Frequently asked questions about maintaining HCBS eligibility under COVID-19 requirements

Lead agencies must complete all applicable rate calculations during the COVID-19 national public health emergency period.

For the Disability Waiver Rate System (DWRS) and rate calculations with an effective date of Jan. 1, 2020, or later, lead agencies must continue to use the Rate Management System (RMS) tool to calculate payment rates for specific authorized services and enter them into MMIS. The RMS User Manual provides lead agencies with guidance to use this tool effectively. Please note:

• The rate will not be banded to an individual or weighted average historic rate.
• The final rate will be the RMS framework rate.
• Manual banding is only appropriate if there are Minnesota Assessment of Parenting for Children and Youth (MAPCY) reductions or rate exceptions approved by DHS.

Lead agencies must continue to monitor and submit DWRS exception requests using the 2020 waiver rate-setting frameworks, as appropriate.

Yes, the person’s eligibility must continue. The case manager/care coordinator cannot renew or reauthorize services other than case management until they make contact with the person.

To maintain a person’s waiver or AC eligibility when a reassessment cannot been completed for this reason, the assessor/care coordinator must:

• Enter a reassessment in MMIS:
  • For a long-term care (LTC) screening, use activity type 06 and assessment result 13.
  • For a developmental disabilities (DD) screening, use action type 01 and assessment result 15.
• Use an activity/action date and effective date that extends the person’s waiver or AC eligibility span with no gap in eligibility.
• Use the assessment information from the person’s last approved screening document.
• Enter “COVID-19 – Program remains open” in the MMIS case manager comments screen.
• Send the person a Notice of Action (Assessments and Reassessments), DHS-2828A (PDF) and include this explanation in the “programs and services available to you” section:

"This notice is to let you know that the [insert name of program] you were on has been extended to provide support during the COVID-19 emergency period. Please contact your care coordinator or case manager to review and renew your support plan and services."

The lead agency must:

• Confirm the person’s choice to continue in their program.
• Arrange for or conduct reassessment activities if the person’s needs have change. Note: AC and Elderly Waiver (EW) case managers/care coordinators can also use activity type 10.
• Enter reassessment activity type 06 or activity type 10 information into MMIS, if applicable.
• Complete support planning activities and service authorization, as appropriate.

Maintaining HCBS eligibility means there are no interruptions or gaps in a person’s waiver eligibility or AC span (i.e., eligibility is continuous). DHS expects that lead agencies continue to track and meet reassessment due dates in all circumstances.

Yes, the person must maintain eligibility for their program. The assessor/care coordinator enters the actual reassessment information, including the correct level-of-care determination, into MMIS. If a person no longer meets an institutional level of care, the assessor/care coordinator uses the following process for the screening document, service authorization and notice of action.

Screening document instructions

For the screening document, the assessor/care coordinator must:

• For an LTC screening, use activity type 06 and assessment result 13
• For a DD screening, use action type 01 and assessment result 15
• Use an activity/action type date and effective date that continues program eligibility with no gap
• Complete the rest of the screening document as usual
• Resolve all edits except for edit 179 (LTC screening) or edit 725 (DD screening)
• Enter “COVID – Reopen – No LOC” in the MMIS case manager comments screen
• Save the document in suspended status
• Use Service Agreement and Screening Document (SASD) Support Team Portal, to send a request to the SASD Support Team to force edit 179 or 725.

Service authorization instructions

When authorizing services for a person who no longer meets level-of-care requirements, the lead agency must:

• Review the person’s assessed needs and current service plan
• Determine the appropriate services in a conversation with the person
• Complete the person’s coordinated services and supports plan (CSSP) as usual to reflect the services agreed upon for the next year.

The case manager/care coordinator can continue to authorize case management for the person, including when the person does not need other services based on the reassessment.

DHS strongly recommends that the lead agency talk directly with the person to explain the changes they might see, explain the effects on their services, their right to appeal these changes and ensure they understand how to contact the lead agency if their situation changes.

