Licensing for Home and Community-Based Services - 245D providers
The Department of Human Services (DHS) licenses certain Home and Community-Based Services (HCBS) provided to people with disabilities and those over age 65. Most of the services are funded under one of Minnesota’s Medicaid waiver programs.
The HCBS standards under Minnesota Statutes, chapter 245D, are part of a larger HCBS Waiver Provider Standards initiative to improve the dignity, health, and independence of the people we serve. Lists below contain links to specific sections in the manual about each service. For a one-page overview, see this 245D license structure (PDF).
If you have further questions regarding the licensing standards of 245D services call our licensing help desk at 651-431-6624. The help desk is staffed Monday through Friday 8:00 am to 4:00 pm.
Services
Information about HCBS that require a 245D HCBS license is available from the Community-Based Services Program Manual (CBSM) by following the links below.
These are services that provide the level of assistance, supervision and care that is necessary to ensure the health and safety of the person. Each is linked to the section in the Community-Based Services Manual with operational details about that specific service. Information about services requiring a license are in the Community-Based Services Program Manual.
24-hour emergency assistance: On-call counseling and problem-solving and/or immediate response for assistance at a person's home due to a health/personal emergency.
Companion services: Non-medical care, supervision and socialization to a person age 18 or older.
Homemaker services: Eligible services range from light household cleaning to household cleaning with incidental assistance with home management and/or activities of daily living.
Night supervision: Provides overnight assistance and monitoring by an awake staff in the person's home.
Personal support: Services provided in the person's home or community in support of achieving potential, increasing independence and meeting community inclusion goals.
Respite care services: Short-term care due to the absence or need for relief of the family member(s) or primary caregiver normally providing the care.
These services are intended to promote training, habilitation or rehabilitation of the person. Each is linked to the section of the CBSM manual about that service. Information about services requiring a license are in the Community-Based Services Program Manual. Lists below contain links to specific sections in the manual about each service.
Positive support services: Services to increase positive behavior and decrease or eliminate severe, challenging behavior.
Specialist services: Services designed to promote staff and caregiver competency to meet a person’s needs in eligible areas.
Crisis respite: Short-term care and intervention strategies provided to a person due to the need for caregiver relief, protection of the person or others living with the person or the person’s need for behavioral or medical intervention.
Semi-independent living skills: Services needed by an adult with a developmental disability or related condition(s) to live successfully in the community.
Foster care services: Adult and child foster care waiver services provided to people who live in a home licensed as foster care. Foster care services are individualized and based on the needs of the person.
ICF/DD: Residential facility licensed as a health care institution and certified by the Minnesota Department of Health to provide health or rehabilitative services for persons with developmental disability or a related condition who require active treatment.
Day training and habilitation: Services that develop and maintain life skills for people with developmental disabilities or related conditions so they can fully participate in community life.
Pre-vocational: Services that prepare people with disabilities for jobs with competitive pay and help them achieve greater independence in their community. Prevocational services teach general work skills and concepts rather than specific work skills for a particular job.
Structured day: Service designed for people who may benefit from continued rehabilitation and community integration directed at the development and maintenance of community living skills.
Supported employment: Effective July 1, 2018, supported employment services began the transition to the new disability waiver employment services.
Employment exploration services: Services that help a person gain a better understanding of competitive, integrated employment opportunities in his/her community. Exploration activities and experiences strengthen a person’s knowledge, interests and preferences so he/she can make informed decisions about competitive employment.
Employment development services: Individualized services designed to help a person achieve competitive, integrated employment, become self-employed or establish a microenterprise business in his/her community.
Employment support services: Individualized services and supports that help people maintain paid employment in community businesses/settings. Employment support services occur in integrated community settings.
Create a chart of your organizational structure with the names of those in highest authority and names of all controlling individuals. Make sure that this chart accurately reflects the structure of your program. If you are the only individual that is part of your program, your organizational chart can reflect that.
Once you have completed the pre-application worksheet, along with all of the required documents in the pre-application worksheet, you are able to complete the application here. All of the required documents must be completed and uploaded as an individual document to your computer in a PDF or Microsoft Word format prior to completing the application. After you submit your application materials:
Pay the $500 application fee. This process is completed online and may be paid via Visa, MasterCard, or E-Check. The application fee is non-refundable.
Complete background studies. After you submit your 245D application, your Authorized Agent will receive an email from the DHS NETStudy Administrator with instructions for a NETStudy 2.0 account to submit background studies on all Controlling Individuals. These background studies for all Controlling Individuals must be submitted and cleared before your license can be issued. Be sure to monitor any Spam/Junk folders for the email correspondence.
