County Licensing Functions Under 245D

Minnesota Department of Human ServicesOffice of Inspector GeneralLicensing DivisionNov 19 and Dec 4, 2013

COUNTY LICENSING FUNCTIONS UNDER 245D

Understand the following about 245D home and community-based services (HCBS)

Implementation of 245D 245D services & settings245D license typesFoster care homes & community residential settingsResources – information & contacts

Nov 19 & Dec 4, 2013 County Licensing Functions Under 245D 2

LEARNING OBJECTIVES

Nov 19 & Dec 4, 2013 3County Licensing Functions Under 245D

IMPLEMENTATION

ScopeThe 245D HCBS Standards govern the provision of home and community-based services to persons with disabilities and people age 65 and older.

ApplicabilityApplies to services defined in the HCBS disability and elderly waiver plans, and to semi-independent living services (SILS) and ICFs/DD provided to persons with developmental disabilities.


SCOPE & APPLICABILITY

First phase of the 245D HCBS standards passed by the 2012 Minnesota Legislature

Required licensure of services that were previously unlicensed

Implementation delayed, DHS required to obtain additional provider input on the license fees


245D IMPLEMENTATION; PHASE 1

Second phase of the 245D HCBS standards and fees passed by the 2013 Minnesota Legislature

245D license application process begins July 2013

245B DD services standards will be repealed Dec. 31, 2013, these services will be licensed under 245D

245D becomes effective Jan. 1, 2014

Technical assistance visits with providers new to DHS Licensing will begin July 2014

License reviews with all other providers will begin July 2015


245D IMPLEMENTATION; PHASE 2


SERVICES & SETTINGS

Person’s homeThis is a person’s own home or the person’s family home

Community-based settingThis is an unlicensed, integrated setting used by and for persons with and without disabilities, side-by-side in the community

Licensed residential or day services settingThis is a licensed program location or facility controlled by a license holder


SETTINGS

Basic supports and services provide assistance and supervision and may be provided in a person’s home:

24-hour emergency assistance

Companion services, excluding the Senior Companion Program

Homemaker, excluding MDH licensed home care providers and cleaning services only

Night supervision

Personal support

Respite care


BASIC SUPPORT SERVICES

Intensive supports and services provide training, habilitation or rehabilitation in addition to assistance and supervision and include:

Intervention support services

In-home support services

Day services

Employment services


INTENSIVE SUPPORT SERVICES

Intervention support services may be provided in a licensed day or residential setting, a person’s home, or in community-based settings:

Behavioral support for children or adults

Crisis respite for children or adults

Specialist services for children or adults


INTERVENTION SUPPORT SERVICES

In-home support services may be provided in a person’s home or in community-based settings:

In-home family support

Independent living skills training, not ILS therapies

Semi-independent living services

Supported living services

In-home services may not be provided in licensed settings or in the home of the provider or the provider’s staff


IN-HOME SUPPORT SERVICES

Residential supports & services may be provided in a licensed residential setting and in community-based settings:

Foster care services

applies only to foster care services defined & funded under one of the disability waivers (CAC, CADI, or BI)

excludes foster care funded only by GRH (with or without DOC) and EW/AC foster care services and customized living services


Residential services provided in an ICF/DD


RESIDENTIAL SUPPORTS & SERVICES

Day services may be provided in a licensed day services facility and in community-based settings:

Day training and habilitation (DT&H)

Prevocational

Structured day

Employment services may be provided in community-based settings:

Supported employment


DAY AND EMPLOYMENT SERVICES

Adult Day Care Assistive Technology Caregiver Living Expenses Caregiver Training and

Education Case Management Chore Service Consumer Directed Community

Supports Customized Living Services Environmental Accessibility

Adaptations Extended Home Care Services Extended Home Health Aide Extended Personal Assistant

Extended Private Duty Nursing EW Foster Care Services Family Training and Counseling Home Delivered Meals Housing Access Coordination ILS Therapies Personal Emergency Response Residential Care Specialized Supplies and

