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    MMIS automation process for Jan. 1, 2025

    Lead agency (county and tribal nation) staff must refrain from adding or making changes to all service agreements for waivers and state plan services (including Type B service agreements), and programs from Dec. 12-20, 2024, or until DHS gives lead agencies the “all clear” message. This includes:

    • Alternative Care (AC)
    • Brain Injury (BI)
    • Community Alternative Care (CAC)
    • Community Access for Disability Inclusion (CADI)
    • Developmental Disabilities (DD)
    • Elderly Waiver (EW)
    • Essential Community Supports (ECS)
    • Personal Care Assistance services (PCA)
    • Community First Services and Supports (CFSS)
    • Consumer Support Grant (CSG).

    During this time, DHS will enter rates in both MnCHOICES and Medicaid Management Information System (MMIS) and run the automation process. MnCHOICES will update rates and budgets starting Dec. 12; MMIS will start Dec. 16. This is a change from prior years.

    Lead agency staff must wait to add or update any line items that begin on or after Jan. 1, 2025, from the support plan into MMIS. The rates in MMIS will align with the support plan rates after the MMIS automation process runs.

    Staff may enter screening documents during this time. Please read these instructions carefully for the changes to the service agreements on Dec. 12-20, 2024.

    The Minnesota Legislature authorized a number of rate and budget increases for home and community-based and state plan services. The following service rate and monthly budget increases are effective Jan. 1, 2025:

    • 4.53% increase to AC and EW case mix budgets.
    • 4.53% increase to EW 24-hour CL case mix budgets. This is on a rolling basis as service plans are renewed throughout the year.
    • Increase to Consumer Directed Community Supports (CDCS) budgets under AC and EW to align with AC and EW case mix budgets.
    • 1.72% increase to ECS budget cap.
    • 6.195% increase to home delivered meals.
    • 3.14% home care nursing.
    • 3.14% home health aide, skilled nursing, occupational therapy, physical therapy, respiratory therapy and speech therapy.
    • 3.14% increase to Consumer Support Grant (CSG) budgets with home care nursing ratings
    • 4.53% BI, CAC, CADI, and DD CDCS budgets.
    • Varying increases for PCA services and Community First Services and Supports (CFSS) services and budgets. PCA and CFSS rates include changes to the wage component value and implementation factor within the PCA/CFSS rate framework:
      • 4.37% increase to 1:1 PCA/CFSS.
      • Range of 4.28% to 4.47%% increase to shared care and complex PCA/CFSS.
    • 4.37% increase to PCA supervision services and worker training and development budgets.
    • 4.37% increase to CSG budgets with PCA ratings.

    Affected line items

    MMIS partially adjusts service agreement lines for AC, BI, CAC, CADI, DD, EW, ESC and CSG services if the line item:

    • Dates include the date of Jan. 1, 2025, or later.
    • Has a status of approved, pending or suspended.

    Reports

    After the automation process, lead agencies should use the following InfoPac reports to identify service agreements to adjust:

    • MW2083A: Procedure Code Rate Increase Report LTC Waivers/AC Program
    • MW2083B: Procedure Code Rate Increase DD Program
    • MW2083D: Procedure Code Rate Increase CSG
    • MW2083H: Procedure Code Rate Change ESC Program.

    If you need access to the InfoPac reports, contact your lead agency MMIS security liaison who will request access.

    Automation process for AC, BI, CAC, CADI, DD, ECS and EW selected services listed above

    Lines that begin before and end after Jan. 1, 2025

    MMIS will:

    1. Change the line item end date to Dec. 31, 2024.
    2. Prorate the units of service.
    3. Add reason code 499 to the line that explains that the line was changed because of the rate increase. Any existing reason codes will now display after the 499.
    4. Post edit 380 (automatic line adjustment).

    MMIS creates a new line for the same procedure code beginning Jan. 1, 2025. On the new line, MMIS will:

    1. Use the same end date as the original line item.
    2. Use the same provider number.
    3. Add the new rate to the Requested and Approved Rate fields when the procedure code uses the statewide maximum rate. For all other procedure codes, the Request and Approved Rate fields or the Total Amount field will be blank.
    4. Add reason code 499 (any other reason codes that were displayed on the original line are moved to this line after the 499).
    5. Suspend the new line.
    6. Change the service agreement (SA) header status to "T" (partially suspended) if it was originally approved.
    7. Post edit 380 (automatic line adjustment) to route the service agreement to the lead agency for further adjustments.

    Lead agencies must:

    1. Review the number of units to determine if adjustments are needed. Lead agencies must check to see if the number of units is sufficient based on the person's needs, adding or subtracting units as appropriate.
    2. Add the requested rate for procedure codes that do not use the statewide maximum rate as identified in Step 3 above.
    3. Remove existing reason codes that are no longer needed (except the 499).
    4. Approve the new line.
    5. Change the header status to “A” (approved).

