Current through Register Vol. 48, No. 39, March 25, 2024
Subpart
1.
Application.
The provider shall apply to the county for a special needs
rate exception to cover the cost of a staff intervention or piece of equipment
necessary to serve clients eligible under part
9510.1050, subpart
2. A separate application
must be completed for each client unless the staff intervention or equipment is
shared by the clients identified. If more than one client is included in the
application, client information must be submitted for each client. The
application must include the information in subparts
2 to
4.
Subp. 2.
Information about client's
needs and methods used to address needs.
The provider shall:
A. identify the client including:
(1) name;
(2) name and address of the client's legal
representative;
(3) medical
assistance identification number;
(4) date of admission or anticipated
admission to the provider's program;
(5) diagnosis;
(6) age;
(7) current residence; and
(8) current day program;
B. describe the client's special need or
needs which put the client at risk of regional treatment center placement or
continued regional treatment center placement;
C. describe the proposed staff intervention
including:
(1) the amount of staff or
consultant time required;
(2)
qualifications of the program staff or outside consultants providing the
intervention;
(3) type of
intervention;
(4) frequency of
intervention;
(5) intensity of
intervention; and
(6) duration of
intervention;
D.
describe the equipment needed and the plan for use of the equipment by the
client;
E. identify the total cost
and the unit cost of the equipment or the staff intervention;
F. describe the modifications needed to
integrate the equipment and staff intervention into the client's individual
program plan;
G. describe the
projected behavioral outcomes of the staff intervention or the use of the
equipment and when the outcomes will be achieved;
H. describe how the client's progress toward
the behavioral outcomes in item G will be measured and monitored by the
provider; and
I. describe the
degree of family involvement with the client.
Subp. 3.
Information about
provider.
The provider shall submit:
A. information identifying the provider
including:
(1) name and address of the
provider;
(2) name and address of
the place where the staff intervention and equipment will be delivered, if
different from subitem (1);
(3)
name and telephone number of the person authorized to answer questions about
the application; and
(4) medical
assistance provider number; and
B. an explanation of the efforts used to meet
the client's needs within the provider's current per diem rate, including:
(1) modifications made to the individual
program plan;
(2) reallocation of
current program personnel;
(3)
training and in-service provided to program personnel for the year immediately
preceding the date of the provider's application to the county; and
(4) other available resources used.
Subp. 4.
Supporting documentation.
The provider shall submit with the application the
following:
A. A copy of the individual
program plan including the measurable behavioral outcomes which are anticipated
to be achieved by the client as a result of the proposed staff intervention or
the equipment.
B. Documentation of
the provider's historical costs on which the current per diem rate is based. An
ICF/DD provider shall submit a copy of the most recent rate determination
letter. A training and habilitation service program shall submit a copy of its
current budget, year-to-date expenses, and current assets.
C. Work papers showing the method used to
determine the cost of the staff intervention and equipment identified in
subpart
2, item E, including the
hourly wage of staff who will implement the intervention, the unit cost of
consultation or training services, and the unit cost of equipment
requested.
D. Documentation that
any equipment requested in the application is not available from the Department
of Vocational Rehabilitation or covered under parts
9505.0170 to
9505.0475.
E. Documentation that any consultant services
requested in the application are not services covered under parts
9505.0170 to
9505.0475.
F. The name and address of any vendor or
contractor to be reimbursed by the special needs rate exception and the name of
the person or persons who will actually provide the equipment or services if
known.
G. A plan to decrease the
client's reliance on the proposed staff intervention.
Statutory Authority: MS s
252.46;
256B.501