Equipment Transportation Transitional Services EW/AC Services, except for

Homemaker, Companion & Respite


WAIVER SERVICES NOT LICENSED UNDER 245D

Child care: family- or centered-based

Chemical dependency treatment programs

Detoxification programsIndependent living

assistance for youthMental health centers &

clinicsMental health residential

treatment for adultsMN sex offender

program

Children’s residential facilities, including: Children’s residential care CD treatment Detention Group residential setting Mental health treatment

services Secure programs (DOC

jurisdiction) Shelter care services Transitional services


ADDITIONAL DHS LICENSED SERVICES AND PROGRAMS NOT LICENSED UNDER 245D


245D LICENSE TYPES

A provider is required to obtain a single 245D-HCBS program license to provide services statewide

The provider must identify on the 245D application which services will be provided under the 245D-HCBS license

The provider may only identify services the provider is qualified to provide (refer to the Community-Based Services Manual)

The services identified on the application will be used by MHCP Provider Enrollment to complete the provider’s record review


245D-HCBS PROGRAM LICENSE

245D-Community Residential Setting license (245D-CRS)

Licensed under sections 245D.21 – 245D.26

245D-Day Services Facility license (245D-DSF) Licensed under sections 245D.21 – 245D.22; and 245D.27 to 245D.31

245D facility licenses operate as a satellite license under the 245D-HCBS program license

A provider must have 245D-HCBS program license in order to hold a 245D satellite facility license


TYPES OF 245D FACILITY LICENSES

Providers licensed under 245D will have the option of applying for adult mental certification

The certification may be applied to all or some services or facilities operated by the provider

The 245D license certificate will identify which services and facilities are covered by the certification

DHS Licensing will monitor for compliance with the certification standards

The certification standards are over and above other 245D standards


ADULT MENTAL HEALTH CERTIFICATION 245D.33

245D.21 Facility Licensure Requirements and Application Process.

245D.22 Facility Sanitation and Health.

245D.23 Community Residential Settings; Satellite Licensure Requirements and Application Process.

245D.24 Community Residential Settings; Physical Plant and Environment.

245D.25 Community Residential Settings; Food and Water.

245D.26 Community Residential Settings; Sanitation and Health.


245D-CRS STANDARDS

This section applies to both community residential settings and day services facilities.

Subdivision 1. Community residential settings and day service facilities.

Subd. 2. Inspections and code compliance.


245D.21 FACILITY LICENSURE REQUIREMENTS AND APPLICATION PROCESS.

This section applies to both community residential settings and day services facilities.

Subdivision 1. General maintenance

Subd. 2. Hazards and toxic substances

Subd. 3. Storage and disposal of medication

Subd. 4. First aid must be available on site

Subd. 5. Emergencies

Subd. 6. Emergency equipment

Subd. 7. Telephone and posted numbers.


245D.22 FACILITY SANITATION AND HEALTH

This section and others that start with “Community Residential Settings” apply only to the CRS requirements.

Subdivision 1. Separate satellite license required for separate sites

Subd. 2. Notification to local agency

Subd. 3. Alternate overnight supervision


245D.23 COMMUNITY RESIDENTIAL SETTINGS; SATELLITE LICENSURE REQUIREMENTS AND

APPLICATION PROCESS

Subdivision 1. Occupancy

Subd. 2. Common area requirements

Subd. 3. Bedrooms


245D.24 COMMUNITY RESIDENTIAL SETTINGS; PHYSICAL PLANT AND

ENVIRONMENT

Subdivision 1. Water

Subd. 2. Food

Subd. 3. Food safety


245D.25 COMMUNITY RESIDENTIAL SETTINGS; FOOD AND WATER

Subdivision 1. Goods provided by the license holder.

Subd. 2. Personal items.

Subd. 3. Pets and service animals

Subd. 4. Smoking in the residence

Subd. 5. Weapons


245D.26 COMMUNITY RESIDENTIAL SETTINGS; SANITATION AND HEALTH


FOSTER CARE HOMES &COMMUNITY RESIDENTIAL

SETTINGS

245D services that may be provided in a child or adult foster care home or a community residential setting include:


Foster care services

Out-of-home crisis respite

Out-of-home respite

If any of these services (or any other 245D services) are provided by the foster care license holder, the foster care license holder must obtain a 245D-HCBS program license, even if the provider is serving one person.


FOSTER CARE HOMES & COMMUNITY RESIDENTIAL SETTINGS

245A.16 Standards For County Agencies and Private Agencies

Subdivision 1. Delegation of authority to agencies.

