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Page 1: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Annual Report on the Use and Availability of Home and Community-Based Services Waivers for Persons

with Disabilities

Disability Services Division

July 2012

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DHS-6568-ENG 7-12
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Minnesota Department of Human Services November 2011

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For more information, contact:

Minnesota Department of Human Services Disability Services Division

P.O. Box 64967 St. Paul, MN 55164-0967

(651) 431-2400

This information is available in other forms (such as Braille, large print or audiotape) by calling:

(651) 431-2400

Or contact us through the Minnesota Relay Service at:

1 (800) 627-3529 (TTY)

1 (877) 627-3848 (Speech-to-Speech relay service)

The estimated cost of preparing this report is approximately $10,000.

Printed with a minimum of 10 percent post-consumer material. Please recycle.

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TABLE OF CONTENTS Executive Summary ........................................................................................................................ 4 I. Legislation ................................................................................................................................... 6 II. Overview of Waiver Programs ................................................................................................... 7

A. Waiver Background ........................................................................................................... 7 B. Waiver Overview Data ....................................................................................................... 8

III. Legislation That Affects Waiver Growth ............................................................................... 11 IV. Waiver Prioritization……………………………………………………………………...…12 IV. Waiver Program Goals and Outcomes ................................................................................. 133 V. Description of Waiver Reports ................................................................................................ 15

A. Reports on the DD Waiver ............................................................................................. 155 B. Reports on CAC, CADI, and BI Waivers ...................................................................... 177

VI. Waiver Reports Appendix ...................................................................................................... 18

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Minnesota Department of Human Services

Disability Services Division Executive Summary For more than two decades, Minnesota has made home and community-based services (HCBS) available to people with disabilities. To support more community-based service options, the Minnesota Department of Human Services (DHS) operates the following HCBS waivers for people with disabilities: Brain Injury (BI) Waiver, established on April 1, 1992, is a community alternative for people with acquired or traumatic brain injuries who need the level of care provided in a nursing facility (NF) that provides specialized cognitive and behavioral supports or a neurobehavioral hospital (NB). The name changed from the Traumatic Brain Injury (TBI) waiver with the 2011 waiver renewal with the Center for Medicare and Medicaid Services (CMS). Community Alternative Care (CAC) Waiver, established on April 1, 1985, is a community alternative for people who are chronically ill or medically fragile and need the level of care provided in a hospital. Community Alternatives for Disabled Individuals (CADI) Waiver, established on October 1, 1987, is a community alternative for people who need the level of care provided in a nursing facility. Developmental Disabilities (DD) Waiver, established on July 1, 1984, is a community alternative for people who need the level of care provided in an intermediate care facility for people with developmental disabilities (ICF/DD). HCBS waivers provide necessary services and supports so that people with disabilities can continue to live in their communities. Services are designed to be meaningful to the person receiving them. As Minnesota’s experience with these four waiver programs for people with disabilities has matured, DHS has focused on the following: Expanding participants’ choice of community living options Developing more person-directed services Building partnerships with communities Offering a variety of employment options Creating more information, referral and assistance services Improving the quality of services Strengthening participant safeguards

In 2009, Minnesota began two initiatives that respond to conditions required by the Centers for Medicare & Medicaid Services (CMS) for continued approval of the disability waiver. These two initiatives will establish provider standards, provider enrollment processes and payment methodologies that are consistent across the state. The planned implementation for these initiatives begins on January 2014, with some phased implementation.

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In 2011, Minnesota was awarded the Money Follows the Person (MFP) Demonstration Program grant from the Centers for Medicare and Medicaid Service (CMS). Minnesota will leverage an award of up to $187.4 million in federal funds over 5 years to improve community services and support people in their homes rather than institutions. This report provides the Minnesota Legislature with: Data regarding the demand for and the available resources for HCBS waiver programs

for persons with disabilities in Minnesota Information on changes to the service delivery system to make it more sustainable into

the future

Data Resources All data in this report were obtained from the following sources: 372 reports for CMS Medicaid Management Information System (MMIS) Screening, Service Agreement, and

Claims Data Public reports on the DHS website Waiver Management System

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I. Legislation This report was prepared for the Minnesota Legislature in accordance with Minnesota Statutes §256B.0916, Subd. 7 and Minnesota Statutes §256B.49, Subd. 21. The statute requires the Commissioner of the Department of Human Services to issue a report on county and state use of available resources for the following home and community-based service (HCBS) waiver programs: Brain Injury (BI) Community Alternative Care (CAC) Community Alternatives for Disabled Individuals (CADI) Developmental Disabilities (DD)

Minnesota Statutes §256B.0916, subdivision. 7. Annual report by commissioner. Beginning November 1, 2001, and each November 1 thereafter, the commissioner shall issue an annual report on county and state use of available resources for the home and community-based waiver for persons with developmental disabilities. For each county or county partnership, the report shall include:

1. The amount of funds allocated but not used. 2. The county-specific allowed reserve amount approved and used. 3. The number, ages and living situations of individuals screened and waiting for

services. 4. The urgency of need for services to begin within one, two, or more than two years for

each individual. 5. The services needed. 6. The number of additional persons served by approval of increased capacity within

existing allocations. 7. Results of action by the commissioner to streamline administrative requirements and

improve county resource management. 8. Additional action that would decrease the number of those eligible and waiting for

waiver services. The commissioner shall specify intended outcomes for the program and the degree to which these specified outcomes are attained.

Minnesota Statutes §256B.49, subd. 21. Report. The commissioner shall expand on the annual report required under section 256B.0916, subd. 7, to include information on the county of residence and financial responsibility, age, and major diagnoses for persons eligible for the home and community-based waivers authorized under subd. 11 who are: (1) receiving those services, (2) screened and waiting for waiver services; and (3) residing in nursing facilities and are under age 65.

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II. Overview of Waiver Programs

A. Waiver Background The goal of HCBS waiver programs is to provide necessary services and supports to people living in their communities who would otherwise require the level of care provided in an institution. Congress first allowed waiver programs in 1982, and opened the door in Minnesota for deinstitutionalization of persons with developmental disabilities. In the late 1990s, there were renewed efforts to provide home and community options for people with all types of disabilities choosing to move from nursing facilities. In 1999, the U.S. Supreme Court’s Olmstead Decision affirmed the right of individuals who are eligible for Medicaid services to receive those services in the least restrictive setting in accordance with the Americans with Disabilities Act. To continue to provide community alternatives to institutionalization, the Continuing Care Administration (CCA) of the Department of Human Services (DHS) has adopted these goals:

Community membership Health, wellness and safety Own place to live Important long-term relationships Control over supports Employment earnings and stable income

Minnesota makes home and community-based services waivers available with federal financial participation. In order to obtain federal participation, Minnesota submits waiver plans that CMS approves initially and every five years. Each of the Minnesota home and community-based waiver programs has been developed to meet federal guidelines, which includes the obligation to meet specified federal assurances in six areas:

1. Level of care 2. Service plan 3. Qualified providers 4. Health and welfare 5. Administrative authority 6. Financial accountability

Services authorized under all waiver program plans must: Help a person avoid institutionalization and be an appropriate alternative to

institutionalization Help a person function with greater independence in the community Be necessary to assure health, safety and welfare of the person Meet the unique needs and preferences of the person Have no other funding source Have a cost that is considered reasonable and customary

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B. Waiver Overview Data The following three tables present statewide data on Minnesota’s disability waiver programs: Table 1: Cost-Effectiveness of Community over Institutional Settings CMS requires waiver services to be cost-neutral when compared with institutional care. Minnesota chooses to strive for cost-effectiveness of the waivers, which continues to provide long-term savings to the state. Table 1 compares waiver costs to institutional costs to show the cost savings of the waivers for people with disabilities. The sources of the data in Table 1 are the reports prepared by DHS for CMS, called 372 reports. These reports compare annual per capita Medicaid costs for an HCBS waiver population and a corresponding institutional population. The waiver and state plan services are included to determine the total waiver costs. The comparison periods are:

BI 04/01/09 to 03/31/10 CAC 04/01/09 to 03/31/10 CADI 10/01/08 to 09/30/09 DD 07/01/08 to 06/30/09

Table 1: Cost-Effectiveness of Community over Institutional Settings – Average Annual Spending Per Recipient

HCBS Waiver Level of Care

HCBS Waiver Costs

Institutional Costs Savings

HCBS Waiver over

Institutional Waiver Services

State Plan Services

Total Waiver Institutional

State Plan

Services

Total Institutional

BI Nursing Facility and Hospital

$61,561 $12,615 $74,176 $124,781 $20,172 $144,953 $70,777

CAC Hospital $52,375 $126,347 $178,722 $241,911 $183,930 $425,841 $247,119

CADI Nursing Facility $24,152 $16,205 $40,357 $45,665 $6,315 $51,980

$11,623

DD Intermediate Care Facility (ICF/DD)

$65,178 $6,674 $71,852 $98,286 $4,781 $103,067 $31,215

Source: Centers for Medicare & Medicaid Services 372 Reports Table 2: Summary of Waiver Populations provides an overview of the number of persons served, eligibility requirements and benefit levels for each of the waivers for people with disabilities. Table 3: Case Load Summary Report for State Fiscal Year 2010 - Statewide provides a statewide caseload summary for the four disability waiver programs.

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Table 2: Summary of Waiver Populations Waiver Persons Served Eligibility Benefit Level CAC

* Average no. recipients/month 316 * Eligible for Medical Assistance * Certified disabled by the State Medical Review

Team (SMRT) or the Social Security Administration (SSA)

* Under age 65 at time of application * Determined through an assessment to need

hospital level of care

* Services identified in a community support plan completed by lead agency case manager

* Funds managed on an aggregate basis across the BI, CAC and CADI waivers at the local level by the lead agency

* Monthly cost per recipient $5,243 * Total annual spending $20m

* Some enrollee support costs are found in the MA Home Care section of the forecast

CADI

* Average no. recipients/ month 15,610 * Eligible for Medical Assistance

* Certified disabled by the SMRT or the SSA * Under age 65 at time of application * Determined through an assessment to need nursing facility level of care

* Services identified in a community service plan completed by lead agency case manager

* Funds managed on an aggregate basis across the BI, CAC and CADI waivers at the local level by the lead agency

* Monthly cost per recipient $2,515 * Total annual spending $471m * Some enrollee support costs are found in

the MA Home Care section of the forecast DD

* Average no. recipients/month 15,158

* Eligible for Medical Assistance * Determined to have a developmental disability, as defined by Minnesota Statute * Determined through an assessment to need ICF/DD level of care

* Services identified in an individualized support plan completed by lead agency case manager

* Funds managed on an aggregate basis at the local level by the lead agency

* Monthly cost per recipient $5,588

* Total annual spending $1,016m

* Some enrollee support costs are found in the MA Home Care section of the forecast

BI

* Average no. recipients/month 1,353 * Eligible for Medical Assistance * Certified disabled by the SMRT or SSA * Documented diagnosis of traumatic or acquired brain injury or degenerative brain disease * Experience significant to severe cognitive and behavioral impairments related to the brain injury * Under age 65 at time of application * Determined through an assessment to need nursing facility or neurobehavioral hospital level of care

* Services identified in a community service plan completed by lead agency case manager

* Funds managed on an aggregate basis across the BI, CAC and CADI waivers at the local level by the lead agency

* Monthly cost per recipient $ 5,963 * Total annual spending $97m

* Some enrollee support costs are found in the MA Home Care section of the forecast

NOTE: Data for FY 2011; Waiver costs do not include home care costs; Source: November 2011 forecast

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Table 3: Case Load Summary Report for State Fiscal Year 2010 - Statewide Age Ranges

Total 0-12 13-17 18-22 23-39 40-64 65-65+ Unduplicated Assessment Totals Public Health Nurse Assessments for Personal Care Assistance (PCA) 18,100 5,655 1,949 1,276 2,285 6,260 625 Long-term Care Consultation 76,670 1,344 829 1,271 4,303 16,348 34,635 Developmental Disability Screening 23,436 3,325 2,088 2,898 6,806 7,061 1,205 Home Care Personal Care Assistant (PCA) - Waiver 5,417 642 466 535 995 2,654 124 PCA - Non-waiver 15,995 4,398 1,609 932 1,895 5,652 1,195 PCA - Total 21,412 5,040 2,075 1,467 2,890 8,306 1,319 Private Duty Nursing (PDN) - Waiver 399 146 46 36 66 99 6 PDN - Non-waiver 361 176 24 12 38 48 40 PDN - Total 760 322 70 48 104 147 46 Skilled Nurse Visit - Waiver 4,092 70 40 54 507 3,243 178 Skilled Nurse Visit - Non-waiver 8,336 1,830 132 413 1,224 2,318 1,517 Skilled Nurse Visit - Total 12,428 1,900 172 467 1,731 5,561 1,695 Home Health Aide (HHA) - Waiver 868 8 8 5 57 723 67 HHA - Non-waiver 1,389 0 2 2 18 183 630 HHA - Total 2,257 8 10 7 75 906 697 Therapies - Waiver 681 39 14 22 86 508 12 Therapies - Non-waiver 727 61 7 13 75 477 81 Therapies - Total 1,408 100 21 35 161 985 93 Institutional Services Nursing Facility (NF) stays <= 90 days (MA funded) 5,365 0 0 17 145 1,559 1,682 NF stays > 90 days (MA funded) 19,673 0 0 7 126 2,032 6,865 ICF/DD stays 1,990 4 30 114 378 1,165 276 Waivers CADI 17,496 1,018 707 1,032 2,983 10,887 868 BI – NF 1,125 9 25 59 277 721 34 BI - NB 437 5 11 23 172 218 8 CAC 407 184 58 42 65 55 3 DD 15,361 756 1,217 1,783 5,250 5,337 964 Other Services Consumer Support Grant (CSG) 1,873 1,350 343 123 30 26 1 Family Support Grant (FSG) 1,628 Semi-Independent Living Services (SILS) 1,552 Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data; Report Run 02/19/2012 Data does not include individuals receiving services through managed care programs

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III. Legislation That Affects Waiver Growth Legislation over the past several years has affected the growth of the disability waiver programs. The BI, CADI and DD waivers have had growth limits imposed by legislation at various times over the past several years. The allocations for the CAC Waiver, and at times the BI Waiver, have been managed through a statewide pool that lead agencies can access when needed. Prior to the 2009 legislative session, the access to a statewide pool of allocations was available for individuals moving out of institutions into the community for the BI and CADI waiver programs. Since the 2009 session, this availability to the statewide pool of allocations was changed for the BI and CADI waivers to individuals moving out of institutions when there is a planned closure or downsizing of an institution. This change has assured consistency across the BI, CADI and DD waivers. Table 4: BI and CADI historical waiver limits provides a historical summary of the allocation limits for the BI and CADI waivers, by fiscal year. Table 5: DD historical waiver limits provides a historical summary of the allocation limits for the DD waiver, by calendar year. Table 4: BI and CADI historical waiver limits Fiscal Year

BI waiver (new allocations per year) CADI waiver (new allocations per year)

2004 150 1140 2005 150 1140 2006 150 1140 2007 150 1140 2008 150 1140 2009 No limits No limits 2010 150 1140 2011 72 720 2012 No limits 720 2013* No limits 720 2014* No limits 1020 2015* No limits 1020 * these are future limits that passed during the 2011 legislative session Table 5: DD historical waiver limits Calendar Year DD (new allocations per year) 2004 50 2005 50 2006 50 2007 50 2008 50 2009 No limits (forecasted 300) 2010 180 2011 72 2012 (fiscal year) 72 2013 (fiscal year)* 72 2014 (fiscal year)* 180 2015 (fiscal year)* 180 * these are future limits that passed during the 2011 legislative session

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During the 2011 session, the legislature implemented other measures that will affect the growth of the disability waiver programs. This legislation included: Reduction in capacity of corporate foster care when an individual receiving BI or CADI

waiver services chooses to move to a community living setting, as defined in 256B.49. Rate reductions for waiver service providers, including:

o 1.5% rate reduction for all waiver and home care providers o 10% rate reduction for CADI and DD corporate foster care and customized living

for certain individuals (the 1.5% rate reduction did not apply in these situations). Corporate foster care is defined as licensed foster care settings where the license holder does not reside in the setting.

