Current through Register Vol. 49, No. 13, September 23, 2024
Subpart 1.
Criteria.
The county shall determine if the provider submitting the
application and the client or clients identified in the application meet the
criteria in subparts
2 to
5. The county shall submit to
the commissioner the applications which meet the criteria in subparts
2 to
5.
Subp. 2.
Client eligibility.
A client shall be eligible for a special needs rate exception
if the client meets the criteria in items A to D:
A. the client is eligible for medical
assistance under Minnesota Statutes, chapter 256B;
B. the client is a resident of an
ICF/DD;
C. the client is a person
as defined in part
9525.0004, subpart 19, and has at
least one of the following characteristics:
(1) severe maladaptive behavior as listed in
unit (a), (b), or (c);
(a) self-injurious
behavior which is a clear danger to the client such as ingesting inedibles;
removing major items of clothing; striking, biting, or scratching self; moving
into dangerous situations which clearly threaten or endanger the client's life,
sensory abilities, limb mobility, brain functioning, physical appearance, or
other major physical functions; or
(b) aggressive behaviors which are a clear
danger to others such as striking, scratching, or biting others; throwing heavy
objects at others; attempting inappropriate sexual activity with others; or
pushing or placing others into dangerous situations which clearly threaten or
endanger their life, sensory abilities, limb mobility, brain functioning,
sexual integrity, physical appearance, or other major physical functions;
or
(c) destructive behaviors which
result in extensive property damage;
(2) severe physical disabilities such as
deafness, blindness, or motor problems which require short-term environmental
orientation training;
(3) medical
conditions as listed in unit (a) or (b);
(a)
degenerative diseases diagnosed by a physician as terminal; or
(b) short-term medical disabilities that can
be treated within the level of care the Minnesota Department of Health
certifies the ICF/DD to provide, such as temporary immobility, intermittent
catheterization, or postoperative recuperation;
D. the client is at risk of placement in a
regional treatment center within 60 days or of remaining in a regional
treatment center, unless additional resources are provided through parts
9510.1020 to
9510.1140 due to:
(1) conditions and characteristics described
in item C; and
(2) the
unavailability of other resources as determined under subpart
4.
Subp. 3.
General provider
eligibility.
A provider shall be eligible for a special needs rate
exception if the provider meets the following criteria:
A. The existing program or services offered
by the provider cannot be modified to meet the client's needs within the
provider's approved per diem rates.
B. The provider's historical cost per diem
does not include the historical cost of providing the same or similar clients
with the same or similar staff interventions.
C. The provider is willing to serve or
continue to serve a client who is eligible for a special needs rate under
subpart
2 if the special needs rate
exception is approved.
Subp.
4.
Availability of other resources.
The provider shall be eligible for a special needs rate
exception only if the county determines that:
A. There are no other existing resources or
services covered under parts
9505.0170 to
9505.0475 available to meet the
client's needs.
B. There are no
other appropriate ICFs/DD, training and habilitation services, or other
services located within a reasonable distance available to meet the person's
needs within their current rates. To determine if another ICF/DD, training and
habilitation service, or other service is appropriate for the client, the case
manager shall:
(1) Consider the placement
preferences of the client and family of the client. If the client cannot
communicate a preference, the client's legal representative must be
consulted.
(2) Consider whether the
location of the alternative ICF/DD training and habilitation service or other
service will impair the current level of family involvement.
(3) Consider the length of time that the
client will need the additional services.
Subp. 5.
Evaluation of staff
intervention and equipment purchases.
The county shall review the information submitted in
accordance with part
9510.1040 to determine if:
A. the proposed staff intervention and
equipment are allowable for purposes of reimbursement under parts
9510.1020 to
9510.1140;
B. all proposed services and service
providers comply with applicable professional and program licensure
standards;
C. the proposed staff
intervention and equipment purchases meet the identified client needs;
and
D. the provider has included a
plan to decrease the client's reliance on the proposed staff intervention which
shall ensure integration of the client into the existing program when the
special needs rate exception terminates.
Statutory Authority: MS s
252.46;
256B.092;
256B.501