Notice of action instructions

After the reassessment, the case manager/care coordinator must complete a Notice of Action (Assessments and Reassessments), DHS-2828A (PDF) as usual and:

• In the "Programs and services available to you" section, include the following explanation: "Although you no longer meet [insert level of care type] level of care based on your assessment dated [insert assessment date], your [insert name of program] will remain open due to certain requirements in place during the COVID-19 peacetime emergency. You no longer meet [insert level of care type] level of care because [explain why the person’s level of care has changed and what is different about the person’s need from the assessment]. For more information on [insert name of program] and level of care, visit CADI Waiver supports people with disabilities, DHS-5712 (PDF), Case Manager’s Guide to Determining ICF/DD Level of Care and DD Waiver Services, DHS-4147 (PDF) or EW program, DHS-5357 (PDF)."
• In the "notice of action about denial, termination or reduction of services” section, check "no change to your current programs or services."

If there is a reduction or termination to the person’s services, the lead agency must send a Notice of Action (Service Plan), DHS-2828B (PDF) to the person and clearly outline which services will continue or be added, as well as the reasons for the reduction/termination of services from their previous plan.

Yes. If the fee increase is related to a need for additional services and is NOT related to financial eligibility, you may increase the fee. Increases due to financial eligibility are not allowed while the COVID-19 public health emergency is in effect. For instructions on how to increase a fee in MMIS, see Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF).

For waivers, the person must maintain waiver eligibility as long as they maintain their MA financial eligibility. Financial workers must follow usual policies to determine if a person is a resident of Minnesota. For more information, see MHCP Eligibility Policy Manual – 1.4 state residency and MHCP Eligibility Policy Manual – 1.4.4 temporary absence. 

For AC, follow MA policy to determine if a person is a resident of Minnesota and should remain on AC.

If the assessor/care coordinator cannot complete a reassessment (e.g., cannot contact the person), the person must maintain waiver or AC eligibility as described in scenario one. The case manager/care coordinator cannot reauthorize services (other than case management) until they have contact with the person.

If the assessor/care coordinator completes a reassessment remotely, they must follow the instructions for policy amendments related to the COVID-19 peacetime emergency. Contact dhs.aasd.hcbs@state.mn.us with questions.

If the person will receive services while they are out of state, the assessor/care coordinator must review the section about out-of-state services on CBSM – BI, CAC, CADI and DD waiver general process and procedure for information about how to authorize and provide services.

If the person will not receive any services while out of state, the assessor/care coordinator must send the person a Notice of Action (Assessments and Reassessments), DHS-2828A (PDF) and include this explanation in the “programs available to you” section:

"This notice is to let you know that the [insert name of program] you were on has been extended to provide support during the COVID-19 emergency period. Please contact your care coordinator or case manager upon your return to Minnesota to review and renew your support plan and services. Please also contact your care coordinator or case manager if you decide your move out of state is permanent."

If the person communicates that they do not intend to return to Minnesota, the case manager/care coordinator must send Lead Agency Assessor/Care Manager/Worker LTC Communication Form, DHS-5181 (PDF) to the financial worker to inform the financial worker of this information. For waivers, the person cannot be exited from their waiver until MA eligibility is terminated. For AC, the case manager must exit the person from the AC program using the date they received this communication from the person.

To enter this information into MMIS, the case manager/care coordinator must:

• For an LTC screening:
  • Use activity type 07, assessment result 24 and exit reason 98.
  • Use an effective date consistent with the end date for MA eligibility.
  • For AC, the case manager must exit the person from the AC program using the date they received this communication from the person.
• For a DD screening:
  • Use action type 03, assessment result 05 and exit reason 09.
  • Use an effective date consistent with the end date for MA eligibility.
• Enter “moved out of state” in the MMIS case manager comments screen.

If the person is available for reassessment and refuses, the assessor/care coordinator must explain the following information:

• Without reassessment, the person’s eligibility and services cannot continue.
• Reassessment can happen remotely; it does not have to happen in person.
• When a reassessment is completed, it cannot result in the person losing waiver or AC services.
• By refusing a reassessment, the person is choosing to exit the waiver or AC program.

