Page reviewed: 10/20/26

Federally approved BI, CAC, CADI and DD waiver plans, Minn. Stat. §245D.03, Minn. Stat. §245D.091, Minn. R. 9544, Minn. R. 9555.5150 to 9555.6265, Minn. R. 2960.3000 to 2960.3340, Minn. Stat. §245D.06, subd. 5-8, Minn. Stat. §245D.061, Minn. Stat. §245D.081, Minn. Stat. §245D.06, subd. 5

Crisis respite: A time-limited, intensive intervention service provided to a person experiencing a behavioral and/or medical crisis. The service is designed to provide intervention to stabilize the person, ensure health and safety and support the person to remain in the community so they can avoid unnecessary institutionalization.

Specialized staff (different from former specialized staff service add-on): Qualified professionals who have completed intensive training and demonstrated competency to support people with complex behavioral and/or medical needs that pose a risk to the person or others. For detailed information about qualifications, refer to the provider standards and qualifications section on this page.
Note: The phrase “specialized staff” previously referred to a service add-on for crisis respite. Now, it refers to staff with specialized training. All providers must have at least one specialized staff to perform all covered services in the covered services section of this page, including the person-specific activities.

Consultative crisis respite (formally called specialized staff): A supplemental, unit-based service provided by qualified professionals with discipline-specific expertise to support specialized staff when a person's behavioral and/or medical needs exceed the competencies of the crisis respite provider's specialized staff. Consultative crisis respite supplements but does not replace specialized staff.

Institution: For the purposes of this page, “institution” means a nursing facility, hospital, intermediate care facility for persons with developmental disabilities (ICF/DD) or institution for mental disease (IMD).

Crisis respite has four related purposes:

A person is eligible to receive crisis respite when all the following are true:

Note: Services under all waiver/AC programs must meet the requirements listed in the services section of CBSM – Waiver/AC programs overview.

Additional requirements for consultative crisis respite

In addition to the above eligibility requirements, a person is eligible to receive consultative crisis respite when all the following are true:

Note: The lead agency cannot authorize consultative crisis respite as a standalone service. Consultative crisis respite is an augmentative service that can only be authorized in conjunction with in-home or out-of-home crisis respite.

Crisis respite is a time-limited intensive intervention service that includes:

Person-specific activities

Crisis respite must include the following person-specific activities completed by the license holder’s staff.

Formal written assessment

Specialized staff or consultative crisis respite staff complete a formal written assessment to determine the factors that resulted in or contributed to the crisis. The written assessment must be based in data collection and analysis and include, at minimum:

Consultation

Specialized staff or consultative crisis respite staff, the person and caregivers collaborate to develop an individualized crisis intervention plan that is:

Implementation and oversight

Specialized staff or consultative crisis respite staff provide oversight of the individualized crisis intervention plan. This oversight includes adjustments to the plan based on data collection and analysis.

Training and supervision

Specialized staff or consultative crisis respite staff provide training and supervision to the direct care crisis respite staff and unpaid caregivers who implement the individualized crisis intervention plan. Training includes on-site and remote instructional learning for staff and caregivers about:

Transition planning

In-home crisis respite

Specialized staff or consultative crisis respite staff create a written plan that outlines when and how services should be discontinued. They must create this plan within 15 calendar days of service initiation.

Out-of-home crisis respite

Specialized staff or consultative crisis respite staff create a formal written transition plan focused on supporting the person’s return home or to other community-based services. They must create this plan within 15 calendar days of service initiation, and it must include:

Consultative crisis respite

Consultative crisis respite provides expert consultation to enhance the specialized staff's delivery of crisis respite. It covers the following activities:

Not covered within the service

The lead agency cannot approve the use of crisis respite:

Crisis respite does not cover the cost of meals for the person’s caregiver when the person receives crisis respite in their own home.

Services that cannot be authorized with crisis respite

The lead agency cannot authorize services that duplicate other Minnesota state plan or waiver services the person already receives, including case management, speech therapy, occupational therapy and nursing services.

Services that cannot be authorized with out-of-home crisis respite

The lead agency cannot authorize the following services with out-of-home crisis respite:

Remote support can only be used by crisis respite consultative staff and in-home crisis respite staff to deliver 15-minute units.

Services delivered through remote support must meet all the requirements on CBSM – Remote support.

The lead agency authorizes in-home crisis respite in 15-minute units and daily units. People receive in-home crisis respite in the following locations:

For more information, refer to CBSM – Requirements for a person’s own home.

