Legal authority

Federally approved BI, CAC, CADI and DD waiver plans, Minn. Stat. Ch. 245D

Definitions

Individualized home supports (IHS): Services for people who live in their own home or family home that provide support and/or training in the community living service categories listed in the covered services section. There are three types of IHS:

All types of IHS can be provided in the person’s own home, family’s home or in community spaces used by the general public, and either in person or remotely (refer to the remote support service delivery option section on this page).

Support in community living service categories: Cueing, skill maintenance, guidance, instruction, assistance with activities of daily living, assistance with coordination of community living activities or direct supervision. Support must be within an allowable community living service category.

Training in community living service categories: Skill-building and instructional services to acquire, retain and improve the person’s experience living in the community. Training must be within an allowable community living service category, and training must meet identified needs specified in the person’s assessment (e.g., MnCHOICES, long-term care consultation).

Overview

This page includes information about:

Eligibility

IHS is available to people who meet the following criteria:

1. Live in their own home or their family’s home.
Note: The IHS provider cannot have any direct or indirect financial interest in the property or housing in which services are delivered. For more information, refer to CBSM – Requirements for a person’s own home.

2. Receive services through one of the following waivers:

Service options for IHS

The IHS service options available to a person are based on their age, living arrangement and the type of support and/or training they need.

Without training

This service option is provided to adults or children when they need support in at least one of the community living service categories.

With training

This service option is provided to adults when they need support and training in at least one of the community living service categories.

This option meets the habilitation requirement for the DD Waiver. For more information about the habilitation requirement, refer to CBSM – Habilitation.

With family training

This service option is designed for people who live with their family to provide training to the person and their family members. The training increases their capabilities to care for and maintain the person’s ability to live in the home.

This service option is provided to adults when the person and their family needs support and training in the family’s home in at least one of the community living service categories.

This service option is provided to children when either of the following is true:

This option meets the habilitation requirement for the DD Waiver. For more information about the habilitation requirement, refer to CBSM – Habilitation.

Additional information

For additional information about these service options, refer to CBSM – Resource: Service options for IHS

Covered services

IHS covers community living services in four categories:

When a person receives IHS without training, they must receive support in at least one of the community living service categories. (Refer to the definition section for information about support.)

When a person receives IHS with training or IHS with family training, they must receive training in at least one of the community living service categories. They also may receive support in any of the community living service categories. (Refer to the definition section for information about training and support.)

Community participation

This category may include:

Health, safety and wellness

This category may include:

Household management

This category may include:

1. Cueing, guidance, supervision, training or instructional support to complete routine household care and maintenance.

2. Household safety knowledge and skills.

3. Tenancy support and advocacy.

4. Training, assistance, support and/or guidance with:

Adaptive skills

This category may include:

Non-covered services

IHS does not cover services that:

1. Duplicate other Minnesota state plan or waiver services.

2. Provide supervision that is not directly related to an assessed need for support in a community living service category.

3. Exceed 16 hours per day of in-person HIS.

4. Primarily deliver activities of daily living (ADLs) support.
Note: A person may also receive personal care assistance (PCA) services when those services are not duplicative. In this situation, the lead agency must:

5. Provide supervision during the person’s primary sleeping hours.
Note: A person may receive support during these hours through another service, such as night supervision services or 24-hour emergency assistance.

IHS with family training is not covered for families, including extended family members, who are licensed to provide adult foster care, child foster care, family residential services or community residential services.

Limitations

If a person receives IHS, they cannot also receive:

Exceptions

Without training

A person may only receive community residential services or family residential services and IHS without training when a separate provider delivers IHS without training.

The provider cannot have any direct or indirect financial interest in the property or housing in which community residential services or family residential services are delivered. IHS without training must be delivered in the community, outside of the residential setting.

With training

A person may only receive customized living (including 24-hour customized living) and IHS with training when a separate provider delivers IHS with training.

The provider cannot have any direct or indirect financial interest in the property or housing in which customized living services are delivered.

Secondary information

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

To meet a person’s support and training needs flexibly, the IHS with training and IHS with family training options include both:

This allows IHS with training or IHS with family training to be authorized to meet both the person’s support and training needs flexibly in a single service.

For help determining which service option to authorize, refer to CBSM – Resource: Service options for IHS.

Remote support service delivery option

All three IHS service options (i.e., without training, with training and with family training) can be delivered through remote support. Services delivered through remote support must meet all the requirements listed on CBSM – Remote support and the following additional remote support requirements specific to IHS.

Additional requirements specific to IHS

Remote support must be in the scope of IHS and be limited to:

In-person support must be scheduled and available a minimum of once a week. Depending on the person’s support plan, it may not be necessary to deliver in-person support every week. A person may receive in-person support and remote support on the same day.

Either the person or the provider may initiate the remote support contact.

Limitations

IHS is limited 730 hours per year (average of two hours per day) of remote support services. A person may use remote support in a flexible manner that meets their needs within the total yearly authorized units. For more information, refer to the service amount section on this page.

Remote support does not cover:

The provider cannot bill for direct support delivered remotely when:

For IHS, live, two-way communication only includes the use of the following enabling technology:

Service delivery documentation requirements for providers

To deliver remote support services, the provider must document the following in the person’s record:

Service amount

In-person services

IHS is limited to a maximum of 16 hours per day of in-person support and training in the community living service categories.

The person-centered support plan, developed by the case manager to meet the person’s specific assessed area of need(s), determines the amount of service authorized. All time included in the person’s support plan for delivery of IHS must:

Remote support

Remote support is a unit-based service authorized in 15-minute units. A maximum of 730 hours can be authorized per year (i.e., 365 days), which is an average of two hours per day.

Exception request for additional hours

The lead agency may send an exception request to DHS for the delivery of more than the average of two hours per day of remote support by completing Remote support exception form, DHS-7759A.

In the request, the lead agency must describe the following:

Provider standards and qualifications

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

License requirement

Providers of IHS with training and IHS with family training must be licensed under Minn. Stat. Ch. 245D as an intensive support services provider.

Unless excluded, providers of IHS without training must meet one of the following requirements:

245D exclusion

In some cases, a person who receives IHS without training can use an individual provider who meets requirements for exclusion from 245D licensure.

For more information, refer to CBSM – Exclusions from 245D licensure.

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 IHS, 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.

Authorization, rates and billing

IHS is a framework service. The lead agency uses the Rate Management System (RMS) to determine rates. For more information, refer to CBSM – RMS and Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF).

The lead agency authorizes IHS:

In-person IHS 15-minute and daily cannot be authorized at the same time. This means in-person 15-minute units and daily units cannot have overlapping service authorizations.

Remote support cannot be authorized without in-person IHS.

For help determining which service option to authorize, refer to CBSM – Resource: Service options for IHS.

Unit breakdown for IHS with training 1:1

The following provides guidance to authorize IHS with training, 1:1 staff-to-person ratio, for a person who will use the service:

Do not authorize both in-person 15-minute units and daily units at the same time. In-person 15-minute units and daily units cannot have overlapping service authorizations.