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Customized living (including 24-hour customized living)

DHS combined the customized living and 24-hour customized living service CBSM pages to align with the federally approved waiver plans. Policies did not change with this combination of CBSM pages. No changes to service agreements are required.

Page posted: 10/1/03

Page reviewed: 3/22/18

Page updated: 3/22/18

Legal authority

Federally approved BI, CADI and EW waiver plans, Minnesota Statutes, Chapter 144D

Definition

Customized living (CL): An individualized package of regularly scheduled health-related and supportive services provided to a person who resides in a qualified, registered housing with services establishment.

24-hour customized living (CL): Customized living services provided with 24-hour supervision.

Covered services

Customized living (CL) and 24-hour CL services include component services designed to meet the person’s assessed needs and goals. The component services are grouped into six categories described below. For more details about the component services, including what is covered and distinctions between each, see Customized Living Component Service Definitions, DHS-6790H (PDF).

Activities of daily living (ADL) assistance

ADL assistance includes assisting the person with the following:

  • • Bathing
  • • Continence care
  • • Dressing
  • • Eating
  • • Grooming
  • • Positioning
  • • Transferring
  • • Use of wheelchair
  • • Walking.
  • Assistance with mental health, cognitive or behavioral concerns

    This category includes assistance with the following:

  • • Agitation
  • • Anxiety
  • • Orientation issues
  • • Physical aggression
  • • Property destruction
  • • Self-injurious behavior
  • • Verbal aggression
  • • Wandering
  • • Other mental health, cognitive or behavioral needs.
  • If the person receives any of these component services, the following requirements must be met:

  • • Support must address a need that has been assessed by an appropriate professional
  • • There must be a plan to implement and monitor the support
  • • There must be a plan to provide feedback on the efficacy of the support
  • • Staff must receive training specific to the person’s needs.
  • Health-related assistance

    Health-related assistance includes the following:

  • • Assistance with therapeutic exercises
  • • Delegated clinical monitoring
  • • Delegated nursing tasks
  • • Help with medication (e.g., set-up and monitoring, visual or verbal reminders, administration or assistance with self-administration)
  • • Insulin draws and injections
  • • Summoning devices.
  • Home management tasks

    Home management tasks include assisting the person with the following:

  • • Arranging transportation
  • • Housekeeping (heavy and light)
  • • Laundry (personal items and linens)
  • • Meal preparation (in his/her own living unit and a congregate setting)
  • • Money management
  • • Scheduling medical and non-medical appointments
  • • Shopping.
  • The customized living/24-hour CL provider must make meal preparation available. If the lead agency authorizes the provider to deliver this component service, the provider must provide meal preparation that adequately meets the nutritional needs of the person, as defined by current FDA guidelines.

    Non-medical transportation

    Non-medical transportation includes transportation of the person to support his/her access to the community.

    Socialization

    If the person receives socialization, it must be part of his/her service plan and related to established goals and outcomes.

    Non-covered services

    Customized living and 24-hour CL services do not cover:

  • • Room and board
  • • Socialization that is diversionary or recreational in nature
  • • Transportation to health care services available through MA state plan services.
  • If the person receives customized living or 24-hour CL, he/she cannot receive chore, homemaker or respite as separate waiver services. These services are included as part of customized living and 24-hour CL.

    24-hour customized living under BI and CADI

    If the person receives 24-hour customized living under CADI or BI, he/she cannot receive personal emergency response systems (PERS) or monitoring technology as separate waiver services.

    24-hour customized living under EW

    If the person receives 24-hour customized living under EW, he/she cannot receive monitoring technology as a separate waiver service. He/she may only receive personal emergency response systems (PERS) for use outside of the customized living setting (see CBSM – Personal emergency response systems).

    Wipes for continence care

    Wipes for continence care cannot be billed for separately. The cost of these wipes is included in the reimbursement for the covered component service of continence care.

    When the person may receive 24-hour CL

    The person may receive 24-hour CL if one of the following four requirements are met:

    1. Person has an assessed need for cognitive or behavioral intervention
    2. Person has an assessed need for clinical monitoring with special treatment
    3. Person is assessed as dependent in at least one of the following ADLs: toileting, positioning or transferring
    4. Person is assessed as dependent in at least three of the following ADLs: bathing, dressing, grooming, walking or eating (when eating is scored as “3” or greater); and person has assessed needs for medication management and at least 50 hours of direct services per month (The lead agency must approve these 50 hours of direct services in the individual, 24-hour CL service plan).

    These needs must be assessed by the lead agency staff who completes the Long-Term Care Consultation (LTCC) or MnCHOICES assessment.

    Service plan

    If the person receives either customized living or 24-hour CL, he/she must have an individualized service plan based on his/her assessed needs. This is an extension of the support plan developed that includes all home and community-based services.

    The lead agency must:

  • • Give the person the opportunity to accept, revise or reject the service plan
  • • Ensure the provider(s) fully meets the person’s needs as documented in the service plan
  • • Approve the service plan as part of the person’s overall support plan.
  • The person directs and the provider ensures service delivery with oversight from the lead agency.

    Supervision

    If the service plan includes supervision, it must document the person’s specific need(s) for supervision and the plan to provide it, including:

  • • Frequency
  • • Mode of contact
  • • Time of day the contact will occur.
  • The service plan must document if the person needs 24-hour supervision.

    Setting requirements

    BI and CADI only

    Under the BI and CADI waivers, the following setting location and size requirements must be met.

