Resource: Customized living component service definitions and guide for computing time for rate-setting tools
Page updated: 1/27/26
This resource is part of the customized living toolkit. Visit other resources in the toolkit for additional information:
Table of contents
This page includes the following sections:
Applicability
This page replaces DHS-6790H. It provides guidance to case managers/care coordinators and providers when they complete the customized living rate tools for people who use:
It also provides guidance to providers when they complete Rate Management Worksheet – Customized Living Services and 24-Hour Customized Living Services, DHS-6790G for people who use BI and CADI.
This page applies to existing home and community-based services (HCBS) customized living waiver rate-setting tools. Existing policies come from:
The information on this page complements existing HCBS policy. It does not replace existing HCBS policy.
General policy and practice
This section includes general policy and practice to consider when customized living is a support option.
1. Assessed need
People who use services must have an assessed need for any service authorized under the Medical Assistance (MA) state plan or HCBS waivers. Case managers/care coordinators must ensure people have a documented assessed need for all authorized components of customized living.
2. Choice of services and providers
Case managers/care coordinators must ensure people have a choice among services and providers. Whenever possible, case managers/care coordinators should consider and incorporate informal supports from family and friends into the support plan.
Customized living providers may offer services to meet people’s assessed needs, but people may decide to:
Providers can never limit people’s choices of services and providers.
For additional information, refer to CBSM – Person-centered practices.
3. Service duplication
Case managers/care coordinators must ensure there is no service duplication between:
When the component service offers different options for individual or shared group time, case managers/care coordinators must use the appropriate rate. For example, socialization, transportation and mileage have different rates depending on how many people and staff are involved in the service delivery.
Case managers/care coordinators allocate time in the Rate Management System (RMS) Customized Living Rate Tool for BI and CADI or in the EW Residential Services Tool, based on information from the MnCHOICES assessment and information from the service provider.
For BI and CADI, service providers allocate time to reflect total staff time in DHS-6790G and share the document with case managers/care coordinators. Case managers/care coordinators enter the final, agreed upon amount of time in to the RMS Customized Living Rate Tool or EW Residential Services Tool, based on the person’s assessed needs.
If two staff are required to complete a task, case managers/care coordinators and providers allocate time to reflect total staff time. For example, if a transfer takes two staff to complete in 20 minutes, they allocate 40 minutes.
When two or more people share a living unit, case managers/care coordinators and providers allocate housekeeping and other tasks between/among people who need the support. For example, if there are two people in a living unit who need homemaking services and one staff takes 40 minutes to complete the homemaking tasks, each person needs 20 minutes allocated for the service.
Whenever possible, support teams should explore and authorize assistive technology, as appropriate.
4. Service limits specific to BI and CADI waivers
Effective Jan. 1, 2022, BI and CADI customized living rates cannot include more than 24 hours per day of support in a daily unit. This maximum is established under Minn. Stat. §256B.4914, subd. 6(d).
The combined number of staffing hours entered into the RMS cannot total more than 24 hours of staffing per day for the following service categories:
Within the 24-hour limitation, the ADL assistance and mental health management service categories have the following additional limitations based on the person’s case mix:
As described in the service duplication section, if two staff are required to complete a task, case managers/care coordinators and providers allocate time to reflect total staff time, which must be contained within the 24-hour limitation.
For more information about these limitations for the BI and CADI waivers, refer to RMS Manual – Customized living and 24-hour customized living fields.
5. Rates based on individual needs
Most component rates are based on how much staff time people reasonably require, based on their individual needs. Each component must only include the staff time directly related to providing the component service to meet the person’s assessed need(s). Time entered for authorized components of customized living must reflect the actual component services delivered to the person. It does not include general supervision or access to available staff.
There are three exceptions for service components that are not based on the person’s individual needs:
6. Inclusive rates
Case managers/care coordinators must base time entry of each customized living service component on people’s support needs and the amount of staff time directly related to providing services to them. Case managers/care coordinators cannot add the following when entering time for component services:
7. Consistency in authorization and rates
The customized living component service definitions included on this page ensure consistency in service authorization and rate-setting. Case managers/care coordinators must only include covered component services in people’s customized living plans that address their assessed needs.
