Service limits for CADI and TBIW-NF and rate limits for assisted living / residential care through CADI for FY 2001

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1 # Bulletin July 28, Lafayette Rd. St. Paul, MN OF INTEREST TO! County Directors! Administrative Contacts: PAS, CADI, TBIW! Accounting Officers! County Public Health Nursing Services ACTION Implement monthly service limits for CADI and TBIW-NF and assisted living / residential care service rate limits under CADI. EFFECTIVE DATE Effective July 1, 2000 Service limits for CADI and TBIW-NF and rate limits for assisted living / residential care through CADI for FY 2001 TOPIC Community Alternatives for Disabled Individuals (CADI) Waiver Traumatic Brain Injury Waiver-Nursing Facility Level (TBIW-NF) PURPOSE Provide county agencies with monthly client service limits for CADI and TBIW-NF, and monthly rate limits for assisted living and residential care services under CADI. These limits are effective July 1, CONTACT CADI: Linda Webster (651) linda.webster@state.mn.us TBIW: Darlene Olson (651) darlene.olson@state.mn.us Conversions: Mike Hughes (651) mike.hughes@state.mn.us For TTY, contact Minnesota Relay Service at 1 (800) Community Supports for Minnesotans with Disabilities (CSMD) 444 Lafayette Road St. Paul, Minnesota SIGNED MARIA R. GÓMEZ Assistant Commissioner Continuing Care

2 Bulletin # July 28, 2000 Page 2 STATEWIDE MONTHLY AVERAGE WAIVER LIMITS CADI AND TBIW-NF The revised monthly services limits, effective July 1, 2000, for the Community Alternatives for Disabled Individuals (CADI) and the Traumatic Brain Injury Waiver - Nursing Facility level (TBIW-NF) are listed on the manual pages in Attachment A. The manual pages also include the assisted living and residential care rate limits for CADI. The new limits are to be used to determine cost-effectiveness of care plans written on or after July 1, The cost of all waiver services and Medical Assistant (MA) home care services (including skilled nurse visits, home health aide visits, personal care services including registered nurse supervision, and private duty nursing services) must be included when determining costeffectiveness of care plans for CADI or TBIW-NF recipients. If the cost of a recipient s services exceeds the recipient s monthly average waiver limit, case managers must adjust recipient services to remain within the individual s limit. If a service agreement change results in any suspension, reduction, or termination of services to a recipient, the recipient or their legal representative must be notified of their appeal rights ten days in advance of the change. The DHS Notice of Action form (DHS 2828) may be used to satisfy this requirement. The statewide monthly average limits for CADI and TBIW-NF are determined as follows: The CADI monthly service limit for adults (age 16 and older) is the statewide average monthly Medical Assistance (MA) payment rate of the case mix class to which the recipient would be assigned under the MA case mix reimbursement system less the average recipient contribution for the cost of their care. The TBIW-NF monthly service limit for adults (age 16 and older) is the average monthly MA payment rate of the case mix class to which the recipient would be assigned under the MA case mix reimbursement system for care in specific nursing facilities less the average recipient contribution for the cost of their care. Monthly CADI and TBIW-NF service limits for children (individuals under the age of 16) are based on the average monthly payment rate of the case mix class to which the child would be assigned under the MA case mix reimbursement system. These limits include an additional 15 percent. The cost of nursing facility care is higher for children as they often require private rooms. Additionally, these rates do not include an income contribution because children generally do not contribute toward nursing facility costs. However, parental fees do apply for any MA services.

3 Bulletin # July 28, 2000 Page 3 MMIS II To update the screening document and service agreement with the new statewide average limit for CADI and TBIW-NF: Screening Document Open the screening document Use action type 08, reassessment code Type over the case mix letter Press F9 to update the screening document The new case mix amount should appear in the Case Mix/DRG Amt field The amount will automatically be transferred to the service agreement when you exit by pressing F3. Service Agreement Open the service agreement Press F9 The new rate will appear in the Cap Amt field CONVERSION RECIPIENTS Recipients who begin waiver services immediately following a discharge from a nursing facility (NF), may be able to access the amount paid to the NF for the cost of their care. To be eligible for a conversion monthly limit, the recipient must meet the following criteria: 1. Is a resident of an NF at the time they request a screening for waiver services and 2. Has been a resident of the NF for at least 30 consecutive days. The monthly limit for the individual will be set at the amount MA reimburses the NF for the recipient s care or the statewide average, whichever is higher. Whether or not the recipient receives a conversion monthly limit or uses the statewide average limit, a person who meets the above criteria is entered as a conversion on screening documents and service agreements. To determine if the conversion monthly limit will be higher than the statewide average limit, complete the Request to Exceed Case Mix Average form (Attachment B). If the conversion limit is higher, the form may be submitted to the Department of Human Services (DHS). Include a remittance advice from the NF showing the amount MA paid for the recipient with the form. A remittance advice may be obtained by contacting the NF. When the documentation is received at DHS, you will be notified of the status of your request by telephone or . If the documentation was sent in advance of the recipient s discharge, please notify Mike Hughes at (651) or by , mike.hughes@state.mn.us, when the screening document is ready for approval.

