Current through Register Vol. 48, No. 39, March 25, 2024
Subpart
1.
General limits.
Only costs for services listed in the approved Minnesota DD
or ACS waiver plan shall be reimbursed under the medical assistance
program.
A. Services reimbursable
through the DD waiver plan are:
(1) case
management;
(2) residential
habilitation services including in-home family support, supported living
services for adults, and supported living services for children;
(3) day training and habilitation, including
supported employment;
(4) homemaker
services;
(5) respite care;
and
(6) minor adaptations and
equipment.
B. Services
reimbursable through the ACS waiver plan are:
(1) residential habilitation services
including in-home family support, supported living services for adults, and
supported living services for children;
(2) day training and habilitation, including
supported employment;
(3) homemaker
services;
(4) respite care;
and
(5) adaptive modifications and
equipment.
Subp.
2. [Repealed, 16 SR 2238]
Subp.
3.
Billing for services.
Billings submitted by the provider, except a provider of
adaptive modifications and equipment, must be limited to time actually and
reasonably spent:
A. In direct contact
with the person to assist the person in attaining the goals and objectives
specified in the person's individual service plan. Direct contact time includes
time spent traveling to and from service sites.
B. [Repealed,
L
2013 c 108 art 13
s
14]
C. [Repealed,
L
2013 c 108 art 13
s
14]
Subp. 4.
Service limitations.
The provision of home and community-based services is limited
as stated in items A to H.
A. Case
management services may be provided as a single service for a period of no more
than 90 days.
B. Day training and
habilitation services must:
(1) only be
provided to persons who receive a residential-based habilitation
service;
(2) not include sheltered
work or work activity services funded or certified by the Minnesota Division of
Vocational Rehabilitation;
(3) be
provided at a different service site than the person's place of residence
unless medically contraindicated, as required in Minnesota Statutes, section
252.41, subdivision
3; and
(4) be provided by an
organization that does not have a direct or indirect financial interest in the
organization that provides the person's residential services unless the person
is residing with:
(a) his or her family;
or
(b) a foster family that does
not have a direct or indirect financial interest in the organization that
provides the person's residential services.
C. Homemaker services may be provided only
if:
(1) the person regularly responsible for
these activities is temporarily absent or is unable to manage the home and care
for the person; or
(2) there is no
person, other than the person, regularly responsible for these activities and
the person is unable to manage the home and his or her own care without ongoing
monitoring or assistance. Homemaker services include meal preparation,
cleaning, simple household repairs, laundry, shopping, and other routine
household tasks.
D.
[Repealed, L 2013 c 108 art
13
s
14]
E. The average dollar amount available for
reimbursement for adaptive modifications and equipment shall be determined
annually based on the approved waiver plan.
Adaptive modifications and equipment must be constructed or
installed to meet or exceed applicable federal, state, and local building
codes.
F. Home and
community-based services are not reimbursable if provided to a person while the
person is a resident of or on leave from an ICF/DD, nursing facility, or a
hospital. This item shall not apply to leave days authorized according to item
C for a person who is hospitalized.
G. Respite care must:
(1) be provided only for the relief of the
person's family or foster family, or if the person is receiving a supported
living service in the provider's residence, for the relief of the person's
primary caregiver; and
(2) be
provided in a service site serving no more than six persons at one time.
If there are no service sites that meet the requirements in
subitem (2) available in the community to serve persons with multiple
disabilities, the county board may grant a variance to the requirement for a
period of no more than one year for each person. When a variance is granted,
the county board must submit to the commissioner a written plan documenting the
need for the variance and stating the actions that will be taken to develop
services within one year that meet the requirements of subitem (2).
H. Room and board costs
are not allowable costs for home and community-based services except respite
care provided out of the person's residence. All room and board costs must be
directly identified on reports submitted by the provider to the county
board.
Subp. 5.
[Repealed, 16 SR 2238]
Subp. 5a.
Other medical or related costs.
The cost of other medical or related services reimbursable
under the Minnesota State Medicaid Plan must not be included in the rate or
rates billed by the provider or providers for reimbursement under parts
9525.1800 to
9525.1930.
Subp. 6.
Other applicable rules.
Home and community-based services must be provided as
required under items A to H unless a variance has been approved by the
commissioner.
A. Homemaker services
must be provided in compliance with parts
9565.1000 to
9565.1300.
B. Day training and habilitation services
must be licensed by the department.
C. Supported living services for children
must be provided by a service provider licensed under Minnesota Statutes,
chapter 245B and at a site licensed under parts
9545.0010 to
9545.0260.
D. Supported living services provided at a
service site serving four or fewer adults must be provided by a service
provider licensed under Minnesota Statutes, chapter 245B and the residence must
be licensed under parts
9555.5105 to
9555.6265. Supported living
services provided at a single residence serving five or six adults must be
licensed under Minnesota Statutes, chapter 245B.
E. Respite care provided at a service site
serving more than four persons must be licensed under Minnesota Statutes,
chapter 245B. Respite care provided at a service site serving four or fewer
persons under 18 years of age must be licensed under parts
9545.0010 to
9545.0260, unless the commissioner
waives this requirement according to Minnesota Statutes, section
256B.092,
subdivision 4a. Respite care provided at a service site serving four or fewer
adults must be licensed under parts
9555.5105 to
9555.6265, unless the commissioner
waives this requirement according to Minnesota Statutes, section
256B.092,
subdivision 4a. This item shall not apply to a person who provides respite care
and who is not required to be licensed under Minnesota Statutes, chapter
245A.
Subp. 7.
Licensing variances.
Requests for variances to the licensing requirements in
subpart
6 must be handled according
to items A to C.
A. The county board
may request a variance from compliance with parts
9545.0010 to
9545.0260 as required in subpart
6, item C, D, or E, for a
provider who provides services to persons under 18 years of age if the county
board determines that no providers who meet the licensing requirements are
available and that granting the variance will not endanger the health, safety,
or development of the persons. The written variance request must be submitted
to the commissioner and must contain:
(1) the
sections of parts
9545.0010 to
9545.0260 with which the provider
cannot comply;
(2) the reasons why
the provider cannot comply with the specified section or sections;
and
(3) the specific measures that
will be taken by the provider to ensure the health, safety, or development of
the persons.
The commissioner shall grant the variance request if the
commissioner determines that the variance was submitted according to this item
and that granting the variance will not endanger the health, safety, or
development of the persons receiving the services.
The commissioner shall review the county board's variance
request and notify the county board, in writing, within 30 days if the variance
request has been granted or denied. If the variance request is denied, the
notice must state the reasons why the variance request was denied and inform
the county board of its right to request that the commissioner reconsider the
variance request.
B. The county board may grant a written
variance from compliance with parts
9555.5105 to
9555.6265 as required in subpart
6, items D and E, for a
provider who provides services to adults if the county board determines that no
providers who meet the licensing requirements are available and that granting
the variance will not endanger the health, safety, or development of the
persons.
C. Requests for a variance
of the provisions must be submitted according to Minnesota Statutes, chapter
245B.
Statutory Authority: MS s
256B.092;
256B.501;
256B.502;
256B.503