24-hour emergency assistance

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

“24-hour emergency assistance must not be provided simultaneously (during the same period of the day) as adult day services bath, adult day service, day support services, employment development services [add] (direct time) [end add], employment exploration services [add] (direct time) [end add], employment support services [add] (direct time) [end add], individualized home supports (without training, with training and with family training), night supervision, prevocational services and respite.”

Adult day services

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

“Adult day services must not be provided simultaneously (during the same period of the day) as day support services, [delete] family adult day services, [end delete] homemaker ([delete] ADL [end delete] assistance [add] with ADLs [end add], [delete] homemaker [end delete] home management), family residential services, community residential services, individualized home supports [add] ( [end add] with training, [delete] individualized home supports [end delete] with family training [add] ) [end add], integrated community supports, prevocational services and respite services.”

Adult day services bath

Clarified services that are not covered based on existing policies

Caregiver living expenses

Clarified services that are not covered based on existing policies

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

“Caregiver living expenses must not be provided simultaneously ([delete] at [end delete] [add] during [end add] the same [delete] time [end delete] [add] period [end add] of the day) as respite (in-home or out-of-home).”

Community residential services

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

“Community residential services for adults may be delivered in a community residential setting (CRS) for up to four people, or a supervised living facility. Under certain conditions as specified by Minnesota Statutes, section 252.28, subd. 3, item d, services may be provided for up to six adults in homes licensed to provide foster care. The commissioner may also authorize services provided in settings that have received authority under Minnesota Statutes, section 245A.11, subd. 2a, paragraph (f) for a fifth bed [add] or settings that have received a variance to allow for the use of a sixth bed under Minnesota Statutes, section 245A.11, subd. 2a, paragraph (d) [end add].

The total number of participants living in the home, who are unrelated to the principal care provider, shall not exceed four except when authorized by the commissioner.

The commissioner may authorize services provided in settings [add] that have received authority under Minnesota Statutes, section 245A.11, subd. 2a, paragraph (d) to serve [end add] up to six participants living in the home who are unrelated to the principal care provider, in emergency situations when the setting is needed to avert a participant’s placement in a hospital, regional treatment center, or nursing facility. This exception for services delivered in a setting with more than four individuals shall not exceed two years. For purposes of this provision, emergency situations are defined as:

Consumer directed community supports (CDCS)

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

Crisis respite

Updated the size limitation to include a temporary variance for a sixth bed based on 2022 legislation

Day support services

Clarified services that are not covered based on existing policies

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

“Day Support Services must not be provided simultaneously (during the same period of the day) as Employment Exploration Services, Employment Development Services, Employment Support Services, Prevocational Services, Adult Day Services, [delete] (including family adult day), [end delete] adult day services bath, 24-hour emergency assistance, community residential services, extended personal care assistance, family residential services, integrated community supports, respite (in-home or out-of-home), and Individualized Home Supports (without training, with training, with family training), with the exception of indirect support provided through Employment Exploration Services, Employment Development Services, and Employment Support Services.”

Employment development services

Clarified services that are not covered based on existing policies

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

Employment exploration services

Clarified services that are not covered based on existing policies

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

Employment support services

Clarified services that are not covered based on existing policies

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

Extended personal care assistance (PCA)

Clarified services that are not covered based on existing policies

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

“[delete] Participants receiving extended [end delete] [add] Extended [end add] personal care assistance [delete] may receive the following services when delivered by another provider and the service is not delivered [end delete] [add] must not be provided [end add] simultaneously ([delete] at [end delete] [add] during [end add] the same [delete] time [end delete] [add] period of the day [end add]) as [delete] extended personal care assistance: [end delete] day support services, homemaker [add] ( [end add] assistance with ADLs [add] ) [end add], individualized home supports (with training, without training and with family training), integrated community supports and night supervision.

Family residential services

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

“Family residential services for adults may be delivered in a setting licensed as adult foster care for up to four people. The commissioner may also authorize services provided in settings that have received authority under Minnesota Statutes, section 245A.11, subd. 2a, paragraph (f) for a fifth bed [add] or settings that have received a variance to allow for the use of a sixth bed under Minnesota Statutes, section 245A.11, subd. 2a, paragraph (d) [end add].

Services provided in a living setting on the same or adjoining property as an institution are not covered if the institution has any financial interest in the living setting or services provided in the setting. For purposes of this limitation, institution means a nursing facility, hospital, intermediate care facility for persons with developmental disabilities, or institution for mental disease. When more than one living setting is located on the same or adjoining property and the settings or property is owned or leased by a single provider, services may only be covered for participants living in one of the settings.

The total number of participants living in the home, who are unrelated to the principal care provider, shall not exceed four except when authorized by the commissioner.

The commissioner may authorize services provided in settings [delete] serving [end delete] [add] that have received authority under Minnesota Statutes, section 245A.11, subd. 2a, paragraph (d) to serve [end add] up to six participants living in the home who are unrelated to the principal care provider, in emergency situations when the setting is needed to avert a participant’s placement in a hospital, regional treatment center, or nursing facility. This exception for services delivered in a setting with more than four individuals shall not exceed two years. For purposes of this provision, emergency situations are defined as:

Homemaker

Clarified services that are not covered based on existing policies

Change during public comment period

CMS approved the following language, with the additional change noted as a result of its review period:

“[delete] Homemaker assistance with ADLs must not be provided simultaneously (during the same period of the day) as extended personal care assistance, homemaker cleaning and homemaker home management.

Homemaker cleaning must not be provided simultaneously (during the same period of the day) as homemaker assistance with ADLs and homemaker home management.

Homemaker home management must not be provided simultaneously (during the same period of the day) as homemaker cleaning and homemaker assistance with ADLs. [end delete]

[add] Homemaker assistance with ADLs must not be provided simultaneously (during the same period of the day) as extended personal care assistance. In addition, the following homemaker services can only be provided individually and are not allowed to be provided simultaneously (during the same period of the day):

Individualized home supports

Clarified services that are not covered based on existing policies

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

“A participant cannot receive both individualized home supports with training and individualized home supports with family training even if [delete] authorized [end delete] [add] provided [end add] by separate providers.”

Integrated community supports

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

“Participants receiving integrated community supports may receive the following services when delivered by another provider and the service is not delivered simultaneously ([delete] at [end deleted] [add] during [end add] the same [delete] time [end delete] [add] period [end add] of [add] the [end add] day) as integrated community supports: adult day services bath, adult day services, day support services, extended personal care assistance and prevocational services.”

Change during CMS’ review period

CMS required the following language be added to the service definition:

“[add] All approved ICS settings that fall under the institutional presumption have been determined to meet HCBS settings criteria. [end add]”

Night supervision

Clarified services that are not covered based on existing policies

Change during public comment period

CMS approved the following language, with the additional change noted as a result of the public comment period:

“For participants receiving night supervision the following services are not covered: [delete] 24-hour emergency assistance, [end delete] community residential services, family residential services or integrated community supports.

Night supervision must not be provided simultaneously (during the same period of the day) as [add] 24-hr emergency assistance [end add], employment development services (direct-time), employment exploration services (direct-time), employment support services (direct-time), individualized home supports (with training, without training, with family training), respite (in-home or out-of-home) or [delete] transportation [end delete] [add] extended personal care assistance [end add].”