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Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


DSD eList announcement

Date: March 31, 2026
To: Lead agency staff and other interested parties
From: DHS Disability Services Division
Purpose: To announce the federal Centers for Medicare & Medicaid Services (CMS) approved the Brain Injury (BI) Waiver renewal and disability waiver amendments
Effective: Implementation timelines vary
Contact: DSD Contact Form

Disability waiver amendments approved by CMS

CMS approved DHS’ waiver renewal for the Brain Injury (BI) Waiver on March 25, 2026. The BI Waiver plan is effective April 1, 2026, to March 31, 2031.

CMS also approved DHS’ waiver amendment package on March 25, 2026, for the following waivers:

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

    • For information about the Elderly Waiver (EW) amendment approval, refer to the Dec. 30, 2025, eList about EW amendments approved by CMS.

    Implementation of changes and clarifications

    DHS has not implemented the changes and clarifications in this eList yet (unless otherwise noted). First, we must update our policy manuals and MMIS. DHS will send eList announcements and/or update CBSM – What’s new when we implement the changes and clarifications.

    Summary of changes and clarifications

    The following sections summarize the policy changes and clarifications included in this waiver amendment package approved by CMS.

    Technical changes include updates based on a new 1915(c) waiver application version with additions to describe current practices that do not change policy.

    Topic/service

    Waiver(s)

    Changes

    Habilitation

  • · DD
  • · Removed the eligibility requirement for people on the DD Waiver to be assessed to need and receive a habilitation service.
    Note: Intermediate care facility for persons with developmental disabilities (ICF/DD) level of care still applies.
  • · Removed the requirement for a person to receive a habilitation service to remain on the DD Waiver.

    • MnCHOICES assessor qualifications

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Updated certified assessor qualifications to align with state law.

    • MnCHOICES hospital assessments

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Added language to allow counties to contract with hospitals to complete MnCHOICES assessments.

    • Frequency of services

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Updated the frequency of waiver services to be provided at least monthly.

    • Assistive technology services

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Added assistive technology as a service option under BI, CAC and CADI.
  • · Updated the assistive technology service definition to clarify the service and distinguish it from specialized equipment and supplies.

    • 24-hour emergency assistance – equipment (personal emergency response systems [PERS])

  • · BI
  • · CADI
  • · Clarified that PERS is available for people receiving customized living services without 24-hour supervision.

    • Adaptive swim lessons

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Added adaptive swim lessons as a service option under family training and counseling services and consumer directed community supports (CDCS) individual-directed goods and services.

    • Adult day services

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Removed age restrictions related to adult day services.
    Note: Other age-related restrictions may still apply.

    • CDCS budgets

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Updated the cost-of-living adjustment (COLA) for CDCS budgets.
  • · Updated one set of criteria for exceptions to the CDCS budget methodology when a person has exceptional needs.

    • CDCS community integration and support

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Added employment supports to the scope of services.

    • Crisis respite services

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Revised the service definition, limitations to scope and duration, provider types and provider standards and qualifications.
  • · Removed licensed hotels as an option for out-of-home crisis respite service delivery.

    • Customized living services

  • · BI
  • · CADI
  • · Removed age restrictions related to customized living services.
    Note: Other age-related restrictions may still apply.

    • Environmental accessibility adaptations (EAA) – home modifications

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Clarified the “primary place of residence” for children.
  • · Clarified that people cannot use the EAA – home modification service to modify provider-controlled settings.

    • Extended Community First Services and Supports (CFSS)

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Updated the transition plan to reflect the anticipated completion date of September 2026.

    • Family residential services

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Changed the rate determination method from a framework model to an acuity-based, tiered-rate model. For more information, refer to DHS – FRS tiered rates FAQ.

    • Home-delivered meals

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Removed age restrictions related to home-delivered meals.
    Note: Other age-related restrictions may still apply.

    • Integrated community supports (ICS)

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Removed age restrictions related to ICS.
    Note: Other age-related restrictions may still apply.

    • Individualized home supports (IHS)

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Limited IHS with training and IHS with family training to 6 total hours per day and no more than 3 hours provided consecutively.
  • · Removed “but are not limited to” from the service definition.

    • Night supervision services

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Moved 24-hour emergency assistance from the list of services that are not covered when a person receives night supervision to the list of services that cannot be provided simultaneously with night supervision.
  • · Added extended CFSS to the list of services that cannot be provided simultaneously with night supervision.

    • Positive support services

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Updated the provider qualifications for positive support professionals.
  • · Updated the provider qualifications for positive support analysts.

    • Rate determination methods

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Added acuity-based tiered rates for family residential services. For more information, refer to DHS – FRS tiered rates FAQ.
  • · Updated information related to inflationary adjustments, per the 2025 legislative session.

    • Respite services

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Updated requirements for when respite is provided in unlicensed settings to align with state law authorized during the 2025 legislative session.

    • Service authorizations subject to approval

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Updated the process for service authorization review and approval by lead agency supervisors and DHS under certain circumstances.

    • Specialized equipment and supplies

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Updated the service definition to clarify the service and distinguish it from assistive technology.

    • Transitional services

  • · BI
  • · CAC
  • · CADI
  • · DD
  • · Removed unlicensed settings from the list of eligible settings from which a person can move, to align with 42 CFR 441.302(a).
  • · Removed age restrictions related to transitional services.

    • Summary of changes that were not approved by CMS

    DHS included the following policy changes in the public comment periods for the BI renewal and CAC, CADI and DD waiver amendment packages:

  • · Verbal attestation to replace reassessment signatures.
  • · Allowance for people to attest to no changes in needs or services for reassessment.

    • DHS submitted these changes to CMS, but CMS did not approve them.

    Previous eList announcements

    DSD LEAD AGENCY ARCHIVE | DSD STAKEHOLDER ARCHIVE

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