IV. Waiver Prioritization In 2009, legislation passed requiring DHS to establish statewide priorities for the allocation of resources for the HCBS waivers, by January 2010. The legislation also required DHS to evaluate the impact of the use of statewide priorities and to report to the legislature in this report on whether the commissioner recommends the continued use of the priorities. The priorities identified in statute are individuals who continue to have a need for waiver services after they have maximized the use of state plan services and other funding resources, including natural supports, prior to accessing waiver services, and who meet at least one of the following criteria:

(1) have unstable living situations due to the age, incapacity, or sudden loss of the primary caregivers;

(2) are moving from an institution due to bed closures;

(3) experience a sudden closure of their current living arrangement;

(4) require protection from confirmed abuse, neglect, or exploitation;

(5) experience a sudden change in need that can no longer be met through state plan services or other funding resources alone; or

(6) meet other priorities established by the department. DHS included an additional priority for individuals at high risk for institutionalization due to severe behavioral issues or intensive medical needs that jeopardize personal health, safety and welfare or pose an imminent danger of harm to others. DHS made changes to assessment documents to provide the ability to track whether individuals receiving waiver allocations met the identified priorities. The use of the statewide priorities provides consistency across the state on who receives allocations. DHS recommends the continued use of the statewide priorities.

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V. Waiver Program Goals and Outcomes DHS identified two major reform goals in the January 2010 Annual Report on the Use and Availability of Home and Community-Based Services Waivers for Persons with Disabilities: Federal Compliance for the HCBS Waivers Changing Current Residential Service Models and Evaluating Housing Options

This section of the report will provide a status update on those two goals, as well as identify what aspects of these goals will be the focus for the upcoming year.

Goal 1—Federal Compliance for the HCBS Waivers DHS submitted the CAC Waiver renewal application in November 2007 to CMS. In its review of this application, CMS identified two areas in which Minnesota was out of compliance with federal requirements: County-negotiated rates, which creates a concern about disparity in the availability of

waiver services from county to county The use of lead agency contracts as the mechanism for establishing and monitoring

waiver provider qualifications and service standards. CMS’ concerns about the CAC Waiver renewal application identified the need for consistent, statewide procedures to determine rates, establish provider standards and permit greater participant choice of providers. CMS asserted that Minnesota was out of compliance with federal requirements by delegating the responsibility of establishing rates and managing contracts to lead agencies. In order to renew the CAC Waiver, DHS submitted to CMS a detailed plan with timelines to ensure consistent, statewide provider standards for all HCBS waivers and to establish statewide rate setting methodologies for disability HCBS waivers. In 2009, the legislature provided authorization and funding to develop rate setting and provider enrollment structures in Minnesota. Subsequently, DHS engaged numerous internal and external stakeholders to assist in the development of the new rate setting methodologies and provider enrollment processes. Legislation required for these new processes will be proposed during the 2013 session, including implementation in January 2014 with a phased in approach for some aspects.

Goal 2— Changing Current Residential Service Models There has been an effort over the past several years to shift the service model for residential services toward the development of more individually designed living arrangements that give an individual more control and more choices about where and with whom to live, and are typically less expensive.

Component Overview and Progress There are several components of this effort, including: A moratorium on new child and adult corporate foster care licenses, with some

exceptions, passed during the 2009 legislative session. Corporate foster care settings are

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settings where the license holder does not reside in the setting. This is a more expensive model of residential service. While it is a valuable service, many people are able to live more independently or in alternative settings. The primary intent of the moratorium was to assure ongoing sustainability of the waivers for people with disabilities. During the 2011 special session and 2012 session, additional legislation was passed that required the department to decrease the capacity of corporate foster care settings using a statewide needs determination process.

Various grants appropriated by the legislature for local planning, technology, case

consultation, evaluation, and consumer information infrastructure to assess the use of technology as an alternative to services in corporate foster care settings. The grants are intended to help support individuals in their own homes with less reliance on the more expensive models of residential services.

A contract with the Arc of Minnesota to assist individuals with disabilities in finding and managing their own housing. The grants that pay for this effort were made available through legislation that passed during the 2008 session. As of March 1, 2012, 389 people moved into homes of their own with Housing Access Services. The Department will be expanding the Housing Access Coordination, currently available through all of the disability HCBS waivers, to include the more robust supports provided through Housing Access Services. The Department is also exploring ways to make this type of service available to individuals who do not receive services through the HCBS waivers.

Implementation of the Money Follows the Person (MFP) Demonstration Program Grant. Minnesota is one of the thirteen states awarded grants in 2011 and joins 29 other states and the District of Columbia already operating MFP programs. Minnesota will leverage the federal funds to improve community services and support people in their homes rather than institutions through the five years of the grant. First year funding for Minnesota is $13.4 million. Participation in this program will help DHS:

Continue to rebalance its long-term care system away from dependence on institutional care to achieve a sustainable balance of institutional and community-based services

Provide more individualized care for some of Minnesota’s most vulnerable residents

Defining home and community based settings for purposes of receiving HCBS waiver

services. The Department was working internally to develop a definition of home and community based settings across populations, based on the proposed CMS rules on this topic, with some modifications to address specific concerns in Minnesota. During the 2012 session, language passed that included a definition in statute that applied to the disability waivers.

Future Efforts DHS will be focusing efforts in this area on the implementation of Money Follows the Person and the Medical Assistance Reform, which was authorized during the 2011 special session. Several of the components mentioned above are being evaluated through the development of the Medical Assistance Reform proposal, which will be released for public comment in June 2012.

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Outcomes The efforts DHS is undertaking related to housing and residential services will expand options available to individuals, as well as achieve long-term sustainability for the waiver programs. The sustainability will be achieved by providing services in less expensive residential settings.

VI. Description of Waiver Reports Minnesota Statutes § 256B.0916 calls for the submission of information for each county or county partnership on the topics on the following pages. The sources for these reports include MMIS Screening and Service Agreement Data, the Waiver Management Systems, and the Continuing Care Management Reporting System (CCMRS).

A. Reports on the DD Waiver

DHS Public Reporting System DHS has developed an on-line public reporting system to replace many of the reports on the individuals waiting for services. The reports are updated quarterly and available by county. DHS will continue to develop the reports and add more to the on-line tool. The reports can be accessed on this website - http://www.dhs.state.mn.us/dhs16_159977. As of August 17, 2011, there were a total of 3,554 individuals waiting for the DD waiver. Approximately 3,000 of the individuals identified as waiting are under age 22, living at home with their parents with the majority likely receiving school services. Almost all on the waiting list are receiving at least one Medicaid or state-funded service. The statewide reports are included in the appendices for each of the following: Appendix 1: DD waiver waitlist by current service and residence Appendix 2: DD waiver waitlist by current services, age and waiver need index Appendix 3: DD waiver waitlist by planned service and residence Appendix 4: DD waiver waitlist by residence, age and waiver need index

When screening an individual, a lead agency case manager discusses with the person and/or the person’s legal representative how soon they require DD Waiver services. The discussion is based on the needs of the person and his or her support system. The person chooses whether they need waiver services:

Within 0 to12 months (Waiver Need Index 001) Within 13 to 36 months (Waiver Need Index 002) At 37 months or later (Waiver Need Index 003)

This is the Waiver Need Index. When determining a person’s Waiver Need Index, the case manager is instructed in the DD Screening Document Codebook to discuss with the person his or her preferred timeframe. The case manager should not make a decision on timeframe based on perceived waiting lists or anticipation of future waiver allocations.

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DD Waiver Funds Allocated but Not Used Appendix 5 details the amount of funds allocated but not used in the DD Waiver for Calendar Year (CY) 2008, 2009 and 2010. The table details for each county:

Total dollars allocated to a county in a given year Total dollars spent on services by the county in that year Difference between the dollars allocated and the dollars spent Percentage difference between dollars allocated and dollars spent

Because Medicaid providers have a full year after providing a service to bill, some services provided in CY 2010 have not yet been billed. The table provides data available through November 1, 2011, for services provided during CY 2010. Each county or county alliance was required to submit a document detailing their policies and procedures for management of their DD Waiver allocation, with updates as changes in policy occurs. The rationale included: Budget reserves needed to meet anticipated and unanticipated changes in current

participant needs within the budget year Analysis of historical spending data and trends Demographics of its current waiver population Recent changes in law or other service programs that could increase demand for waiver

services among current participants.

DHS addresses large reserves by factoring them into the methodology to determine the number of new allocations a county will receive. DHS collects and maintains a copy of each county’s policy and procedure guidelines, including the county’s planned reserve. Specific county reserve guidelines are available from DHS upon request. Beginning in January 2010, DHS instituted statewide allocation priorities, as directed by legislation that passed during the 2009 session (see section IV for specific information on the statewide allocation priorities).

Number of Additional Persons Served on the DD Waiver within Existing Allocations Appendix 6 presents the number of additional people who were served through this capacity in calendar years (CY) 2008, 2009 and 2010 as of October 1, 2010, for each county. It is important to note that this report does not take into account the number of people who leave the waiver every year. Counties manage their DD Waiver allocation in an aggregate model. Within this model, counties can serve additional persons through increased capacity within their existing allocations.

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B. Reports on BI, CAC, and CADI Waivers

People Receiving BI, CAC or CADI Waiver Services by Primary Diagnosis and Age Appendix 7 provides a summary by county and statewide of the age and diagnosis of the number of people receiving services through the BI, CAC and CADI waivers.

People Screened but Not Yet on Program for BI, CAC or CADI Waiver(s) by Primary Diagnosis and Age Appendix 8 summarizes the number of people by county and statewide who have been screened and are waiting for services on the BI, CAC and CADI waivers.

People Residing in a Nursing Facility by Primary Diagnosis and Age Appendix 9 provides a summary by county and statewide of this information.

BI, CAC, and CADI BI Aggregate Waiver Funds Allocated But Not Authorized Appendix 10 details the amount of funds allocated but not authorized in the BI, CAC and CADI waivers aggregate allocation for fiscal years (FY) 2009, 2010 and 2011. Because Medicaid providers have a full year after a service is provided to bill for services, some services provided in FY 2011 have not yet been billed. The table provides data available through October 1, 2011, for services provided during FY 2011. The table provides the following details for each county:

Total dollars allocated to a county in a given year Total dollars authorized on services by the county in that year Difference between the dollars allocated and the dollars authorized Percentage difference between dollars allocated and dollars authorized

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Use and Availability of Home and Community-Based Waivers for Persons with Disabilities

Minnesota Department of Human Services 18 January 2010

Appendices DD waiver waitlist by current service and residence DD waiver waitlist by current services, age and waiver need index DD waiver waitlist by planned service and residence DD waiver waitlist by residence, age and waiver need index Appendix 1 – DD Waiver funds allocated, but not used Appendix 2 – Number of additional persons served on the DD Waiver within existing allocations Appendix 3 – People receiving BI, CAC or CADI Waiver services by primary diagnosis and age Appendix 4 – People screened but not yet on program for BI, CAC or CADI waiver(s) by primary diagnosis and age Appendix 5 – People residing in a nursing facility by primary diagnosis and age Appendix 6 – BI, CAC and CADI funds allocated, but not used

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Appendix 1: DD Waiver Funds Allocated But Not Used

thousands) thousands) thousands)

Aitkin $3,683 $3,300 $383 10.4% $3,767 $3,271 $496 13.2% $3,622 $3,257 $364 10.1%

Anoka $50,443 $48,699 $1,744 3.5% $54,527 $51,604 $2,923 5.4% $55,882 $54,077 $1,805 3.2%

Becker $5,263 $4,910 $354 6.7% $5,605 $4,749 $856 15.3% $5,702 $4,726 $976 17.1%

Beltrami $8,497 $7,986 $511 6.0% $8,631 $8,174 $457 5.3% $8,775 $8,220 $555 6.3%

Benton $7,220 $6,712 $508 7.0% $7,876 $7,182 $694 8.8% $8,467 $7,377 $1,089 12.9%

Big Stone $2,061 $2,061 $1 0.0% $2,270 $2,138 $131 5.8% $2,266 $2,110 $156 6.9%

Blue Earth $10,374 $9,470 $904 8.7% $10,544 $9,845 $699 6.6% $10,740 $10,253 $487 4.5%

Brown $7,096 $6,533 $563 7.9% $7,335 $6,547 $787 10.7% $7,304 $6,645 $659 9.0%

Carlton $9,760 $9,127 $633 6.5% $10,328 $9,197 $1,130 10.9% $10,321 $9,099 $1,222 11.8%

Carver $9,556 $9,182 $374 3.9% $10,545 $9,845 $700 6.6% $10,903 $10,243 $659 6.0%

Cass $7,452 $7,149 $303 4.1% $7,814 $7,242 $572 7.3% $7,796 $7,287 $509 6.5%

Chippewa $4,156 $3,499 $658 15.8% $4,253 $3,654 $599 14.1% $4,351 $3,787 $564 13.0%

Chisago $8,797 $7,474 $1,323 15.0% $9,238 $7,431 $1,807 19.6% $9,055 $7,491 $1,564 17.3%

Clay $13,829 $12,736 $1,094 7.9% $14,801 $13,153 $1,648 11.1% $14,819 $13,182 $1,637 11.0%

Clearwater $847 $693 $154 18.2% $1,208 $727 $481 39.8% $1,184 $763 $421 35.6%

Cook $979 $924 $55 5.6% $1,007 $993 $13 1.3% $1,126 $1,002 $123 11.0%

Cottonwood $3,426 $3,037 $389 11.4% $3,569 $3,260 $309 8.7% $3,520 $3,335 $185 5.3%

Crow Wing $8,565 $8,519 $46 0.5% $9,052 $8,739 $313 3.5% $9,319 $8,890 $429 4.6%

Dakota $57,046 $53,861 $3,185 5.6% $62,418 $55,880 $6,538 10.5% $63,441 $59,048 $4,393 6.9%

Dodge $4,967 $4,483 $484 9.7% $5,308 $4,649 $659 12.4% $5,558 $5,022 $537 9.7%

Douglas $6,019 $5,862 $157 2.6% $6,487 $5,927 $559 8.6% $6,544 $5,883 $660 10.1%

Faribault $4,672 $3,850 $822 17.6% $4,924 $4,092 $832 16.9% $5,049 $4,202 $847 16.8%

Fillmore $4,940 $4,647 $293 5.9% $5,427 $5,120 $307 5.7% $5,786 $5,369 $417 7.2%

Freeborn $7,806 $7,531 $275 3.5% $8,284 $7,624 $660 8.0% $8,290 $7,545 $744 9.0%

Goodhue $10,058 $9,108 $950 9.4% $11,053 $9,792 $1,261 11.4% $11,254 $9,948 $1,307 11.6%

Grant $1,233 $1,200 $33 2.7% $1,273 $1,224 $49 3.8% $1,248 $1,216 $32 2.6%

Hennepin $227,419 $222,218 $5,202 2.3% $245,033 $227,855 $17,179 7.0% $248,303 $230,667 $17,636 7.1%

Houston $5,639 $5,556 $83 1.5% $6,143 $5,809 $334 5.4% $6,316 $5,898 $418 6.6%

Hubbard $2,898 $2,447 $452 15.6% $2,908 $2,576 $332 11.4% $2,842 $2,605 $236 8.3%

Isanti $4,904 $4,492 $413 8.4% $5,021 $4,722 $299 6.0% $5,078 $4,583 $494 9.7%

Itasca $10,566 $9,572 $993 9.4% $11,231 $9,840 $1,391 12.4% $11,273 $9,879 $1,394 12.4%

Jackson $2,586 $2,160 $426 16.5% $2,892 $2,041 $850 29.4% $2,784 $2,115 $669 24.0%

Kanabec $2,784 $2,568 $216 7.8% $3,084 $2,642 $442 14.3% $3,072 $2,746 $326 10.6%

Kandiyohi $7,708 $6,915 $793 10.3% $8,209 $7,258 $951 11.6% $8,250 $7,341 $908 11.0%

Kittson $1,330 $1,187 $142 10.7% $1,357 $1,342 $16 1.2% $1,464 $1,414 $50 3.4%

CY 2008 CY 2009 CY 2010 (As of 10-1-2011)

County $ Allocated Allocated - Spent $ Allocated Allocated - Spent $ Allocated Allocated - Spent$ Spend (in $ Spend (in $ Spend (in

Name (in (in (in thousands) (in thousands) (in thousands) (in

thousands) (%) thousands) (%) thousands) (%)

Appendix 1 - DD Waiver funds allocated, but not used

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Koochiching $4,119 $3,978 $141 3.4% $4,321 $4,129 $192 4.5% $4,508 $4,202 $306 6.8%

Lac Qui

Parle $2,697 $2,473 $224 8.3% $2,914 $2,535 $379 13.0% $2,862 $2,434 $427 14.9%

Lake $4,489 $4,252 $236 5.3% $4,900 $4,181 $719 14.7% $4,882 $4,085 $797 16.3%

Lake of the

Woods $1,067 $836 $231 21.6% $878 $788 $90 10.3% $932 $801 $130 14.0%

Le Sueur $6,846 $6,286 $559 8.2% $7,336 $6,809 $527 7.2% $7,714 $7,009 $705 9.1%

Lincoln $2,118 $1,607 $511 24.1% $1,973 $1,719 $254 12.9% $2,003 $1,740 $262 13.1%

