Minnesota Minnesota

Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


Residential support service criteria effective July 1, 2025

Page posted: 5/27/25

Page reviewed:

Page updated:

Legal authority

Federally approved BI, CAC, CADI and DD waiver plans, Minn. Stat. 256B.49, subd. 29, Minn. Stat. §256B.092, subd. 11

Overview

Effective July 1, 2025, a person using a disability waiver can only access community residential services (CRS) and customized living (CL) services (including 24-hour CL), if they meet the following residential support service criteria:

  • · The person has complex medical or behavioral health needs.
  • · The service planning team has considered all other available residential service options and determined those options are not appropriate to meet the person's support needs.
  • Definitions

    Residential support service criteria (RSSC): Requirements (defined under Minn. Stat. §256B.49, subd. 29 and Minn. Stat. §256B.092, subd. 11) that a person must meet to access the following residential support services:

  • · Community residential services (CRS).
  • · Customized living (CL) services (including 24-hour CL).
  • RSSC does not apply to family residential services (FRS) or integrated community supports (ICS).

    Informed choice: A choice a person makes after receiving complete, accurate, accessible and timely information so they can understand all options available, including where to live, where to work, how technology can support them and their provider options. Informed choice means the person has information to make decisions based on their needs, strengths, goals, likes, dislikes, cultural identity and life experiences.

    Complex medical needs: Health conditions or situations that require extensive and/or specialized medical care, management or interventions. For more information, refer to the section below about the assessment determination process.

    Complex behavioral health needs: Conditions or situations that cause a person to experience significant challenges related to their mental health or behavioral well-being, which may require specialized and comprehensive interventions. For more information, refer to the section below about the assessment determination process.

    Applicability

    CRS

    RSSC applies to adults and children who receive CRS authorized after July 1, 2025, on the following waivers:

  • · Brain Injury (BI) Waiver.
  • · Community Alternative Care (CAC) Waiver.
  • · Community Access for Disability Inclusion (CADI) Waiver.
  • · Developmental Disabilities (DD) Waiver.
  • CL

    RSSC applies to adults who receive CL (including 24-hour CL) authorized after July 1, 2025, on the following waivers:

  • · BI Waiver.
  • · CADI Waiver.
  • RSSC does not apply to CL on the Elderly Waiver (EW).

    Exception

    A person is exempt from RSSC if they have an active service agreement for CRS or CL on July 1, 2025, and continual authorization for the waiver. This exemption continues to apply even if the person moves out of the CRS or CL setting to try less restrictive options. In this situation, the person may return to CRS or CL without meeting RSSC. Continual authorization includes a temporary waiver exit, as described on CBSM Temporary waiver exits and restarts: MMIS actions.

    Determination process: Assessment

    All assessments after July 1, 2025, include the eligibility determination for residential support services.

    Before the assessment

    Before assessment, the case manager should communicate with the assessor using MnCHOICES Communication Form, DHS-6791E to provide relevant information about the person’s needs, circumstances and other details that may help the assessor make an informed evaluation.

    During the assessment

    The assessor makes the determination that the person has complex medical and/or complex behavioral health needs. For additional information, refer to the practice guide – MnCHOICES assessment form document within the MnCHOICES Help Center.

    After the assessment

    The assessor sends the person the results of their assessment, including the determination of complex health and/or behavioral health needs.

    Determination process: Support planning

    Before the assessment (skip for initial assessments)

    During waiver span leading up to the MnCHOICES reassessment, the case manager must:

  • · Monitor the support plan and the services authorized to ensure the services meet the person’s needs and are delivered in a manner that aligns with their preferences.
  • · Coordinate conversations with the person, their service providers and family (if applicable) to discuss all available service options.
  • If the person expresses an interest in CRS or CL, the case manager should have an informed choice and informed decision-making conversation with the person, including discussing all available least-restrictive housing options and explaining RSSC to access CRS or CL.

    If the service planning team has considered all other available least-restrictive and own-home options and determined those options are not appropriate to meet the person's support need and the person still would like to access CRS or CL services, the case manager must:

  • · Determine the urgency of this request and whether the person needs an early reassessment.
  • · Complete MnCHOICES Communication Form, DHS-6791E (or the agency’s version of the form) to notify the assessor of the person’s interest in CRS or CL services.
  • Based on case management monitoring activities, the case manager may anticipate a potential need for CRS or CL in the near future, even if the person has not expressed an interest. They can complete MnCHOICES Communication Form, DHS-6791E (or the agency’s version of the form) to notify the assessor as a proactive measure to avoid a request for an early reassessment.

    After the assessment

    The case manager enters the assessor’s determination of complex medical and/or complex behavioral health needs in the about me section of the MnCHOICES support plan. For additional information, refer to the practice guide – MnCHOICES support plan form document within the MnCHOICES Help Center.

    If the person would like to access CRS or CL, the case manager:

    1. Determines whether the person meets the exception (i.e., had an active service agreement/continual authorization for CRS or CL on July 1, 2025) and takes the appropriate action:

  • · Meets the exception: The person has access to CRS or CL.
  • · Does not meet the exception: Go to the next step.
  • 2. Confirms from the assessment that the person does meet the criteria for complex medical or behavioral health needs and takes the appropriate action:

  • · Presents all available least-restrictive and own-home options before provider-owned or -managed options and provides an informed decision-making process. The case manager can only authorize CRS or CL if no other available least-restrictive or own-home options meet the person's needs. The case manager must send a notice of action (NOA) if they deny CRS or CL and support the person through the appeal process if they choose to appeal.
  • · Documents the person’s informed choice and informed decision-making process with their case notes and in the signature sheet section of the MnCHOICES support plan.
  • If the person does not meet the criteria for complex needs as determined by their assessment, go to the next step.

    3. Confirms from the assessment that the person does not meet the criteria for complex medical or behavioral health needs. In this situation, the case manager:

  • · Cannot authorize CRS or CL.
  • · Must send an NOA.
  • · Must support the person through the appeal process if they choose to appeal.
  • For more information, refer to CBSM – NOA.

    Early reassessment

    A person might need an early reassessment if they either:

  • · Are interested in CRS or CL, but their assessment was before July 1, 2025.
  • · Had their assessment after July 1, 2025, and did not meet complex medical or behavioral health criteria (or the exception) but now has a change in need and is seeking CRS or CL services.
  • Provider responsibilities

    To implement RSSC effective July 1, 2025, CRS and CL providers are responsible to:

  • · Ensure the person has active BI, CAC, CADI or DD service agreement for CRS or CL before the start of service delivery.
  • · Clearly document the scope of services provided in the person’s service delivery plan and communicate about needs that exceed scope with the support planning team.
  • · Consider alternative service models to increase independent living options for people with disabilities in accordance with Minn. Stat. §256B.4905 and Minnesota’s Olmstead Plan.
  • Additional resources

    CBSM CRS
    CBSM CL (including 24-hour CL)
    CBSM – Support planning for long-term services and supports
    CBSM – NOA

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