Minn. R. agency 196, ch. 9510, SPECIAL NEEDS RATE EXCEPTION FOR VERY DEPENDENT PERSONS WITH SPECIAL NEEDS, pt. 9510.1090

Current through Register Vol. 49, No. 20, November 12, 2024

Part 9510.1090 - ESTABLISHING SPECIAL NEEDS RATE EXCEPTION PAYMENT

Subpart 1.Established by commissioner.

The commissioner shall establish the special needs rate exception payment according to subparts 2 to 5.

Subp. 2.Allowable costs.

Unless otherwise reimbursable by the Department of Vocational Rehabilitation or by direct payments under parts 9505.0170 to 9505.0475, the following costs, if approved by the commissioner in accordance with parts 9510.1020 to 9510.1140 and 9553.0010 to 9553.0080, are allowable for purposes of establishing the special needs rate exception payment:

A. additional salary, employee benefits, and payroll-related costs for direct care staff required to meet the client's needs as identified in the provider's application;

B. additional costs of services provided by a licensed medical, therapeutic, or rehabilitation practitioner; a mental health practitioner supervised by a board-certified psychiatrist; or a licensed psychologist or licensed consulting psychologist;

C. the costs of equipment required to meet the client's needs as identified in the provider's application.

Subp. 3.Nonallowable costs.

Only costs listed in subpart 2 are allowable for purposes of establishing the special needs rate exception. All other costs shall be disallowed.

Subp. 4.Limitation.

The combined per diem costs of training and habilitation services, ICF/DD services, and the special needs rate exception payment and any other special needs rate exception payments in effect for the same client, shall not exceed the medical assistance per diem cost of providing services to persons with developmental disabilities in regional treatment centers. For the purpose of determining this limitation, items A to F apply.

A. The training and habilitation services per diem in effect on the date the provider's completed application is submitted to the county must be multiplied by the number of days the services are provided annually.

B. The ICF/DD's temporary or final payment rate in effect on the date the provider's completed application is submitted to the county must be multiplied by 365.

C. The special needs rate exception amount must not exceed the total of the costs allowable under subpart 2. If a special needs rate exception is necessary for a client in both the ICF/DD and the training and habilitation service program, the amounts of both special needs rate exceptions must be combined. If the client is currently receiving a special needs rate exception, that amount must also be included.

D. The amounts determined in items A to C must be combined and divided by 365 to determine the combined per diem cost.

E. The regional treatment center medical assistance per diem rate must be the rate in effect on the date the provider's completed application is submitted to the county.

F. If the per diem cost in item D exceeds the per diem cost in item E, the commissioner shall deny the special needs rate exception application unless the per diem cost can be adjusted to meet the client's needs within the per diem cost in item E or the commissioner grants a variance under part 9510.1100.

Subp. 5.Computation of special needs rate exception payment.

The special needs rate exception payment must be calculated as follows:

A. The cost of additional equipment allowed in accordance with subpart 2, item C shall be paid as a lump sum payment during the first billing period following approval of the special needs rate exception.

B. Except as provided in item C, in order to compute the special needs rate exception payment for personnel costs, the costs of additional personnel allowable according to subpart 2, items A and B, must be divided by the estimated number of days the staff intervention will be needed.

C. In order to compute the special needs rate exception payment for personnel costs which vary during the estimated staff intervention period, the costs must be assigned on a monthly basis proportionate to the actual personnel costs incurred and then divided by the number of client days in the month.

D. Costs computed under items B and C shall be reimbursed as incurred and billed.

Minn. R. agency 196, ch. 9510, SPECIAL NEEDS RATE EXCEPTION FOR VERY DEPENDENT PERSONS WITH SPECIAL NEEDS, pt. 9510.1090

10 SR 922; 12 SR 1148; 14 SR 2354; L 2005 c 56 s 2

Statutory Authority: MS s 252.46; 256B.501