Lyon $6,686 $6,770 -$83 -1.2% $7,241 $6,924 $317 4.4% $7,212 $7,053 $158 2.2%

Mc Leod $6,254 $6,017 $237 3.8% $6,829 $6,362 $468 6.8% $7,164 $6,547 $617 8.6%

Mahnomen $2,043 $1,798 $245 12.0% $2,035 $1,909 $127 6.2% $2,043 $1,766 $278 13.6%

Marshall $3,503 $3,186 $316 9.0% $3,489 $3,309 $180 5.2% $3,602 $3,142 $460 12.8%

Martin $4,370 $4,255 $115 2.6% $4,754 $4,616 $138 2.9% $4,904 $4,921 -$16 -0.3%

Meeker $4,649 $4,388 $262 5.6% $4,995 $4,545 $450 9.0% $4,843 $4,797 $46 0.9%

Mille Lacs $4,990 $4,478 $511 10.2% $5,310 $4,639 $672 12.6% $5,147 $4,682 $465 9.0%

Morrison $7,631 $7,230 $402 5.3% $8,061 $7,362 $700 8.7% $7,923 $7,654 $270 3.4%

Mower $10,124 $9,916 $208 2.1% $10,672 $10,026 $645 6.0% $10,800 $10,195 $605 5.6%

Murray $2,016 $1,659 $357 17.7% $1,850 $1,792 $58 3.1% $1,889 $1,843 $46 2.5%

Nicollet $4,008 $3,647 $361 9.0% $4,122 $3,751 $372 9.0% $4,215 $4,043 $173 4.1%

Nobles $4,108 $3,757 $351 8.5% $4,117 $3,695 $422 10.3% $4,093 $3,597 $495 12.1%

Norman $2,329 $2,155 $173 7.4% $2,476 $2,099 $377 15.2% $2,448 $2,215 $233 9.5%

Olmsted $27,539 $26,113 $1,426 5.2% $28,995 $27,387 $1,608 5.5% $29,796 $28,647 $1,149 3.9%

Otter Tail $10,046 $9,024 $1,022 10.2% $10,597 $9,357 $1,240 11.7% $10,634 $9,219 $1,415 13.3%

Pennington $2,706 $2,323 $383 14.1% $2,754 $2,269 $485 17.6% $2,584 $2,172 $413 16.0%

Pine $5,471 $4,964 $507 9.3% $5,633 $5,017 $616 10.9% $5,680 $5,191 $490 8.6%

Pipestone $2,040 $1,697 $343 16.8% $2,260 $1,961 $299 13.2% $2,303 $1,967 $337 14.6%

Polk $10,159 $9,218 $941 9.3% $9,970 $9,489 $480 4.8% $10,155 $9,398 $757 7.5%

Pope $3,156 $2,770 $386 12.2% $3,278 $2,855 $424 12.9% $3,215 $2,892 $323 10.0%

Ramsey $111,844 $107,805 $4,038 3.6% $119,997 $109,815 $10,183 8.5% $121,929 $111,910 $10,019 8.2%

Red Lake $987 $878 $109 11.1% $1,151 $884 $267 23.2% $970 $860 $110 11.3%

Redwood $4,006 $3,760 $246 6.1% $4,385 $3,898 $487 11.1% $4,368 $4,035 $333 7.6%

Renville $4,782 $4,390 $392 8.2% $5,007 $4,626 $381 7.6% $4,877 $4,883 -$5 -0.1%

Rice $15,562 $15,396 $165 1.1% $16,794 $16,380 $414 2.5% $17,230 $17,022 $208 1.2%

Rock $3,132 $2,788 $343 11.0% $3,200 $2,748 $452 14.1% $3,080 $2,655 $426 13.8%

Roseau $3,484 $3,003 $482 13.8% $3,392 $3,011 $381 11.2% $3,308 $3,060 $248 7.5%

St. Louis $55,417 $52,719 $2,698 4.9% $60,097 $53,422 $6,675 11.1% $60,381 $55,765 $4,616 7.6%

Scott $14,124 $13,459 $665 4.7% $15,681 $14,458 $1,223 7.8% $16,178 $15,162 $1,016 6.3%

Sherburne $9,334 $8,538 $796 8.5% $9,705 $9,194 $511 5.3% $9,934 $9,550 $384 3.9%

Sibley $3,213 $2,881 $332 10.3% $3,421 $3,213 $208 6.1% $3,555 $3,278 $277 7.8%

Stearns $22,071 $21,060 $1,011 4.6% $22,820 $21,494 $1,326 5.8% $23,237 $21,505 $1,732 7.5%

Appendix 1 - DD Waiver funds allocated, but not used

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Steele $5,649 $5,054 $596 10.5% $5,795 $5,273 $522 9.0% $6,032 $5,586 $446 7.4%

Stevens $2,490 $2,299 $191 7.7% $2,779 $2,340 $440 15.8% $2,968 $2,468 $499 16.8%

Swift $2,515 $2,341 $174 6.9% $2,635 $2,449 $186 7.1% $2,690 $2,634 $56 2.1%

Todd $5,326 $5,042 $284 5.3% $5,888 $5,339 $548 9.3% $5,954 $5,402 $552 9.3%

Traverse $634 $522 $112 17.6% $757 $549 $208 27.5% $795 $596 $199 25.1%

Wabasha $6,479 $5,862 $617 9.5% $6,624 $6,006 $618 9.3% $6,609 $5,871 $738 11.2%

Wadena $2,833 $2,443 $390 13.8% $3,003 $2,509 $494 16.4% $3,134 $2,615 $520 16.6%

Waseca $2,983 $2,951 $32 1.1% $3,190 $3,082 $108 3.4% $3,249 $3,163 $85 2.6%

Washington $31,944 $31,223 $721 2.3% $35,046 $32,787 $2,259 6.4% $36,249 $35,555 $694 1.9%

Watonwan $3,402 $3,122 $280 8.2% $3,479 $3,172 $307 8.8% $3,426 $3,247 $179 5.2%

Wilkin $2,862 $2,341 $520 18.2% $3,028 $2,334 $695 22.9% $2,836 $2,740 $96 3.4%

Winona $11,157 $10,699 $459 4.1% $11,950 $11,235 $715 6.0% $11,783 $11,294 $489 4.2%

Wright $13,319 $12,737 $582 4.4% $14,551 $14,024 $527 3.6% $15,214 $15,189 $25 0.2%

Yellow

Medicine $3,009 $2,783 $226 7.5% $3,282 $2,873 $409 12.5% $3,139 $2,863 $276 8.8%

State Wide $1,012,305 $960,562 $51,743 5.1% $1,082,839 $992,783 $90,055 8.3% $1,098,380 $1,018,346 $80,034 7.3%

Appendix 1 - DD Waiver funds allocated, but not used

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Appendix 2: Number of Additional Persons Served on the DD Waiver within Existing Allocations

County NameCY

2008

CY

2009

CY

2010County Name

CY

2008

CY

2009

CY

2010

Aitkin 0 2 2 Martin 2 4 8

Anoka 49 77 16 Meeker 4 0 1

Becker 5 4 3 Mille Lacs 7 4 3

Beltrami 3 6 2 Morrison 2 4 1

Benton 6 1 5 Mower 7 7 10

Big Stone 0 0 3 Murray 2 3 3

Blue Earth 10 6 3 Nicollet 7 0 5

Brown 6 3 4 Nobles 1 0 2

Carlton 3 4 10 Norman 2 3 2

Carver 5 8 13 Olmsted 17 6 5

Cass 4 3 3 Otter Tail 8 4 1

Chippewa 4 1 3 Pennington 0 2 0

Chisago 5 5 1 Pine 1 3 4

Clay 4 8 15 Pipestone 2 2 1

Clearwater 0 0 1 Polk 2 8 0

Cook 0 1 1 Pope 3 1 4

Cottonwood 3 3 2 Ramsey 36 67 153

Crow Wing 6 6 4 Red Lake 4 0 1

Dakota 41 69 44 Redwood 3 1 2

Dodge 3 1 3 Renville 2 0 0

Douglas 2 3 3 Rice 1 19 7

Faribault 2 1 6 Rock 3 1 3

Fillmore 1 0 1 Roseau 1 2 1

Freeborn 2 5 2 St. Louis 17 21 43

Goodhue 13 6 6 Scott 9 13 9

Grant 0 1 1 Sherburne 17 10 6

Hennepin 85 98 81 Sibley 4 2 2

Houston 6 3 1 Stearns 8 10 7

Hubbard 1 2 0 Steele 5 4 6

Isanti 4 0 2 Stevens 1 4 4

Itasca 5 13 8 Swift 5 3 1

Jackson 2 2 0 Todd 7 1 3

Kanabec 2 1 2 Traverse 0 1 0

Kandiyohi 5 4 3 Wabasha 5 1 2

Kittson 0 0 0 Wadena 5 3 1

Koochiching 1 1 3 Waseca 0 2 1

Lac Qui Parle 4 1 2 Washington 27 36 43

Lake 1 1 2 Watonwan 1 3 3

Lake of the Woods 0 0 1 Wilkin 2 4 2

Le Sueur 10 5 5 Winona 4 3 7

Lincoln 0 1 1 Wright 17 10 15

Lyon 3 3 3 Yellow Medicine 1 0 3

Mc Leod 4 6 3 State Wide 566 641 656

Mahnomen 0 2 1 Source: DD Waiver Management System,

Marshall 4 2 6 10/1/2010

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Minnesota Department of Human Service

Continuiing Care Administration

Report run date: Report author:

6/27/2012 pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Appendix 3: People Receiving CCB Waiver Services for AITKIN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

50 2 3 5 9 31

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 5 1 0 0 0 4

05. Mental Disorders 20 1 2 4 5 8

06. Diseases of the Nervous System and Sense Organs 12 0 0 0 1 11

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 3 0 0 0 1 2

14. Congenital Anomalies 2 0 1 1 0 0

17. Injury and Poisoning 3 0 0 0 2 1

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Appendix 3: People Receiving CCB Waiver Services for ANOKA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

953 92 60 52 193 556

01. Infectious & Parasitic Diseases 9 1 0 0 3 5

02. Neoplasms 15 1 1 0 1 12

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 49 1 0 0 2 46

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 433 53 37 29 98 216

06. Diseases of the Nervous System and Sense Organs 157 15 8 11 44 79

07. Diseases of the Circulatory System 43 0 2 1 1 39

08. Diseases of the Respiratory System 22 0 0 0 0 22

09. Diseases of the Digestive System 6 1 0 0 0 5

10. Diseases of the Genitourinary System 8 1 0 1 1 5

13. Diseases of the Musculoskeletal System and Connective Tissue 59 0 0 0 5 54

14. Congenital Anomalies 38 15 6 3 8 6

15. Certain Conditions Originating in the Perinatal Period 5 0 4 0 1 0

16. Symptoms, Signs and Ill-Defined Conditions 10 3 0 1 3 3

17. Injury and Poisoning 95 1 1 6 26 61

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 1 0 0 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

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Appendix 3: People Receiving CCB Waiver Services for BECKER

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

170 18 8 9 39 96

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 4 1 0 0 1 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 24 0 0 0 1 23

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 1 0

05. Mental Disorders 54 6 2 4 22 20

06. Diseases of the Nervous System and Sense Organs 27 4 2 2 7 12

07. Diseases of the Circulatory System 12 0 0 0 0 12

08. Diseases of the Respiratory System 4 0 0 0 0 4

10. Diseases of the Genitourinary System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 1 0

13. Diseases of the Musculoskeletal System and Connective Tissue 13 1 0 0 0 12

14. Congenital Anomalies 11 2 3 3 1 2

15. Certain Conditions Originating in the Perinatal Period 1 0 0 0 1 0

16. Symptoms, Signs and Ill-Defined Conditions 4 2 0 0 1 1

17. Injury and Poisoning 11 2 1 0 3 5

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

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Appendix 3: People Receiving CCB Waiver Services for BELTRAMI

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

142 7 2 6 33 94

01. Infectious & Parasitic Diseases 1 0 0 0 1 0

02. Neoplasms 3 0 0 0 1 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 18 0 0 0 0 18

04. Diseases of the Blood and Blood-Forming Organs 2 0 0 0 0 2

05. Mental Disorders 55 1 0 5 21 28

06. Diseases of the Nervous System and Sense Organs 19 3 1 1 4 10

07. Diseases of the Circulatory System 9 0 0 0 1 8

08. Diseases of the Respiratory System 5 0 0 0 0 5

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 2 0 0 0 0 2

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 7 0 0 0 0 7

14. Congenital Anomalies 3 2 1 0 0 0

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

17. Injury and Poisoning 12 0 0 0 5 7

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 1 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 27: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for BENTON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

131 6 2 7 33 83

01. Infectious & Parasitic Diseases 1 0 0 0 1 0

02. Neoplasms 2 1 0 0 1 0

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 5 0 0 0 1 4

05. Mental Disorders 54 1 1 6 14 32

06. Diseases of the Nervous System and Sense Organs 27 1 1 0 7 18

07. Diseases of the Circulatory System 9 0 0 0 1 8

08. Diseases of the Respiratory System 7 0 0 0 0 7

13. Diseases of the Musculoskeletal System and Connective Tissue 7 0 0 0 0 7

14. Congenital Anomalies 4 2 0 1 0 1

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 1 1

17. Injury and Poisoning 9 1 0 0 4 4

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 4 0 0 0 3 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 28: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for BIG STONE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

32 1 1 1 6 23

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 9 0 0 0 0 9

05. Mental Disorders 9 1 1 1 1 5

06. Diseases of the Nervous System and Sense Organs 4 0 0 0 1 3

07. Diseases of the Circulatory System 1 0 0 0 1 0

08. Diseases of the Respiratory System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 2 0 0 0 1 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

14. Congenital Anomalies 1 0 0 0 1 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 1 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 29: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for BLUE EARTH

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

199 29 7 21 43 99

01. Infectious & Parasitic Diseases 3 0 0 0 0 3

02. Neoplasms 2 0 0 0 1 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 7 0 0 1 0 6

05. Mental Disorders 91 6 3 14 27 41

06. Diseases of the Nervous System and Sense Organs 35 9 2 2 5 17

07. Diseases of the Circulatory System 16 1 0 0 2 13

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 4 1 0 0 0 3

14. Congenital Anomalies 12 7 1 1 2 1

15. Certain Conditions Originating in the Perinatal Period 5 4 1 0 0 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 17 0 0 1 6 10

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 1 0 2 0 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 30: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for BROWN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

90 7 9 6 18 50

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 3 0 0 0 1 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

05. Mental Disorders 46 4 6 4 7 25

06. Diseases of the Nervous System and Sense Organs 21 2 2 2 4 11

07. Diseases of the Circulatory System 3 0 0 0 1 2

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 3 0 0 0 0 3

16. Symptoms, Signs and Ill-Defined Conditions 1 0 1 0 0 0

17. Injury and Poisoning 7 0 0 0 5 2

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 1 0 0 0 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 31: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for CARLTON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

128 5 3 12 26 82

02. Neoplasms 1 0 0 1 0 0

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 7 0 0 1 0 6

05. Mental Disorders 51 0 2 3 10 36

06. Diseases of the Nervous System and Sense Organs 28 3 1 2 9 13

07. Diseases of the Circulatory System 9 0 0 0 1 8

08. Diseases of the Respiratory System 2 0 0 0 0 2

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 3 0 0 0 0 3

14. Congenital Anomalies 4 1 0 2 1 0

15. Certain Conditions Originating in the Perinatal Period 4 1 0 1 2 0

17. Injury and Poisoning 15 0 0 2 2 11

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 0 0 1 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 32: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for CARVER

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

199 10 9 20 50 110

01. Infectious & Parasitic Diseases 2 0 0 0 0 2

02. Neoplasms 3 1 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 9 0 0 0 0 9

05. Mental Disorders 79 2 5 8 29 35

06. Diseases of the Nervous System and Sense Organs 38 2 1 2 10 23

07. Diseases of the Circulatory System 12 0 0 1 0 11

08. Diseases of the Respiratory System 2 0 0 0 0 2

09. Diseases of the Digestive System 3 0 0 0 0 3

10. Diseases of the Genitourinary System 1 1 0 0 0 0

13. Diseases of the Musculoskeletal System and Connective Tissue 12 0 0 0 1 11

14. Congenital Anomalies 8 3 2 0 2 1

15. Certain Conditions Originating in the Perinatal Period 6 0 0 3 3 0

16. Symptoms, Signs and Ill-Defined Conditions 5 1 0 1 0 3

17. Injury and Poisoning 12 0 0 2 4 6

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 7 0 1 3 1 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 33: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for CASS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

