Federally approved BI, CAC, CADI and DD waiver plans, Minn. Stat. §245D.03, Minn. Stat. §245D.091, Minn. R. 9544, Minn. R. 9555.5150 to 9555.6265, Minn. R. 2960.3000 to 2960.3340, Minn. Stat. §245D.06, subd. 5-8, Minn. Stat. §245D.061, Minn. Stat. §245D.081, Minn. Stat. §245D.06, subd. 5

Crisis respite: A specialized service that provides both short-term care and intervention to a person due to the need for all the following:

Specialized staff: Professional staff who are specially trained in crisis prevention, intervention and resolution and meet certain qualifications, as explained in the provider standards and qualifications section on this page.

Institution: For the purposes of this page, “institution” means a nursing facility, hospital, intermediate care facility for persons with developmental disabilities (ICF/DD) or institution for mental disease (IMD).

Incident: An occurrence that involves a person receiving services and requires the provider to respond in a way that is not a part of typical service delivery to that person.

The following criteria must be met for a person to receive crisis respite services:

Crisis respite services cover the activities described in the following sections.

Assessment

Crisis respite services cover an assessment to determine the factors that contribute to the crisis. Examples of acceptable assessments include, but are not limited to:

1. Functional behavior assessment (FBA).

2. Assessment (e.g., DHS Licensing Intensive Support Self-Management Assessment [.DOCX]) of the person’s ability to manage:

3. Assessment of the person’s ability to manage:

Medical or behavioral intervention plan

Crisis respite services cover the development of a medical or behavioral intervention plan, in coordination with the support planning team. Examples include, but are not limited to:

1. Positive behavior support plan that includes the following elements:

2. Person-centered description and plan, as described on CBSM – Resource: Guide for person-centered planning facilitation, that includes information about why the person is in crisis.

Consultation and staff training

Crisis respite services cover consultation and staff training for the provider(s) and/or caregiver(s) necessary to ensure they successfully implement the person’s specific intervention plan.

Written transition plan

Crisis respite covers the development and implementation of a written transition plan to help the person return home if they received out-of-home crisis respite. For a template that includes all required components, refer to Transition Summary and Plan After Out-of-Home Crisis Respite, DHS-8633A.

Technical assistance

Crisis respite covers ongoing technical assistance for the caregiver or primary provider as they implement the person’s intervention plan.

Not covered within the service

Crisis respite does not cover the cost of hotel rooms and meals for:

Services that cannot be authorized with crisis respite

The lead agency cannot authorize services that duplicate other Minnesota state plan or waiver services the person already receives, including case management.

Crisis respite can be delivered through remote support. When crisis respite is provided through remote support, the caregiver is responsible to respond to the person's health, safety and other support needs (as needed) when remote support is appropriate, chosen and preferred by the person.

Services delivered through remote support must meet all the requirements on CBSM – Remote support.

In-home crisis respite can be provided in 15-minute units and daily units.

Location for 15-minute units

In-home 15-minute crisis respite can be provided in:

Location for daily units

In-home crisis respite daily can be provided in the person’s own home or family home. For more information, refer to CBSM – Requirements for a person’s own home.

Service amount

In-home crisis respite does not have a limit on the number of days authorized as part of the person’s support plan.

Out-of-home crisis respite can be provided when it is necessary for the relief of the caregiver and the protection of the person or others living in the home. Providers must deliver out-of-home crisis respite in one of the following settings:

Children younger than age 18 in out-of-home crisis respite

Bulletin 24-68-05: Clarifying when disability waiver community residential services are foster care placements for children and youth (PDF) clarifies when crisis respite services and community residential services must be considered a foster care placement consistent with Adoption and Foster Care Analysis and Reporting System (AFCARS).

Size limit

For adult foster care, child foster care and CRS, the total number of people who reside in a licensed living setting cannot be more than five. This means five people not related to the principal care provider.

If a provider is licensed to provide services to fewer than five people and would like to request an increase up to five, refer to CBSM – Changes to the size of setting by waiver service.

Service amount

The use of out-of-home crisis-respite cannot exceed 180 days, except when authorized as part of a plan approved by the lead agency. To exceed the 180-day limit, the lead agency must ensure and document:

MDH-licensed hotels

A person can receive out-of-home crisis respite services in an MDH-licensed hotel when it is necessary for the relief of the caregiver and the protection of the person or others living in the home with the person. The lead agency may only authorize crisis respite in an MDH-licensed hotel for up to seven days when either of the following is true:

In this situation, the crisis respite provider must:

Crisis respite does not pay for the cost of lodging or for caregivers to stay in a hotel while the person remains at home.

After seven days of crisis respite in an MDH-licensed hotel, the lead agency must submit documentation of the person’s continued need for DHS approval on a weekly basis using Extension Request for Out-of-Home Waiver Crisis Respite in MDH-Licensed Hotel, DHS-8633.

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

The lead agency must document all the following in the person’s support plan:

For additional documentation requirements, refer to the out-of-home setting section on this page.

Crisis respite is a DHS enrollment-required service. For more information, refer to CBSM – Waiver/AC service provider overview.

License requirements

A crisis respite provider must have a license under Minn. Stat. Ch. 245D as an intensive support service provider.

Additional requirements

All crisis respite providers must have the specific experience, skills and qualifications required to meet the person’s behavioral and/or medical intervention needs that resulted in or contributed to the crisis situation, as identified in the person’s support plan.

The lead agency must document in the support plan the provider’s specific experience, skills and qualifications needed to meet the person’s needs.

Examples

Examples of specific experience include:

Examples of specific skills include demonstrated abilities in:

Specialized staff

In addition to the above requirements, crisis respite specialized staff must be provided by professional staff who either:

Requirements to complete an FBA

To complete an FBA as required by Minn. R. 9544.0040, the provider must meet the definition of a qualified professional in Minn. R. 9544.0020, subp. 47.

Reporting

A provider licensed under 245D must report all uses of controlled procedures, emergency use of manual restraint and prohibited procedures according to Minn. Stat. §245D.06, subd. 5 to DHS via the Behavioral Intervention Report Form, DHS-5148.

Background studies

To provide crisis respite, 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.

The lead agency authorizes crisis respite at the market rate. The lead agency should use specific components of the person’s service and support needs to work with the provider to determine an appropriate service rate. For more information, refer to CBSM – Market rate services.

Rates set for staffing should be related directly to supporting the person’s extraordinary needs and be based on the following:

Authorization codes

The lead agency uses the following codes to authorize crisis respite:

Room and board costs

Out-of-home crisis respite includes payment for room and board costs when the person receives the service in a licensed foster care facility or licensed CRS (for up to five people) developed to provide crisis respite. Crisis respite does not include room and board costs for a private residence or a licensed hotel.