AASD and DSD eList announcement

Date: Oct. 6, 2022
To: Lead agencies and other interested parties
From: DHS Aging and Adult Services and Disability Services divisions
Purpose: To announce the implementation of the policy related to people receiving home and community-based (HCBS) waiver services who temporarily enter certain facilities for 121 or fewer days
Effective: May 1, 2022
Contact: For questions related to disability services, use the DSD Contact Form. For questions related to aging and adult services, email DHS.AASD.HCBS@state.mn.us.

Policy change about temporary admissions to certain facilities for 121 or fewer days

Effective retroactive to May 1, 2022, people who were admitted to certain settings for 121 or fewer days and were receiving HCBS may return to the community with HCBS waiver services without needing an assessment. The 2021 Minnesota Legislative Session amended Minn. Stat. §256B.0911, subd. 3a (n) to include this change.

This change applies to the following settings:

· Hospital.

· Institution for mental disease (IMD).

· Nursing facility.

· Intensive residential treatment services program (IRTS).

· Transitional care unit.

· Inpatient substance use disorder treatment setting.

Instructions for lead agencies

DHS is in the process of updating its manuals to reflect this change. In the meantime, lead agencies can use instructions in the following sections:

· Transition or relocation assistance.

· Other required assessments and evaluations.

· Reassessments.

· Admissions between 1-29 days.

· Admissions between 30-121 days.

· Deletion requests to replace previous exit documents.

Note: The federal peacetime emergency remains in effect until further notice. Lead agencies must continue to ensure people maintain waiver eligibility, as identified in DHS Bulletin 20-56-06: Participation in LTSS Programs Cannot Be Terminated (PDF).

Transition or relocation assistance

Lead agencies must continue to complete any assessments when required as part of access to transition or relocation services.

The statutory amendment does not affect any policies, eligibility determination, service authorization/claims payment or roles and responsibilities related to the following services to assist in a person’s transition back to the community:

· Relocation services coordination targeted case management (RSC-TCM).

· Housing Stabilization Services (HSS).

· Moving Home Minnesota (MHM) services.

· Conversion case management for Alternative Care (AC).

Other required assessments and evaluations

Lead agencies must continue to follow policies for preadmission screenings (PAS), OBRA Level II evaluations and MnCHOICES assessments required within 80 days of admission for people younger than age 65 in a nursing facility.

The statutory amendment does not affect these policies, so these required assessments and evaluations must be completed per current policy. For more information, see:

· CBSM – PAS and OBRA.

· CBSM – OBRA Level II evaluative report for people with developmental disabilities.

· CBSM – Assessment applicability and timelines.

Reassessments

Lead agencies must continue to complete reassessments if a person’s annual reassessment is otherwise due while they are residing in an applicable facility. The statutory amendment specifies that this policy does not apply in this situation. Lead agencies must continue to use the LTSS Recipient Report to track when reassessments are due.

For all admissions, lead agencies must continue to follow the temporary COVID-19 policy listed on CBSM – Temporary waiver exits and restarts: MMIS actions until further notification from DHS.

For additional information, see the May 16, 2022, eList about maintaining waiver eligibility during the COVID-19 public health emergency.

Admissions between 1-29 days

DHS updated CBSM – Temporary waiver exits and restarts: MMIS actions to immediately allow a person’s waiver/AC to remain open for 30 days when they have been admitted to one of the following settings:

· IMD.

· Intensive residential treatment services program.

· Inpatient substance use disorder treatment setting.

The policy related to treatment settings now aligns with the policy related to 30-day short-term admissions to nursing facilities and hospitals.

Admissions between 30-121 days

Lead agencies must close a person’s waiver program when they are admitted to a residential treatment setting or institution for more than 29 days. To allow a person to return to or “restart” their previous waiver program within 121 days of an admission without an assessment (per the statutory amendment), DHS created an administrative task for lead agencies to complete in the long-term care (LTC) and developmental disabilities (DD) screening document (SDOC) subsystem in MMIS at discharge.

Brain Injury (BI), Community Access for Disability Inclusion (CADI), Community Alternative Care (CAC) and Elderly Waiver (EW) instructions

For people on BI, CAC, CADI and EW, lead agencies must complete this administrative activity in the LTC SDOC. The administrative activity includes:

· New exit reason to indicate a temporary exit from the waiver.

· New assessment result to restart eligibility to allow service authorizations to restart.