4 Bulletin # July 28, 2000 Page 4 Conversion monthly limits will not automatically be increased when NF rates increase. To take advantage of a NF rate increase for a conversion recipient, the Request to Exceed Case Mix Average form and the current NF rate for the recipient s case mix need to be submitted to DHS each year for review and approval. MMIS II To update the screening document and service agreement with a conversion monthly limit: Screening document Send documentation to DHS Open the screening document Use action type 08, reassessment code Type over the amount in the Case Mix/DRG Amount field Enter the new conversion amount Press F3 to save the document Notify Mike Hughes at (651) or by , mike.hughes@state.mn.us, to approve the document After approval, the amount will automatically be transferred to the service agreement Service Agreement After approval of the screening document, open the service agreement Press F9 The new rate will appear in the Cap Amt field ASSISTED LIVING AND RESIDENTIAL CARE RATE LIMITS FOR CADI The monthly service rate limits for assisted living (AL) or residential care (RC) services provided to CADI recipients are the non-federal share of the average monthly MA payment (for persons under 65) for nursing facility care statewide or within a geographic group of the recipient s case mix classification. This method for rate determination applies to all but two assisted living pilot sites (explained below). The new monthly rate limits, effective July 1, 2000, for AL and RC under CADI are listed on the manual pages in Attachment A. AL and RC service rate limits change twice in a 12-month period. On July 1, the beginning of the state fiscal year, the limit is adjusted using the July 1, 2000 statewide and geographic groups average monthly nursing facility rate for each case mix resident class. On October 1, the beginning of the federal fiscal year, the limit is adjusted using the revised non-federal share of the average Medicaid nursing facility payment for each case mix resident class.

5 Bulletin # July 28, 2000 Page 5 County negotiated service rates for AL and RC services may not exceed the limits established for the month the service is received. Additional waiver services not provided by the AL or RC service package may be added to the recipient s care plan if the total cost of services does not exceed the recipient s total monthly limit. Counties are divided into three geographic groups (included in Attachment A). In each county, the monthly service rate limit to use for AL or RC services is the greater of either: C The non-federal share of the statewide average monthly MA nursing facility payment rate of the recipient s case mix letter; or C The non-federal share of the geographic group average monthly MA nursing facility payment rate of the recipient s case mix letter. (The county in which the AL or RC package of services is provided to the recipient is considered the recipient s county of residence for determining geographic group rate.) An exception to these rates was established under Minnesota Laws 1988, Chapter 689, Article 2, Section 256, for AL services at two pilot sites: Signe Burckhardt Manor in Minneapolis and Dunedin Terrace Apartments in St. Paul. The assisted living rate for the pilot sites is 65 percent of the average monthly MA payment for nursing facility care, either statewide or within their geographic group of the recipient s case mix classification. LEGAL AUTHORITY Minnesota Statutes, sections 256B.0912, 256B.0915, 256B.093, and 256B.49 SPECIAL NEEDS Upon request, this information will be made available in an alternative format, such as Braille, large print, or audiotape.

6 Attachment A HOME AND COMMUNITY BASED-SERVICES MANUAL July 1, 2000 Chapter 7 Section 02 Community Alternatives for Disabled Individuals (CADI) Monthly Limits FY 2001 MONTHLY LIMITS FOR CADI CASE MIX CLASS ADULT MONTHLY LIMITS CHILDREN MONTHLY LIMITS* A $1, $2, B $2, $3, C $2, $3, D $2, $3, E $2, $3, F $3, $4, G $3, $4, H $3, $4, I $3, $4, J $3, $4, K $4, $5, * Children s monthly limits apply to persons under age 16 Effective July 1, 2000 through June 30, 2001

7 Attachment A HOME AND COMMUNITY BASED-SERVICES MANUAL July 1, 2000 Chapter 7 Section 02 Community Alternatives for Disabled Individuals (CADI) NF Geographic Groups NURSING FACILITY GEOGRAPHIC GROUPS GROUP 1 GROUP 2 GROUP 3 Beltrami Big Stone Cass Chippewa Clearwater Cottonwood Crow Wing Hubbard Jackson Kandiyohi Lac qui Parle Lake of the Woods Lincoln Lyon Mahnomen Meeker Morrison Murray Nobles Pipestone Redwood Renville Rock Swift Todd Wadena Yellow Medicine Becker Benton Blue Earth Brown Chisago Clay Dodge Douglas Faribault Fillmore Freeborn Goodhue Grant Houston Isanti Kanabec Kittson Le Seuer Marshall Martin McLeod Mille Lacs Mower Nicollet Norman Olmsted Ottertail Pennington Pine Polk Pope Red Lake Rice Roseau Sherburne Sibley Stearns Steele Stevens Traverse Wabasha Waseca Watonwan Wilkin Winona Wright Aitkin Anoka Carlton Carver Cook Dakota Hennepin Itasca Koochiching Lake Ramsey Scott St. Louis Washington