91 3 4 7 15 62

02. Neoplasms 2 0 0 0 1 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 8 0 2 0 1 5

05. Mental Disorders 30 1 1 4 7 17

06. Diseases of the Nervous System and Sense Organs 22 0 1 2 1 18

07. Diseases of the Circulatory System 7 1 0 0 0 6

08. Diseases of the Respiratory System 3 0 0 0 0 3

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

14. Congenital Anomalies 3 1 0 0 1 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 12 0 0 1 3 8

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 1 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 34: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for CHIPPEWA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

41 3 0 2 6 30

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

05. Mental Disorders 9 1 0 0 1 7

06. Diseases of the Nervous System and Sense Organs 10 1 0 1 2 6

07. Diseases of the Circulatory System 6 0 0 0 0 6

08. Diseases of the Respiratory System 4 0 0 1 1 2

13. Diseases of the Musculoskeletal System and Connective Tissue 3 0 0 0 0 3

14. Congenital Anomalies 2 1 0 0 1 0

17. Injury and Poisoning 2 0 0 0 1 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 35: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for CHISAGO

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

123 18 10 9 31 55

02. Neoplasms 6 0 0 0 0 6

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 8 1 0 0 3 4

05. Mental Disorders 47 9 3 7 15 13

06. Diseases of the Nervous System and Sense Organs 24 3 4 1 5 11

07. Diseases of the Circulatory System 8 1 0 0 1 6

08. Diseases of the Respiratory System 2 1 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 11 0 0 0 3 8

14. Congenital Anomalies 8 3 2 1 1 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 1 0

17. Injury and Poisoning 5 0 0 0 2 3

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 1 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 36: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for CLAY

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

371 28 31 23 79 210

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 3 1 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 9 1 0 0 1 7

05. Mental Disorders 193 9 16 17 50 101

06. Diseases of the Nervous System and Sense Organs 50 5 7 4 8 26

07. Diseases of the Circulatory System 21 2 0 0 2 17

08. Diseases of the Respiratory System 5 1 0 0 0 4

09. Diseases of the Digestive System 5 1 0 0 1 3

10. Diseases of the Genitourinary System 3 0 0 0 0 3

13. Diseases of the Musculoskeletal System and Connective Tissue 18 0 0 0 1 17

14. Congenital Anomalies 21 6 5 1 6 3

16. Symptoms, Signs and Ill-Defined Conditions 4 1 1 0 0 2

17. Injury and Poisoning 33 1 2 1 10 19

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 5 0 0 0 0 5

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 37: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for CLEARWATER

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

37 2 2 5 7 21

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 15 2 1 1 4 7

06. Diseases of the Nervous System and Sense Organs 8 0 0 3 1 4

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 1 0 0 0 0 1

14. Congenital Anomalies 2 0 1 0 1 0

17. Injury and Poisoning 2 0 0 1 0 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 1 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 38: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for COOK

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

10 1 1 0 2 6

05. Mental Disorders 4 0 1 0 0 3

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 2 0 0 0 0 2

17. Injury and Poisoning 2 0 0 0 2 0

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 1 0 0 0 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 39: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for COTTONWOOD

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

30 1 0 0 4 25

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 4 0 0 0 0 4

05. Mental Disorders 3 0 0 0 1 2

06. Diseases of the Nervous System and Sense Organs 4 0 0 0 1 3

07. Diseases of the Circulatory System 3 0 0 0 0 3

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 5 0 0 0 0 5

14. Congenital Anomalies 2 1 0 0 0 1

17. Injury and Poisoning 5 0 0 0 2 3

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 40: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for CROW WING

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

187 9 7 4 34 133

02. Neoplasms 3 0 0 0 1 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 12 2 0 0 0 10

05. Mental Disorders 74 2 1 2 14 55

06. Diseases of the Nervous System and Sense Organs 48 2 2 2 12 30

07. Diseases of the Circulatory System 14 0 0 0 0 14

08. Diseases of the Respiratory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 7 0 0 0 0 7

14. Congenital Anomalies 8 2 2 0 3 1

15. Certain Conditions Originating in the Perinatal Period 2 0 0 0 2 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 12 0 2 0 2 8

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 1 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 41: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for DAKOTA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1,319 71 56 98 375 719

01. Infectious & Parasitic Diseases 11 0 0 0 5 6

02. Neoplasms 24 1 0 2 3 18

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 61 4 0 2 5 50

04. Diseases of the Blood and Blood-Forming Organs 2 0 0 0 1 1

05. Mental Disorders 655 27 27 56 235 310

06. Diseases of the Nervous System and Sense Organs 222 17 13 18 48 126

07. Diseases of the Circulatory System 72 1 1 4 4 62

08. Diseases of the Respiratory System 16 0 0 0 2 14

09. Diseases of the Digestive System 3 1 0 0 0 2

10. Diseases of the Genitourinary System 8 2 0 0 1 5

12. Diseases of the Skin and Subcutaneous Tissue 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 41 0 1 0 1 39

14. Congenital Anomalies 33 12 2 5 11 3

15. Certain Conditions Originating in the Perinatal Period 12 3 3 1 5 0

16. Symptoms, Signs and Ill-Defined Conditions 6 1 0 0 0 5

17. Injury and Poisoning 143 2 9 10 48 74

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 8 0 0 0 6 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 42: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for DODGE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

38 4 3 1 9 21

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

05. Mental Disorders 9 2 2 1 1 3

06. Diseases of the Nervous System and Sense Organs 8 0 1 0 3 4

07. Diseases of the Circulatory System 3 0 0 0 1 2

08. Diseases of the Respiratory System 3 0 0 0 0 3

13. Diseases of the Musculoskeletal System and Connective Tissue 3 0 0 0 0 3

14. Congenital Anomalies 1 1 0 0 0 0

15. Certain Conditions Originating in the Perinatal Period 1 1 0 0 0 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 7 0 0 0 4 3

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 43: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for DOUGLAS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

136 8 3 13 26 86

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 11 0 0 0 1 10

05. Mental Disorders 65 4 1 7 16 37

06. Diseases of the Nervous System and Sense Organs 18 2 0 1 4 11

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 3 0 0 0 0 3

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 11 0 0 0 2 9

14. Congenital Anomalies 7 0 2 3 1 1

15. Certain Conditions Originating in the Perinatal Period 3 0 0 1 2 0

16. Symptoms, Signs and Ill-Defined Conditions 1 1 0 0 0 0

17. Injury and Poisoning 9 1 0 1 0 7

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 44: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for FARIBAULT

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

28 1 0 2 8 17

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 9 0 0 1 4 4

06. Diseases of the Nervous System and Sense Organs 8 0 0 1 2 5

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 2 1 0 0 1 0

17. Injury and Poisoning 3 0 0 0 1 2

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 45: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for FILLMORE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

46 0 1 2 10 33

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 7 0 0 0 0 7

05. Mental Disorders 5 0 1 1 1 2

06. Diseases of the Nervous System and Sense Organs 18 0 0 1 8 9

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 2 0 0 0 0 2

09. Diseases of the Digestive System 3 0 0 0 0 3

10. Diseases of the Genitourinary System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 4 0 0 0 0 4

14. Congenital Anomalies 1 0 0 0 1 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 46: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for FREEBORN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

51 2 1 2 13 33

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 1 2

05. Mental Disorders 19 1 0 1 7 10

06. Diseases of the Nervous System and Sense Organs 10 1 1 0 3 5

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 2 0 0 0 0 2

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 3 0 0 0 0 3

14. Congenital Anomalies 1 0 0 0 1 0

17. Injury and Poisoning 6 0 0 1 1 4

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 47: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for GOODHUE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

150 1 1 6 33 109

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 9 0 0 0 0 9

05. Mental Disorders 72 0 1 3 25 43

06. Diseases of the Nervous System and Sense Organs 24 1 0 1 4 18

07. Diseases of the Circulatory System 5 0 0 0 0 5

08. Diseases of the Respiratory System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 10 0 0 0 1 9

14. Congenital Anomalies 5 0 0 2 0 3

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

17. Injury and Poisoning 17 0 0 0 3 14

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 0 0 0 3

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 48: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for GRANT

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

22 1 1 0 8 12

02. Neoplasms 1 0 1 0 0 0

05. Mental Disorders 8 0 0 0 3 5

06. Diseases of the Nervous System and Sense Organs 7 1 0 0 5 1

07. Diseases of the Circulatory System 3 0 0 0 0 3

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 49: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for HENNEPIN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4,047 75 48 87 675 3,162

01. Infectious & Parasitic Diseases 83 0 0 0 13 70

02. Neoplasms 74 0 1 1 11 61

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 247 4 2 1 15 225

04. Diseases of the Blood and Blood-Forming Organs 13 1 1 1 1 9

05. Mental Disorders 1,410 15 14 45 298 1,038

06. Diseases of the Nervous System and Sense Organs 670 24 18 24 143 461

07. Diseases of the Circulatory System 307 0 0 0 17 290

08. Diseases of the Respiratory System 114 8 1 3 5 97

09. Diseases of the Digestive System 44 2 0 0 3 39

10. Diseases of the Genitourinary System 58 0 0 0 11 47

12. Diseases of the Skin and Subcutaneous Tissue 17 0 0 0 0 17

13. Diseases of the Musculoskeletal System and Connective Tissue 376 0 1 0 23 352

14. Congenital Anomalies 74 16 6 4 24 24

15. Certain Conditions Originating in the Perinatal Period 14 4 0 0 5 5

16. Symptoms, Signs and Ill-Defined Conditions 56 0 1 2 9 44

17. Injury and Poisoning 460 1 3 5 96 355

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 30 0 0 1 1 28

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 50: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for HOUSTON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

43 11 2 1 7 22

02. Neoplasms 2 0 1 0 1 0

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 1 2

05. Mental Disorders 12 2 0 1 2 7

06. Diseases of the Nervous System and Sense Organs 8 3 0 0 1 4

07. Diseases of the Circulatory System 4 0 0 0 0 4

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 5 4 0 0 1 0

17. Injury and Poisoning 8 2 1 0 1 4

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 51: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for HUBBARD

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

59 8 4 2 20 25

02. Neoplasms 1 0 0 0 1 0

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 6 3 0 0 1 2

05. Mental Disorders 20 0 2 0 9 9

06. Diseases of the Nervous System and Sense Organs 14 2 1 1 6 4

07. Diseases of the Circulatory System 2 0 0 0 1 1

08. Diseases of the Respiratory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

14. Congenital Anomalies 3 1 1 1 0 0

15. Certain Conditions Originating in the Perinatal Period 2 2 0 0 0 0

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 1 1

17. Injury and Poisoning 2 0 0 0 1 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 52: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for ISANTI

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

107 8 5 6 30 58

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 1 0 0 2

05. Mental Disorders 48 1 3 2 15 27

06. Diseases of the Nervous System and Sense Organs 21 3 1 1 6 10

07. Diseases of the Circulatory System 5 2 0 0 1 2

08. Diseases of the Respiratory System 4 0 0 0 0 4

09. Diseases of the Digestive System 3 0 0 0 0 3

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 3 0 0 0 0 3

14. Congenital Anomalies 7 1 0 0 4 2

15. Certain Conditions Originating in the Perinatal Period 3 0 0 3 0 0

17. Injury and Poisoning 8 1 0 0 4 3

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 53: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for ITASCA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

113 2 2 8 28 73

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 4 0 0 0 1 3

05. Mental Disorders 42 1 0 3 13 25

06. Diseases of the Nervous System and Sense Organs 26 0 2 3 10 11

07. Diseases of the Circulatory System 8 0 0 0 0 8

08. Diseases of the Respiratory System 2 0 0 0 0 2

09. Diseases of the Digestive System 2 0 0 0 0 2

10. Diseases of the Genitourinary System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 8 0 0 0 0 8

14. Congenital Anomalies 4 1 0 2 1 0

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

17. Injury and Poisoning 12 0 0 0 3 9

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 54: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for JACKSON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

30 1 1 1 12 15

05. Mental Disorders 19 0 1 1 9 8

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

08. Diseases of the Respiratory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 1 0 0 0 0

14. Congenital Anomalies 1 0 0 0 1 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 3 0 0 0 2 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 55: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for KANABEC

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

60 3 0 2 15 40

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 6 1 0 0 0 5

04. Diseases of the Blood and Blood-Forming Organs 1 1 0 0 0 0

05. Mental Disorders 20 0 0 0 11 9

06. Diseases of the Nervous System and Sense Organs 8 1 0 0 1 6

07. Diseases of the Circulatory System 7 0 0 0 0 7

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 5 0 0 0 1 4

14. Congenital Anomalies 1 0 0 0 0 1

15. Certain Conditions Originating in the Perinatal Period 2 0 0 2 0 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 1 0

17. Injury and Poisoning 6 0 0 0 1 5

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 56: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for KANDIYOHI

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

171 7 7 17 37 103

01. Infectious & Parasitic Diseases 2 0 0 0 0 2

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 20 0 1 0 0 19

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 54 2 4 7 20 21

06. Diseases of the Nervous System and Sense Organs 36 1 1 6 8 20

07. Diseases of the Circulatory System 9 0 0 0 2 7

08. Diseases of the Respiratory System 7 0 0 0 0 7

10. Diseases of the Genitourinary System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 7 0 0 0 1 6

14. Congenital Anomalies 10 3 1 3 1 2

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 19 1 0 1 5 12

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 0 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 57: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for KITTSON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

10 1 0 0 1 8

05. Mental Disorders 7 0 0 0 1 6

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 1 1 0 0 0 0

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 58: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for KOOCHICHING

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

48 5 6 5 10 22

02. Neoplasms 2 0 0 0 1 1

05. Mental Disorders 29 2 5 5 4 13

06. Diseases of the Nervous System and Sense Organs 5 0 1 0 2 2

07. Diseases of the Circulatory System 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

14. Congenital Anomalies 3 3 0 0 0 0

17. Injury and Poisoning 5 0 0 0 3 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 59: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for LAC QUI PARLE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

28 2 2 1 3 20

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 1 0 0

05. Mental Disorders 9 1 1 0 1 6

06. Diseases of the Nervous System and Sense Organs 6 0 0 0 1 5

07. Diseases of the Circulatory System 2 0 0 0 0 2

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

14. Congenital Anomalies 2 1 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 2 0 1 0 0 1

17. Injury and Poisoning 1 0 0 0 1 0

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 60: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for LAKE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

38 2 0 1 11 24

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 14 0 0 0 5 9

06. Diseases of the Nervous System and Sense Organs 12 2 0 1 4 5

07. Diseases of the Circulatory System 5 0 0 0 0 5

08. Diseases of the Respiratory System 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 0 0 1

15. Certain Conditions Originating in the Perinatal Period 1 0 0 0 1 0

17. Injury and Poisoning 3 0 0 0 1 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 61: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for LAKE OF THE WOODS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

27 1 2 2 6 16

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 20 1 1 0 6 12

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

15. Certain Conditions Originating in the Perinatal Period 1 0 0 1 0 0

17. Injury and Poisoning 1 0 1 0 0 0

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 1 0 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 62: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for LE SUEUR

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

72 5 3 7 11 46

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

05. Mental Disorders 35 1 1 6 5 22

06. Diseases of the Nervous System and Sense Organs 10 1 0 1 2 6

07. Diseases of the Circulatory System 5 0 0 0 0 5

08. Diseases of the Respiratory System 2 0 0 0 1 1

09. Diseases of the Digestive System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 3 1 0 0 0 2

14. Congenital Anomalies 3 1 1 0 1 0

17. Injury and Poisoning 8 1 1 0 2 4

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 63: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for LINCOLN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

24 5 1 2 2 14

02. Neoplasms 1 0 0 1 0 0

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 1 0 0 0 1

04. Diseases of the Blood and Blood-Forming Organs 2 2 0 0 0 0

05. Mental Disorders 12 1 1 1 2 7

06. Diseases of the Nervous System and Sense Organs 3 0 0 0 0 3

07. Diseases of the Circulatory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 1 0 0 0 0

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 64: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for LYON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

144 19 5 8 27 85

01. Infectious & Parasitic Diseases 2 0 0 0 1 1

02. Neoplasms 2 0 0 0 1 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 12 1 0 1 0 10

05. Mental Disorders 43 3 2 7 7 24

06. Diseases of the Nervous System and Sense Organs 38 6 1 0 10 21

07. Diseases of the Circulatory System 9 2 0 0 0 7

08. Diseases of the Respiratory System 5 1 1 0 0 3

13. Diseases of the Musculoskeletal System and Connective Tissue 7 0 0 0 2 5

14. Congenital Anomalies 8 4 1 0 3 0

16. Symptoms, Signs and Ill-Defined Conditions 2 1 0 0 0 1

17. Injury and Poisoning 14 0 0 0 3 11

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 1 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 65: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for MCLEOD