When entering time into the customized living rate tools, case managers/care coordinators must ensure all time and other units are covered within the definition of the applicable component service. The time entered for the component service is time staff provide the service directly to the person when the person is awake and involved. Any time entered for services delivered directly to the person while they are asleep must be clearly documented and meet an assessed need. Most hours will occur with the person awake and involved, but there may be rare cases in which the service is delivered directly to the person during primary asleep hours (e.g., repositioning every 4 hours during the person's primary asleep hours).
“Assisting with” means providing the level of support necessary to complete the task. This ranges from reminding the person to initiate the task, to total assistance with the task, or, as appropriate, completing the task for the person (e.g., cleaning for people with limited stamina). Support teams must consider people’s goals and outcomes when determining the level of support they need. Providers should deliver assistance in a way that supports people’s continued or increased levels of self-sufficiency, as described in their support plan.
Note: This page includes typical activities as guidance for each component service. These examples are not an inclusive list of all tasks that may be authorized within a component service.
8. Billing for additional units
Providers must accept MHCP reimbursement as payment in full for covered services provided to people. For more information, refer to MHCP Provider Manual – Billing policy overview – MHCP reimbursement is payment in full.
Providers cannot bill or otherwise charge people or their families for additional units of any covered component service beyond those approved in the support plan by the lead agency.
Example: A person has an assessed need for housekeeping that is met through services in the customized living plan. One week, it takes the cleaners longer than usual to complete their work. The provider cannot charge that person or their family for the extra time.
People and/or their families may choose to buy additional covered services from another provider.
Home management tasks
Service | Covered component services | Non-covered component services | Additional clarification |
Light housekeeping | Typical tasks include: | This service does not include: Note: Ensure non-duplication with heavy housekeeping, described in the next row. | Light housekeeping tasks are typically done on a daily or weekly basis and take little time to complete. |
Heavy housekeeping | Typical tasks include: | This service does not include: | N/A |
Laundry – personal | This service includes cleaning of personal items, such as the person's clothing and other items (excluding personal linens). Typical tasks include: | This service does not include: | Waivers do not cover laundry soap. Housing Support covers household supplies, including laundry soap. For more information, refer to DHS – Housing Support. |
Laundry – personal linens | This service includes cleaning of linens (e.g., sheets and blankets) that are not the person's clothing. Typical tasks include: | This service does not include: | Waivers do not cover laundry soap. Housing Support covers household supplies, including laundry soap. For more information, refer to DHS – Housing Support. |
Shopping | This service includes helping the person make purchases. Shopping “for” the person without the person’s presence requires supporting documentation of need in their support plan. | This service does not include shopping “for” a person if there is not supporting documentation of need in their support plan. | This service can include internet shopping. |
Participant assistance w/ food prep in own apartment | This service includes helping the person (who has purchased food) prepare it within their living unit. Typical tasks include: | N/A | “Making food accessible” means the person can access it with less or no additional human assistance (e.g., opening jars or reorganizing so all items are within reach). |
Congregate meal breakfast prep – also for lunch, supper and snack prep | This service includes all food preparation and service of the person’s meal done simultaneously with food preparation for other people who use services. Typical tasks include, but are not limited to: | This service does not include raw food costs. | Waivers do not cover raw food costs. Housing Support covers raw food costs. For more information, refer to DHS – Housing Support. |
Assistance making appointments | This service includes helping the person make medical and non-medical appointments. | This service does not include medical appointments scheduled by a case manager/care coordinator. | N/A |
Arrange transportation | This service includes helping the person: | This service does not include arranging MA state plan transportation. | For more information about MA state plan transportation, refer to MHCP Provider Manual – Nonemergency medical transportation (NEMT) services. |
Money management | This service includes tasks that support the person to control and use personal financial resources, such as: | This service is not covered if the person has a representative payee because it is considered service duplication. | For more information about representative payees, refer to Disability Benefits 101 – Representative payee definition. |
Standardized monthly socialization
Service | Covered component services | Non-covered component services | Additional clarification |
