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Discontinuation of the residential care waiver service

DHS discontinued the BI, CADI and EW residential care service, effective June 30, 2018. The residential care waiver service does not include these other waiver services: customized living, foster care and supported living services (SLS).

This page is a resource for residential care providers and lead agencies to follow DHS’ progress in discontinuing the residential care waiver service. It includes:

  • Current status of the waiver amendments
  • Timelines for residential care service authorizations
  • Information about a customized-living option for current BI and CADI residential care providers
  • Information about what lead agencies can do now
  • DHS’ next steps
  • Frequently asked questions.
  • Current status of waiver amendments

    The Centers for Medicare & Medicaid Services (CMS) approved the amendment to discontinue the residential care service under the BI, CADI and EW waivers.

    Timelines for residential care service authorizations

    As of July 1, 2017, a person cannot receive a service authorization for residential care unless he or she was receiving this service as of June 30, 2017.

    Exception

    From July 1, 2017 to June 30, 2018, DHS may have approved a new service authorization for a person who was not receiving residential care on June 30, 2017, if the person met both of the following requirements:

  • • Was discharged from an institutional setting (e.g., nursing facility, hospital, ICF/DD, IMD), or a short-term crisis or stabilization program
  • • Received the residential care service immediately before he or she entered the institutional setting, short-term crisis or stabilization program.
  • Customized-living option for BI and CADI residential care providers

    CMS’ additional guidance on the HCBS settings rule in 2016 led Minnesota to pursue tiered standards as an option for some existing providers and services. Based on this guidance and continued public input from stakeholders, DHS added an amendment in the BI and CADI waiver amendment package to support more transition options for people affected by the discontinuation of the residential care waiver service.

    This added BI and CADI waiver amendment allows a residential care provider to meet the customized living service "size and location – size exception" policy if it currently meets the residential care service "size and location – size exception" policy.

    This provision allowed former residential care providers to enroll as customized living providers. The residential care provider that transitions to customized living must also comply with HCBS settings rule requirements and complete a HCBS Provider Attestation for the customized living setting. For more information, see DHS – Transition plan for home and community-based settings.

    EW does not have the “size and location – size exception” policy. Therefore, this exception was not needed for providers who served only people on EW.

    Cost-neutral corporate foster care moratorium exception

    The 2017 Minnesota Legislature created a cost-neutral exception to the moratorium on corporate foster care and community residential settings for people on the BI and CADI waivers affected by the discontinuation of the residential care waiver service.

    To request an exception, the lead agency followed the current process as outlined on CBSM – Moratorium on corporate foster care and community residential settings. Find exceptions to the foster care moratorium on the CBSM page and in Minn. Stat. §245A.03, subd. 7(a).

    What lead agencies can do now

    Lead agencies may continue transition planning for people affected by this change using the Person-Centered, Informed Choice and Transition Protocol, DHS-3825 (PDF) and the My Move Plan Summary, DHS-3936 (PDF). For more information on the move plan summary, see the July 14, 2016, eList announcement.

    For the discontinuation of residential care, the lead agency must provide each person with one of the following items 30 days before transitioning him or her from residential care to different service(s):

  • Notice of action
  • • Denial, termination or reduction (DTR) notice of action if he/she is enrolled in an MCO.
  • DHS’ steps

    DHS took the following next steps:

    1. Coordinated a training and technical assistance webinar for lead agencies and residential care providers (see the June 28, 2017, Discontinuation of Residential Care presentation [PDF]). This webinar identified tools and provided information to support a person’s transition to alternative services.

    2. Sent a formal notice to people who received residential care that the service will be discontinued, as outlined in the waiver amendments.

    3. Communicated the following to residential care providers:

  • • Notice that the service will be discontinued
  • • Requirements a residential care provider must meet to become a customized living provider.
  • • Steps a provider must take to demonstrate compliance with the HCBS settings rule requirements.
  • Frequently asked questions

    How many people did this change affect?

    This change affected approximately 192 people on the BI, CADI and EW waivers. Other waiver services are still available to people on the BI, CADI and EW waiver programs that will support their unique needs, either in their own homes or in provider settings.

    Why make this change?

    We pursued this change for a number of reasons, including:

  • • Many people who received residential care require more support than the service is allowed to provide
  • • The "boarding and lodging with special service registration requirement" (Minn. Stat. §157.17) does not provide the health, safety and rights standards required for people eligible for home and community-based waiver programs
  • • Changing the special services registration to meet higher licensing standards would unnecessarily affect approximately 3,500 people served in boarding and lodging facilities who are not on a waiver program (For more details, see Could residential care providers meet new standards? below)
  • • Other waiver services have appropriate levels of service and standards for people on the BI, CADI and EW waivers.
  • Who received the residential care service?