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

114 17 6 8 22 61

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 3 0 0 0 2 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

05. Mental Disorders 44 8 2 1 9 24

06. Diseases of the Nervous System and Sense Organs 24 2 1 1 8 12

07. Diseases of the Circulatory System 5 0 0 0 1 4

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 9 0 0 0 0 9

14. Congenital Anomalies 10 3 3 3 0 1

16. Symptoms, Signs and Ill-Defined Conditions 2 1 0 0 0 1

17. Injury and Poisoning 12 3 0 3 2 4

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 66: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for MAHNOMEN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

34 2 1 0 6 25

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 7 0 0 0 0 7

05. Mental Disorders 5 0 1 0 2 2

06. Diseases of the Nervous System and Sense Organs 9 1 0 0 2 6

07. Diseases of the Circulatory System 3 0 0 0 0 3

08. Diseases of the Respiratory System 1 0 0 0 1 0

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 4 0 0 0 0 4

14. Congenital Anomalies 1 1 0 0 0 0

17. Injury and Poisoning 2 0 0 0 1 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 67: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for MARSHALL

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

28 1 0 2 10 15

02. Neoplasms 1 0 0 0 1 0

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 1 0

05. Mental Disorders 14 1 0 1 6 6

06. Diseases of the Nervous System and Sense Organs 4 0 0 1 0 3

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 4 0 0 0 1 3

17. Injury and Poisoning 1 0 0 0 1 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 68: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for MARTIN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

84 4 0 8 11 61

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 9 0 0 1 1 7

05. Mental Disorders 20 0 0 3 5 12

06. Diseases of the Nervous System and Sense Organs 14 2 0 1 2 9

07. Diseases of the Circulatory System 8 0 0 0 0 8

08. Diseases of the Respiratory System 3 0 0 0 0 3

13. Diseases of the Musculoskeletal System and Connective Tissue 15 0 0 0 0 15

14. Congenital Anomalies 3 1 0 0 1 1

15. Certain Conditions Originating in the Perinatal Period 1 0 0 1 0 0

16. Symptoms, Signs and Ill-Defined Conditions 1 1 0 0 0 0

17. Injury and Poisoning 9 0 0 2 2 5

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 69: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for MEEKER

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

83 2 5 5 17 54

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 13 0 1 0 0 12

05. Mental Disorders 25 0 2 3 8 12

06. Diseases of the Nervous System and Sense Organs 17 1 1 1 3 11

07. Diseases of the Circulatory System 7 0 0 0 0 7

08. Diseases of the Respiratory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

14. Congenital Anomalies 5 1 0 1 2 1

16. Symptoms, Signs and Ill-Defined Conditions 3 0 1 0 1 1

17. Injury and Poisoning 4 0 0 0 2 2

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 1 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 70: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for MILLE LACS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

154 16 9 12 31 86

01. Infectious & Parasitic Diseases 2 0 0 0 0 2

02. Neoplasms 2 1 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 9 0 1 0 0 8

04. Diseases of the Blood and Blood-Forming Organs 1 0 1 0 0 0

05. Mental Disorders 73 4 3 8 22 36

06. Diseases of the Nervous System and Sense Organs 20 1 2 3 4 10

07. Diseases of the Circulatory System 9 2 1 0 1 5

08. Diseases of the Respiratory System 9 0 0 0 0 9

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 7 0 0 0 1 6

14. Congenital Anomalies 8 5 1 0 2 0

15. Certain Conditions Originating in the Perinatal Period 2 1 0 1 0 0

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 1 1

17. Injury and Poisoning 8 2 0 0 0 6

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 71: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for MORRISON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

89 9 5 8 15 52

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 6 1 0 0 0 5

04. Diseases of the Blood and Blood-Forming Organs 1 0 1 0 0 0

05. Mental Disorders 44 6 2 8 8 20

06. Diseases of the Nervous System and Sense Organs 14 1 1 0 1 11

07. Diseases of the Circulatory System 3 0 0 0 0 3

08. Diseases of the Respiratory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 1 0

13. Diseases of the Musculoskeletal System and Connective Tissue 4 0 0 0 1 3

14. Congenital Anomalies 2 1 1 0 0 0

17. Injury and Poisoning 9 0 0 0 3 6

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 1 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 72: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for MOWER

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

137 8 7 1 29 92

01. Infectious & Parasitic Diseases 2 0 0 0 0 2

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 14 1 0 0 2 11

05. Mental Disorders 51 2 4 1 14 30

06. Diseases of the Nervous System and Sense Organs 25 2 2 0 8 13

07. Diseases of the Circulatory System 12 0 0 0 0 12

08. Diseases of the Respiratory System 4 1 0 0 0 3

09. Diseases of the Digestive System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 11 0 0 0 1 10

14. Congenital Anomalies 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 1 0 0 0 0

17. Injury and Poisoning 10 0 1 0 3 6

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 1 0 0 1 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 73: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for MURRAY

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

38 1 3 6 3 25

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 4 0 1 0 0 3

05. Mental Disorders 16 0 2 4 3 7

06. Diseases of the Nervous System and Sense Organs 5 0 0 2 0 3

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 2 1 0 0 0 1

09. Diseases of the Digestive System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 3 0 0 0 0 3

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 74: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for NICOLLET

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

80 5 2 7 22 44

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 7 1 0 0 0 6

05. Mental Disorders 36 1 2 5 15 13

06. Diseases of the Nervous System and Sense Organs 17 1 0 1 5 10

07. Diseases of the Circulatory System 4 0 0 1 0 3

08. Diseases of the Respiratory System 4 0 0 0 0 4

10. Diseases of the Genitourinary System 1 0 0 0 0 1

14. Congenital Anomalies 2 1 0 0 1 0

16. Symptoms, Signs and Ill-Defined Conditions 3 1 0 0 0 2

17. Injury and Poisoning 4 0 0 0 1 3

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 75: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for NOBLES

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

82 3 1 3 18 57

02. Neoplasms 2 0 0 0 1 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 1 2

05. Mental Disorders 50 0 1 2 11 36

06. Diseases of the Nervous System and Sense Organs 8 0 0 0 2 6

07. Diseases of the Circulatory System 3 0 0 0 0 3

08. Diseases of the Respiratory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 4 0 0 0 0 4

14. Congenital Anomalies 3 2 0 1 0 0

16. Symptoms, Signs and Ill-Defined Conditions 3 1 0 0 2 0

17. Injury and Poisoning 2 0 0 0 1 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 76: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for NORMAN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

34 6 2 1 6 19

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 1 0 0 0 0

05. Mental Disorders 16 4 2 1 2 7

06. Diseases of the Nervous System and Sense Organs 5 0 0 0 0 5

07. Diseases of the Circulatory System 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 2 1 0 0 1 0

17. Injury and Poisoning 2 0 0 0 1 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 2 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 77: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for OLMSTED

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

499 34 25 27 99 314

01. Infectious & Parasitic Diseases 4 0 0 0 0 4

02. Neoplasms 7 0 0 0 1 6

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 38 0 0 0 2 36

04. Diseases of the Blood and Blood-Forming Organs 2 0 0 0 1 1

05. Mental Disorders 161 15 18 17 34 77

06. Diseases of the Nervous System and Sense Organs 105 9 3 5 32 56

07. Diseases of the Circulatory System 34 1 0 0 2 31

08. Diseases of the Respiratory System 7 1 0 0 0 6

09. Diseases of the Digestive System 7 0 0 0 0 7

10. Diseases of the Genitourinary System 6 0 0 0 0 6

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 26 0 1 0 0 25

14. Congenital Anomalies 18 4 2 3 5 4

15. Certain Conditions Originating in the Perinatal Period 5 4 0 0 1 0

16. Symptoms, Signs and Ill-Defined Conditions 8 0 0 1 2 5

17. Injury and Poisoning 67 0 1 1 19 46

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 0 0 0 3

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 78: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for OTTER TAIL

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

239 16 9 14 57 143

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 14 0 0 1 1 12

05. Mental Disorders 129 9 8 11 38 63

06. Diseases of the Nervous System and Sense Organs 27 4 0 1 6 16

07. Diseases of the Circulatory System 9 0 0 0 0 9

08. Diseases of the Respiratory System 8 0 0 0 1 7

09. Diseases of the Digestive System 2 0 0 0 0 2

10. Diseases of the Genitourinary System 2 0 0 0 0 2

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 1 0

13. Diseases of the Musculoskeletal System and Connective Tissue 15 0 0 0 0 15

14. Congenital Anomalies 11 3 1 0 5 2

15. Certain Conditions Originating in the Perinatal Period 2 0 0 1 1 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 13 0 0 0 4 9

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 0 0 0 3

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 79: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for PENNINGTON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

76 1 6 8 17 44

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 5 0 0 0 0 5

05. Mental Disorders 40 1 4 5 12 18

06. Diseases of the Nervous System and Sense Organs 11 0 1 3 0 7

08. Diseases of the Respiratory System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 6 0 0 0 0 6

14. Congenital Anomalies 1 0 1 0 0 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 1 0

17. Injury and Poisoning 8 0 0 0 3 5

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 1 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 80: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for PINE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

71 6 1 5 14 45

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 5 1 0 0 0 4

05. Mental Disorders 26 0 0 5 8 13

06. Diseases of the Nervous System and Sense Organs 11 2 0 0 2 7

07. Diseases of the Circulatory System 5 0 0 0 1 4

08. Diseases of the Respiratory System 3 0 0 0 2 1

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 1 0

13. Diseases of the Musculoskeletal System and Connective Tissue 6 0 0 0 0 6

14. Congenital Anomalies 3 2 1 0 0 0

15. Certain Conditions Originating in the Perinatal Period 1 1 0 0 0 0

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

17. Injury and Poisoning 6 0 0 0 0 6

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 81: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for PIPESTONE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

29 4 0 2 6 17

01. Infectious & Parasitic Diseases 1 1 0 0 0 0

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 12 2 0 1 2 7

06. Diseases of the Nervous System and Sense Organs 6 1 0 0 3 2

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 3 0 0 0 0 3

17. Injury and Poisoning 2 0 0 1 1 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 82: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for POLK

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

156 3 3 2 14 134

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 18 0 0 0 0 18

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 40 0 2 0 9 29

06. Diseases of the Nervous System and Sense Organs 23 2 1 1 2 17

07. Diseases of the Circulatory System 22 0 0 0 1 21

08. Diseases of the Respiratory System 10 0 0 0 0 10

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 18 1 0 0 1 16

14. Congenital Anomalies 2 0 0 1 0 1

15. Certain Conditions Originating in the Perinatal Period 1 0 0 0 1 0

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

17. Injury and Poisoning 12 0 0 0 0 12

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 83: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for POPE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

33 1 0 2 3 27

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

05. Mental Disorders 11 0 0 1 2 8

06. Diseases of the Nervous System and Sense Organs 4 1 0 0 0 3

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 4 0 0 0 0 4

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 2 0 0 1 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 3 0 0 0 1 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 84: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for RAMSEY

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2,659 247 169 118 404 1,721

0 1 0 0 0 1 0

01. Infectious & Parasitic Diseases 39 0 0 0 8 31

02. Neoplasms 22 0 1 0 4 17

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 206 2 0 0 13 191

04. Diseases of the Blood and Blood-Forming Organs 8 0 2 0 4 2

05. Mental Disorders 1,100 146 116 75 206 557

06. Diseases of the Nervous System and Sense Organs 401 36 25 24 76 240

07. Diseases of the Circulatory System 178 2 1 0 9 166

08. Diseases of the Respiratory System 61 2 0 0 2 57

09. Diseases of the Digestive System 24 1 0 0 3 20

10. Diseases of the Genitourinary System 37 2 1 1 6 27

12. Diseases of the Skin and Subcutaneous Tissue 15 1 0 0 2 12

13. Diseases of the Musculoskeletal System and Connective Tissue 252 2 1 1 18 230

14. Congenital Anomalies 88 46 6 12 8 16

15. Certain Conditions Originating in the Perinatal Period 16 2 4 3 6 1

16. Symptoms, Signs and Ill-Defined Conditions 27 0 6 0 3 18

17. Injury and Poisoning 174 2 6 2 35 129

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 10 3 0 0 0 7

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 85: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for RED LAKE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

11 0 1 2 1 7

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 1 0 1 0 0 0

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 1 0

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

15. Certain Conditions Originating in the Perinatal Period 1 0 0 1 0 0

17. Injury and Poisoning 3 0 0 1 0 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 86: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for REDWOOD

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

40 1 5 4 4 26

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 4 1 1 0 0 2

05. Mental Disorders 10 0 0 2 2 6

06. Diseases of the Nervous System and Sense Organs 7 0 0 1 0 6

07. Diseases of the Circulatory System 3 0 1 0 0 2

10. Diseases of the Genitourinary System 1 0 0 0 0 1

11. Complications of Pregnancy, Childbirth, and the Puerperium 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

14. Congenital Anomalies 3 0 1 0 2 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 1 0 0 0

17. Injury and Poisoning 6 0 1 1 0 4

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 87: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for RENVILLE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

41 2 0 3 10 26

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 4 0 0 0 1 3

05. Mental Disorders 19 1 0 2 5 11

06. Diseases of the Nervous System and Sense Organs 4 0 0 1 1 2

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 1 1 0 0 0 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 10 0 0 0 3 7

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 88: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for RICE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

154 8 8 14 38 86

01. Infectious & Parasitic Diseases 2 0 1 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 10 0 1 0 2 7

05. Mental Disorders 83 3 1 12 26 41

06. Diseases of the Nervous System and Sense Organs 18 1 0 1 8 8

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 9 1 0 1 0 7

13. Diseases of the Musculoskeletal System and Connective Tissue 12 0 0 0 0 12

14. Congenital Anomalies 5 3 2 0 0 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 10 0 3 0 2 5

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 89: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for ROCK

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

45 2 1 6 11 25

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

05. Mental Disorders 23 0 0 4 9 10

06. Diseases of the Nervous System and Sense Organs 3 0 1 1 0 1

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

14. Congenital Anomalies 3 2 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 1 1 0

17. Injury and Poisoning 4 0 0 0 1 3

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 90: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for ROSEAU

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

41 2 1 3 8 27

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 1 1

05. Mental Disorders 9 0 0 1 1 7

06. Diseases of the Nervous System and Sense Organs 7 2 0 1 2 2

07. Diseases of the Circulatory System 7 0 0 0 1 6

08. Diseases of the Respiratory System 3 0 0 0 1 2

10. Diseases of the Genitourinary System 3 0 0 1 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 4 0 0 0 0 4

14. Congenital Anomalies 1 0 1 0 0 0

17. Injury and Poisoning 5 0 0 0 2 3

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 91: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for ST. LOUIS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

833 33 31 41 120 608

01. Infectious & Parasitic Diseases 7 0 0 0 1 6

02. Neoplasms 7 0 0 0 1 6

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 55 2 0 0 3 50

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 344 15 18 27 63 221

06. Diseases of the Nervous System and Sense Organs 135 5 5 5 23 97

07. Diseases of the Circulatory System 63 1 0 0 2 60

08. Diseases of the Respiratory System 25 0 0 1 1 23

09. Diseases of the Digestive System 7 0 0 0 0 7

10. Diseases of the Genitourinary System 2 0 0 0 1 1

12. Diseases of the Skin and Subcutaneous Tissue 4 0 0 0 0 4

13. Diseases of the Musculoskeletal System and Connective Tissue 63 0 0 0 2 61

14. Congenital Anomalies 18 6 0 0 5 7

15. Certain Conditions Originating in the Perinatal Period 8 1 2 1 4 0

16. Symptoms, Signs and Ill-Defined Conditions 14 0 0 0 1 13

17. Injury and Poisoning 59 1 1 1 13 43

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 21 2 5 6 0 8

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 92: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for SCOTT

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

278 56 44 21 59 98

01. Infectious & Parasitic Diseases 2 0 0 0 1 1

02. Neoplasms 4 3 1 0 0 0

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 20 6 1 1 3 9

05. Mental Disorders 118 26 19 13 28 32

06. Diseases of the Nervous System and Sense Organs 52 6 11 5 13 17

07. Diseases of the Circulatory System 16 0 0 0 1 15

08. Diseases of the Respiratory System 3 0 0 0 1 2

09. Diseases of the Digestive System 2 0 0 0 0 2

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 7 0 0 0 2 5

14. Congenital Anomalies 21 13 6 0 1 1

15. Certain Conditions Originating in the Perinatal Period 3 0 3 0 0 0

16. Symptoms, Signs and Ill-Defined Conditions 5 1 1 1 0 2

17. Injury and Poisoning 22 1 2 1 9 9

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 0 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 93: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for SHERBURNE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

