Skip To: Main content|Subnavigation|
Minnesota Department of Human Services Community-Based Services Manual (CBSM)
Advanced Search|  

Customized living

Tier 1 service

Page posted: 10/1/03

Page reviewed: 9/3/15

Page updated: 9/3/15

Legal authority

Federally approved BI, CADI, and EW waiver plans, Minn. Stat. chapter 144D

Definition

Customized living: An individualized package of regularly scheduled health-related and supportive services provided to a person who resides in a qualified residential center that is a registered housing with services establishment.

Covered services

Customized living services include individualized supports that the person and his/her team choose and design specifically to meet his/her needs. The services include:

  • • Arranging for or providing transportation
  • • Assisting the person with personal funds
  • • Assisting the person with setting up meetings or appointments
  • • Home care aide tasks
  • • Home management tasks including laundry and meal prep
  • • Socialization
  • • Up to 24-hour supervision and oversight
  • • Help with personal care or mobility
  • • Help with medication
  • • Delegated nursing tasks as ordered by a physician and described in the plan
  • • Active behavioral, mental health or cognitive support which requires:
  • 1. Support needs that an appropriate professional has assessed
    2. A plan to implement and monitor the support
    3. Feedback on the efficacy of the support
    4. Training for staff that is specific to the person’s needs.

    Additional services may be available through providers licensed to provide home care services.

    Non-covered services

    The service will not cover:

  • • Room and board
  • • Socialization when it is diversionary or recreational in nature.
  • The following services are not billable as separate services during the period that the person receives customized living services:

  • • Chore
  • • Homemaker
  • • Respite
  • Additionally, providers cannot bill for days on which the recipient is absent.

    Secondary information

  • • The person (or the provider) directs service delivery with oversight from the case manager/service coordinator.
  • • The case manager/service coordinator is the primary party responsible for negotiations with the provider. He or she assures the provider(s) fully meets the needs of the person through the package specifically designed for that person.
  • • Customized living services must meet all of the homemaker and chore service needs for the person.
  • • Customized living services may be provided in any number of apartments in a residential center for people who rent or own distinct units.
  • Size and location

    BI and CADI waivers only

    Lead agencies may not authorize customized living services for people who reside in either of the following:

  • • A living setting if adjoined to or on the same property as an institution (nursing facility, hospital, ICF/DD) or institution for mental disease 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, only one of the settings may receive authorization for services.

    For people under the age of 55 years, up to four people unrelated to the principal care provider may reside in a living setting.

    Size exception

    The size limitation does not apply if the residence:

  • • Was developed before May 1, 2001
  • • Has continuously provided customized living waiver services.
  • For information about temporary exceptions to the size of a setting, see CBSM – Changes to size of setting – 5th bed.

    Provider standards and qualifications

    (Enrollment required tier 1)

    State law and/or administrative rule require providers to be licensed, certified and registered. This includes:

    1. Class A license home care agency
    2. Class F license customized living
    3. Comprehensive Home Care license from the Minnesota Department of Health under Minn. R. chapter 4668 and Minn. R. chapter 4669.

    Customized living service providers not licensed under Minn. R. 9555.5105 to 9555.6265 (adult foster care) and who provide services in settings of one to four persons, must comply with Minn. R. 9555.6205, subp. 1 to 3 and Minn. R. 9555.6225, subp.1, 2, 6 and 10.

    Home health aide task qualifications are listed in Minn. R. 4668.0100, subp. 2. Qualifications for persons who perform home health aide tasks are listed in Minn. R. 4668.0100, subp. 5

    Staff providing supervision, oversight and supportive services must have:

  • • A valid state driver’s license if they provide transportation to waiver recipients
  • • Good physical and mental health and maturity of attitudes toward work assignments
  • • Experience and/or training in caring for persons with functional limitations
  • • The ability to converse on the telephone, to work under intermittent supervision, to deal with minor emergencies arising in connection with the assignment and work under stress in a crisis situation
  • • The ability to read, write and follow written or oral instructions
  • • The ability to understand, respect and maintain confidentiality
  • Minn. Stat. §256B.4912, subd.1 (3b) (3c) and the federal waiver plan requires this service to apply standards concerning criminal background studies to staff that provide direct contact, as defined in Minn. Stat. §245C.02, subd. 11, and service owners and managerial officials oversee the management or policies of services that provide direct contact.

    Providers are required to complete and submit individual background studies using New Electronically Transmitted Study (NETStudy) through DHS licensing.

    Lead agency responsibilities

    County or tribal agencies act as agents for the state Medicaid agency (DHS) and are responsible to administer programs.

    Service authorization/

    rates/billing

    Service authorization

    The case manager/service coordinator completes the MMIS Waiver Service Agreement by adding the:

  • • Vendor’s name
  • • Provider number
  • • Appropriate code
  • • Number of units
  • • Rate authorized.
  • For more information, see authorization section on CBSM – BI, CAC, CADI and DD waiver general process and procedures.

    Rates and billing

    Elderly Waiver 24-hour customized living rate limit

    To be eligible for 24-hour customized living rate limit under EW:

  • • The recipient must meet eligibility requirements
  • • The provider must meet applicable provider standards.
  • Authorizations for the 24-hour CL rate limit should use T2030 with modifier TG-monthly.

    Provider responsibilities

    To be eligible to for the 24-hour customized living-rate limit, the provider must:

  • • Provide ongoing awareness of recipient’s needs and activities via an employee of the customized living services provider. (This person cannot be a recipient of services. His or her primary job responsibility is to provide supervision to people in the setting.)
  • • Provide a way for the person to call for help.
  • • Make a 24-hour customized living services employee available to respond in person to the request within a reasonable amount of time. See Comprehensive Policy on EW Customized Living (PDF) for more information.
  • Lead agency role

    To be eligible for the 24-hour customized living rate limit, the lead agency must document that the recipient needs one or more of the following:

  • • Cognitive or behavioral intervention
  • • Clinical monitoring with special treatment
  • • Staff assistance in toileting, positioning or transferring (single dependency)
  • A person also is eligible if they meet each of the following:

  • • They need assistance with medication management
  • • They need at least 50 hours of customized living service per month
  • • They have a dependency in at least three of the following activities of daily living (ADLs):
  • 1. Bathing
    2. Dressing
    3. Grooming
    4. Walking
    5. Eating (when eating is scored 3 or greater).

    Additional resources

    Rate/Report this pageReport/Rate this page

    © 2017 Minnesota Department of Human Services Updated: 3/30/16 8:30 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 3/30/16 8:30 AM