We will review your application for all required fields and documents. Your application will be approved when the license application fee has been paid and cleared; the application and all materials meet compliance with 245D standards and background studies for all Controlling Individuals have been cleared. 245A.04 states that the commissioner shall act on the application within 90 working days after a complete application and any required reports have been received from other state agencies or departments, counties, municipalities, or other political subdivisions. The commissioner shall not consider an application to be complete until the commissioner receives all of the required information.
245A.055, subdivision 1, states that the commissioner may close a license if the commissioner determines that a licensed program has not been serving any client for a consecutive period of 12 months or longer. The license holder is not prohibited from reapplying for a license if the license holder's license was closed under this chapter.
All 245D license holders are required to understand and implement Statutes 245A, 245C and 245D prior to providing services.
245A.03, subdivision 7, prevents any new community residential setting licenses for people receiving services under chapter 245D due to a licensing moratorium.
Applicants submitting a 245D license application will pay a $500 application fee.
Annual renewal fees
All DHS licenses expire on Dec 31, of each calendar year. To renew the license for the next calendar year, an annual license fee must be paid before Jan 1. DHS Licensing sends by email an invoice to the license holder’s Authorized Agent starting in October for the annual license fee. The email contains a link for the license holder to pay the annual renewal fee online through US Bank.
If a 245D license holder does not pay the renewal fee by Dec 31, they are in violation of Minnesota Statutes, section 245A.10, subdivision 6, and must not operate after Dec 31.
It is important that DHS has the current email address for the license holder’s authorized agent because the invoices are sent to this email address. To update this information, call your DHS licensor or the HCBS help desk at 651-431-6624
For more information about 245D annual renewal fees, see Minnesota Statutes, section 245A.10.
Revenue-based fee
The 245D annual license fee is based on revenues derived from the provision of services that would require licensure under chapter 245D during the calendar year immediately preceding the year in which the license fee is paid.
Revenue means only the revenues derived from the provision of services that would require licensure under chapter 245D.
The lowest fee is $200 for revenues equal to or less than $10,000 and the highest fee is $18,000 for revenues equal to or greater than $15 million.
Verification of revenues
If requested, the license holder must provide information to DHS to verify the annual revenues or other information as needed, including copies of documents submitted to the Department of Revenue.
At each annual renewal, a license holder may elect to pay the highest renewal fee, and not provide annual revenue information to DHS. A license holder that knowingly provides incorrect revenue amounts for the purpose of paying a lower license fee shall be subject to a civil penalty in an amount that is double the fee the provider should have paid.
Background studies are required for people who provide licensed home and community-based services. For further information about this studies, visit the background studies page.
These checklists can be used in their entirety or individually. Each checklist begins with general information that guides the license holder in applying the checklist to an individual program or a person receiving services. Some definitions are included to assist the license holder when using the checklist.
If a family or corporate child or adult foster care license holder is the provider of any of the following services to residents in the foster care home, the foster care license holder is required to hold a 245D-HCBS program license.
Out-of-home respite for persons with disabilities, including DD, or persons age 65 and older
Out-of-home crisis respite for persons with developmental disabilities
Supported living services for persons with developmental disabilities
Foster care services for persons with disabilities.
If the foster care license holder does not provide a 245D licensed service to the residents in the foster care home or a different 245D licensed provider comes into the foster care home to provide a 245D service, the foster care license holder is not required to hold a 245D-HCBS program license. In this case, there is no change to the foster care license.
The following services are not licensed under 245D, regardless of the funding source for the service:
Foster care services for persons age 65 and older under the Elderly Waiver (EW) or the Alternative Care (AC) programs
Customized living services for persons with disabilities or age 65 and older.
Corporate adult foster care homes are licensed under DHS Rule 203 (Minnesota Rules, parts 9555.5150 to 9555.6265) and the adult foster care license holder does not live in the home. The county agency performs some of the licensing functions for the adult foster care sites.
Out-of-home respite for persons with disabilities, including developmental disabilities, or persons age 65 and older may be provided as part of a 245D license.
Community residential settings are licensed under 245D (245D-CRS). These are residential sites where at least one of the 245D services listed here is provided to all at least one of residents of the home and the license holder does not live in the home. The county agency performs some of the licensing functions for these sites.
245D services that may be provided in this setting include:
Out-of-home respite for persons with disabilities, including developmental disabilities, or persons age 65 and older
Out-of-home crisis respite for persons with developmental disabilities
Supported living services for persons with developmental disabilities
Foster care services for persons with disabilities.