226 45 24 16 41 100

01. Infectious & Parasitic Diseases 3 1 0 0 0 2

02. Neoplasms 2 0 1 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 8 1 0 0 0 7

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 1 0

05. Mental Disorders 90 18 14 10 18 30

06. Diseases of the Nervous System and Sense Organs 49 9 8 3 10 19

07. Diseases of the Circulatory System 10 1 0 0 0 9

08. Diseases of the Respiratory System 6 1 0 0 0 5

09. Diseases of the Digestive System 4 2 0 0 0 2

10. Diseases of the Genitourinary System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 9 0 0 0 0 9

14. Congenital Anomalies 14 6 1 1 5 1

15. Certain Conditions Originating in the Perinatal Period 4 1 0 1 2 0

16. Symptoms, Signs and Ill-Defined Conditions 6 1 0 0 2 3

17. Injury and Poisoning 15 2 0 1 3 9

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 2 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 94: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for SIBLEY

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

50 8 5 3 9 25

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 5 0 0 0 1 4

05. Mental Disorders 16 1 5 2 2 6

06. Diseases of the Nervous System and Sense Organs 8 3 0 0 2 3

07. Diseases of the Circulatory System 4 1 0 0 0 3

08. Diseases of the Respiratory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

14. Congenital Anomalies 4 2 0 1 1 0

16. Symptoms, Signs and Ill-Defined Conditions 2 1 0 0 0 1

17. Injury and Poisoning 6 0 0 0 3 3

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 95: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for STEARNS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

434 36 24 23 107 244

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 9 0 0 0 3 6

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 12 0 0 0 3 9

04. Diseases of the Blood and Blood-Forming Organs 1 0 1 0 0 0

05. Mental Disorders 176 15 11 14 47 89

06. Diseases of the Nervous System and Sense Organs 85 4 6 6 15 54

07. Diseases of the Circulatory System 22 0 1 0 2 19

08. Diseases of the Respiratory System 15 2 1 0 2 10

09. Diseases of the Digestive System 3 0 0 0 0 3

10. Diseases of the Genitourinary System 8 1 0 0 1 6

12. Diseases of the Skin and Subcutaneous Tissue 2 0 0 0 1 1

13. Diseases of the Musculoskeletal System and Connective Tissue 25 0 1 0 6 18

14. Congenital Anomalies 23 10 2 1 6 4

15. Certain Conditions Originating in the Perinatal Period 4 1 0 1 2 0

16. Symptoms, Signs and Ill-Defined Conditions 6 1 1 0 1 3

17. Injury and Poisoning 39 2 0 1 17 19

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 0 0 1 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 96: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for STEELE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

86 1 4 7 19 55

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

05. Mental Disorders 37 0 1 3 9 24

06. Diseases of the Nervous System and Sense Organs 17 1 1 1 5 9

07. Diseases of the Circulatory System 8 0 0 1 0 7

08. Diseases of the Respiratory System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 4 0 2 0 2 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 1 0

17. Injury and Poisoning 10 0 0 2 2 6

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 97: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for STEVENS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

21 0 1 3 2 15

02. Neoplasms 1 0 0 0 0 1

05. Mental Disorders 11 0 1 2 1 7

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 3 0 0 0 0 3

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 1 0

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 2 0 0 1 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 98: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for SWIFT

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

40 2 0 3 4 31

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 12 0 0 0 1 11

05. Mental Disorders 8 1 0 1 2 4

06. Diseases of the Nervous System and Sense Organs 6 0 0 1 1 4

07. Diseases of the Circulatory System 6 0 0 0 0 6

08. Diseases of the Respiratory System 3 0 0 0 0 3

13. Diseases of the Musculoskeletal System and Connective Tissue 2 1 0 0 0 1

14. Congenital Anomalies 1 0 0 1 0 0

17. Injury and Poisoning 1 0 0 0 0 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 99: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for TODD

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

128 7 4 11 36 70

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 6 0 0 0 3 3

05. Mental Disorders 61 2 0 8 25 26

06. Diseases of the Nervous System and Sense Organs 18 3 2 2 2 9

07. Diseases of the Circulatory System 7 0 0 0 0 7

08. Diseases of the Respiratory System 7 0 0 0 0 7

09. Diseases of the Digestive System 2 0 0 0 0 2

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 10 0 1 0 1 8

14. Congenital Anomalies 7 2 1 1 2 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 1 0

17. Injury and Poisoning 7 0 0 0 2 5

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 100: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for TRAVERSE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

7 1 0 0 2 4

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 2 0

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 1 0 0 0 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 101: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for WABASHA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

74 3 5 1 25 40

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 6 0 0 0 1 5

04. Diseases of the Blood and Blood-Forming Organs 1 0 1 0 0 0

05. Mental Disorders 29 1 3 0 13 12

06. Diseases of the Nervous System and Sense Organs 15 1 0 0 5 9

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 2 0 1 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 1 0 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 1 0

17. Injury and Poisoning 7 1 0 0 1 5

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 6 0 0 0 4 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 102: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for WADENA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

101 8 1 4 21 67

01. Infectious & Parasitic Diseases 1 0 0 0 1 0

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 7 0 0 0 0 7

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 49 3 1 2 14 29

06. Diseases of the Nervous System and Sense Organs 11 0 0 1 3 7

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 3 0 0 0 0 3

10. Diseases of the Genitourinary System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 3 0 0 0 0 3

14. Congenital Anomalies 8 3 0 1 3 1

15. Certain Conditions Originating in the Perinatal Period 3 2 0 0 0 1

17. Injury and Poisoning 5 0 0 0 0 5

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 0 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 103: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for WASECA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

54 7 5 4 19 19

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

05. Mental Disorders 30 1 4 2 15 8

06. Diseases of the Nervous System and Sense Organs 9 4 0 1 2 2

07. Diseases of the Circulatory System 7 1 1 0 0 5

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 1 1 0 0 0 0

17. Injury and Poisoning 1 0 0 0 1 0

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 0 1 1 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 104: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for WASHINGTON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

389 35 20 24 82 228

02. Neoplasms 5 0 0 0 3 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 23 0 0 0 0 23

05. Mental Disorders 148 12 9 20 45 62

06. Diseases of the Nervous System and Sense Organs 81 15 5 3 13 45

07. Diseases of the Circulatory System 25 0 0 0 3 22

08. Diseases of the Respiratory System 6 0 0 0 1 5

09. Diseases of the Digestive System 3 0 0 0 1 2

10. Diseases of the Genitourinary System 4 0 0 0 1 3

13. Diseases of the Musculoskeletal System and Connective Tissue 34 0 0 0 2 32

14. Congenital Anomalies 13 5 2 0 2 4

15. Certain Conditions Originating in the Perinatal Period 4 1 2 1 0 0

16. Symptoms, Signs and Ill-Defined Conditions 5 0 1 0 2 2

17. Injury and Poisoning 35 2 1 0 9 23

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 0 0 0 3

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 105: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for WATONWAN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

29 0 0 4 5 20

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 4 0 0 0 0 4

05. Mental Disorders 8 0 0 3 1 4

06. Diseases of the Nervous System and Sense Organs 4 0 0 1 1 2

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 2 0 0 0 0 2

14. Congenital Anomalies 1 0 0 0 1 0

17. Injury and Poisoning 3 0 0 0 2 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 0 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 106: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for WILKIN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

34 1 4 5 4 20

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

05. Mental Disorders 19 0 3 5 1 10

06. Diseases of the Nervous System and Sense Organs 5 1 1 0 1 2

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 0 0 2 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 107: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for WINONA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

311 36 21 16 48 190

01. Infectious & Parasitic Diseases 3 0 0 0 1 2

02. Neoplasms 5 0 0 0 0 5

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 22 2 0 0 4 16

05. Mental Disorders 139 22 16 7 28 66

06. Diseases of the Nervous System and Sense Organs 41 6 2 1 6 26

07. Diseases of the Circulatory System 20 0 0 0 2 18

08. Diseases of the Respiratory System 6 0 0 0 0 6

10. Diseases of the Genitourinary System 2 0 0 0 0 2

12. Diseases of the Skin and Subcutaneous Tissue 3 0 0 0 0 3

13. Diseases of the Musculoskeletal System and Connective Tissue 29 0 0 0 2 27

14. Congenital Anomalies 15 5 2 4 0 4

15. Certain Conditions Originating in the Perinatal Period 3 0 0 1 2 0

16. Symptoms, Signs and Ill-Defined Conditions 6 1 0 0 0 5

17. Injury and Poisoning 17 0 1 3 3 10

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 108: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for WRIGHT

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

405 75 35 34 88 173

01. Infectious & Parasitic Diseases 3 0 1 0 0 2

02. Neoplasms 5 1 1 0 1 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 18 1 0 0 1 16

05. Mental Disorders 187 35 18 20 48 66

06. Diseases of the Nervous System and Sense Organs 57 6 6 3 16 26

07. Diseases of the Circulatory System 15 0 0 0 0 15

08. Diseases of the Respiratory System 8 1 0 0 0 7

09. Diseases of the Digestive System 2 0 0 0 0 2

10. Diseases of the Genitourinary System 4 0 0 0 1 3

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 19 0 1 0 1 17

14. Congenital Anomalies 33 11 4 6 8 4

15. Certain Conditions Originating in the Perinatal Period 5 2 1 0 2 0

16. Symptoms, Signs and Ill-Defined Conditions 4 1 1 0 0 2

17. Injury and Poisoning 19 0 1 3 7 8

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 25 17 1 2 3 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 109: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for YELLOW MEDICINE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

58 3 3 4 14 34

02. Neoplasms 1 0 0 0 1 0

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 6 0 0 0 0 6

05. Mental Disorders 13 2 1 2 3 5

06. Diseases of the Nervous System and Sense Organs 16 0 1 2 5 8

07. Diseases of the Circulatory System 5 0 0 0 0 5

08. Diseases of the Respiratory System 4 1 0 0 0 3

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 1 1

14. Congenital Anomalies 2 0 0 0 0 2

15. Certain Conditions Originating in the Perinatal Period 2 0 1 0 1 0

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 6 0 0 0 3 3

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 110: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 3: People Receiving CCB Waiver Services for Statewide

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

18,404 1,243 814 958 3,586 11,803

0 1 0 0 0 1 0

01. Infectious & Parasitic Diseases 193 3 2 0 36 152

02. Neoplasms 263 11 8 5 44 195

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1,187 40 12 9 79 1,047

04. Diseases of the Blood and Blood-Forming Organs 43 4 7 2 9 21

05. Mental Disorders 7,446 520 444 571 1,850 4,061

06. Diseases of the Nervous System and Sense Organs 3,111 248 158 178 684 1,843

07. Diseases of the Circulatory System 1,198 19 8 8 63 1,100

08. Diseases of the Respiratory System 464 22 4 6 21 411

09. Diseases of the Digestive System 156 9 0 0 9 138

10. Diseases of the Genitourinary System 187 7 1 3 26 150

11. Complications of Pregnancy, Childbirth, and the Puerperium 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 56 1 0 0 5 50

13. Diseases of the Musculoskeletal System and Connective Tissue 1,274 8 7 1 82 1,176

14. Congenital Anomalies 643 237 78 72 142 114

15. Certain Conditions Originating in the Perinatal Period 127 31 21 24 44 7

16. Symptoms, Signs and Ill-Defined Conditions 225 21 16 7 37 144

17. Injury and Poisoning 1,638 31 39 56 423 1,089

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 191 31 9 16 31 104

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 111: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for ANOKA

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

11 0 0 1 2 8

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 5 0 0 0 2 3

08. Diseases of the Respiratory System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 1 0 0

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 112: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for BECKER

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 1 0 1

05. Mental Disorders 2 0 0 1 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 113: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for BELTRAMI

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

05. Mental Disorders 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 114: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for BIG STONE

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

05. Mental Disorders 1 0 0 0 0 1

07. Diseases of the Circulatory System 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 115: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for BLUE EARTH

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

5 2 0 1 0 2

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 2 2 0 0 0 0

07. Diseases of the Circulatory System 1 0 0 0 0 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 1 0 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 116: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for CARVER

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 0 0 0 0 3

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 117: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for CASS

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 1 0 0 0

05. Mental Disorders 1 0 1 0 0 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 118: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for CHISAGO

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 1 0 0

17. Injury and Poisoning 1 0 0 1 0 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 119: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for CLAY

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 0 1 0 1 1

05. Mental Disorders 2 0 1 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 1 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 120: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for COOK

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 1 1 0 0 0

05. Mental Disorders 1 0 1 0 0 0

14. Congenital Anomalies 1 1 0 0 0 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 121: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for CROW WING

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 1 0 1

05. Mental Disorders 1 0 0 1 0 0

08. Diseases of the Respiratory System 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 122: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for DAKOTA

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

5 0 0 1 1 3

02. Neoplasms 1 0 0 0 1 0

05. Mental Disorders 2 0 0 1 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 123: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for DODGE

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 1 0 0 0

05. Mental Disorders 1 0 1 0 0 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 124: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for DOUGLAS

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 125: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for FREEBORN

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

5 0 0 1 1 3

05. Mental Disorders 2 0 0 1 1 0

07. Diseases of the Circulatory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 126: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for GRANT

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 127: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for HENNEPIN

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

43 2 1 0 13 27

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 1 0 0 0 0

05. Mental Disorders 20 0 1 0 10 9

06. Diseases of the Nervous System and Sense Organs 7 0 0 0 2 5

07. Diseases of the Circulatory System 3 0 0 0 1 2

08. Diseases of the Respiratory System 2 0 0 0 0 2

10. Diseases of the Genitourinary System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 1 1 0 0 0 0

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

17. Injury and Poisoning 2 0 0 0 0 2

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 128: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for HOUSTON

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 129: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for HUBBARD

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 1 3

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

05. Mental Disorders 2 0 0 0 1 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 130: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for ISANTI

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 0 1 2 0 0

05. Mental Disorders 3 0 1 2 0 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 131: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for ITASCA

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

05. Mental Disorders 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 132: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for KANABEC

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 1 0

05. Mental Disorders 1 0 0 0 1 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 133: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for KANDIYOHI

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 1 0 5

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

17. Injury and Poisoning 2 0 0 1 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 134: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for KITTSON

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 1 1 0 0

05. Mental Disorders 2 0 1 1 0 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 135: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for LAC QUI PARLE

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 1 0 0 0 0

06. Diseases of the Nervous System and Sense Organs 1 1 0 0 0 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 136: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for LE SUEUR

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 137: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for LINCOLN

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 138: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for LYON

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 1 3

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 1 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 139: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for MCLEOD

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 140: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for MAHNOMEN

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 1 0 0

06. Diseases of the Nervous System and Sense Organs 1 0 0 1 0 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 141: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for MARTIN

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 142: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for MEEKER

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 0 0 0 1 2

02. Neoplasms 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 1 0

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 143: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for MILLE LACS

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 0 0 1 1 1

5. Mental Disorders 2 0 0 1 1 0

7. Injury and Poisoning 1 0 0 0 0 1

0

1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 144: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for MORRISON

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 2 0 0 0 1

05. Mental Disorders 2 2 0 0 0 0

08. Diseases of the Respiratory System 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 145: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for MURRAY

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

0 0 0 0 2 2

0 0 0 0 2 205. Mental Disorders

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 146: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for NORMAN

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 147: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for OLMSTED

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

14 1 6 3 0 4

02. Neoplasms 2 1 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 9 0 6 3 0 0

08. Diseases of the Respiratory System 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 148: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for OTTER TAIL

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 0 4

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 0 2

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 149: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for PENNINGTON

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

02. Neoplasms 1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 150: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for PINE

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 151: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for PIPESTONE

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

02. Neoplasms 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 152: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for POLK

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 1 3

02. Neoplasms 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 1 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 153: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for REDWOOD

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

02. Neoplasms 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 154: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for RENVILLE

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

02. Neoplasms 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 155: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for RICE

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 156: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for ROCK

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 1 0

08. Diseases of the Respiratory System 1 0 0 0 1 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 157: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for ROSEAU

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 2 0 0 0 0

05. Mental Disorders 1 1 0 0 0 0

06. Diseases of the Nervous System and Sense Organs 1 1 0 0 0 0

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Minnesota Department of Human Service Report run date: Report author:

Continuiing Care Administration 6/27/2012 pwmxg57

Page 158: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for ST. LOUIS

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

16 0 1 0 3 12

02. Neoplasms 1 0 0 0 0 1

05. Mental Disorders 6 0 1 0 2 3

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 1 0

07. Diseases of the Circulatory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 3 0 0 0 0 3

17. Injury and Poisoning 2 0 0 0 0 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 159: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for SCOTT

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 1 0 0 0

06. Diseases of the Nervous System and Sense Organs 1 0 1 0 0 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 160: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for SHERBURNE

