Minnesota Minnesota

Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


Changes to the size of setting by waiver service

Page posted: 10/1/03

Page reviewed: 2/9/24

Page updated: 1/23/25

Legal authority

Federally approved BI, CAC, CADI and DD waiver plans, Minn. Stat. §245A.03, subd. 7, Minn. Stat. §245A.11, Minn. Stat. §256B.092, Minn. Stat. §256B.49, Minn. Stat. Ch. 245D, Minn. R. 9525.1860, subd. 6, Minn. R. 9555.5050-9555.6265

Applicability

The instructions on this page only apply to the following waivers:

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

    • These instructions do not apply to the Elderly Waiver (EW) or Alternative Care (AC) programs. For more information, refer to CBSM – Adult foster care.

    Definitions

    Temporary capacity variance: Permission for a license holder to temporarily serve up to five people with developmental disabilities or severe and persistent mental illness (SPMI) in a foster care setting or community residential setting (CRS). The variance does not permanently increase the setting’s license capacity. There are two types of variances: initial and general.

    Initial variance: A first-time approval from DHS Licensing to temporarily serve one specific person above the setting’s license capacity for no more than six months.

    General variance: Approval from DHS Licensing after an initial variance expires. It allows providers to temporarily serve one additional person at a time above the setting’s licensed capacity. A general variance is not specific to one person. A general variance lasts for the length of the licensing period. The license holder must renew the variance at relicensing. Under a general variance, a specific person can stay in the setting for no more than six months.

    Permanent fifth bed capacity license: Permission from DHS for a license holder to serve up to five people.

    Overview

    When a service limits the size of a setting for people on BI, CAC, CADI and DD waivers, a license holder must request approval to add an additional temporary bed or renew an existing fifth bed capacity license. This page outlines the process for the following services that have limits to the size of a licensed setting:

  • · Community residential services.
  • · Family residential services.
  • · Crisis respite.
  • · Respite.

    • DD Waiver exception

    For homes dually licensed as 245D and supervised living facilities (SLFs), providers may serve up to six adults. There are no additional approvals for new development of this type of setting.

    People age 55 or older on BI, CAC or CADI waivers

    A CRS license holder may have a maximum license capacity of five if all people in care are age 55 or older and do not have an SPMI or a developmental disability.

    Process and procedure

    Refer to the specific sections on this page:

  • · Temporary variance for an additional bed, up to five.
  • · Permanent fifth bed capacity license.

    • Additional resources

    CBSM – Community residential services
    CBSM – Family residential services
    CBSM – Crisis respite
    CBSM – Respite
    CBSM – Adult foster care
    MHCP Provider Manual – EW and AC program – Adult foster care services
    License for Five Checklist (PDF)
    License Renewal Recommendation Form, DHS-3324 (PDF)

    Process/procedure: Temporary capacity variance for an additional bed, up to five

    Applicability

    This section applies to adults on BI, CAC, CADI and DD waivers who receive the following services in a licensed setting:

  • · Family residential services.
  • · Crisis respite.
  • · Respite.
  • · Community residential services (refer to note below).

    • Note: DHS Licensing may grant a licensed community residential setting (CRS) a temporary capacity variance for a fifth bed if the provider has permanent licensed capacity of four beds. This variance lasts for the length of the licensing period. The license holder must renew the variance at relicensing.

    Eligibility

    The license holder may request a temporary capacity bed variance from the county to deliver any of the following:

  • · Services in an adult foster care or community residential setting for people in an emergency situation.
  • · Emergency crisis services for a person with developmental disabilities or SPMI, regardless of age.
  • · Respite services for a person with disabilities, regardless of age.

    • A license holder is eligible for a temporary capacity bed variance if both 1 and 2 are true:

    1. One of the following emergency situations exists:

  • · Loss of the person’s services or housing due to a natural disaster.
  • · Risk of separating siblings when one or more needs foster care.
  • · Risk of the person being placed in a hospital, regional treatment center or nursing facility.
  • · Sudden closure of the person’s current living arrangement.
  • · Unexpected loss of the person’s primary caregiver.

    • 2. The license holder does all of the following:

  • · Ensures waiver services are authorized on a per-person basis.
  • · Has adequate space to protect the privacy and service needs of all people who live in the setting.
  • · Provides adequate staff and supervision to all people who live in the setting.
  • · Consults people who currently live in the setting, their legal representatives and their case managers to address concerns before adding the temporary bed.

