Minnesota Minnesota

Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)

Consumer Support Grant (CSG) transition to Community First Services and Supports (CFSS)

Page posted: 10/1/03

Page reviewed: 5/20/24

Page updated: 8/11/25

Legal authority

Minn. Stat. §256.476, Minn. Stat. §256B.85

Comparison of CSG and CFSS

DHS is in the process of replacing personal care assistance (PCA) and CSG with CFSS. For more information about this transition, refer to CFSS Manual – Transition from PCA and CSG to CFSS.

In CFSS, a person chooses between two models. CSG has some similarities to and differences from both models.

Similarities between CSG and both the CFSS agency model and the CFSS budget model

In CSG and both CFSS models:

  • A person using CSG in place of PCA is eligible for CFSS.
  • A person’s spouse can be their worker.
  • A minor’s parent can be their worker.
  • A person can purchase goods and/or services.
  • A person must have a service delivery plan that describes the goods and services they will use.

    • Similarities between CSG and the CFSS budget model

    In CSG and the CFSS budget model, a person:

  • Receives a budget instead of units.
  • Is the employer of their direct care workers.
  • Works with a financial management services (FMS) provider.

    • Differences between CSG and both CFSS models

    In CSG, a person receives only the state portion of funding for services.

    In CFSS, a person:

  • Receives both state and federal funding.
  • Develops their service delivery plan using the same process as all people receiving CFSS throughout the state.
  • Works with a consultation services provider.
  • Has a separate worker training and development budget, as described on CFSS Manual – CFSS worker training and supervision.
  • Cannot convert home care nursing (HCN) hours to a CFSS budget.
  • Can use either CFSS model if they are on a waiver, on the Alternative Care (AC) program and/or age 65 or older and enrolled in a managed care organization (MCO).
  • Receives the CFSS home care rating P, Q or R if they had the PCA home care rating LT, and they are eligible for more hours per day.

    • Definition

    CSG: A state-funded alternative to the following Medical Assistance home care services:

  • Home care nursing (HCN).
  • Home health aide (HHA).
  • Personal care assistance (PCA).

    • CFSS will replace both PCA and CSG.

    Eligibility

    To be eligible for CSG, a person must:

    1. Meet eligibility requirements to receive HCN, HHA and/or PCA, which include:

  • Be eligible for Medical Assistance.
  • Be able to direct and purchase their own care and supports or have a family member, legal representative or other authorized representative do so on their behalf.
  • Have a functional limitation that requires ongoing supports to live in the community.
  • Live in their own home/family home and not in an institution.

    • 2. Not participate in:

  • AC.
  • Home and community-based services (HCBS) waivers.
  • Minnesota Senior Health Options (MSHO) or Minnesota Senior Care Plus (MSC+).
  • PCA.
  • HHA.
  • HCN.
  • Family Support Grant (FSG).

    • 3. Have a PCA and/or HCN home care rating.

    CFSS eligibility

    The eligibility for CFSS is the same as the eligibility for PCA (refer to CFSS Manual – PCA/CFSS eligibility). People using CSG instead of PCA are eligible for CFSS.

    The following people who previously could not use CSG can now use CFSS:

  • People participating in a waiver or AC.
  • People age 65 or older enrolled in an MCO.

    • Budget determination

    Person replacing PCA with CSG

    A person’s CSG budget is based on the number of PCA units for which they are eligible. The CSG budget is approximately the PCA units for which the person is eligible, multiplied by the current PCA rate, divided by two.

    For exact amounts, refer to the CSG monthly budget limits section in Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

    Person replacing HCN with CSG

    A person replacing HCN with CSG receives a portion of their HCN budget. For exact amounts, refer to the CSG monthly budget limits HCN and vent dependent section in Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

    Person using CFSS

    A person’s CFSS units or budget depend on their model. Unless a person’s eligibility changes:

  • Agency model: The person will have the same number of units they would have had if they had selected PCA.
  • Budget model: The person’s CFSS budget will be approximately twice as large as it was in CSG.

    • Note: If a person with the PCA home care rating LT was using CSG, their CFSS units/budget will be higher.