    Location

    The lead agency cannot authorize customized living or 24-hour CL services for people who reside in either of the following:

  • • A living setting adjoined to or on the same property as an institution (nursing facility, hospital, ICF/DD) or institution for mental disease [IMD] if the institution or IMD has any financial interest in the living setting
  • • A living setting adjoined to or on the same property as a nursing facility, hospital, ICF/DD or institute for mental disease.
  • When a single provider leases or owns more than one living setting located on the same or adjoining property, the lead agency can only authorize services in one of the settings.

    Size limit

    For people younger than age 55, up to four people unrelated to the principal care provider may reside in a living setting. The size limitation does not apply if the residence meets both of the following requirements:

  • • Was developed before May 1, 2001
  • • Has continuously provided customized living waiver services.
  • Exception to size limit

    There are two scenarios in which DHS may approve an exception for the setting size limit.

    Scenario 1

    DHS may approve an exception to the size limit if the following requirements are met:

  • • Person is being discharged from or at imminent risk of being placed in a hospital, intermediate care facility or nursing facility
  • • Person has no other options for living in his/her home community, other than a setting that does not meet the current size limit requirements.
  • If the customized living setting has more than four units, it can serve people who receive services under the BI, CAC, CADI and DD waivers in up to 25 percent of the units. The 25 percent limit does not apply to settings that receive funding through the HUD program Housing Opportunities for Person with AIDS (HOPWA), but a DHS-approved exception is still required for HOPWA settings.

    Scenario 2

    DHS may approve an exception to the size limit during emergency situations when the setting is needed to avert a person’s placement in a regional treatment center or a nursing home.

    A setting may receive this exception if up to five people live in the setting and are unrelated to the principal care provider. If approved, this exception cannot exceed two years.

    For purposes of this provision, an emergency situation is defined as one of the following:

  • • An unexpected loss of an essential caregiver
  • • A sudden loss of housing due to closure
  • • Loss of services or housing due to a natural disaster
  • • Necessary to place siblings together.
  • Submitting an exception request

    To submit an exception request to DHS for scenario 1 or 2, the lead agency must contact its assigned DSD Regional Resource Specialist (RRS).

    Provider standards and qualifications

    Customized living and 24-hour CL are DHS enrollment-required services. For more information, see CBSM – Waiver/AC service provider overview.

    License requirements

    A customized living or 24-hour CL provider must have a comprehensive home care license under Minnesota Statues, Chapter 144A with the Minnesota Department of Health.

    A customized living or 24-hour CL provider who does not have a foster care license under Minn. R. 9555.5105 to 9555.6265 and provides services in settings of one to four people (or five with a DHS-approved permanent fifth-bed license or temporary fifth-bed variance), must comply with Minn. R. 9555.6205, subp. 1 to 3 and Minn. R. 9555.6225, subp.1, 2, 6 and 10.

    Customized living and 24-hour CL services can only be provided in settings registered as housing with services establishments under Minnesota Statutes, Chapter 144D.

    Additional provider requirements

    Provider staff must be able to:

  • • Communicate effectively
  • • Follow the person’s individualized service plans
  • • Identify and address emergencies, including calling for assistance
  • • Read, write and follow written and verbal instructions
  • • Recognize the need for and provide assistance, or arrange for appropriate assistance
  • • Understand, respect and maintain confidentiality
  • • Work under intermittent supervision.
  • In addition to meeting the requirements above, staff who provide supervision must:

  • • Be able to respond in-person to a person within a time frame that meets his/her needs and does not exceed 10 minutes
  • • Have an ongoing awareness of the person’s needs and activities
  • • Have his/her primary work responsibility be the supervision of people in the customized-living setting
  • • Work onsite in the customized-living setting.
  • A person who receives customized living or 24-hour CL services cannot be employed to provide customized living/24-hour CL services in the same building in which he/she resides.

    Authorization, rates and billing

    The lead agency is primarily responsible to complete the tools that establish the individualized service rates.

    The provider cannot bill for days on which the person is absent from the customized living setting. For more information, see Provider Manual – Billing for Waiver and Alternative Care (AC) Programs.

    Below is waiver-specific information for CL. For more information, see both Customized Living Component Service Definitions, DHS-6790H (PDF) and Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF).

    Providers may not request supplemental payment for covered services. For more information, see Provider Manual – Billing policy overview.

    For example, a provider may not bill or otherwise charge a person on a waiver, or his/her family, for:

  • • Additional units of any allowable component service beyond those available under the service rate limits for that service
  • • Additional units of any allowable component service beyond those approved in the service plan by the lead agency.
  • BI and CADI

    Under the BI and CADI waivers, customized living and 24-hour CL are framework services. The lead agency uses the Rate Management System (RMS) to determine rates. For more information, see CBSM – Rate Management System.

    EW

    Lead agencies use the Residential Services (RS) Tool to develop service plans and determine rates for EW customized living services. For more information, see DHS – EW residential services. This page includes links to the most recent versions of:

  • • EW Residential Services – Workbook
  • • Instructions to complete and use the RS Tool
  • • Instructions to upload the RS Tool
  • • Release notes for the RS Tool
  • • Tips, alerts and guidance for EW residential services.
  • Additional resources

    CBSM – BI, CAC, CADI and DD waivers general process and procedures
    CBSM – Changes to the size of setting by waiver service

    CBSM – Requirements for a person’s own home

    MDH – Locate a licensed, registered or certified health care provider
    (includes the five-digit HFID number)

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