Minnesota Administrative Rules

9525.0950 REIMBURSEMENT STANDARDS.

Subpart 1.

Limits on unit of service activities.

Activities for which staff time may be charged in determining a unit of service as defined in part 9525.0900, subpart 21, are limited to:

A.

Direct contact activities involving contact with the participant, either face-to-face or over the phone, which facilitates the participant's attainment of individual service plan goals and objectives.

B.

Collateral activities involving direct verbal or written contact with professionals or others regarding the participant which facilitates the participant's attainment of individual service plan goals and objectives.

C.

Individual program planning activities, including attending the participant's interdisciplinary team meetings, assessing the participant's functioning levels, developing and reviewing the participant's quarterly and annual individual program plans, and charting and reporting the participant's progress toward individual service plan goals.

D.

Staff member's transportation time to and from locations where SILS are provided. Costs of transportation time between a staff member's residence and the location of the first site visit of the service day may be charged only when the distance is less than the distance between the first site visit and the provider's central office.

Subp. 2.

Reimbursable costs.

County boards may be reimbursed for costs of providing semi-independent living services and living allowances under parts 9525.0900 to 9525.1020 directed at maintaining and improving a participant's functioning level. The cost of services for any person exceeding the state share of the average medical assistance costs for services provided by intermediate care facilities for persons with developmental disabilities for the same fiscal year are not reimbursable to the county board under parts 9525.0900 to 9525.1020. The cost of semi-independent living services provided by a participant's family members or guardian are not reimbursable under parts 9525.0900 to 9525.1020.

Subp. 2a.

Semi-independent living services.

Services for which costs are reimbursable include training and assistance in the areas listed in items A to L:

A.

nutrition, meal planning, and preparation;

B.

shopping;

C.

first aid;

D.

money management and budgeting;

E.

self administration of medications;

F.

use of the telephone and other public utilities;

G.

personal appearance and hygiene;

H.

obtaining and maintaining housing;

I.

use of community emergency resources;

J.

rights and responsibilities of community living;

K.

social, recreational, and transportation skills; and

L.

appropriate social behaviors.

Subp. 2b.

Living allowances.

County-paid living allowances eligible for state reimbursement must not exceed $1,500 per participant in each calendar year. Participants are eligible for a living allowance once per period of continuous participation in SILS. The provision of a living allowance must be used for the purpose of enabling the participant to receive semi-independent living services. The provision of a living allowance is limited to the following expenditures:

A.

damage or security deposits for housing rental;

B.

utility deposits and connection costs;

C.

household furnishings; and

D.

other items necessary to enable the participant to secure a home in which to receive semi-independent living services.

Subp. 3.

Authorization for services.

Costs of providing semi-independent living services are reimbursable only when the services provided have been authorized by the case manager. The authorization must indicate the amount, types and cost of SILS to be provided, and the expected participant outcome or outcomes. The written authorization for services to a participant must be added to the participant's case record.

Subp. 4.

[Repealed, 18 SR 506]

Subp. 5.

Services to persons in an ICF/DD.

Costs of semi-independent living services provided to a person with developmental disability while the person resides in an ICF/DD must be reimbursed only when the amount of service provided while the person resides in an ICF/DD does not exceed a total of 20 hours and when the services provided result in the person's moving directly from the ICF/DD into a semi-independent living arrangement.

Subp. 6.

Relationship of SILS to day programs and employment activities.

Costs of semi-independent living services provided on a schedule that precludes the participant from participation in the day programs or employment activities specified in the participant's individual service plan, or provided as a substitute for the specified day programs or employment activities, must not be reimbursed. This subpart does not prohibit reimbursement for SILS provided during the day to participants who are working on a part-time basis or seeking employment if SILS participation does not preclude the participant's part-time work or employment seeking.

Subp. 7.

No reimbursement for case management services costs and county administrative costs.

Any case management costs incurred by counties or by SILS providers under contract with counties are not reimbursable as costs of semi-independent living services. When the county board provides SILS directly, the county must be reimbursed for costs of services provided according to the units of service defined in part 9525.0900 and must not be reimbursed for administrative costs. SILS provided by the county case manager assigned to the participant must not be reimbursed under parts 9525.0900 to 9525.1020.

Subp. 8.

No reimbursement for room and board.

With the exception of living allowances provided for under subpart 2, expenditures for room and board are not reimbursable as costs of semi-independent living services. Room and board expenses are the costs of:

A.

normal and special diet food preparation and service;

B.

linen, bedding, laundering, and laundry supplies;

C.

housekeeping, including cleaning and lavatory supplies;

D.

maintenance and operation of the building and grounds, including fuel, electricity, water, and supplies, parts, and tools to repair and maintain equipment and facilities; and

E.

allocation of salaries and other costs related to these areas.

Subp. 9.

SILS cost allocations.

Providers that provide both SILS and ICF/DD services must show SILS cost allocations according to the cost category allocation principles and procedures in parts 9553.0010 to 9553.0080, Determination of Payment Rates for Intermediate Care Facilities for Persons with Developmental Disabilities. The following costs are not reimbursable as costs of SILS:

A.

costs specified as nonallowable costs in parts 9553.0010 to 9553.0080; and

B.

costs not specifically identified as reimbursable costs of SILS in parts 9525.0900 to 9525.1020.

Statutory Authority:

MS s 252.275

History:

10 SR 994; 12 SR 1148; 18 SR 506; L 2005 c 56 s 2

Published Electronically:

October 16, 2013