    • Process

    DHS Licensing is working to update the variance process. We will update this page with the process once it has been finalized. Until then, the license holder must contact the county licensor where the site is located to start the process.

    Crisis respite for up to five people in foster care settings

    DHS Licensing may grant a variance to allow the use of an additional bed, up to five, for emergency crisis respite services for people with SPMI or developmental disabilities, if both the following are true:

  • · The variance complies with the requirements in Minn. Stat. §245A.04, subd. 9.
  • · The county licensor recommends the variance.

    • To request a variance, the license holder must contact the county licensor where the site is located to start the process.

    Respite for up to five adults

    DHS Licensing may grant a variance for respite services to allow for the use of an additional bed, for up to five people age 18 or older, if both the following are true:

  • · The variance complies with the requirements in Minn. Stat. §245A.04, subd. 9.
  • · The county licensor recommends the variance.

    • The provider must deliver respite services under all of the following conditions:

  • · The provider cannot reduce staffing ratios below the approved level for the people served in the home on a permanent basis.
  • · The provider cannot accept more than two different people for respite services in any calendar month, and the total respite days cannot exceed 120 days per program in any calendar year.
  • · The person who receives respite services must have their own bedroom, which cannot be used for alternative purposes when not used as a respite bedroom (i.e., the room cannot be the room of another person who lives in the setting).
  • · The provider must notify people living in the setting when DHS Licensing approves the variance.

    • Notice guidelines

    The provider must give 60 days’ written notice to the current residents and their legal representatives before they accept the first respite placement. With all future respite placements, the provider must give current residents at least two days’ notice before they provide respite to a person. If the provider does not have two days to provide notice, they must notify the current residents as soon as possible. Current residents or legal representatives can waive the requirement for the two-day notice for all future respite placements.

    How to request a variance

    To request a variance, the license holder must contact the county licensor where the site is located to start the process.

    Process/procedure: Permanent fifth bed capacity license

    Applicability

    This section applies to adults on BI, CAC, CADI and DD waivers who receive the following services:

  • · Community residential services provided in a CRS.
  • · Family residential services provided in family foster care setting.

    • Eligibility

    DHS cannot issue a new permanent fifth bed capacity license for a CRS setting because the statutory authority expired on Dec. 31, 2020 (Minn. Stat. §245A.11, subd. 2a.(g)).

    Existing fifth bed capacity licenses will continue if they comply with DHS Licensing policy. For additional information on existing fifth bed capacity licenses, refer to the renewals portion of the process for licensed corporate/CRS settings section on this page.

    Note: The moratorium liaison can submit Request to Close or Develop New Corporate Foster Care, DHS-6021 to increase a CRS setting’s license capacity when all people in care are age 55 or older and do not have an SPMI or DD diagnosis. To contact a liaison, refer to CBSM – Corporate foster care moratorium liaison contact list.

    Renewal process for licensed corporate/CRS settings

    Renewal of a permanent fifth bed capacity license requires a recommendation from the county licensor and approval from DHS Licensing.

    Step 1

    The license holder consults with the county licensor and completes the requirements on the License for Five Checklist (PDF).

    After completing the checklist:

    1. The license holder submits the required information to the county licensor.

    2. The county licensor verifies the requirements listed on the License for Five Checklist.

    3. The county licensor requests additional information, as needed, and determines the recommendation to make to DHS Licensing.

    Step 2

    The licensor completes the License Renewal Recommendation Form, DHS-3324 (PDF) and submits the following to DHS Licensing Family Systems for review and approval:

  • · Completed DHS-3324 form.
  • · Recommendation to increase the setting’s license capacity to five.
  • · License for Five Checklist and all supporting documentation.

    • Process for licensed family foster care settings

    For licensed family foster care settings, a permanent fifth bed capacity license requires approval from DHS Licensing. The license holder must have approval before a person moves into the fifth bed.

    Step 1

    The license holder consults with the county licensor and completes the requirements on the License for Five Checklist (PDF).

    After completing the checklist:

    1. The license holder submits the required information to the county licensor.

    2. The county licensor verifies the requirements listed on License for Five Checklist.

    3. The county licensor requests additional information, as needed, and determines the recommendation to make to DHS Licensing.

    Step 2

    The licensor completes the License Renewal Recommendation Form, DHS-3324 (PDF) and submits the following to DHS Licensing Family Systems for review and approval:

  • · Completed DHS-3324 form.
  • · Recommendation to increase the setting’s license capacity to five.
  • · License for Five Checklist and all supporting documentation.

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