(f) During implementation of chapter 245D, the commissioner shall consider:

(1) the role of counties in quality assurance;

(2) the duties of county licensing staff; and

(3) the possible use of joint powers agreements, according to section 471.59, with counties through which some licensing duties under chapter 245D may be delegated by the commissioner to the counties.

Any consideration related to this paragraph must meet all of the requirements of the corrective action plan ordered by the federal Centers for Medicare and Medicaid Services.


COUNTY LICENSING AUTHORITY FOR 245D

A family AFC home is licensed under Rule 203

The AFC license holder does live in the AFC residence

If supported living services, foster care services, crisis respite or respite services are provided by the license holder to any residents in the home, the license holder:

must obtain a 245D-HCBS program license; and

is exempt from certain AFC license requirements

Family AFC homes will remain licensed as AFC homes

The county licensing agency will perform the licensing functions for these AFC licenses


FAMILY ADULT FOSTER CARE HOMEONE OR MORE RESIDENTS RECEIVE 245D SERVICES

AFC Exemptionsa) 9555.6185 Foster Care

Training, (including VA maltreatment under 245A.65)

b) 9555.6225 Sanitation and Health

c) 9555.6245 Personal Record of Resident in Foster Care

d) 9555.6255 Resident's Rights

e) 9555.6265 Safeguards for Cash

245D Requirementsa) 245D.09 Staffing

Standards

b) 245D.05 Health Needsc) 245D.095 Record

Requirements

d) 245D.04 Service Recipient Rights

e) 245D.06 Protections, subd. 4. Funds and property


FAMILY ADULT FOSTER CARE LICENSELICENSE HOLDERS WITH A 245D-HCBS LICENSE

A corporate AFC home is licensed under Rule 203

The AFC license holder does not live in the AFC residence

If supported living services, foster care services, crisis respite or respite services are provided by the license holder to some, but not all residents in the home, the license holder:

must obtain a 245D-HCBS program license; and

is not exempt from AFC license requirements

These corporate AFC homes will remain licensed as AFC homes

The county licensing agency will perform the licensing functions for these AFC licenses


CORPORATE ADULT FOSTER CARE HOMENOT ALL RESIDENTS RECEIVE 245D SERVICES

A child foster care home, either family or corporate, is a home licensed under MN Rules, parts 2960.3000 to 2960.3340

If supported living services, foster care services, crisis respite or respite services are provided by the license holder to any residents in the home, the license holder must obtain a 245D-HCBS program license

Child foster care homes will remain licensed as child foster care homes

The county licensing agency will perform the licensing functions for child foster care licenses


CHILD FOSTER CARE HOMEONE OR MORE RESIDENTS RECEIVE 245D SERVICES

A community residential setting is a home licensed under 245D according to standards in sections 245D.21 – 245D.26

The community residential setting license holder does not live in the home

All residents in the home receive supported living services, foster care services, or crisis respite services from the CRS license holder

Once a home is licensed as a CRS it will remain a CRS regardless of future admissions or discharges

The county agency will perform licensing functions for the CRS according to the CRS standards in 245D


COMMUNITY RESIDENTIAL SETTING (CRS)ALL RESIDENTS RECEIVE 245D SERVICES


245D-CRS LICENSING FUNCTIONS

Any corporate AFC license required to convert will do so through the online 245D license application system either when: the provider applies for the 245D-HCBS program license; or the provider is converting one or more existing DD services licenses

under 245B to a single 245D-HCBS program license

The 245D-CRS license will be assigned a new license number upon conversion due to IT limitations

Licenses that are converted, either AFC or 245B, are not new or initial licenses; the conversion is service class update

This means that license history is maintained for all licenses with a converted service class

DHS Licensing will provide a list of the converted license numbers to the county agencies and providers


CONVERSION FROM AFC TO CRS

The terms of the existing corporate AFC license will transfer to the 245D-CRS license upon conversion

Each 245D-CRS license will include terms for the age of residents and the capacity of the home

Beginning 1/1/2014, the county will process any change in terms to a 245D-CRS licenses in the same manner as the AFC license

The form used for change of terms of an AFC license is being updated to include CRS


CRS LICENSE TERMS AND CHANGE OF TERMS

Beginning 1/1/2014, the county will receive and approve applications for new CRS licenses in the same manner as adult foster care licenses

The AFC license application form is being updated to include CRS

Counties retain the authority to collect licensing fees under section 245A.10, subd. 2(e), which states in part: For purposes of adult foster care and child foster care licensing, and

licensing the physical plant of a community residential setting, under this chapter, a county agency may charge a fee to a corporate applicant or corporate license holder to recover the actual cost of licensing inspections, not to exceed $500 annually. [Emphasis added.]