    A person cannot replace their HCN budget with CFSS. For information about how these people will transition, refer to the section lower on the page about the transition process.

    Covered services

    A person may use CSG funds to purchase a variety of goods, supports and services beyond the usual home care categories. Covered goods and services must:

  • Be directly related to the person’s functional limitations.
  • Help delay or prevent out-of-home placement of the person.
  • Be related to an assessed need.
  • Not be covered by another source, such as Medical Assistance or private insurance.

    • CFSS services

    For information about CFSS covered services, refer to:

  • CFSS Manual – PCA/CFSS covered services.
  • CFSS Manual – Goods and services through CFSS.
  • CFSS Manual – Personal emergency response systems (PERS) through CFSS.

    • Note: There are more restrictions in CFSS for covered goods and services. When a person using CSG transitions to CFSS, their consultation services provider must explain the differences to them.

    Service delivery plan

    People in CSG and CFSS must have a service delivery plan that describes their personal care, goods and services. In both CSG and CFSS, the lead agency must approve the service delivery plan.

    In CSG, the county/tribal nation process for plan development and approval may vary across the state.

    In CFSS, all people using CFSS select a consultation services provider who:

  • Helps them write their service delivery plan, if desired.
  • Reviews their service delivery plan.
  • Submits their service delivery plan to the lead agency for approval.

    • Person’s responsibilities

    People using CSG and CFSS:

  • Write their service delivery plan.
  • Direct their care (or have a representative direct care on their behalf).
  • Get their service delivery plan approved by the lead agency.
    Note: In CFSS, the consultation services provider helps facilitate approval. Refer to CFSS Manual – PCA/CFSS service delivery plan development and approval process.
  • Fulfill the responsibilities described below to purchase goods and services, if applicable.
  • Fulfill the responsibilities described below to employ personal care workers, if applicable.

    • People purchasing goods and/or services (CSG and both CFSS models)

    To purchase goods and/or services, people using CSG or CFSS are responsible to:

  • Identify the good(s) and service(s) to meet their needs.
  • Identify the cost of the goods and services.
  • Add the goods and services to their service delivery plan.
  • Purchase the goods and services after the lead agency approves them.
  • Save receipts and submit them according to the financial management services (FMS) provider’s policies.

    • People employing workers (CSG and CFSS budget model)

    People using CSG or the CFSS budget model employing personal care workers must fulfill employer responsibilities, including:

  • Recruit and hire workers.
  • Train workers.
  • Confirm worker competency.
  • Schedule workers.
  • Supervise workers.
  • Determine the workers’ pay rate.
  • Follow the FMS provider’s process to verify the worker’s hours.
  • Fire workers, if necessary.
  • Comply with the terms of the Service Employee’s International Union (SEIU) Healthcare Minnesota and Iowa collective bargaining agreement.

    • People using workers in the agency model (CFSS agency model only)

    People in the CFSS agency model are responsible to:

  • Work with the provider agency to finalize their service delivery plan.
  • Inform their provider agency of worker preferences.
  • Direct their care (or have a representative direct care on their behalf).
  • Review and approve the worker’s documentation of time worked.

    • FMS provider responsibilities

    In both CSG and CFSS, the FMS provider is responsible to:

  • Submit enrollment paperwork to Minnesota Health Care Programs (MHCP).
    Note: For CFSS, they submit CFSS Worker Enrollment Application (form coming soon). For CSG, they submit Individual Support Worker Enrollment Application (CDCS and CSG), DHS-4469A (PDF).
  • Bill DHS (or the MCO for people age 65 or older receiving their CFSS services through their MCO) for goods, personal care services and other approved services.
  • Provide payroll functions for personal care workers, if applicable.
  • Collect receipts for approved goods and services and reimburse the person, if applicable.
  • Comply with the terms of the Service Employee’s International Union (SEIU) Healthcare Minnesota and Iowa collective bargaining agreement if the person employs personal care workers.

    • Provider agency responsibilities

    Provider agencies do not serve people using CSG.