Socialization is part of an individualized plan designed to support the person to achieve person-centered goals and outcomes, as described in their support plan. Typical tasks may include supports that help the person maintain or develop relationships. This includes helping the person: | This service does not include activity programs that do not facilitate the person’s stated outcomes and goals, as described in their support plan. | Socialization can be used to support the person’s engagement in the community. |
Non-medical transportation
Service | Covered component services | Non-covered component services | Additional clarification |
This service includes driver time when the person is in the vehicle. It accounts for the driver's time to transport the person in the community. | This services does not include: | Transportation is differentiated based on whether it is provided for one person or for a group of riders. MHCP Provider Manual – Nonemergency medical transportation (NEMT) services includes information about MA state plan transportation. MA state plan transportation is a primary service and must be used before waiver-funded transportation. When the person requires staff to provide assistance in the community, the lead agency should authorize that support under the applicable component service (e.g., assistance with wheeling if the person needs help due to a physical limitation or assistance to manage wandering if the person has an orientation challenge). The lead agency should authorize both driver time and mileage when the person is in the vehicle. Note: Transportation may be a critical element in supporting the person to achieve their goals and outcomes related to socialization. | |
Mileage 1:1 | This service includes the estimated number of miles the person will be transported. | This service does not include miles when the person is not in the vehicle. | Mileage is differentiated based on whether it is provided for one person or for a group of riders. Note: Transportation may be a critical element in supporting the person to achieve their goals and outcomes related to socialization. |
Activities of daily living (ADL) assistance
Service | Covered component services | Non-covered component services | Additional clarification |
Assistance dressing | Typical tasks include helping the person: | N/A | N/A |
Assistance grooming | Typical tasks include helping the person: | N/A | N/A |
Assistance bathing | Typical tasks include helping the person: | N/A | N/A |
Continence care | Typical tasks include helping the person: | This service does not include laundry of soiled items or wipes the person needs to self-manage toileting-related tasks. | Laundering personal laundry or linens due to incontinence must be included as laundry – personal or laundry – personal linens (described above). If a provider is authorized to provide this component service, the lead agency cannot authorize wipes as a separate waiver-covered supply. The cost of wipes is included in the reimbursement for this service. If a provider is not authorized to provide this component service and the person needs wipes to self-manage toileting-related tasks, the lead agency may authorize wipes as a separate waiver-covered supply. This need must be identified in the person’s support plan. |
Assistance with eating | Typical tasks include: | This service does not include: | If the assistance is not on a continuous, 1:1 basis, the lead agency should authorize it based on allocation of time. |
Assistance with positioning | Typical tasks include helping the person with body positioning needed to maintain health and increase functioning. | This service does not include assistance with transferring (described below). | N/A |
Assistance with walking | Typical tasks include providing the person with: | N/A | N/A |
Assistance with use of wheelchair | This service is to help the person with use of a wheelchair. Typical tasks include helping the person: | N/A | N/A |
Assistance with transferring | Typical tasks include helping the person move from one place to another (e.g., from bed to wheelchair). | N/A | If two staff are required to assist with transfers, the total staff time should be included for the component service. For example, if a transfer takes two staff 10 minutes to complete, allocate 20 minutes. The support team should consider assistive technology (e.g., hoyer lift) as an alternative to human assistance and authorize it as appropriate. |
Health-related assistance
Service | Covered component services | Non-covered component services | Additional clarification |
Medication setups and monitoring | This service is to arrange medication for later administration by the person or others. Typical tasks include: | This service does not include: | N/A |
Insulin draws | This service is to draw insulin. Typical tasks include: | This service does not include: | Only a nurse can complete insulin draws. Insulin administration is a nursing task that can be delegated or assigned to unlicensed staff. For information about nursing practices, refer to Minnesota Nurse Practice Act. |
Verbal or visual medication reminders | Typical tasks include: | N/A | N/A |
Medication administration or assistance with self-administration | This service is to perform a set of tasks to ensure the person takes medications. Typical tasks include: | N/A | Time for nurse supervision and staff training is included in the component rate and should not be included in the calculation of time needed to complete the task. Nurse supervision and staff training must be completed by a nurse. Medication administration can be a delegated or assigned nursing task. |