CRS LICENSE APPLICATION

Beginning 1/1/2014, the county agency will renew CRS licenses in the same manner they renew AFC licenses

The converted CRS license will retain the renewal schedule established by the county when it was an AFC license

Forms used for renewal of AFC licenses are being updated to include CRS


CRS LICENSE RENEWAL

Beginning 1/1/2014, the county will issue correction orders and recommend negative actions for CRS licenses in the same manner as AFC licenses

Forms used for AFC correction orders and negative action recommendations are being updated to include CRS


CRS LICENSING ACTIONS

DHS Licensing will monitor for license holder compliance with background study requirements for 245D-CRS applicants and license holders under section 245A.04 and chapter 245C under the 245D-HCBS program license


BACKGROUND STUDIES

Under section 245A.07, subd. 3, fines assessed against a license holder that holds a license to provide home and community-based services, as identified in section 245D.03, subdivision 1, and a community residential setting or day services facility license under chapter 245D where the services are provided, may be assessed against both licenses for the same occurrence, but the combined amount of the fines shall not exceed the amount specified in this clause for that occurrence.

This same provision currently applies to residential program providers holding both a 245B license for residential habilitation/supported living services license and a foster care license.


FINES

Under section 245A.16, subdivision 1(a)(7), variances for community residential setting licenses under chapter 245D may only be issued by the commissioner.

Beginning 1/1/2014, the county may recommend variances for a CRS license in the same manner as for non-delegated AFC license variances

Forms used for recommending AFC license variances are being updated to include CRS


CRS VARIANCES

Under section 245A.11, subd. 7(d), a variance granted before 01/01/2014, for an AFC home must transfer with the license when the license converts to a 245D-CRS license. The terms and conditions of the variance remain in effect as approved at the time the variance was granted.

Under section 245A.11, subd. 7a, the option of issuing an alternate overnight supervision technology license for an AFC home also applies to a 245D-CRS license.


ALTERNATE OVERNIGHT SUPERVISION

Beginning 1/1/2014, the county will process requests for a variance for alternate overnight supervision for a CRS license or a 245D-CRS alternate overnight supervision license in the same manner as for an AFC license

Forms used for recommending an alternate overnight supervision variance or license for an AFC license are being updated to include CRS


ALTERNATE OVERNIGHT SUPERVISION, CONT’D

A provider may apply for an adult mental health certification for their 245D-HCBS or 245D-CRS license(s) under section 245D.33

The certification standards under 245D.33 are the same as 245A.03, subd. 6a

Under section 245A.03, subd. 7(d)(2), a 245D-CRS license, that would otherwise be subject to the decreased license capacity is exempt when the provider's beds occupied by residents whose primary diagnosis is mental illness and the provider is certified under the requirements in section 245D.33


ADULT MENTAL HEALTH CERTIFICATION

Beginning 1/1/2014, the county will monitor provider compliance with the adult mental health certification standards for 245D-CRS licenses

Forms used for adult mental health certification for an AFC license are being updated to include CRS


ADULT MENTAL HEALTH CERTIFICATION, CONT’D

The licensing moratorium established under section 245A.03, subd. 7, applies to community residential settings

It states that the commissioner shall not issue an initial license for a community residential setting licensed under chapter 245D.

The exceptions allowed to the moratorium under this subdivision

apply to community residential settings meeting the same criteria set out for foster care homes.


LICENSING MORATORIUM


COUNTY & DHS PARTNERSHIP

The DHS Licensing Division’s Family Systems and Home and Community-based Services (HCBS) Units work together to coordinate licensing functions for residential programs governed under 245D and the foster care licensing requirements

Continuing our partnership with the county licensing agencies remains a critical function in ensuring the goals of regulation are achieved; protection of health, safety and rights of persons served by these licensed programs


CONNECTIONS & PARTNERSHIPS

County licensors who observe possible violations of the 245D-HCBS program license requirements should report those concerns to the DHS Licensing Division Intake line at (651) 431-6600

County licensors may contact a HCBS licensor directly to discuss provider concerns by calling (651) 431-6500 and follow the prompts to speak to the on call HCBS licensor

HCBS licensors will reach out to county licensors when they observe possible violations under the foster care license or the CRS license requirements.