    For an overview of CFSS provider agency responsibilities, refer to CFSS Manual – PCA/CFSS provider agency requirements overview.

    Consultation services responsibilities

    Consultation services providers do not serve people using CSG.

    For an overview of CFSS consultation services responsibilities, refer to CFSS Manual – CFSS consultation services provider requirements.

    Transition process from CSG to CFSS

    Person using CSG in place of PCA

    At the time of the person’s assessment:

    1. The county/tribal nation conducts the assessment.

    2. The person selects a consultation services provider (refer to CFSS Manual – Consultation services overview).

    3. The consultation services provider is responsible to educate the person about CFSS, including similarities and differences with CSG.

    4. The person’s services follow the typical CFSS process (refer to CFSS Manual – Overview of the PCA and CFSS process).

    Person using CSG in place of HCN

    People cannot use CFSS in place of HCN.

    If the person is using CSG as an alternative to HCN:

    1. The county/tribal nation must offer the person a MnCHOICES assessment when it is time for their annual assessment.

    2. The county/tribal nation and the person discuss how to meet their needs based on the assessment results.

    3. If the person will use other services, the person follows the process and procedures for those other services.

    4. If the person will use CFSS, the person selects a consultation services provider to plan their CFSS services (refer to CFSS Manual – Consultation services overview).

    5. The person follows the process for CFSS on CFSS Manual – Overview of the PCA and CFSS process.

    The person can use CSG in place of HCN during the transition if an HCN agency conducts an assessment and the medical review agent assigns the person an HCN rating. The county/tribal nation follows the process in the HCN instructions below.

    County/tribal nation responsibilities

    Effective Oct. 1, 2024, the county/tribal nation is responsible to:

    1. Make arrangements to complete an in-person assessment in one of the following locations:

  • The person’s home.
  • A location where services take place.
  • An institution the person is planning to leave.

    • Note: If the person is using CSG in place of HCN, the county/tribal nation must offer the person a MnCHOICES assessment.

    2. Conduct an assessment within 20 business days of receiving the request that:

  • Documents the person’s health status.
  • Determines the person’s need for a representative.
  • Determines the person’s need for services.
  • Determines the amount of services to authorize.
  • Identifies service options.
  • Provides the person with a list of CFSS consultation services providers.
  • Refers the person to other resources, when appropriate.

    • 3. Approve the person’s CSG service plan following CSG program guidelines.

    Note: If the person will use CSG in place of HCN during the transition, the county/tribal nation must follow the process in the HCN instructions below.

    4. Enter the service agreement into the Medicaid Management Information System (MMIS) with:

  • Six sessions of consultation services.
  • Six months of PCA or CSG services if the person currently uses CSG. If the person switches from CSG to PCA for their six-month service agreement, the county/tribal nation follows the instructions on CFSS Policy Manual – Assessment for PCA/CFSS services.

    • For MMIS instructions, refer to DSD MMIS Reference Guide – Type B service agreement for CSG.

    5. Provide all the following information to people:

  • DHS – List of consultation services providers.
  • Information for People Who Use CFSS – English, DHS-6893U-ENG (PDF) or translated version:
    Information for People Who Use CFSS – Hmong, DHS-6893U-HMN (PDF).
    Information for People Who Use CFSS – Karen, DHS-6893U-KAR (PDF).
    Information for People Who Use CFSS – Russian, DHS-6893U-RUS (PDF).
    Information for People Who Use CFSS – Somali, DHS-6893U-SOM (PDF).
    Information for People Who Use CFSS – Spanish, DHS-6893U-SPA (PDF).
    Information for People Who Use CFSS – Vietnamese, DHS-6893U-VIE (PDF).
  • For people currently using PCA/CSG, CFSS Information Sheet – English, DHS-8477A-ENG (PDF) or translated version:
    CFSS Information Sheet – Hmong, DHS-8477A-HMN (PDF).
    CFSS Information Sheet – Karen, DHS-8477A-KAR (PDF).
    CFSS Information Sheet – Somali, DHS-8477A-SOM (PDF).
    CFSS Information Sheet – Spanish, DHS-8477A-SPA (PDF).

