Federally approved BI, CADI and EW plans, Minn. Stat. Ch. 144A, Minn. Stat. Ch. 144G, Minn. Stat. Ch. 256S, Minn. Stat. Ch. 325F, Minn. Stat. §256B.0911, subd. 19, Minn. Stat. §256B.49, subd. 29

Customized living (CL): An individualized package of regularly scheduled, health-related and supportive services provided to a person age 18 or older who resides in a qualified setting. CL services are funded under the Brain Injury (BI) Waiver, Community Access for Disability Inclusion (CADI) Waiver and Elderly Waiver (EW) and typically are provided in assisted living settings. For information about allowable settings, refer to the provider standards and qualifications section on this page.

24-hour customized living (CL): Customized living services provided with 24-hour supervision. For additional information, refer to the eligibility section on this page.

Component services: Distinct health-related and supportive services available as part of CL. For more information, refer to the covered services section on this page.

Institution: For the purposes of this page, “institution” means:

Publicly owned institution: Institution financed and operated by a county, state, municipality or other unit of government. A privately owned nursing facility is not a public institution.

To be eligible for CL or 24-hour CL, a person must:

24-hour CL eligibility

In addition to the above requirements, a person is eligible to receive 24-hour CL if their case mix is A through K or V. Case mix L is not eligible. The person must also have an assessed need for at least one of the following four requirements:

1. Cognitive or behavioral intervention.

2. Clinical monitoring with special treatment.

3. Dependency in at least one of the following activities of daily living (ADLs):

4. All of the following assessed needs:

These needs must be assessed and documented in the service plan by the lead agency staff member who completes the MnCHOICES assessment. For more information, refer to CBSM – MnCHOICES and the service plan section on this page.

Setting eligibility

Eligible CL settings must comply with:

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, refer to CBSM – Resource: CL component service definitions and guide for computing time for rate-setting tools.

Activities of daily living (ADL) assistance

ADL assistance includes assisting the person with:

Assistance with mental health, cognitive or behavioral concerns

Assistance with mental health, cognitive or behavioral concerns includes assisting the person with:

Each component service from this category included in the person’s support plan must be assessed by an appropriate professional. The provider must have a plan to:

For additional information, refer to the assistance with mental health, cognitive or behavioral concerns section on CBSM – CL component service definitions and guide for computing time for rate-setting tools.

Health-related assistance

Health-related assistance includes:

Note: A person’s 24-hour CL service plan must include a summoning device. A person’s CL service plan (non-24-hour) may include a summoning device when all of the following is true:

Home management tasks

Home management tasks include assisting the person with:

The CL/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 Food and Drug Administration (FDA) guidelines.

For information about authorizing home-delivered meals in CL settings, refer to the secondary information section.

Non-medical transportation

Non-medical transportation includes transportation of the person to support their access to the community.

Socialization

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

Not covered within the service

CL and 24-hour CL services do not cover:

Services that cannot be authorized with CL/24-hour CL

If the person receives CL or 24-hour CL, they cannot receive any of the following as separate waiver services:

Chore, homemaker and respite services are included as part of CL and 24-hour CL.

If the CL setting will transition to an ICS setting, refer to CBSM – ICS transition plans.

Wipes for continence care

If a provider is authorized for the continence care CL component service, the lead agency cannot authorize wipes as a waiver-covered supply for the person. The cost is included in the reimbursement for this service.

If a provider is not authorized for the continence care CL component service and the person needs wipes to self-manage toileting tasks, the lead agency may authorize wipes as a separate waiver-covered supply. This need must be identified in the person’s support plan.

24-hour CL under BI and CADI

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

24-hour CL under EW

If the person receives 24-hour CL under EW, the provider must provide a way for the person to summon assistance. The person cannot receive PERS as a separate waiver service for use inside the setting. The person may only receive PERS (e.g., pendant call systems) that may be appropriate for the person to use outside of the CL setting (refer to CBSM – PERS).

The PERS provider cannot be the same provider as the person’s 24-hour CL provider.

The location limitation applies to CL or 24-hour CL settings developed and operational on or after May 1, 2001.

The location limitation does not apply to:

Setting connected to an institution

The lead agency cannot authorize CL or 24-hour CL services for people who reside in a living setting adjoined to or on the same property as an institution, nursing facility, hospital or intermediate care facility for persons with developmental disabilities (ICF/DD).

This location limitation does not apply to settings that successfully complete the HCBS Rule heightened-scrutiny process. The settings adjoined to or on the same property as an institution are currently in the heightened-scrutiny process with the federal Centers for Medicare & Medicaid Services (CMS). For more information, refer to DHS – HCBS settings heightened-scrutiny process.

Collocated settings

Any service setting developed after Jan. 1, 2023, must comply with the following requirement.

When a single provider leases or owns more than one service setting located on the same or adjoining property, the lead agency can only authorize services in one of the settings.