15-minute units in a licensed waiver residential services setting

When a person receives in-home 15-minute unit crisis respite in a licensed waiver residential provider setting, the crisis respite provider must be different staff/caregivers from the provider staff/caregivers (paid and unpaid) that operate the person’s residential service.

The residential provider staff/caregivers remain responsible to meet all staffing and service delivery requirements included in the residential service. The crisis respite provider is responsible to deliver the specialized crisis assessment, intervention, oversight, data collection and caregiver training required under the crisis respite service. This separation ensures crisis respite is provided as a distinct service and does not supplement or replace staffing responsibilities covered by the residential service payment.

The lead agency authorizes out-of-home crisis respite in daily units. People receive out-of-home crisis respite when they meet eligibility requirements on this page and temporarily live in one of the following licensed settings to receive crisis respite:

Children younger than age 18 in out-of-home crisis respite

DCYF Bulletin 26-68-06: Clarifying waiver-funded services are foster care placements (PDF):

1. Clarifies when federal and state law consider the following waiver services to be foster care placements, consistent with the Adoption and Foster Care Analysis and Reporting System (AFCARS):

2. Outlines the requirements for SSIS data entry to document placement stability when children and youth receive waiver crisis respite in hotel settings.

3. Clarifies how waiver residential services intersect with child welfare foster care requirements, documentation expectations and foster care maintenance payments.

Size limit

For adult foster care, child foster care and community residential services, the total number of people who reside in a licensed living setting cannot be more than five. This means five people not related to the principal care provider. If a provider is licensed to provide services to fewer than five people and would like to request an increase up to five, refer to CBSM – Changes to the size of setting by waiver service.

The lead agency authorizes consultative crisis respite in 15-minute units when the person meets eligibility requirements. The lead agency must authorize consultative crisis respite services with either in-home crisis respite or out-of-home crisis respite.

People receive consultative crisis respite in the following locations:

The person is limited to 180 calendar days for each modality of crisis respite authorized in the support plan: (i.e., in-home crisis respite, out-of-home crisis respite and consultative crisis respite).

The person cannot:

Examples:

Lead agency tracking

The lead agency must track the number of calendar days authorized and used for each crisis respite modality across providers and authorizations.

The lead agency uses the support plan service begin and end dates to track the 180-day limit for each modality. The 180-day limit is based on the authorized period.

For 15-minute services, the lead agency does not add together the 15-minute units to calculate 180 days. Instead, the lead agency tracks the calendar days between the authorized service begin and end dates, consistent with the support plan.

The lead agency may review billing and authorization reports to identify situations in which a person received more than 180 calendar days of crisis respite for a modality or appears to have switched providers, service types, locations or authorizations to avoid a service limit. If the review identifies potential attempts to avoid the 180-day limit, the lead agency may require additional review, documentation or approval before authorizing additional services.

Effective Jan. 1, 2027, people must follow an extension request process for the continued use of crisis respite beyond the 180-day limit. DHS will monitor the use of crisis respite, including people who have exceeded the 180-day limit, and will reach out to lead agencies to provide technical assistance and support implementation of the new requirements, as needed.

Lead agency and provider actions (effective immediately)

Before Jan. 1, 2027, DHS encourages lead agencies and providers to start reviewing cases for people currently receiving crisis respite to determine whether:

Lead agencies should not wait until Jan. 1, 2027, to begin their case review, especially for people who have already received crisis respite for an extended period. Early review will allow the person, case manager, provider and support team time for transition planning when crisis respite is no longer appropriate or when the person is approaching the 180-day limit.

Transition planning

If the lead agency determines the person does not meet the eligibility criteria or crisis respite is no longer necessary to address their assessed needs, the lead agency should start working with the person and their team to identify and transition to other appropriate services.

Extension requests (effective Jan. 1, 2027)

DHS will provide details about extension requests before Jan. 1, 2027.

Crisis respite is a DHS enrollment-required service. For more information, refer to CBSM – Waiver/AC service provider overview.

License requirement

A crisis respite provider must have a license under Minn. Stat. Ch. 245D as an intensive support service provider.

Additional provider requirements

Crisis respite services must be delivered by intensively trained and skilled staff with demonstrated competencies that distinguish this service from long-term residential supports.

Licensed crisis respite providers must have the experience and skills necessary to address the person’s behavioral and/or medical needs that led to the crisis, as identified in the person’s support plan.