    For lines that begin on or after Jan. 1, 2025, with unused units or total amounts

    MMIS will:

    1. Change the line item status to suspend (if previously approved).
    2. Post edit 380 (automatic line adjustment).
    3. Add reason code 499 to the line that explains the line was changed because of a rate change (any existing reason codes will now display after the 499).
    4. Add the new rate to the Requested and Approved Rate fields when the procedure code uses the statewide maximum rate. For all other procedure codes, the Requested and Approved Rate fields or the Total Amount field will be blank.

    Lead agencies must:

    1. Add the requested rate for procedure codes that do not use the statewide maximum rate as identified in Step 4 above.
    2. Remove existing reason codes that are no longer needed other than code 499.
    3. Approve the line.
    4. Change the header status to "A" (approved).

    Lines that end after Dec. 31, 2024, with no unpaid units remaining or with no units left after the calculation is performed to prorate the units

    MMIS will:

    1. Change the line item end date to Dec. 31, 2024.
    2. Add reason code 499.

    Lead agencies must:

    1. Do nothing unless the service continues after Dec. 31, 2024. If the service continues, lead agencies must enter a new line that begins Jan. 1, 2025, with the correct rate and units.
    2. Approve any new lines created by the lead agency.

    Homemaker, Cleaning (S5130) disability waivers only

    Homemaker, Cleaning service MMIS rate files were not updating during the MMIS automation process in December 2023. The rate method of this service changed effective Jan. 1, 2024, from a market rate service to a state-set rate. Beginning Jan. 1, 2024, all rates for this service should have been $7.90 per 15-minute unit.

    Rates policy staff elected to have Homemaker, Cleaning (S5130) service for BI, CAC, CADI and DD to be part of the MMIS automation process in December 2024. The MMIS rate file will be updated to reflect the $13.83 rate ending Dec. 31, 2024, and add the correct lower rate of $7.90 effective Jan. 1, 2025.

    InfoPac reports MW2083A and MW2083B will identify any service agreement lines that need updating. Follow the automation steps above.

    Exceptions

    Pre-paid health plans (PPHP) home care services (X5609) represent the total cost of the MA state plan services the managed care organization (MCO) is responsible to cover for waiver recipients enrolled with an MCO. However, the new cost of the home care services (home care nursing, if applicable, and home health services) should be added to the X5609 total.

    Alternative Care and Elderly Waiver budget cap increases

    Follow these instructions to increase the service agreement total cap amount if needed to allow for the increased rate changes.

    Lead agencies must:

    1. Enter and approve a new AC or EW screening document using activity type 05 and assessment result 98 or the next scheduled reassessment entered with an activity type date of Jan. 1, 2025, or later to change the total cap amount on the service agreement when the service agreement is entered and edited. Those months through Dec. 31, 2024, will use the case mix budget before the increased cap amount. Those remaining months in the service agreement starting Jan. 1, 2025, will use the increased case mix budget.
    2. Enter into the service agreement and edit it with PF9 to change the total cap amount field to the new pro-rated amount.
    3. Ensure the cost of all services does not exceed the prorated total service agreement budget, otherwise edit 672 (total authorized amount is excessive) will post. The units or total amount on one or more line items must be reduced to bring the amount in the total authorized amount field to be equal to or less than the total cap amount field on the MMIS ASA1 screen.
    4. PF3 to save the changes to the service agreement and exit the document.

    Consumer Directed Community Supports (CDCS) - T2028

    For lines that begin before Jan. 1, 2025, and end on or after Jan. 1, 2025, MMIS will not adjust line items but identify the lines on InfoPac reports MW2083A or MW2083B.

    Lead agencies must:

    1. For AC and EW: Enter and approve a new AC or EW screening document using activity type 05 and assessment result 98 or the next scheduled reassessment entered with an activity type date of Jan. 1, 2025, or later to change the case mix amount and the CDCS amount. This will then update the total cap amount on the service agreement when the service agreement is entered and edited. This will allow the amount on the CDCS line item to be increased. The months through Dec. 31, 2024, will use the CDCS annual maximum that were in place before Jan. 1, 2025. The remaining months in the service agreement starting Jan. 1, 2025, will use the increased CDCS annual maximum that aligns with the case mix budgets.
    2. Determine the original approved CDCS monthly budget.
    3. Take the original approved CDCS monthly budget times the number of months on the service agreement line item up to Dec. 31, 2024.
    4. For budgets beginning Jan. 1, 2025:
      1. For AC and EW, use the annual CDCS budget that aligns with the case mix budget that is published in Long-Term Services and Supports Service Rate Limits Effective Jan. 1, 2025, DHS-3945-ENG, for the remaining months of the service agreement.
      2. For BI, CAC, CADI, and DD, apply a 4.53% increase to the number of months remaining on the service agreement.
    5. Add both sums and update the existing service agreement line item with the new amount. For EW and AC, the final budget amount cannot exceed the annual maximum CDCS service budget amount published in Long-Term Services and Supports Service Rate Limits Effective Jan. 1, 2025, DHS-3945-ENG.
    6. Inform people of changes to their budget with CDCS Community Support Plan Addendum, DHS-6633A (PDF).