Insulin injections | This service is to perform insulin injections. | N/A | This service requires nurse delegation or assignment, per assisted living licensing (Minn. Stat. §144G.62, subd. 2) and the Minnesota Nurse Practice Act. |
Therapeutic exercises | This service is to assist with exercises ordered by a physician or other health care professional for therapeutic benefit. The service is provided in a 1:1 staff-to-person ratio. | This service does not include: | N/A |
Delegated clinical monitoring | This service includes nursing procedures delegated or assigned to unlicensed staff, related to the person's diagnosis and medically unstable condition and high risk condition(s). All criteria in AC, BI, CADI, EW Case Mix Classification Worksheet, DHS-3428B (PDF) must be met as part of the MnCHOICES assessment process. | This service does not include delegated or assigned nursing tasks or other tasks that do not meet clinical monitoring criteria listed in the next column. | Clinical monitoring criteria requires that the medical record establish all of the following: |
Delegated or assigned nursing tasks | This service covers tasks the person needs due to their individual health status that require and can be delegated or assigned by a licensed health care professional to people who: This service also covers delegated or assigned tasks that meet these qualifications and are not included in other component services. | This service does not include: | Delegated or assigned tasks must be: If a nurse provides services they could delegate or assign to others, the nurse will be paid at the rate of unlicensed staff. |
Provide summoning device | This service provides the means for a person to summon assistance effectively. The device must meet the person’s needs and reflect the person’s preferences. | N/A | For BI and CADI, the person must have a summoning device when receiving 24-hour customized living, as stated on CBSM – Customized Living (including 24-hour customized living). For EW, if the person receives 24-hour customized living, the provider must provide a way for the person to summon assistance. The person cannot receive monitoring technology as a separate waiver service for use inside the setting. A person on EW may only receive personal emergency response systems (PERS) (e.g., pendant call systems) that may be appropriate for the person to use outside of the customized living setting (refer to CBSM – PERS). The PERS provider cannot be the same provider as the person’s 24-hour customized living provider. |
Assistance with mental health, cognitive or behavioral concerns
Service | Covered component services | Non-covered component services | Additional clarification | ||||
Assistance with: | This service includes support provided due to mental health, cognitive or behavioral needs that have been assessed by an appropriate professional. For each of these service components included in the person’s support plan, the provider must have a plan to: | This service does not include: | Only services designed to address assessed cognitive, behavioral or mental health concerns may be included in this component. The description of the support(s) provided should include the person-specific interventions and frequency of the 1:1 interventions needed, as assessed by the appropriate professional and documented in the person’s support plan. The provider’s plan to address each mental health, cognitive or behavioral concern should include a description of alternative strategies (i.e., what strategies were used), the efficacy and changes made to improve outcomes. | ||||
Other mental health, cognitive or behavioral needs | This service includes planning for other assessed mental health, cognitive or behavioral needs, including: For each of these service components included in the person’s support plan, the provider must have a plan to: | This service does not include: | Only services designed to address assessed cognitive, behavioral or mental health concerns may be included in this component. The description of the support(s) provided should include the person-specific interventions and frequency of the 1:1 interventions needed, as assessed by the appropriate professional and documented in the person’s support plan. The provider’s plan to address each mental health, cognitive or behavioral concern should include a description of alternative strategies (i.e., what strategies were used), the efficacy and changes made to improve outcomes. | ||||
Additional resources
Tools
AC, BI, CADI, EW Case Mix Classification Worksheet, DHS-3428B (PDF)
Disability Services Division Customized Living/24-hour Customized Living/Residential Care Services Rate Framework (.XLS)
Lead Agency Provider Tool for DWRS Exceptions (Customized Living), DHS-5820E
Rate Management Worksheet – Customized Living Services and 24-Hour Customized Living Services, DHS-6790G
Policy and procedure
CBSM – Customized living (including 24-hour customized living
CBSM – MnCHOICES
MHCP Provider Manual – HCBS waiver services
RMS Manual – Quick reference guide on rate calculations for customized living/24-hour customized living for disability waivers
RMS Manual – Customized living and 24-hour customized living fields
Legal authority
Minn. Stat. Ch. 144G (assisted living)
Minn. Stat. §144A.43 through §144A.49 (nursing homes and home care)
Minn. Stat. Ch. 256S (MA EW)
Minn. Stat. §256B.0911 (long-term care consultation services)
Minn. Stat. §256B.4914 (HCBS waiver rate-setting)
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