    • Note: Counties/tribal nations can print documents for people who cannot access content electronically.

    6. Send CFSS eligibility results within 10 business days to the person or their representative (if applicable).

    7. Send CFSS eligibility results to the following providers (if applicable and/or known):

  • FMS provider.
  • PCA/CFSS provider agency.
  • Consultation services provider.

    • 8. Continue monitoring CSG expenditures until the person transitions to CFSS and ensure spending complies with program rules.

    9. Review the CFSS service delivery plan from the consultation services provider within established timeframes and approve or deny it. For timeline information, refer to CBSM – Support planning for LTSS.

    If the county/tribal nation approves the CFSS service delivery plan, they must:

  • Update the support plan and service agreement.
  • Send the support plan to the person and their providers.

    • If the county/tribal nation denies the CFSS service delivery plan, they must follow the requirements described on CBSM – Notice of action.

    For more information, refer to CFSS Policy Manual – CFSS service delivery plan development and approval process.

    10. End the current service agreement and enter a new service agreement that starts on the day after the end date of the six-month service agreement and ends on the last day of the person’s service plan year. For most people, this new service agreement lasts for six months.

    Example of authorization to avoid gap in services

    The person’s six-month CSG authorization is for Jan. 1, 2025, through June 30, 2025. After approving the person’s CFSS service delivery plan, the county/tribal nation enters a new service agreement for July 1, 2025, through Dec. 31, 2025, with:

  • A six-month consultation services line with six sessions.
  • A six-month worker training and development line for the full amount allowed (if applicable).
  • Six-month lines for the person’s other CFSS services.

    • County/tribal nation instructions for people who need additional time to complete the transition from CSG to CFSS

    Counties/tribal nations must use the following instructions to avoid a gap in services for people who need additional time to complete the transition from CSG to CFSS. Counties/tribal nations can enter six additional months of CSG services for a person who already has a six-month CSG service agreement if the person meets at least one of the following criteria:

  • The person’s service agreement will end in two months or less.
  • The county/tribal nation determines the person is likely to require more time to complete the transition from CSG to CFSS due to unique circumstances (e.g., the person uses HCN in place of CSG, the person has a language barrier).
  • The county/tribal nation authorized CSG at the person’s last reassessment, and they have not completed the transition from CSG to CFSS by their next reassessment.

    • Note: All people must transition to CFSS by Sept. 30, 2026.

    Instructions for people who had their first CFSS assessment after Oct. 1, 2024, and are not due for a reassessment

    The county/tribal nation must:

  • Finalize the service agreement.
  • Manually route it to DHS for any exception codes the county/tribal nation cannot resolve.

    • For more information, refer to DSD MMIS Reference Guide – Type B service agreement for CSG.

    The county/tribal nation does not need to enter a new consultation services line, but they may need to update the number of units and the end date of the existing consultation services line if it does not match the end date of the new CSG lines.

    Instructions for reassessments that happen between Oct. 1, 2025, and March 31, 2026

    The county/tribal nation conducts the person’s reassessment between Oct. 1, 2025, and March 31, 2026. If the person has not yet transitioned to CFSS, the county/tribal nation must enter a new service agreement with a start date immediately following the end date of the person’s existing service agreement. The new six-month service agreement must include the following lines:

  • Six months of CSG services, prorated based on the person’s assessment results. For more information, refer to DSD MMIS Reference Guide – Type B service agreement for CSG.
  • Six units of consultation services. For more information, refer to DSD MMIS Reference Guide – ASA3 screen for consultation services (T1023).

    • Instructions for reassessments that happen between April 1 and Sept. 30, 2026

    The county/tribal nation conducts the person’s reassessment between April 1 and Sept. 30, 2026. If the person has not yet transitioned to CFSS, the county/tribal nation must enter a new service agreement with a start date immediately following the end date of the person’s existing service agreement. The new service agreement must end on Sept. 30, 2026, and include the following lines:

  • CSG services, prorated based on the person’s assessment results and the number of months between the start date of the new service agreement and Sept. 30, 2026. For more information, refer to DSD MMIS Reference Guide – Type B service agreement for CSG.
  • Six units of consultation services. For more information, refer to DSD MMIS Reference Guide – ASA3 screen for consultation services (T1023).