Lead agencies must create a partial waiver eligibility span in MMIS to ensure the annual reassessment occurs.

The following is a brief description of the LTC SDOC administrative activity. For all waivers except DD, the lead agency must:

1. Close the service agreement before closing the waiver, per usual practice.

2. Use the new exit reason 53, “temporary waiver exit,” for admissions exceeding 29 days. Please note:

· DHS developed exit reason 53 to close the waiver when an admission to one of these settings exceeds 29 days.

· Lead agencies should use activity type 07, “administrative activity” with exit reason 53.

· Lead agencies can use exit reason 53 for exits effective on or after May 1, 2022.

· The person will remain open to their program for 29 days. When the admission is 30 days or longer, the lead agency should use the date of admission (also known as assessment result date) as the effective date of the exit.

3. Send a notice of action to the person and other individuals as required (see CBSM – Notice of action), per usual practice.

4. Send Lead Agency Assessor/Case Management/Worker LTC Communication Form, DHS-5181 (PDF) to the person’s financial worker, per usual practice.

5. Use new assessment result 54, “restart the waiver,” to restart BI, CAC, CADI or EW participation within 121 days of admission. Please note:

· Lead agencies can use assessment result 54 if the person returns to the community within 121 days of admission.

· Lead agencies can only use assessment result 54 to return the person to their previous waiver program.

· Lead agencies can only use assessment result 54 following the new exit reason 53.

· MMIS will create a partial waiver eligibility span that will ensure lead agencies complete an annual reassessment as required under the approved federal waiver plans; it will not create a new 12-month waiver eligibility span.

6. Enter a new service agreement to restart waiver services for the partial waiver eligibility span MMIS created.

7. Complete a reassessment to extend eligibility beyond that period created using assessment result 54 when the person returns to the community.

Developmental Disabilities (DD) Waiver instructions

For people on the DD Waiver, lead agencies must use the DSD Contact Form to request assistance for individual scenarios until DHS fully implements MMIS changes for the DD Waiver.

Note: This change in policy does not apply to people with developmental disabilities who enter a regional treatment center (RTC). Lead agencies must continue to follow DD Screening Document Codebook – DD Waiver scenario 4 for instructions in this circumstance.

Alternative Care (AC) instructions

For people in the AC program, lead agencies must:

· Leave the AC program open for 121 days following admission to applicable settings.

· Close all line items on the AC service agreement, effective the date of admission.

· Add AC conversion case management to the AC service agreement, if applicable, at any time during the admission as long as the AC program remains open.

· Complete the annual reassessment if otherwise due during the admission.

· Close the AC program if the stay lasts longer than 121 days, effective on the 122th day, unless the person is receiving AC conversion case management.

The AC program can remain open for up to 180 days. This ensures the person's access to AC conversion case management during this period. For more information about AC conversion case management, see section 201.08, RSC, RSC-TCM, NF Admissions, AC Conversion Case, in Instructions for Completing and Entering the LTCC Screening Document and Service Agreement Into MMIS, DHS-4625 (PDF) and CBSM – AC conversion case management.

Deletion requests to replace previous exit documents

Lead agencies can request a deletion of a previous exit document to replace it with an exit document using the new codes to exit and subsequently restart the person’s waiver if both of the following are true:

· The person was admitted to an applicable setting for 121 or fewer days on or after May 1, 2022.

· The person experienced a delay in waiver provider payment for services delivered upon their return to the community as a result of a delayed assessment.

Lead agencies can request a deletion of a previous AC exit document to allow the program to remain open during the stay.

To submit screening deletion requests, lead agencies must use Screening Deletion Request, DHS-4689A (PDF).

Additional information

For more detailed information about MMIS action steps and examples, see:

· Instructions for Completing and Entering the LTCC Screening Document and Service Agreement Into MMIS, DHS-4625 (PDF).

· Instructions for Completing and Entering the LTCC Screening Document into MMIS for the MSHO, MSC and MSC+ Programs, DHS-4669 (PDF).

· DD Screening Document Codebook.

DHS is in the process of updating the above manuals, as well as the Community Based Services Manual (CBSM), to reflect this new exit scenario with more detailed information about MMIS action steps and examples.

For technical assistance related to service agreements and/or screening documents in MMIS, contact the Resource Center.

Previous eList announcements

AASD LEAD AGENCY ARCHIVE | DSD LEAD AGENCY ARCHIVE | DSD STAKEHOLDER ARCHIVE