8 Attachment A HOME AND COMMUNITY BASED-SERVICES MANUAL July 1, 2000 Chapter 7 Section 02 Community Alternatives for Disabled Individuals (CADI) Geographical Group Limits GEOGRAPHICAL GROUP LIMITS MONTHLY DOLLAR LIMITS FOR ASSISTED LIVING AND RESIDENTIAL CARE SERVICES FOR CADI RECIPIENTS BY CASE MIX CLASSIFICATIONS GROUP 1 LIMITS FOR CADI RECIPIENTS GROUP 2 LIMITS FOR CADI RECIPIENTS GROUP 3 LIMITS FOR CADI RECIPIENTS CASE MIX 7/1/00TO 9/30/00 10/1/00 TO 6/30/01 7/1/00 TO 9/30/00 10/1/00 TO 6/30/01 7/1/00 TO 9/30/00 10/1/00 TO 6/30/01 A $ $ $ $ $1, $1, B $ $ $ $1, $1, $1, C $1, $1, $1, $1, $1, $1, D $1, $1, $1, $1, $1, $1, E $1, $1, $1, $1, $1, $1, F $1, $1, $1, $1, $1, $1, G $1, $1, $1, $1, $1, $1, H $1, $1, $1, $1, $1, $1, I $1, $1, $1, $1, $1, $1, J $1, $1, $1, $1, $2, $2, K $1, $1, $1, $1, $2, $2,359.01

9 Attachment A HOME AND COMMUNITY BASED-SERVICES MANUAL July 1, 2000 Chapter 7 Section 02 Community Alternatives for Disabled Individuals (CADI) Statewide Limits for Assisted Living and Residential Care STATEWIDE LIMITS MONTHLY DOLLAR LIMITS FOR ASSISTED LIVING AND RESIDENTIAL CARE SERVICES FOR CADI PROGRAM RECIPIENTS BY CASE MIX CLASSIFICATIONS STATEWIDE CADI MONTHLY LIMITS FOR AL AND RC CASE MIX 7/1/00 to 9/30/00 10/1/00 to 6/30/01 A $ $ B $1, $1, C $1, $1, D $1, $1, E $1, $1, F $1, $1, G $1, $1, H $1, $1, I $1, $1, J $1, $1, K $2, $2,169.86

10 Attachment A HOME AND COMMUNITY BASED-SERVICES MANUAL July 1, 2000 Chapter 7 Section 02 Community Alternatives for Disabled Individuals (CADI) Pilot Site Limits ONLY APPLICABLE FOR PILOT SITES (i.e. SIGNE BURCKHARDT MANOR IN MINNEAPOLIS AND DUNEDIN TERRACE APARTMENTS IN ST. PAUL) ASSISTED LIVING SERVICES MONTHLY DOLLAR LIMITS CADI RECIPIENTS BY CASE MIX CLASSIFICATIONS CASE MIX CLASS PILOT PROJECT MONTHLY LIMITS FOR CADI A $1, B $1, C $1, D $1, E $1, F $1, G $2, H $2, I $2, J $2, K $2, Effective July 1, 2000 through June 30, 2001

11 Attachment A HOME AND COMMUNITY BASED-SERVICES MANUAL July 1, 2000 Chapter 9 Section 07 Traumatic Brain Injury Waiver (TBIW) TBIW-NF Monthly Limits FY 2001 MONTHLY LIMITS FOR TBIW-NF CASE MIX CLASS ADULT MONTHLY LIMITS CHILDREN MONTHLY LIMITS* A $3, $4, B $3, $4, C $3, $4, D $4, $5, E $4, $5, F $4, $5, G $4, $5, H $5, $6, I $5, $6, J $5, $6, K $6, $7, * Children s monthly limits apply to persons under age 16 Effective July 1, 2000 through June 30, 2001

12 REQUEST TO EXCEED CASE MIX AVERAGE (Conversions) Attachment B G CADI G TBIW-NF Case Manager: County: address: Phone: ( ) Recipient: Recipient ID number: Date of request: Birth date: Name of Nursing Facility (NF) where the recipient currently resides: Case mix level (A through K): Cost of waiver care plan: $ G New request Attach the Medical Assistance remittance advice form from the NF G Annual rate adjustment (CADI and TBIW-NF only)attach documentation showing the current NF rate Per diem NF rate for this case mix in the month of conversion is: $ per day Multiply per diem rate x 365 (days): (x) $ Divide by 12 (months): ( ) $ Recipient's monthly income: $ Subtract: (-) $ Use all income the recipient received in the NF in the month of conversion. Income includes RSDI, personal income, veterans' payments, private disability insurance payments, and pensions, etc. (Income does not include SSI payments as SSI is reduced to the personal needs allowance for NF inpatients.) Recipient's personal needs allowance: $ Add: (+) $ Add the allowance only for recipients who have income that is recorded on the income line. Conversion monthly limit: (=) $ DHS Staff: Date: G Approved G Denied G More Information is Needed : Mail to: Department of Human Services CSMD - Waiver Conversions 444 Lafayette Road St. Paul, MN Fax: (651) /00