case mix budget before the increased cap amount. Those remaining months in the service agreement starting July 1 will use the increased case mix budget.

The cost of all services must not exceed the prorated total service agreement budget, otherwise edit 672 (Total Authorized Amount is Excessive) will post. Reduce the units or total amount on one or more line items to bring the amount in the Total Authorized Amount field to be equal to or less than the Total Cap Amount field on the MMIS ASA1 screen.

AC and EW consumer directed community supports (CDCS) - T2028

For lines that begin before July 1, 2020, and end on or after July 1, 2020, MMIS will not adjust line items but identify the lines on the Infopac report MW2083A. Note:The increase does not apply to case mix A or L. The increase was too small to change monthly and annual budget caps for these two case mix classes.

Lead agencies must:

  1. Determine the original approved CDCS monthly budget
  2. For the services ending June 30, 2020, take the CDCS monthly budget times the number of months on the line item
  3. For the budget beginning July 1, 2020, apply a 0.04% increase to the number of months remaining on the service agreement
  4. Add both sums and add to the existing line item. The final budget amount cannot exceed the Annual Maximum CDCS Service Budget Amount published in Long-Term Services and Supports Service Rate Limits Effective July 1, 2020, DHS-3945-ENG (PDF).
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