In MMIS, the assessor/care coordinator must:

• For an LTC screening:
  • Use activity type 07, with an activity type date equal to the date the person refused the reassessment
  • Use assessment result 23 and 02 or 03
• For a DD screening:
  • Use action type 03, with an action type date equal to the date the person refused the reassessment
  • Use assessment result 05 with an appropriate exit reason
• Send a Notice of Action (Service Plan), DHS-2828B (PDF) to the person that outlines the reason for service termination.

Note: The effective date for closing the program based on choice for both LTC and DD screenings must be at least 10 days and not more than 60 days from the date the person refused the reassessment. If the person refused the reassessment within the last 10 days of the current service authorization period, the lead agency must allow a minimum of a 10-day period before ending services. For help, contact dhs.aasd.hcbs@state.mn.us.

Yes. For waivers, the lead agency must maintain the person’s waiver eligibility as long as they maintain their MA financial eligibility. Financial workers must follow usual policies to determine if a person is a resident of Minnesota. For more information, see MHCP Eligibility Policy Manual – 1.4 state residency and MHCP Eligibility Policy Manual – 1.4.4 temporary absence.

The case manager/care coordinator must end service agreement lines using the date of incarceration and keep the person’s waiver or AC program open. Reassessment may be completed remotely under COVID-19-related policy.

If the person remains incarcerated when a reassessment is due, the assessor/care coordinator must do one of the following:

• Complete a reassessment to continue the person’s waiver or AC eligibility except when the person has declined their reassessment.
• Continue the person’s eligibility as described in scenario one if either:
  • The person cannot be reached to complete a reassessment.
  • The person's anticipated release date to return to community will not occur during the upcoming reassessment span.
• Exit the person following scenario 5 if they decline assessment.

The assessor/care coordinator will determine whether a reassessment is needed upon the person’s return to the community. For AC and EW, the assessor/care coordinator can also use activity type 10. The case manager/care coordinator may not authorize services until they make contact with the person. 

The policy related to termination of HCBS program participation based on a facility admission of 30 days applies to:

• Hospitals
• Skilled nursing facilities
• Certified board and care facilities
• Intermediate care facilities for persons with developmental disabilities (ICFs/DD).

The policy does not apply to any other setting, such as a treatment setting for behavioral health or substance use disorders. People admitted to other settings must maintain their waiver or AC eligibility.

If the person is admitted to any of the above facilities for more than 30 days, the case manager/care coordinator must:

• Use the date of facility admission for the effective date of the exit
• For an LTC screening, use activity type 07 and assessment results 22 and 04, 06-09
• For a DD screening, exit the person from the waiver or AC program at the time the person enters the facility and:
  • If a person is admitted to a certified board and care facility or ICF/DD, use action type 03 and assessment result 16
  • If a person is admitted to a nursing facility, follow the instructions on DD Screening Document Codebook – OBRA Level II evaluative report scenarios.

No. To be eligible for PCA services, the person must have an annual reassessment. If the assessor/care coordinator cannot locate the person, the person’s PCA services cannot continue until a reassessment is completed. 

Yes. The lead agency must end service agreement lines using the date of admission and keep the person’s waiver or AC program open. Reassessment may be completed remotely under COVID-19-related policy.

If the person remains in the residential treatment setting when a reassessment is due, the assessor/care coordinator must do one of the following:

• Complete a reassessment to continue the person’s waiver or AC eligibility if the person requests an assessment
• Continue the person’s eligibility as described in scenario one if either:
  • The person cannot be reached to complete a reassessment.
  • The person's discharge plan is incomplete.
• Exit the person following scenario 5 if they decline assessment.

The assessor/care coordinator will determine whether a reassessment is needed upon the person’s return to the community. For AC and EW, the assessor/care coordinator may also use activity type 10. The case manager/care coordinator may not authorize services until they make contact with the person.