A service setting includes a setting used to deliver any of the following services:

Collocated setting exceptions

Setting status: The provider maintains ownership/control of the setting, and the 2017/2018 HCBS attestation/validation process determined HCBS setting compliance. In this situation:

Setting status: There was a sale or transfer of ownership to a new provider, and the 2017/2018 HCBS attestation/validation process determined HCBS setting compliance. In this situation:

Heightened scrutiny requirements

Effective March 18, 2023, new customized living providers cannot bill for CL services (including 24-hour CL services) in settings adjoined to or on the same property as an institution until they successfully complete the HCBS rule heightened scrutiny process. For more information, refer to DHS – Requirements for new HCBS settings.

Lead agency instructions

Lead agencies should:

Provider instructions

To start the heightened-scrutiny process, new CL providers must email the DHS Aging and Adult Services HCBS unit at dhs.aasd.hcbs@state.mn.us with the subject “Heightened Scrutiny” and include the provider’s name, setting address and contact information.

The size limitation applies to CL or 24-hour CL settings developed and operational on or after May 1, 2001, and before Jan. 11, 2021.

The size limitation does not apply to:

Limit

For people younger than age 55, up to four people who are unrelated to the principal care provider may reside in a living setting.

Note: If a provider chooses to serve people younger than age 55 in a setting with more than four units, they must follow instructions in the exception to the limit section below (scenario 1).

Exception to the 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:

In this type of CL setting:

To submit an exception request to DHS for scenario 1, the lead agency must use CL Size Limit Exception Request, DHS-7759B.

Scenario 2

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

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

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.

To submit an exception request to DHS for scenario 2, the lead agency must contact its assigned DSD regional resource specialist (RRS) using information on CBSM – RRS.

Setting list

For a list of settings subject to this limitation, refer to CBSM – Resource: Assisted living facilities licensed by MDH and enrolled to deliver customized living by DHS.

CL or 24-hour CL settings developed and operational on or after Jan. 11, 2021, may only serve people age 55 and older.

Change in ownership

A CL or 24-hour CL setting is not considered developed and operational on or after Jan. 11, 2021, if it has a change in ownership but was operational before Jan. 11, 2021. Providers must notify DHS when a change in ownership occurs by following instructions in the changes to enrollment section on MHCP Provider Manual – Enrollment with MHCP.

Change in location

When a CL or 24-hour CL setting that was operational before Jan. 11, 2021, changes their location, it becomes a new setting and is subject to the BI and CADI CL setting age limitation to serve only people age 55 or older. Providers must notify DHS when a location change occurs by following instructions in the changes to enrollment section on MHCP Provider Manual – Enrollment with MHCP. For exceptions to this requirement, refer to the assisted living license portability section on this page.

Setting list

For a list of settings subject to this limitation, refer to CBSM – Resource: Assisted living facilities licensed by MDH and enrolled to deliver customized living by DHS.

The 2021 Minnesota Legislature established a CL setting moratorium affecting new BI and CADI CL living settings developed in single-family homes. Effective July 1, 2021, DHS cannot enroll any new CL settings serving four or fewer people in a single-family home for delivery of BI and CADI CL or 24-hour CL, per Minn. Stat. §256B.49, subd. 28. The CL moratorium does not apply to CL or 24-hour CL services funded by EW.

The lead agency is financially responsible for all HCBS service payments when services are delivered both:

For purposes of the CL setting moratorium, "operational" means CL services are authorized and delivered to a person in the CL setting.

DHS may approve an exception to this moratorium when an existing CL setting changes ownership at the same address. For more information, refer to Minn. Stat. §256B.49, subd. 28(b).

The 2024 Minnesota Legislature established a process for certain assisted living providers to transfer their approved assisted living license to a new location. For more information on settings that qualify for this allowance, refer to Minn. Stat. §144G.195.

Additional information for BI and CADI

Licensed assisted living settings that are approved by MDH to transfer their setting license may transfer their current CL enrollment date to the new setting when the setting meets all the requirements of Minn. Stat. §256B.49, subd. 28a.

Services under all waiver/AC programs must meet the requirements listed in the services section of CBSM – Waiver and Alternative Care programs overview.

Home-delivered meals in CL settings

The lead agency can authorize home-delivered meals in CL settings if all the following is true:

For information about the home-delivered meals service, refer to CBSM – Home-delivered meals.

Assisted Living Report Card

The Assisted Living Report Card is a resource to help people when they search for assisted living. It allows people to look up assisted living residences and find comparative ratings based on resident and family surveys. For more information about the Assisted Living Report Card, refer to DHS – Assisted Living Report Card overview.

As of Jan. 1, 2024, providers licensed as an assisted living facility under Minn. Stat. Ch. 144G must participate in resident quality of life and family satisfaction surveys on an annual basis when requested by DHS, per Minn. Stat. §256B.439, subd. 3d.