Minn. Statutes, sections 245D.21 to 245D.22; and 245D.27 to 245D.31, establish standards for community residential settings. 245D-CRS homes were previously corporate adult foster care (AFC) sites.
Family adult foster care homes are licensed under DHS Rule 203 (Minnesota Rules, parts 9555.5150 to 9555.6265) and the Adult Foster Care license holder does live in the home. The county agency performs some of the licensing functions for the Adult Foster Care sites.
245D services that may be provided in a family adult foster care setting include:
Out-of-home respite for persons with disabilities, including developmental disabilities, or persons age 65 and older
Out-of-home crisis respite for persons with developmental disabilities
Supported living services for persons with developmental disabilities
Foster care services for persons with disabilities.
The provider is exempt from compliance with certain Rule 203 adult foster care requirements when the provider holds both the adult foster care and the 245D-HCBS license.
Child foster care sites are licensed under Minn. Rules, parts 2960.3000 to 2960.3340. In a family foster home the child foster care license holder lives in the home. In a corporate foster residence the license holder does not live in the home. The county agency performs some of the licensing functions for the child foster care sites.
245D services that may be provided in a family or corporate child foster care setting include:
Out-of-home respite for persons with disabilities, including developmental disabilities, or persons age 65 and older
Out-of-home crisis respite for persons with developmental disabilities
Supported living services for persons with developmental disabilities
Foster care services for persons with disabilities.
Intermediate Care Facilities for Persons with Developmental Disabilities(ICF/DD) are licensed as an Supervised Living Facility(SLF) and are ICF/DD certified. Licensing functions for the SLF and the federal certification are described here.
If the ICF/DD license holder is the provider of residential services to persons with developmental disabilities in the ICF/DD, the ICF/DD license holder is required to also hold a 245D-HCBS program license regardless of the funding source for the service.
A ICF/DD/245D-HCBS program license holder is exempt from the following 245D licensing requirements:
Service recipients rights under section 245D.04; the license holder is required to comply with the Health Care Bill of rights under section 144.651.
The license holder is required to comply with the ICF/DD federal certification standards instead of the 245D licensing requirements in these areas:
Medication administration under section 245D.05, subdivision 1b
Environment under section 245D.06, subdivision 2, clauses (4) and (5)
Services outcomes and supports and progress reviews under section 245D.071, subdivisions 4 and 5
Coordination and evaluation of individual service delivery under section 245D.081, subdivision 2
Use of volunteers to provide direct care services under section 245D.09, subdivision 7
Admission and discharge register under section 245D.095, subdivision 2
Data privacy policy and procedures under section 245D.11, subdivision 3.
Supervised living facilities (SLF) are licensed under chapter 144 by the Minnesota Department Health (MDH). MDH performs the licensing functions for the SLF.
245D services that may be provided in the SLF setting include supported living services (SLS)
If the SLF license holder is the provider of supported living services to persons with developmental disabilities in the SLF, the SLF license holder is required to also hold a 245D-HCBS program license regardless of the funding source for the service.
A SLF/245D-HCBS license holder is exempt from the following 245D licensing requirements:
Service recipients rights under section 245D.04; the license holder is required to comply with the Health Care Bill of rights under section 144.651.
Residential programs and services for the physically disabled are licensed under Minnesota Statues, chapter 245A and are governed by Minnesota Rules, chapter 9570, also known as Rule 80. The facility is also licensed as a nursing home under chapter 144A by the Department of Health.
At least these essential aims must be incorporated in the general philosophy and policies of programs governed by Rule 80:
To promote the greatest degree of independence possible for each resident
To enhance the ability of each resident to cope with the resident's environment
To maximize and foster the human qualities of each resident
To provide a homelike atmosphere to the greatest possible extent, in which the resident is recognized as an individual whose personal interests are maintained and developed and whose personal dignity is respected and safeguarded.
Resources for New HCBS Waiver/245D Licensed Providers (PDF) This document describes the Home and Community Based Waiver and Alternative Care Programs and provides information on how to become a 245D Licensed HCBS Waiver or Alternative Care Provider, including enrolling as a Minnesota Health Care program provider.
Home and Community Based Services Waiver & Alternative Care - Provider Training 101 (PDF) This document provides information about the Home and Community Based Services (HCBS) waiver and Alternative Care (AC) Programs Provider Training 101. This online training helps providers learn basic information about Minnesota Health Care Programs (MHCP) and the home and community-based services(HCBS).DirectCourse: College of Direct Support – online curriculum that focuses on improving knowledge, promoting high-quality services and helping people lead more self-directed lives.