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 1 0 0 1 1

16. Symptoms, Signs and Ill-Defined Conditions 1 1 0 0 0 0

17. Injury and Poisoning 2 0 0 0 1 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 161: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for SIBLEY

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 162: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for STEARNS

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

14 0 2 1 7 4

05. Mental Disorders 10 0 2 1 4 3

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 1 0

07. Diseases of the Circulatory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 1 0

17. Injury and Poisoning 1 0 0 0 1 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 163: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for WABASHA

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 164: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for WADENA

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 1 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 1 0 0 0 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 165: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for WASHINGTON

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

7 0 0 4 1 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 5 0 0 4 1 0

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 166: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for WATONWAN

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 1 0 0

17. Injury and Poisoning 1 0 0 1 0 0

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 167: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for WINONA

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 0 4

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

05. Mental Disorders 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 168: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for WRIGHT

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 0 0 0 0 3

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 0 2

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 169: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Appendix 4: People screened but not yet on one of CCB Waiver(s) for Statewide

By Reason for service request And Age

Age Ranges

Reason for service request Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

218 13 17 22 37 129

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 13 1 0 0 1 11

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 11 1 0 0 0 10

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 101 3 16 16 24 42

06. Diseases of the Nervous System and Sense Organs 25 5 1 1 6 12

07. Diseases of the Circulatory System 10 0 0 0 1 9

08. Diseases of the Respiratory System 10 0 0 0 1 9

09. Diseases of the Digestive System 2 0 0 0 0 2

10. Diseases of the Genitourinary System 5 0 0 0 0 5

13. Diseases of the Musculoskeletal System and Connective Tissue 11 0 0 0 1 10

14. Congenital Anomalies 3 2 0 1 0 0

16. Symptoms, Signs and Ill-Defined Conditions 5 1 0 0 0 4

17. Injury and Poisoning 17 0 0 3 2 12

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 0 1 1 1

Minnesota Department of Human Service

Continuiing Care Administration

Report run date:

6/27/2012

Report author:

pwmxg57

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 170: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

Minnesota Department of Human Service

Continuing Care Administration

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

People Residing In Nursing Facility for AITKIN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 0 4

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

07. Diseases of the Circulatory System 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Report run date:

10/14/2011

Report author:

Page 171: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for ANOKA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

78 0 0 0 4 74

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 7 0 0 0 1 6

05. Mental Disorders 15 0 0 0 0 15

06. Diseases of the Nervous System and Sense Organs 15 0 0 0 2 13

07. Diseases of the Circulatory System 11 0 0 0 0 11

08. Diseases of the Respiratory System 5 0 0 0 0 5

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 3 0 0 0 0 3

12. Diseases of the Skin and Subcutaneous Tissue 3 0 0 0 0 3

13. Diseases of the Musculoskeletal System and Connective Tissue 7 0 0 0 0 7

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 4 0 0 0 1 3

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 4 0 0 0 0 4

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 172: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for BECKER

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

17 0 0 0 0 17

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 4 0 0 0 0 4

05. Mental Disorders 4 0 0 0 0 4

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

11. Complications of Pregnancy, Childbirth, and the Puerperium 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 173: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for BELTRAMI

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

26 0 0 0 2 24

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 4 0 0 0 0 4

07. Diseases of the Circulatory System 4 0 0 0 0 4

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 0 0 1

17. Injury and Poisoning 9 0 0 0 2 7

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 174: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for BENTON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

10 0 0 0 0 10

06. Diseases of the Nervous System and Sense Organs 3 0 0 0 0 3

07. Diseases of the Circulatory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 175: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for BIG STONE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 0 0 6

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

05. Mental Disorders 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 176: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for BLUE EARTH

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

16 0 0 0 0 16

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 6 0 0 0 0 6

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

07. Diseases of the Circulatory System 3 0 0 0 0 3

08. Diseases of the Respiratory System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 177: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for BROWN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

7 0 0 0 1 6

06. Diseases of the Nervous System and Sense Organs 3 0 0 0 0 3

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 1 0

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 178: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for CARLTON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 0 0 6

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 179: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for CARVER

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

10 0 0 0 2 8

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

07. Diseases of the Circulatory System 3 0 0 0 0 3

08. Diseases of the Respiratory System 1 0 0 0 1 0

14. Congenital Anomalies 1 0 0 0 1 0

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 180: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for CASS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

12 0 0 0 1 11

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 5 0 0 0 1 4

17. Injury and Poisoning 4 0 0 0 0 4

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 181: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for CHIPPEWA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

5 0 0 0 0 5

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 182: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for CHISAGO

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 0 0 6

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 183: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for CLAY

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

20 0 0 0 0 20

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 4 0 0 0 0 4

06. Diseases of the Nervous System and Sense Organs 5 0 0 0 0 5

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 3 0 0 0 0 3

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 184: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for CLEARWATER

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 185: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for COTTONWOOD

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 0 0 0 0 3

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

07. Diseases of the Circulatory System 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 186: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for CROW WING

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

19 0 0 0 1 18

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 6 0 0 0 0 6

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 1 0

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 187: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for DAKOTA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

59 0 0 0 2 57

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 7 0 0 0 0 7

05. Mental Disorders 10 0 0 0 0 10

06. Diseases of the Nervous System and Sense Organs 9 0 0 0 1 8

07. Diseases of the Circulatory System 8 0 0 0 0 8

08. Diseases of the Respiratory System 3 0 0 0 0 3

09. Diseases of the Digestive System 2 0 0 0 0 2

10. Diseases of the Genitourinary System 2 0 0 0 0 2

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 5 0 0 0 0 5

14. Congenital Anomalies 2 0 0 0 0 2

17. Injury and Poisoning 6 0 0 0 1 5

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 0 2

No LTC Screening Found 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 188: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for DODGE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 189: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for DOUGLAS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 0 4

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 190: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for FARIBAULT

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 0 0 6

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

17. Injury and Poisoning 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 191: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for FILLMORE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

13 0 0 0 2 11

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 3 0 0 0 1 2

07. Diseases of the Circulatory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 1 0

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 3 0 0 0 0 3

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 192: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for FREEBORN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

18 0 0 0 0 18

05. Mental Disorders 4 0 0 0 0 4

06. Diseases of the Nervous System and Sense Organs 3 0 0 0 0 3

07. Diseases of the Circulatory System 6 0 0 0 0 6

10. Diseases of the Genitourinary System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 193: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for GOODHUE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

36 0 0 0 1 35

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

05. Mental Disorders 3 0 0 0 0 3

06. Diseases of the Nervous System and Sense Organs 15 0 0 0 0 15

07. Diseases of the Circulatory System 3 0 0 0 0 3

08. Diseases of the Respiratory System 3 0 0 0 0 3

09. Diseases of the Digestive System 1 0 0 0 0 1

17. Injury and Poisoning 7 0 0 0 1 6

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 194: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for GRANT

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 195: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for HENNEPIN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

723 0 0 0 42 681

01. Infectious & Parasitic Diseases 8 0 0 0 1 7

02. Neoplasms 17 0 0 0 1 16

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 42 0 0 0 2 40

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 223 0 0 0 7 216

06. Diseases of the Nervous System and Sense Organs 113 0 0 0 9 104

07. Diseases of the Circulatory System 89 0 0 0 5 84

08. Diseases of the Respiratory System 38 0 0 0 2 36

09. Diseases of the Digestive System 24 0 0 0 1 23

10. Diseases of the Genitourinary System 16 0 0 0 0 16

12. Diseases of the Skin and Subcutaneous Tissue 13 0 0 0 0 13

13. Diseases of the Musculoskeletal System and Connective Tissue 20 0 0 0 0 20

14. Congenital Anomalies 5 0 0 0 2 3

16. Symptoms, Signs and Ill-Defined Conditions 23 0 0 0 2 21

17. Injury and Poisoning 76 0 0 0 10 66

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 15 0 0 0 0 15

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 196: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for HOUSTON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

5 0 0 0 1 4

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

17. Injury and Poisoning 3 0 0 0 1 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 197: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for HUBBARD

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

10 0 0 0 0 10

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 3 0 0 0 0 3

07. Diseases of the Circulatory System 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 198: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for ISANTI

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

9 0 0 0 0 9

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 3 0 0 0 0 3

06. Diseases of the Nervous System and Sense Organs 3 0 0 0 0 3

09. Diseases of the Digestive System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 199: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for ITASCA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

19 0 0 0 1 18

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 1 1

05. Mental Disorders 4 0 0 0 0 4

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

07. Diseases of the Circulatory System 5 0 0 0 0 5

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 200: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for JACKSON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

5 0 0 0 1 4

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 1 0

09. Diseases of the Digestive System 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 201: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for KANABEC

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 202: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for KANDIYOHI

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

20 0 0 0 0 20

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 4 0 0 0 0 4

05. Mental Disorders 3 0 0 0 0 3

06. Diseases of the Nervous System and Sense Organs 8 0 0 0 0 8

07. Diseases of the Circulatory System 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 203: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for KITTSON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 0 0 6

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 204: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for KOOCHICHING

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

8 0 0 0 0 8

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 205: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for LAC QUI PARLE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 206: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for LAKE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 207: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for LE SUEUR

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

9 0 0 0 0 9

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 208: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for LYON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

10 0 0 0 1 9

05. Mental Disorders 4 0 0 0 0 4

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

07. Diseases of the Circulatory System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 1 0

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 209: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for MCLEOD

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

17 0 0 0 1 16

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 4 0 0 0 0 4

07. Diseases of the Circulatory System 6 0 0 0 1 5

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 2 0 0 0 0 2

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 210: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for MAHNOMEN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 1 3

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 1 0

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 211: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for MARSHALL

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 0 4

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

07. Diseases of the Circulatory System 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 212: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for MARTIN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 0 0 0 0 3

02. Neoplasms 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 213: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for MEEKER

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

11 0 0 0 0 11

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 3 0 0 0 0 3

17. Injury and Poisoning 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 214: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for MILLE LACS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

10 0 0 0 0 10

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 3 0 0 0 0 3

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 215: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for MORRISON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

9 0 0 0 1 8

05. Mental Disorders 3 0 0 0 0 3

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

07. Diseases of the Circulatory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 1 0

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 216: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for MOWER

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

9 0 0 0 0 9

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

No LTC Screening Found 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 217: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for NICOLLET

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

3 0 0 0 0 3

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 218: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for NOBLES

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

5 0 0 0 0 5

05. Mental Disorders 1 0 0 0 0 1

07. Diseases of the Circulatory System 3 0 0 0 0 3

08. Diseases of the Respiratory System 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 219: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for NORMAN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 0 4

05. Mental Disorders 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 220: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for OLMSTED

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

19 0 0 0 1 18

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 3 0 0 0 0 3

06. Diseases of the Nervous System and Sense Organs 7 0 0 0 1 6

07. Diseases of the Circulatory System 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 221: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for OTTER TAIL

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

26 0 0 0 1 25

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 3 0 0 0 0 3

06. Diseases of the Nervous System and Sense Organs 6 0 0 0 0 6

07. Diseases of the Circulatory System 3 0 0 0 0 3

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 3 0 0 0 1 2

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 3 0 0 0 0 3

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 222: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for PENNINGTON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 0 4

02. Neoplasms 1 0 0 0 0 1

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 223: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for PINE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

11 0 0 0 1 10

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 5 0 0 0 1 4

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

17. Injury and Poisoning 1 0 0 0 0 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 224: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for PIPESTONE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

5 0 0 0 0 5

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 225: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for POLK

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

16 0 0 0 2 14

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

05. Mental Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 5 0 0 0 0 5

07. Diseases of the Circulatory System 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

17. Injury and Poisoning 2 0 0 0 2 0

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 226: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for POPE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 227: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for RAMSEY

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

265 0 0 2 14 249

01. Infectious & Parasitic Diseases 3 0 0 0 2 1

02. Neoplasms 6 0 0 1 0 5

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 25 0 0 0 1 24

05. Mental Disorders 60 0 0 0 3 57

06. Diseases of the Nervous System and Sense Organs 39 0 0 0 2 37

07. Diseases of the Circulatory System 41 0 0 0 1 40

08. Diseases of the Respiratory System 15 0 0 0 0 15

09. Diseases of the Digestive System 5 0 0 0 0 5

10. Diseases of the Genitourinary System 13 0 0 1 0 12

12. Diseases of the Skin and Subcutaneous Tissue 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 12 0 0 0 1 11

14. Congenital Anomalies 2 0 0 0 0 2

16. Symptoms, Signs and Ill-Defined Conditions 10 0 0 0 0 10

17. Injury and Poisoning 21 0 0 0 4 17

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 8 0 0 0 0 8

No LTC Screening Found 3 0 0 0 0 3

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 228: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for RED LAKE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

07. Diseases of the Circulatory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 229: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for REDWOOD

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 1 0 5

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

07. Diseases of the Circulatory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 1 0 0

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 230: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for RENVILLE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

9 0 0 1 0 8

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 3 0 0 0 0 3

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

09. Diseases of the Digestive System 1 0 0 0 0 1

17. Injury and Poisoning 2 0 0 1 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 231: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for RICE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

9 0 0 0 0 9

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

07. Diseases of the Circulatory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 232: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for ROCK

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 0 4

02. Neoplasms 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 233: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for ROSEAU

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 1 0 5

02. Neoplasms 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 2 0 0 1 0 1

07. Diseases of the Circulatory System 2 0 0 0 0 2

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 234: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for ST. LOUIS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

101 0 0 0 6 95

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 7 0 0 0 0 7

05. Mental Disorders 10 0 0 0 1 9

06. Diseases of the Nervous System and Sense Organs 25 0 0 0 1 24

07. Diseases of the Circulatory System 14 0 0 0 0 14

08. Diseases of the Respiratory System 5 0 0 0 1 4

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 3 0 0 0 0 3

12. Diseases of the Skin and Subcutaneous Tissue 2 0 0 0 1 1

13. Diseases of the Musculoskeletal System and Connective Tissue 4 0 0 0 0 4

14. Congenital Anomalies 3 0 0 0 1 2

16. Symptoms, Signs and Ill-Defined Conditions 4 0 0 0 0 4

17. Injury and Poisoning 13 0 0 0 1 12

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 8 0 0 0 0 8

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 235: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for SCOTT

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

21 0 0 0 2 19

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 3 0 0 0 1 2

07. Diseases of the Circulatory System 6 0 0 0 0 6

09. Diseases of the Digestive System 1 0 0 0 1 0

10. Diseases of the Genitourinary System 2 0 0 0 0 2

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

17. Injury and Poisoning 2 0 0 0 0 2

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 236: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for SHERBURNE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

12 0 0 0 1 11

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 1 1

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 1 0 0 0 0 1

17. Injury and Poisoning 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 237: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for SIBLEY

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

7 0 0 0 0 7

02. Neoplasms 1 0 0 0 0 1

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

07. Diseases of the Circulatory System 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

10. Diseases of the Genitourinary System 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 238: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for STEARNS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

35 0 0 0 0 35

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

04. Diseases of the Blood and Blood-Forming Organs 1 0 0 0 0 1

05. Mental Disorders 6 0 0 0 0 6

06. Diseases of the Nervous System and Sense Organs 9 0 0 0 0 9

07. Diseases of the Circulatory System 5 0 0 0 0 5

08. Diseases of the Respiratory System 3 0 0 0 0 3

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 5 0 0 0 0 5

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 239: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for STEELE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

4 0 0 0 0 4

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

07. Diseases of the Circulatory System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 240: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for STEVENS

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 1 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 1 0 0

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 241: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for SWIFT

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 0 0 6

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 2 0 0 0 0 2

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 242: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for TODD

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

9 0 0 0 0 9

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

02. Neoplasms 1 0 0 0 0 1

05. Mental Disorders 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

08. Diseases of the Respiratory System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

17. Injury and Poisoning 3 0 0 0 0 3

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 243: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for TRAVERSE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

07. Diseases of the Circulatory System 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 244: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for WABASHA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 0 0 6

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 245: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for WADENA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

8 0 0 0 0 8

06. Diseases of the Nervous System and Sense Organs 3 0 0 0 0 3

07. Diseases of the Circulatory System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 246: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for WASECA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

7 0 0 0 0 7

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 2 0 0 0 0 2

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 247: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for WASHINGTON

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

35 0 0 0 4 31

02. Neoplasms 2 0 0 0 0 2

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 6 0 0 0 0 6

05. Mental Disorders 4 0 0 0 0 4

06. Diseases of the Nervous System and Sense Organs 7 0 0 0 2 5

07. Diseases of the Circulatory System 8 0 0 0 0 8

10. Diseases of the Genitourinary System 1 0 0 0 0 1

14. Congenital Anomalies 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

17. Injury and Poisoning 5 0 0 0 2 3

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 248: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for WATONWAN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