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

License requirements

A CL or 24-hour CL provider must be licensed as one of the following:

CL or 24-hour CL provided in an affordable housing setting, as defined under Minn. Stat. §256S.20, subd. 1, also must comply with Minn. Stat. Ch. 325F.722 (consumer protections for exempt settings).

Additional BI and CADI requirements

For BI and CADI, a CL 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 both:

Background study

To provide CL or 24-hour CL, providers must have a background study. For more information, refer to CBSM – Waiver/AC service provider overview – Required DHS background studies for direct-contact services.

Additional provider requirements

Provider staff must be able to:

If the CL provider delivers transportation, staff must have a valid driver’s license appropriate to the type of transportation they provide and adequate insurance coverage, including auto insurance as required under Minn. R. 8840.6000.

In addition to meeting the requirements above, staff members who provide supervision must:

A person who receives CL or 24-hour CL services cannot be employed to provide CL or 24-hour CL services.

For CL and 24-hour CL services to be covered by the waivers, the provider must:

For CL or 24-hour CL provided in licensed assisted living facilities, these requirements also are included in the assisted living regulations outlined in Minn. Stat. Ch. 144G and the Assisted Living Bill of Rights, which all people receiving CL services in a licensed assisted living facility must receive.

A Provider’s Guide to Putting the HCBS Rule into Practice (PDF) and DHS – HCBS provider toolkit contain informational guidance, best practices and examples to help waiver service providers understand the HCBS setting requirements and generate ideas about HCBS-compliant practices.

Rights modification

The HCBS setting requirements described above allow the following rights to be modified for people who receive CL or 24-hour CL and have an assessed need for the modification:

The modification must be:

To implement an HCBS settings requirement rights modification, the case manager, provider and person must complete HCBS Rights Modification Support Plan Attachment, DHS-7176H. For additional HCBS rights modification information, refer to DHS – HCBS Rule rights modification FAQ.

Rates

The lead agency is primarily responsible to complete the tools that establish the individualized service rates. The following sections include waiver-specific information for CL and 24-hour CL. For more information, refer to:

BI and CADI

Under the BI and CADI waivers, CL and 24-hour CL are framework services. The lead agency uses the MnCHOICES Support Plan to determine rates for BI and CADI CL services.

EW

The lead agency uses the Elderly Waiver Residential Services (EW RS) Rate Tool in the MnCHOICES Support Plan to develop service plans and determine rates for EW CL services. For more information, refer to CBSM – Rate methodologies for AC, ECS and EW service authorization and PartnerLink – MnCHOICES.

When EW CL component service rates and daily limits increase, DHS updates the rate and limit values in the EW RS Rate Tool. After the new rate and limit values take effect, people on EW access them throughout the year when the lead agency completes a new EW RS Rate Tool for a person due to:

EW 24-hour CL rate floor

Providers can apply to receive a rate floor, or minimum daily rate, for the people they serve on EW who receive 24-hour CL. DHS and managed care organizations (MCOs) apply the rate floor as a rate adjustment when eligible providers submit claims.

The rate floor rate adjustments do not affect lead agency processes or individual monthly case mix budgets. Please note:

For more information, refer to the EW CL services rate adjustment subsection of MHCP Provider Manual – EW and AC program – Billing.

Billing

For information about billing when a person is absent, enters an institutional setting or moves to another residential service setting, refer to MHCP Provider Manual – Billing for Waiver and AC programs.

Providers may not request supplemental payment for covered services. For example, a provider may not bill or otherwise charge a person or their family for:

For more information, refer to MHCP Provider Manual – Billing policy overview.

Assisted Living Report Card
CBSM – Changes to the size of setting by waiver service
CBSM – Resource: Assisted living facilities licensed by MDH and enrolled to deliver customized living by DHS
CBSM – ICS transition plans
CBSM – PERS
CBSM – Rate methodologies for AC, ECS and EW service authorization
CBSM – Resource: CL component service definitions and guide for computing time for rate-setting tools
CBSM – Requirements for a person’s own home
CBSM – RMS
CBSM – RSSC effective July 1, 2025
CBSM – Waiver, AC and ECS general process and procedures
CBSM – Waiver and AC programs overview
CL Size-Limit Exception Request, DHS-7759B
DHS – EW residential services
DHS – Requirements for new HCBS settings
DHS – HCBS provider toolkit
DHS – Assisted Living Report Card overview
HCBS Rights Modification Support Plan Attachment, DHS-7176H
Lead Agency Provider Tool for DWRS Exceptions (CL), DHS-5820E
MDH – Assisted living licensure (effective Aug. 1, 2021)
MDH – Health care provider directory (includes the five-digit HFID number)
MHCP Provider Manual – Billing policy overview
MHCP Provider Manual – Enrollment with MHCP
Rate Management Worksheet – CL Services and 24-Hour CL Services, DHS-6790G
RMS Manual – CL and 24-hour CL fields
RMS Manual – Quick reference guide on rate calculations for CL and 24-hour CL for disability waivers