    Of the 192 people who received residential care:

  • • 48 percent live in St. Louis County
  • • 53 percent are older than 50 years old
  • • 70 percent receive outpatient mental health services.
  • How many providers offered residential care?

    Twenty providers offered residential care as a waiver service.

    Could residential care providers meet new standards?

    Adding new standards to residential care would result in service duplication of other HCBS waiver services. Extending Chapter 245D licensing standards to boarding and lodging facilities with special service registration would require higher-than-necessary standards of care for facilities that are appropriately serving other people.

    What options are available for residential care providers?

    A provider may choose to offer other waiver services to people who formerly used the residential care service. To address customized living size and setting limitations under BI and CADI, DHS created an option for BI and CADI residential care providers to transition to customized living. For more information, see the customized-living option for current BI and CADI residential care providers section.

    Providers will need to ensure they meet the requirements of the new home and community-based settings rule issued by CMS in January 2014. For additional information, see DHS – Transition plan for home and community-based settings.

    What options are available for people affected by this change?

    Individuals and providers had until June 30, 2018, to transition to new services. During this time, each person worked with his/her case manager/care coordinator to develop a person-centered transition plan.

    As an alternative to residential care, a person may have chosen to live in:

  • • His/her own home with appropriate services
  • • A customized living setting
  • • A foster care home.
  • Although discontinuation of residential care as a waiver service removed one service choice for a person, many other waiver services and resources can support a person in the community on a waiver program.

    The following resources provide information:

  • CBSM – Waiver programs and MHCP Provider Manual – EW and AC have a complete list of services and supports for a person on a waiver program
  • DHS – Minnesota Supplemental Aid (MSA) Housing Assistance has information on how to help people with disabilities who pay more than 40 percent of their income toward housing find choices about where they live
  • DHS – Supplemental Nutritional Assistance Program (SNAP) has information on how to help Minnesotans with low incomes get the food they need for nutritious and well-balanced meals.
  • What steps have we already taken?

    The following is a timeline of previous events and DHS communication. The list begins with the most recent events/communication:

  • • On-going: DHS continues to provide technical assistance to lead agencies, service providers and associations to support the discontinuation of residential care
  • • July 1, 2018: DHS discontinued the residential care service, effective June 30, 2018
  • • June 28, 2017: DHS hosted a webinar for providers and lead agencies. To view the PowerPoint, see the June 28, 2017, Discontinuation of Residential Care presentation [PDF]
  • • May 31, 2017: DHS sent an eList to lead agencies providing an update on the discontinuation of residential care
  • • May 8, 2017: DHS BI and CADI waiver amendments received approval from CMS
  • • Feb. 8, 2017: DHS EW amendment received approval from CMS
  • • Oct. 4 – Nov. 2, 2016: DHS’ Disability Services Division republished residential care waiver amendment for public comment
  • • Aug. 22, 2016: DHS sent emails directly to residential care providers sharing the update to the discontinuation of residential care information
  • • Aug. 18, 2016: DHS sent an eList to lead agencies providing an update on the discontinuation of residential care.
  • • April 2016: DHS submitted waiver amendments to CMS
  • • March 24, 2016: DHS emailed MCOs following presentation
  • • March 16, 2016: DHS presented plan to discontinue residential care to managed care organizations (MCOs)
  • • Feb. 10 – March 10, 2016: DHS Aging and Adult Services Division published residential care waiver amendment for public comment
  • • Feb. 8 – March 9, 2016: DHS' Disability Services Division republished residential care waiver amendment for public comment
  • • January and February 2016: DHS staff called residential care providers to communicate updates made to the residential care waiver amendment to reflect public comments
  • • Jan. 28, 2016: DHS emailed lead agencies to communicate updates made to the residential care waiver amendment to reflect public comments
  • • Sept. 14, 2015: DHS hosted a webinar for providers
  • • Aug. 24 – Sept. 23, 2015: DHS' Disability Services Division published the residential care waiver amendment for public comment
  • • July 31, 2015: DHS hosted a lead agency conference call
  • • July 16, 2015: DHS hosted a webinar for providers and lead agencies announcing plan to discontinue the residential care waiver service.
  • What are the next steps for people who used residential care?

    DHS is committed to ensuring people receive services with the appropriate health, safety and rights protections. DHS will continue to work with lead agencies to explore additional opportunities for people who received residential care as a waiver service. Each person and his or her case manager/care coordinator explored other waiver services and community resources as they developed the person-centered plan. Everyone's goal is to consider what is important to a person and what is important for the person in the plan and service delivery.

    What if I have questions?

    For additional questions, please contact the DSD Response Center at DSD.ResponseCenter@state.mn.us.

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    © 2018 Minnesota Department of Human Services Updated: 10/11/18 3:13 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 10/11/18 3:13 PM