5 0 0 0 0 5

02. Neoplasms 1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 2 0 0 0 0 2

07. Diseases of the Circulatory System 1 0 0 0 0 1

No LTC Screening Found 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 249: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for WILKIN

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

6 0 0 0 0 6

05. Mental Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

09. Diseases of the Digestive System 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

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Page 250: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for WINONA

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

20 0 0 0 0 20

01. Infectious & Parasitic Diseases 1 0 0 0 0 1

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 2 0 0 0 0 2

06. Diseases of the Nervous System and Sense Organs 6 0 0 0 0 6

07. Diseases of the Circulatory System 5 0 0 0 0 5

08. Diseases of the Respiratory System 1 0 0 0 0 1

09. Diseases of the Digestive System 2 0 0 0 0 2

11. Complications of Pregnancy, Childbirth, and the Puerperium 1 0 0 0 0 1

16. Symptoms, Signs and Ill-Defined Conditions 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 251: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for WRIGHT

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

19 0 0 0 0 19

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 1 0 0 0 0 1

05. Mental Disorders 4 0 0 0 0 4

06. Diseases of the Nervous System and Sense Organs 5 0 0 0 0 5

07. Diseases of the Circulatory System 4 0 0 0 0 4

08. Diseases of the Respiratory System 1 0 0 0 0 1

12. Diseases of the Skin and Subcutaneous Tissue 1 0 0 0 0 1

13. Diseases of the Musculoskeletal System and Connective Tissue 2 0 0 0 0 2

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 252: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for YELLOW MEDICINE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

2 0 0 0 0 2

05. Mental Disorders 1 0 0 0 0 1

17. Injury and Poisoning 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 253: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for MILLE-LACS-BAND TRIBE

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1 0 0 0 0 1

06. Diseases of the Nervous System and Sense Organs 1 0 0 0 0 1

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

Page 254: Annual Report on the Use and Availability of HCBS Waivers ... · July 2012 . DHS-6568-ENG 7-12. Minnesota Department of Human Services ... Minnesota Department of Human Services November

People Residing In Nursing Facility for Statewide

By Primary Diagnosis And Age

Age Ranges

ICD-9-CM Category Total 0 - 12 13 - 17 18 - 22 23 -39 40 - 64

1,985 0 0 6 97 1,882

01. Infectious & Parasitic Diseases 19 0 0 0 3 16

02. Neoplasms 48 0 0 1 1 46

03. Endocrine, Nutritional and Metabolic Diseases & Immunity Disorders 160 0 0 0 5 155

04. Diseases of the Blood and Blood-Forming Organs 6 0 0 0 0 6

05. Mental Disorders 411 0 0 0 11 400

06. Diseases of the Nervous System and Sense Organs 382 0 0 1 22 359

07. Diseases of the Circulatory System 283 0 0 0 8 275

08. Diseases of the Respiratory System 98 0 0 0 5 93

09. Diseases of the Digestive System 56 0 0 0 2 54

10. Diseases of the Genitourinary System 51 0 0 1 1 49

11. Complications of Pregnancy, Childbirth, and the Puerperium 2 0 0 0 0 2

12. Diseases of the Skin and Subcutaneous Tissue 37 0 0 0 2 35

13. Diseases of the Musculoskeletal System and Connective Tissue 85 0 0 0 1 84

14. Congenital Anomalies 21 0 0 0 4 17

16. Symptoms, Signs and Ill-Defined Conditions 62 0 0 1 2 59

17. Injury and Poisoning 205 0 0 2 30 173

18. Supplementary Classification of Factors Influencing Health Status and Conact with Health Services 53 0 0 0 0 53

No LTC Screening Found 6 0 0 0 0 6

Minnesota Department of Human Service

Continuing Care Administration

Report run date:

10/14/2011

Report author:

Data Source: Medicaid Management Information System (MMIS) Screening & Service Agreement Data

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Minnesota Department of Human Services

Continuing Care Administration

Appendix 6: CAC, CADI, and BI Aggregate Waiver Funds Allocated But Not Authorized

FY 2009 FY 2010 FY 2011 (As of 10-1-2011)

Allocated - Authorized Allocated - Authorized Allocated - AuthorizedCounty $ Allocated $ Authorized $ Allocated $ Authorized $ Allocated $ Authorized

Name (in (in (in (in (in (in (in (in (in

thousands) thousands) (%) thousands) thousands) (%) thousands) thousands) (%)thousands) thousands) thousands)

Aitkin $2,349 $1,927 $422 18.0% $2,349 $1,726 $623 26.5% $2,510 $2,024 $486 19.3%

Anoka $38,611 $37,480 $1,131 2.9% $42,595 $41,700 $895 2.1% $48,554 $47,441 $1,113 2.3%

Becker $6,565 $5,995 $570 8.7% $8,216 $7,435 $781 9.5% $8,823 $7,778 $1,045 11.8%

Beltrami $5,021 $4,856 $165 3.3% $5,998 $5,531 $467 7.8% $6,899 $6,281 $617 8.9%

Benton $4,971 $4,460 $511 10.3% $5,169 $4,479 $691 13.4% $5,630 $4,717 $914 16.2%

Big Stone $991 $885 $107 10.8% $1,072 $1,020 $51 4.8% $1,197 $887 $310 25.9%

Blue Earth $9,246 $8,962 $284 3.1% $10,118 $9,355 $763 7.5% $11,112 $10,754 $358 3.2%

Brown $6,491 $5,304 $1,187 18.3% $7,109 $6,269 $840 11.8% $7,604 $6,100 $1,504 19.8%

Carlton $7,556 $7,425 $131 1.7% $7,904 $7,343 $561 7.1% $8,478 $8,119 $359 4.2%

Carver $7,674 $7,492 $182 2.4% $9,108 $8,990 $119 1.3% $10,566 $10,316 $250 2.4%

Cass $4,021 $3,502 $519 12.9% $4,077 $3,195 $882 21.6% $4,402 $3,668 $734 16.7%

Chippewa $1,395 $1,284 $112 8.0% $1,429 $1,269 $160 11.2% $1,508 $1,351 $157 10.4%

Chisago $10,806 $9,459 $1,347 12.5% $11,303 $10,603 $700 6.2% $11,655 $10,867 $788 6.8%

Clay $19,922 $19,017 $905 4.5% $20,851 $19,042 $1,809 8.7% $22,115 $20,147 $1,968 8.9%

Clearwater $960 $833 $126 13.2% $1,110 $960 $150 13.5% $1,411 $1,198 $213 15.1%

Cook $776 $668 $108 13.9% $698 $659 $39 5.6% $728 $564 $164 22.5%

Cottonwood $1,045 $842 $204 19.5% $1,105 $910 $194 17.6% $1,168 $930 $238 20.4%

Crow Wing $8,449 $6,590 $1,858 22.0% $8,924 $6,949 $1,975 22.1% $9,394 $7,598 $1,796 19.1%

Dakota $69,913 $68,644 $1,269 1.8% $75,431 $72,131 $3,301 4.4% $84,438 $78,535 $5,904 7.0%

Dodge $1,659 $1,239 $420 25.3% $1,813 $1,369 $445 24.5% $2,078 $1,765 $313 15.1%

Douglas $6,590 $6,081 $509 7.7% $7,002 $6,452 $549 7.8% $7,457 $7,035 $422 5.7%

Faribault $745 $806 -$61 -8.2% $968 $974 -$6 -0.7% $1,260 $1,155 $105 8.3%

Fillmore $2,036 $2,021 $15 0.7% $2,177 $2,045 $132 6.1% $2,233 $1,802 $432 19.3%

Freeborn $2,147 $1,800 $347 16.2% $2,345 $1,998 $347 14.8% $2,528 $2,284 $244 9.6%

Goodhue $5,722 $5,252 $469 8.2% $6,642 $5,962 $679 10.2% $7,457 $6,523 $934 12.5%

Grant $948 $913 $36 3.8% $1,086 $916 $169 15.6% $1,290 $976 $313 24.3%

Hennepin $148,300 $141,612 $6,688 4.5% $162,750 $146,326 $16,425 10.1% $190,361 $173,250 $17,112 9.0%

Houston $2,172 $1,488 $684 31.5% $2,437 $1,626 $811 33.3% $2,609 $1,649 $960 36.8%

Hubbard $2,902 $2,517 $384 13.2% $3,153 $2,926 $227 7.2% $3,352 $2,982 $369 11.0%

Isanti $4,352 $4,027 $325 7.5% $4,624 $4,135 $489 10.6% $5,188 $4,646 $542 10.5%

Itasca $7,803 $7,144 $659 8.4% $8,157 $7,544 $613 7.5% $8,530 $8,075 $455 5.3%

Jackson $1,804 $1,285 $520 28.8% $1,813 $1,386 $427 23.6% $1,933 $1,448 $485 25.1%

Kanabec $2,479 $2,375 $104 4.2% $2,598 $2,522 $77 2.9% $2,738 $2,674 $64 2.3%

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Kandiyohi $10,512 $9,264 $1,248 11.9% $11,404 $10,325 $1,078 9.5% $12,411 $10,772 $1,639 13.2%

Kittson $530 $409 $122 22.9% $563 $546 $17 3.0% $587 $361 $226 38.4%

Koochiching $2,613 $2,076 $537 20.6% $2,644 $2,280 $364 13.8% $2,795 $2,535 $260 9.3%

Lac Qui

Parle $1,438 $1,019 $419 29.1% $1,426 $1,151 $275 19.3% $1,475 $1,276 $199 13.5%

Lake $2,381 $2,142 $239 10.0% $2,563 $2,278 $285 11.1% $2,736 $2,182 $554 20.2%

Lake of the

Woods $688 $577 $111 16.1% $843 $813 $29 3.5% $911 $752 $158 17.4%

Le Sueur $2,733 $2,623 $110 4.0% $3,386 $3,219 $167 4.9% $3,724 $3,333 $391 10.5%

Lincoln $1,721 $770 $950 55.2% $1,730 $912 $818 47.3% $1,824 $870 $953 52.3%

Lyon $7,078 $7,229 -$152 -2.1% $7,620 $7,590 $30 0.4% $8,484 $8,924 -$440 -5.2%

Mc Leod $5,568 $5,071 $496 8.9% $5,677 $5,149 $528 9.3% $6,081 $5,697 $384 6.3%

Mahnomen $1,013 $950 $63 6.2% $1,021 $857 $164 16.1% $1,073 $896 $177 16.5%

Marshall $968 $927 $42 4.3% $1,004 $883 $122 12.1% $1,149 $1,050 $99 8.6%

Martin $3,228 $2,762 $467 14.5% $3,533 $3,062 $471 13.3% $3,781 $3,427 $355 9.4%

Meeker $3,129 $2,611 $519 16.6% $3,743 $3,101 $642 17.1% $4,224 $3,672 $552 13.1%

Mille Lacs $7,300 $6,526 $774 10.6% $7,744 $6,813 $930 12.0% $8,435 $7,822 $613 7.3%

Morrison $3,507 $3,017 $490 14.0% $3,887 $3,249 $639 16.4% $4,166 $3,561 $605 14.5%

Mower $4,809 $4,390 $419 8.7% $5,830 $5,620 $211 3.6% $6,400 $6,372 $28 0.4%

Murray $1,017 $855 $161 15.9% $1,223 $958 $264 21.6% $1,288 $1,190 $98 7.6%

Nicollet $4,380 $3,999 $380 8.7% $4,618 $4,288 $330 7.1% $5,122 $4,816 $306 6.0%

Nobles $2,676 $2,448 $228 8.5% $3,025 $2,725 $301 9.9% $3,263 $3,197 $66 2.0%

Norman $1,175 $1,028 $147 12.5% $1,299 $1,141 $158 12.2% $1,514 $1,350 $164 10.8%

Olmsted $21,632 $20,601 $1,032 4.8% $25,745 $23,976 $1,769 6.9% $28,290 $26,788 $1,503 5.3%

Otter Tail $9,789 $8,672 $1,117 11.4% $10,470 $9,644 $826 7.9% $10,908 $9,891 $1,017 9.3%

Pennington $3,358 $2,945 $413 12.3% $3,522 $2,957 $564 16.0% $3,729 $3,238 $491 13.2%

Pine $3,195 $2,869 $326 10.2% $3,174 $2,905 $269 8.5% $3,266 $2,918 $348 10.7%

Pipestone $1,062 $917 $144 13.6% $1,131 $1,051 $80 7.1% $1,312 $1,192 $120 9.1%

Polk $6,229 $6,186 $43 0.7% $6,986 $5,895 $1,091 15.6% $7,746 $6,496 $1,250 16.1%

Pope $1,871 $1,425 $446 23.9% $1,884 $1,572 $312 16.6% $1,879 $1,589 $290 15.4%

Ramsey $96,925 $89,098 $7,827 8.1% $103,984 $102,523 $1,461 1.4% $117,173 $109,940 $7,232 6.2%

Red Lake $344 $261 $84 24.3% $339 $325 $14 4.3% $379 $308 $72 18.9%

Redwood $2,063 $1,832 $231 11.2% $2,144 $1,836 $307 14.3% $2,359 $2,241 $118 5.0%

Renville $3,057 $2,236 $821 26.9% $3,047 $2,196 $851 27.9% $3,209 $2,253 $956 29.8%

Rice $6,376 $5,698 $678 10.6% $6,939 $6,585 $354 5.1% $7,651 $7,158 $493 6.4%

Rock $2,113 $1,900 $213 10.1% $2,135 $1,873 $262 12.3% $2,244 $1,720 $524 23.3%

Roseau $2,408 $2,090 $318 13.2% $2,419 $2,135 $284 11.7% $2,539 $2,238 $301 11.9%

St. Louis $42,040 $39,798 $2,241 5.3% $44,508 $37,939 $6,569 14.8% $46,600 $37,478 $9,122 19.6%

Scott $10,254 $9,744 $510 5.0% $11,925 $10,918 $1,007 8.4% $13,704 $13,210 $494 3.6%

Minnesota Department of Human Services

Continuing Care Administration

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Sherburne $8,574 $8,164 $411 4.8% $9,285 $8,877 $408 4.4% $10,224 $9,474 $750 7.3%

Sibley $1,888 $1,806 $81 4.3% $2,113 $1,844 $269 12.7% $2,375 $2,055 $320 13.5%

Stearns $18,030 $16,235 $1,795 10.0% $19,987 $18,888 $1,099 5.5% $22,352 $21,854 $498 2.2%

Steele $4,192 $3,497 $695 16.6% $4,461 $3,443 $1,017 22.8% $4,748 $3,671 $1,077 22.7%

Stevens $1,248 $1,113 $135 10.8% $1,328 $1,254 $74 5.6% $1,439 $1,360 $78 5.4%

Swift $1,331 $1,269 $62 4.7% $1,586 $1,464 $123 7.7% $1,769 $1,725 $44 2.5%

Todd $5,376 $4,835 $541 10.1% $6,027 $5,487 $539 9.0% $6,574 $6,034 $540 8.2%

Traverse $444 $263 $182 40.9% $476 $334 $142 29.8% $624 $499 $125 20.0%

Wabasha $2,676 $2,380 $296 11.1% $2,889 $2,648 $241 8.4% $3,165 $2,927 $239 7.5%

Wadena $3,549 $3,107 $442 12.4% $4,083 $3,506 $577 14.1% $4,548 $4,012 $536 11.8%

Waseca $2,167 $2,039 $128 5.9% $2,750 $2,604 $146 5.3% $3,118 $2,944 $174 5.6%

Washington $15,461 $15,077 $384 2.5% $17,470 $15,442 $2,028 11.6% $19,957 $16,902 $3,055 15.3%

Watonwan $1,572 $1,278 $295 18.7% $1,651 $1,386 $265 16.0% $1,784 $1,587 $196 11.0%

Wilkin $2,027 $1,922 $105 5.2% $2,075 $2,086 -$11 -0.5% $2,159 $2,164 -$5 -0.2%

Winona $10,399 $8,920 $1,479 14.2% $11,392 $10,623 $769 6.8% $12,337 $11,657 $680 5.5%

Wright $17,185 $16,343 $842 4.9% $18,754 $17,097 $1,657 8.8% $20,281 $19,368 $914 4.5%

Yellow

Medicine $3,231 $2,557 $674 20.9% $3,467 $3,129 $338 9.8% $4,088 $3,428 $660 16.1%

Leech Lake

Tribe $60 $30 $30 50.4% $121 $166 -$45 -37.1% $172 $99 $73 42.3%

White Earth

Tribe $0 $0 $0 0.0% $0 $0 $0 0.0% $246 $153 $93 37.9%

State Wide $777,014 $721,986 $55,028 7.1% $847,183 $777,316 $69,866 8.2% $943,600 $860,167 $83,433 8.8%

Minnesota Department of Human Services

Continuing Care Administration