    CFSS Budget model on a waiver – T1019 UB (with modifiers, if applicable)

    For lines that begin before Jan. 1, 2025, and end on or after Jan. 1, 2025, MMIS will not adjust line items but identify the lines on InfoPac reports MW2083A or MW2083B.

    Lead agencies must:

    1. Determine the original approved CFSS monthly budget.
    2. Take the original approved CFSS monthly budget times the number of months on the service agreement line item up to Dec. 31, 2024.
    3. For budgets beginning Jan. 1, 2025, apply a 4.53% increase to the number of months remaining on the services agreement.
    4. Add both sums and update the existing service agreement line item with the new amount.
    5. Case managers should notify people of their budget increase.

    PCA, CFSS and Home Care Type B agreements

    Lead agencies are not responsible to modify PCA/CFSS rates or budgets, home care nursing or home health agency services on Type B agreements. These are not run through the MMIS automation process. The MMIS rate file is adjusted and updated automatically during the billing process.

    PCA, CFSS and Home Care Services on waiver agreements

    Lead agencies must adjust the rates for all home care, PCA and CFSS services that are authorized on a waiver service agreement.

    For lines that begin on or after Jan. 1, 2025, with unused units

    MMIS will:

    1. Change the line item status to suspend (if previously approved).
    2. Post edit 380 (automatic line adjustment).
    3. Add reason code 499 to the line that explains the line was changed because of a rate change (any existing reason codes will now display after the 499).
    4. Add the new rate to the Requested and Approved Rate fields when the procedure code uses the statewide maximum rate. For all other procedure codes, the Requested and Approved Rate fields or the Total Amount field will be blank.

    Lead agencies must:

    1. Add the requested rate for procedure codes that do not use the statewide maximum rate as identified in Step 4 above.
    2. Remove existing reason codes that are no longer needed other than code 499.
    3. Approve the line.
    4. Change the header status to "A" (approved).

    Worker Training and Development (WTD) S5116 with all modifiers on Type B service agreements

    • Do not run through MMIS automation process.
    • Provider must follow the standard process to request additional funds.

    WTD on waiver agreements

    • MMIS will split the line items during the automation process.
    • Service line identified on InfoPac reports MW2083A and MW2083B.

    For Type B service agreements for CSG monthly budget

    Lead agencies will follow the Consumer Support Grants (CSG) manual adjustment of service agreement line instructions below.

    CSG service agreements for both PCA and HCN home care ratings are part of the MMIS automation process that runs on Dec. 12, 2024.

    For lines that begin before and end after Jan. 1, 2025

    MMIS will:

    1. Change the line item end date to Dec. 31, 2024.
    2. Add reason code 499 to the line that explains that the line has been changed because of the rate increase. Any existing reason codes will now display after the 499.
    3. Post edit 380 (automatic line adjustment) and add the service agreement to report MW2083D issued to the lead agency for further adjustments.

    MMIS creates a new line for the same procedure codes beginning Jan. 1, 2025. On the new lines, MMIS will:

    1. Use the same end date as the original line items.
    2. Use the same provider numbers.
    3. Leave the requested total amount fields blank.
    4. Add reason code 499 (any other reason codes that were displayed on the original line are moved to this line after the 499).
    5. Suspend the new lines.
    6. Change the service agreement (SA) header status to "T" (partially suspended) if it was originally approved.
    7. Post edit 380 (automatic line adjustment) and add the service agreement to report MW2083D issued to the lead agency for further adjustments.

    Lead agencies must:

    1. Reduce the requested total amount fields on the line items that end Dec. 31, 2024.
    2. Determine the new CSG monthly budget effective Jan. 1, 2025.
    3. Review new lines, one for FMS and one for the county administrative costs (95% - 5%), beginning Jan. 1, 2025, and extending to the end of the service agreement.
    4. Enter the new total amount on the lines beginning Jan. 1, 2025, based on the 2025 CSG monthly budget limit times the number of months of the line.
    5. Press PF9 to edit the service agreement. MMIS will redetermine the CSG cap amount on the ASA1 screen and post edits as appropriate.
    6. Resolve all county-based edits.
    7. Approve the new lines.
    8. Verify the header status is "A" (approved).

    For lines beginning on or after Jan. 1, 2025

    MMIS will:

    1. Change the line item status to suspend (if previously approved).
    2. Add reason code 499 to the line that explains the line was changed because of a rate change (any existing reason codes will now display after the 499).
    3. Leave the requested total amount field as-is.
    4. Post edit 380 (automatic line adjustment) and add the service agreement to report MW2083D issued to the lead agency for further adjustments.

    Lead agencies must:

    1. Determine the new CSG monthly budget effective Jan. 1, 2025.
    2. Add the total amount on the two CSG lines, one for the FMS provider and one for the county administrative costs (95% - 5%) using the 2025 CSG monthly budget limit times the number of months on the line.
    3. Press PF9 to edit the service agreement. MMIS will re-determine the CSG cap amount on the ASA1 screen and post edits as appropriate.
    4. Resolve all county-based edits.
    5. Verify the header status is "A" (approved).
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