ONGOING COMMUNICATION

There are an estimated 1,600 providers that have to obtain a 245D-HCBS program license

As of 11/15/2013 approximately 925 providers have either started or completed an application

DHS Licensing will ensure that complete applications received on or before Dec 1 will be approved for licensure effective Jan. 1; providers are responsible for timely submission of the application


STATUS OF 245D APPLICATION PROCESS

Minnesota Health Care Program (MHCP) enrolled providers were required to complete the provider record review which began in Dec 2012

Providers who did not complete their record review by Sept 30, 2013 had their category of service (COS) end resulting in their being unable to bill for services until they resolved the issue

Providers who need to submit a copy of their current license to complete the record review must contact the correct licensing authority to obtain it; they should contact the county for a foster care license or MDH for a health license; the DHS HCBS Licensing Unit does have access to and cannot provide these certificates


RELATED REQUIREMENTS

Some providers have confused the record review requirements with the need to obtain a 245D-HCBS license; assuming completion of one meant completion of the other

The record review and the 245D license application are separate requirements; a provider does not have to complete one to do the other

MHCP Provider Enrollment and the HCBS Licensing Unit each operate a help desk to provide assistance with the respective requirements; providers have assumed these are the same and may not get necessary assistance as a result


CLARIFICATION OF REQUIREMENTS

County licensing agencies can reach out to providers of services that will become subject to 245D on Jan. 1, 2014, if they suspect the provider has not yet applied for the 245D license.

County agencies may refer to DHS Bulletin #13-56-02 issued 9/5/2013 for additional information on the transition to a centralized waiver provider system. This includes hosting onsite DHS provider waiver record review and 245D license application training (page 14).

Ensuring providers are contacting the correct help desk for assistance with the 245D license application is also essential.


ACTION NEEDED NOW


INFORMATION & RESOURCES

Go to the DHS Home Page at www.dhs.state.mn.us/ and select your area of interest: From General Public - select Licensing

Go to DHS licensed programs Select - Home and Community-Based Services

From Partners & Providers - select Health Care Go to Minnesota Health Care Program (MHCP) Enrolled Providers – Home

Select provider type – Waiver and Alternative Care (AC) for provider resources & requirements


DHS ONLINE INFORMATION RESOURCES

From Partners & Providers - select Continuing Care then Disability Services Go to Programs and services

Select A-Z of DSD initiatives, programs and services Go to HCBS Waiver Provider Standards for background and updates

From Partners & Providers – select County and Tribes Go to Manuals

Select Community-Based Services Manual (CBSM), previously the Disability Services Program Manual (DSPM) for service descript


MORE DHS ONLINE RESSOURCES

The Family Systems Unit provides forms for county licensors that are available online from the DHS Licensing webpages.

Forms will be updated to reflect the inclusion of the new 245D-CRS license. Expect changes to the forms listed under these sections:

General Licensing – Section A Adult Foster Care – Section D


CHANGES TO LICENSING FORMS

For questions about fee-for-service coverage policies and billing procedures provided to Minnesota Health Care Programs (MHCP) recipients, contact the Provider Call Center or email Healthcare-Providers:

Hours: 8 a.m. to 4:15 p.m. Monday through Friday (closed 12:00 to 12:45 p.m.)

Email: [email protected]

Voice: (651) 431-2700 or 1-800-366-5411 TTY: 711 or 1-800-627-3529

Fax: Call the Provider Call Center for the correct number to use if you need to fax information or use the fax number that is on the form you are faxing.


MHCP PROVIDER CALL CENTER

245D License Application:

For questions about completing the online 245D license application or navigating the DHS eLicensing system please call 651-431-6624. Hours: 8:00am to 4:30pm Monday through Friday

245D Home and Community-Based Services (HCBS) Standards:

Please email questions about the new licensing standards for HCBS providers to [email protected].

Other DHS Licensing Questions:

Licensing Division general information line (651) 431-6500


HCBS LICENSING UNIT CONTACTS

E-mail at: [email protected] Call (651) 431-6500, press 4, then press 5


FAMILY SYSTEMS UNIT CONTACTS


QUESTIONS?

Remember to visit the online resources often to obtain updated information


THANK YOU!

Documents

County Licensing Functions Under 245D