    • County/tribal nation instructions for people who want to start CFSS before their CSG transition service agreement ends

    If a person wants to start CFSS services before their CSG/CFSS transition service agreement ends, the county/tribal nation must help the person end their CSG services and start their CFSS services early if all the following are true:

  • The person has an approved CFSS service delivery plan.
  • The person selected enrolled providers.
  • The person’s CFSS provider confirms they are ready to provide CFSS services to the person.
  • The person wants to start CFSS before the end of their CSG service agreement.

    • The county/tribal nation must:

    1. Ask the existing FMS provider the date the person will stop using CSG and how many dollars they need to complete a coordinated transfer of care.

    Note: This step is required even if the FMS provider will also deliver CFSS services to the person.

    2. Complete Lead Agency Addendum to CFSS Individual Service Delivery Plan, DHS-6893W based on the information they gathered in step 1.

    3. End the person’s current service agreement.

    4. Enter a new service agreement with:

  • Six units of consultation services. For more information, refer to DSD MMIS Reference Guide – ASA3 screen for consultation services (T1023).
  • Lines for the person’s approved CFSS services based on the start date listed on DHS-6893W. For more information, refer to DSD MMIS Reference Guide – ASA3 screen overview.

    • 5. Finalize the service agreement. For more information, refer to DSD MMIS Reference Guide – Finalize a type B service agreement for PCA/CFSS.

    Additional resources

    CFSS Policy Manual
    PCA Manual – PCA and CSG enhanced rate/budget

    Additional information about HCN

    HCN plan

    A person replacing HCN with CSG must have documentation of:

  • Back-up plan for staff absences.
  • Signed HCN participant agreement between the person/responsible party and the county/tribal nation, documenting understanding of the ability to return to the program of origin and assumption of increased risks.
  • Evidence of the role of the qualified professional.
  • Regular respite plan for support providers.
  • Health care professional’s report that informal providers have been trained to care for person.
  • Specific description of all formal and informal support providers.
  • Specific description of necessary medical supports.

    • HCN procedures

    HCN provider agency responsibilities

    A person using CSG to replace HCN must request an HCN home care rating. To get an HCN home care rating, the HCN provider agency must:

  • Conduct an HCN assessment.
  • Fax the assessment, HCN plan and physician orders to the DHS-contracted medical review agency and indicate the request is for CSG purposes (for instructions, refer to MHCP Provider Manual – Authorization – Review agents)
  • Submit an HCN service agreement into MMIS via MN–ITS and clearly indicate it is for CSG home care rating determination.

    • The medical review agency reviews all documentation to determine the HCN home care rating and enters the HCN rating on the HCN service agreement.

    County/tribal nation HCN plan responsibilities

    The county/tribal nation is responsible to:

  • Work with the person to create a CSG HCN plan following the county/tribal nation’s procedures.
  • Enter a service agreement for CSG into MMIS.
  • Check HCN on the AHC1 screen and submit the service agreement to DHS.
    Note: Some fields will be missing. MMIS will suspend the service agreement and automatically route it to DHS for coordination of information during the next phase of review.
  • Fax the proposed CSG HCN plan to 651-431-7575, ATTN: CSG Policy (for a person writing their first HCN plan only).
  • Follow the county/tribal nation’s CSG policies.

    • DHS responsibilities

    Within 30 days, DHS will:

  • Approve the plan if it includes all the required elements or request more information if the plan is incomplete (for a person writing their first HCN plan only).
  • Merge the CSG and HCN service agreements.
  • Add the appropriate home care rating.
  • Send the service agreement to the county/tribal nation to finalize the appropriate budget amounts (refer to LTSS Service Rate Limits, DHS-3945 [PDF]).

    • Person’s responsibilities

    The person continues using CSG following their approved plan.

    Report this page