Medical emergency occurring as a result of the use of a restrictive intervention with a person that leads to a call to 911 or seeking physician treatment or hospitalization for a person
Behavioral incident that results in a call to 911
Mental health crisis occurring as a result of the use of a restrictive intervention that leads to a call to 911 or a provider of mental health crisis services as defined in Minnesota Statutes, section 245.462, subdivision 14c
Incident that requires a call to mental health mobile crisis intervention services
Person’s use of crisis respite services due to use of a restrictive intervention
Use of a pro re nata (PRN) medication to intervene in a behavioral situation. This does not include the use of psychotropic medication prescribed to treat a medical symptom or a symptom of a mental illness or to treat a child with severe emotional disturbance
Incident that the person’s positive support transition plan requires the program to report
Use of a restrictive intervention as part of a positive support transition plan as required in the plan.
Minnesota law says vulnerable adults must be safe and that a process must be in place to report suspected maltreatment, protect vulnerable adults and requires respond to reports of suspected maltreatment in appropriate cases. The DHS Adult Protection Unit provides training and consultation to citizens, service providers, counties, law enforcement and state agencies regarding the Minnesota Vulnerable Adult Act.
The Minnesota Department of Human Services Adult Protective Services Unit helps to meet those requirements by:
Providing training and consultation to the public, serve providers, counties, law enforcement and state agencies on the Minnesota Vulnerable Adult Act
Developing policy and identifying best practices to prevent maltreatment of vulnerable adults and to respond to it if it occurs
Collecting and evaluating data regarding maltreatment of vulnerable adults
Operating the Minnesota Adult Abuse Reporting Center.
Minnesota Adult Abuse Reporting Center (MAARC)
The Adult Protective Services Unit administers the Minnesota Adult Abuse Reporting Center (MAARC). MAARC web reporting mn.gov/dhs/reportadultabuse/ is designed for mandated reporters to meet their reporting duty. Mandated reporters may refer to the MAARC Report Guide for information on using the web-based reporting system. MAARC also has a statewide toll-free number, 1-844-880-1574 for the public and mandated reporters.
Reports must be made within 24 hours of the death or serious injury, or when you first learned that the death or serious injury occurred. Providers may use report of death or serious injury forms available online from the Ombudsman’s Office. Deaths and serious injuries occurring in ICFs/DD must be submitted to the Office of Health Facilities Complaints instead of DHS Licensing. The same report forms may be used.
General resources for providers and people receiving services
Positive Supports Minnesota – approaches that offer respectful, supportive, and effective ways to help people make positive changes in their lives
DHS Positive Supports - strength-based strategies developed after individualized assessment to teach productive and self-determined skills or alternative strategies and behaviors without the use of restrictive interventions
Person-centered practices – learn more about how Minnesota is moving toward person-centered practices in all areas of service delivery
Disability Hub MN – free statewide resource network that helps people solve problems, navigate the system, and plan for the future
HCBS programs and services – an overview of eligibility rules, benefits, and application process for people to receive home and community-based services
DirectCourse: College of Direct Support – online curriculum that focuses on improving knowledge, promoting high-quality services and helping people lead more self-directed lives.
Maltreatment of Minors or Vulnerable Adults – online training form mandated reporters. This provides training about applicable state laws, license holders must also train their staff on their policies including all internal policies and procedures related to the prevention and reporting of maltreatment and program abuse prevention plan.
The commissioner may grant variances to rules that do not affect the health or safety of persons in a licensed program if the following conditions are met:
The variance must be requested by an applicant or license holder on a variance request form DHS-3141 (PDF) and in a manner prescribed by the commissioner
The request for a variance must include the reasons that the applicant or license holder cannot comply with a requirement as stated in the rule and the alternative equivalent measures that the applicant or license holder will follow to comply with the intent of the rule
The request must state the period of time for which the variance is requested.
Continuous variances: the commissioner may grant a continuous variance when conditions under which the variance is requested do not affect the health or safety of persons being served by the licensed program, nor compromise the qualifications of staff to provide services.
An applicant or license holder must inform the commissioner of any changes or modifications that have occurred in the conditions that warranted the continuous variance. Failure to advise the commissioner shall result in revocation of the continuous variance and may be cause for other sanctions under sections 245A.06 and 245A.07.
Expiration of variances: a variance expires upon the specified date on the approved variance or when the conditions that warranted the variance are modified in any way. A continuous variance expires as soon as the conditions that warranted the variance are modified in any way.
Variances not subject to appeal: the commissioner's decision to grant or deny a variance request is final and not subject to appeal.
