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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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24-hour customized living

Tier 1 service

Page posted: 10/1/03

Page reviewed: 9/3/15

Page updated: 9/3/15

Legal authority

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


24-hour customized living: Package of regularly scheduled individualized health-related and supportive services provided to a person who resides in a residential center (apartment buildings) that is a registered housing with services establishment.

Covered services

24-hour customized living services must include 24-hour on site supervision in addition to services provided by home care aides, home health aides or residential staff.

24-hour customized living services include individualized supports:

  • • Chosen and designed specifically for each person’s needs
  • • Provided only in a registered housing with services establishment.
  • Services include:

  • • 24-hour supervision and oversight
  • • 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
  • • Meal preparation
  • • Socialization.
  • Additional services may be available through providers licensed by the Minnesota Department of Health to provide home care.

    24-hour on site supervision means:

  • • A method for the person to summon assistance
  • • 24-hour customized living employee available to respond, in person, to the request within a reasonable amount of time, and
  • • Ongoing awareness of person’s needs and activities provided by an employee of the 24-hour customized living provider.
  • 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 client is absent.

    Secondary information

  • • The 24-hour customized living employee provides supervision for residents as a primary job. He or she cannot also receive customized living services in the same building that they reside.
  • • 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 that the provider fully meets the needs of the person through the package designed for that person.
  • • Customized living services must meet all of the homemaker and chore service needs of the person.
  • 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

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

  • • 24 hour customized living home care providers, licensed by the Minnesota Department of Health under Minn. R. chapter 4668 and Minn. R. chapter 4669.
  • • 24 hour customized living services can only be provided in settings registered as Housing with Services establishments under Minn. Stat. chapter 144D
  • • 24 hour customized living service providers who are not licensed under Minn. R. 9555.5105 to 9555.6265 (adult foster care) and who provide services in settings of one to four residents, must comply with Minn. R. 9555.6205, subp. 1 to 3 and Minn. R. 9555.6225, subp.1, 2, 6 and 10
  • • Class A licensed home care
  • • Class F licensed customized living
  • Home care aide qualifications are listed in Minn. R. 4668.0100, subp. 2. Home health aide qualifications are listed in Minn. R. 4668.0100, subp. 5.

    Staff providing supervision, oversight and supportive services must have::

  • • A valid Minnesota driver’s license and required insurance coverage if they provide transportation to waiver consumers
  • • Experience and/or training in caring for persons with functional limitations
  • • The ability to perform essential job functions
  • • The self-direction 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 verbal instructions and converse on the telephone
  • • The ability to understand and respect confidentiality issues
  • 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 who 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.

    Rates and billing

    Customized living service component definition document DHS-6790H (PDF)

    CBSM — Waiver rates and billing

    Additional resources

    CBSM – Requirements for a person's own home

    CBSM – Changes to size of setting – 5th bed

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