Required competencies

Providers must be able to:

Specialized staff requirements

Crisis respite specialized staff must be competent to perform duties outlined in the service definition and the person’s support plan. They must meet at least one of the following criteria:

Required competencies

Specialized staff must be able to perform all activities explained in the license requirement – required competencies section above.

Consultative crisis respite staff requirements

Consultative crisis respite staff must have qualifications and experience aligned with the person’s needs. They must be one of the following:

Direct support staff requirements

All other staff who provide crisis respite must be overseen by a specialized staff and have at least one year of experience supporting people with disabilities or demonstrated competency working with people who have challenging behaviors.

Required competencies

Direct support staff must be able to:

Requirement for crisis respite for medical needs

Staff providing crisis respite for medical needs must have the training and competency necessary to meet the person’s specific medical needs safely.

Requirement to complete an FBA

To complete an FBA as required by Minn. R. 9544.0040, the provider must meet the definition of a qualified professional in Minn. R. 9544.0020, subp. 47.

Reporting

A provider licensed under 245D must report all uses of controlled procedures, emergency use of manual restraint and prohibited procedures according to Minn. Stat. §245D.06, subd. 5 to DHS via the Behavioral Intervention Report Form, DHS-5148.

Background studies

To provide crisis respite, all providers must have a background study. For more information, refer to CBSM – Waiver/AC service provider overview – Required DHS background studies for direct-contact services.

The lead agency authorizes crisis respite at the market rate. The lead agency should use the person’s specific service and support needs to work with the provider to determine an appropriate rate for the authorized service. For more information, refer to CBSM – Market rate services.

The provider’s requested rate does not, by itself, establish the market rate or determine the amount the lead agency must authorize. The lead agency should consider whether the requested rate is reasonably related to the staffing, training, credentials and other service requirements necessary to meet the person’s documented needs. Considerations include:

In the person’s support plan, the lead agency and provider should document the factors they considered when the authorized rate is substantially higher than the provider’s usual rate for the service. This documentation should explain the person-specific needs and extraordinary service requirements that support the authorized rate.

Temporary authorization codes

Lead agencies must use these codes to authorize crisis respite until DHS publishes the new codes:

Room and board costs

Out-of-home crisis respite includes payment for room and board costs when the person receives the service in a licensed foster care facility or licensed community residential setting (for up to five people) developed to provide crisis respite. Crisis respite does not include room and board costs for a private residence.

Alex (age 12)

In-home, 15-minute units

Alex is having a serious behavioral crisis at home, including frequent aggression and unsafe behaviors. A crisis respite staff member provides 15 minutes of coaching and intervention at a time, based on Alex’s needs. Multiple 15-minute units can be provided as authorized.

Out-of-home, daily

Alex’s crisis has become too difficult for the family to manage at home safely. Alex temporarily stays in a licensed child foster residential care or community residential setting where trained crisis respite staff provide intensive support. The goal is to stabilize Alex and help Alex return home safely.

Consultative crisis respite

Alex is receiving in-home crisis respite during the transition home after stabilizing in out-of-home crisis respite. Alex’s behaviors are complex and require a qualified behavior professional. The consultative crisis respite licensed behavior analyst provides consultation to Alex’s parents, reviews the crisis plan, recommends strategies and trains the entire family.

Jordan (age 45)

In-home, 15-minute units

Jordan lives in a licensed community residential setting and is experiencing a behavioral crisis that is putting Jordan and others at risk. The group home staff are unable to manage the crisis safely with their usual supports. A crisis respite provider sends specialized crisis respite staff to Jordan's group home and provides support in 15-minute units. Specialized staff conduct the formal assessment, collect data and provide brief periods of coaching or intervention during times when Jordan's behavior escalates.

Out-of-home, daily

The group home cannot manage the crisis safely, so Jordan temporarily stays in a licensed adult crisis respite setting. Crisis respite staff provide intensive support while Jordan's usual residential provider and the crisis respite team work on a plan for Jordan to return to the licensed community residential setting safely.

Consultative crisis respite

Jordan is receiving crisis respite, but the specialized crisis respite staff need additional expertise because Jordan's needs are more complex than their current training or experience. A licensed behavior analyst under consultative crisis respite provides recommendations, reviews the crisis intervention plan and coaches the specialized crisis respite staff and group home staff. The consultant supplements the crisis respite service and does not replace the crisis respite staff.