Page posted: 8/8/22

This resource is part of the customized living toolkit. Visit other resources in the toolkit for additional information:

· CBSM – Customized living (including 24-hour customized living)

· CBSM – Resource: Customized living component service definitions and guide for computing time for rate-setting tools

· Rate Management Worksheet – Customized Living Services and 24-Hour Customized Living Services, DHS-6790G

· Lead Agency Provider Tool for DWRS Exceptions (Customized Living), DHS-5820E

· RMS Manual – Customized living and 24-hour customized living fields

Overview

This guidance helps lead agencies and providers understand and apply the service requirements and staffing hour policies for customized living services provided to people on:

· Brain Injury (BI) Waiver

· Community Access for Disability Inclusion (CADI) Waiver.

For more information about customized living input fields, including maximum allowable staffing hours, see RMS Manual – Customized living and 24-hour customized living fields.

Primary contact

Each lead agency’s Disability Waiver Rate System (DWRS) rate mentor is the primary contact for discussions about customized living rates (see RMS Manual – DWRS rate mentor contact list). The rate mentor works with providers and other lead agencies to ensure appropriate authorization of this service. If further guidance is needed, the rate mentor or provider may seek additional help by using the DSD Contact Form.

Service planning basics

Before determining the rate, the lead agency and provider should work together to determine the task-specific, non-duplicative time spent working directly with the person receiving customized living services. For guidance about what is included within each component service, see CBSM – Resource: Customized living component service definitions and guide for computing time for rate-setting tools.

The lead agency and provider must ensure the following when determining the number of units within each customized living component service:

· The person receiving services has a need reflected in the assessment and described in the support plan, and the support instructions indicate how the provider meets the need

· The task is covered under the identified component service (see CBSM – Resource: Customized living component service definitions and guide for computing time for rate-setting tools for a list of covered and non-covered tasks within each component service)

· The task is counted in only one of the component services (e.g., socialization or mental health management)
Note: If a task could fit within two services, the provider and lead agency should determine which component service most closely aligns to the task.

· The task is counted in only one component service within the specific service category (i.e., no duplication between time entered for services within multiple mental health management services)

· The time entered for the component service is time staff provide the service directly to the person when the person is awake and involved
Note: 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).

· The task does not duplicate another service provided/authorized (e.g., individualized home supports with training)

· Task time is not counted when staff are available but not providing services directly to the person.

Certain service categories have a maximum number of staffing hours that can be entered into RMS. Lead agencies and providers cannot exceed the maximum number of staffing hours allowed under statute.

The combined number of staffing hours entered into RMS may not total more than 24 hours of staffing per day for the following service categories:

· Home management

· Socialization

· Activities of daily living (ADL) assistance

· Health-related assistance (excluding summoning device)

· Mental health management.

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:

· People with case mix B may not have more than 4 units per day of ADL assistance

· People with case mix D may not have more than 6 units per day of ADL assistance

· People with case mixes A, D or G may not have more than 2 units per day of mental health management.

For more information, see RMS User Manual – Customized living and 24-hour customized living fields.

Differences between customized living and community residential services

The following table explains the most common differences between customized living and community residential services.

Service considerations	Customized living	Community residential services
Onsite available staff who are not providing direct support may be included in rate inputs.	No	Yes
Time is entered for individual tasks.	Yes	No
The rate is determined by staffing inputs, which can be shared or individual, and non-staff component values.	No	Yes
The rate is determined by the amount of time needed to complete each non-duplicative specific task with a person who is awake and involved.	Yes	No
Time may be included in the rate when the person is asleep.	No	Yes
Service values include all supervision, training and administrative costs.	Yes	No Note: These costs are calculated separately using the community residential services rate tool.
The service requires an assisted living license.	Yes	No
The service requires Ch. 245D and community residential setting licenses.	No	Yes

Rate exceptions

Lead agencies can use Lead Agency Provider Tool for DWRS Exceptions (Customized Living), DHS-5820E to submit a rate exception.

As with all other DWRS services, lead agencies should only approve a rate exception for a person whose extraordinary needs require a service-based response with a cost that cannot be met within the framework rate.

Rate exception requests cannot include more than 24 hours of support. Requests must comply with case mix maximums identified in state law. If an exception is appropriate, the exception will increase the specific service task rate to account for the extraordinary service-based response.

Before submitting a rate exception for customized living, the lead agency should consider the following:

1. Are entries in two or more fields duplicative? Rate tool inputs are duplicative if the same time span is included in multiple fields within the tool. Removing duplicate entries may eliminate the need to request a rate exception. Consider the following:

· Is support provided during an hour that could fall into two fields on the rate tool? Select one of the fields and document the time there.

· Example: The provider takes the person shopping, and shopping causes the person anxiety. Consider whether time should be documented in the “shopping” or “manage anxiety” field. The same time should not be documented in both fields. However, some of the shopping trip time may be included in “shopping,” and some of the time may be included in “manage anxiety.”

2. Are all hours included in the rate tool appropriate? Removing inappropriate entries may eliminate the need to request a rate exception. Consider the following:

· Is all support time included in the rate tool for only when the person is awake and involved? If not, remove time when the person is asleep.

· Is time included in the rate tool covering only direct support provided to the person? Remove time when staff is available but not providing direct support to the person.

3. What support is being provided that requires a rate exception? Consider the following:

· Rate exception requests should be applied to specific services identified in the rate tool.

· Example: The person needs staff with additional training to manage the person’s anxiety, but the same training is not required for light housekeeping. In this case, the exception may apply to “manage anxiety” but not “light housekeeping.”

4. Does available documentation support the exception request? Consider the following:

· Does the person’s MnCHOICES assessment identify that the person has extraordinary needs, compared to other people who receive customized living? The lead agency may consider the person’s needs compared to other people the lead agency supports.

· If the person requires staff with additional training, does the provider have documentation of the staff’s training to support the request? This may include staff training records or provider records of how they support the person.

Additional resources

CBSM – Customized living (including 24-hour customized living)
CBSM – Resource: Customized living component service definitions and guide for computing time for rate-setting tools
Rate Management Worksheet – Customized Living Services and 24-Hour Customized Living Services, DHS-6790G
Lead Agency Provider Tool for DWRS Exceptions (Customized Living), DHS-5820E
RMS Manual – Customized living and 24-hour customized living fields
RMS Manual – DWRS rate mentor contact list