What is the 245D/HCBS/Waiver License?

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.

245D/HCBS/Waiver services are broken down into two categories, Basic Support Services and Intensive Support Services. Basic Support Services include Individual community living supports (ILCS), 24-hour emergency assistance, Companion services, Homemaker services, Night supervision, Personal support, and Respite care services. Intensive Support Services include Positive support services, Specialist services, Crisis respite, Independent living skills training, Semi-independent living skills, Residential-based habilitation (including in-home family support and support living services for adults in their own home), Foster care services, ICF/DD, Day training and habilitation, Pre-vocational, Structured day, Supported employment, Employment exploration services, Employment development services, and Employment support services.

Services that are not covered by 245D can be found here.

What do I need to start?

The 245D license requires, at a minimum, a designated coordinator and a designated manager.

The designated coordinator must have one of the following: (1) a baccalaureate degree in a field related to human services, and one year of full-time work experience providing direct care services to persons with disabilities or persons age 65 and older; (2) associate degree in a field related to human services, and two years of full-time work experience providing direct care services to persons with disabilities or persons age 65 and older; (3) a diploma in a field related to human services from an accredited postsecondary institution and three years of full-time work experience providing direct care services to persons with disabilities or persons age 65 and older; or (4) minimum of 50 hours of education and training related to human services and disabilities; and four years of full-time work experience providing direct care services to persons with disabilities or persons age 65 and older under the supervision of a staff person who meets the qualifications identified in clauses (1) to (3). 

The designated manager must qualify as a designated coordinator (although it does not need to be the same person) AND they must have a minimum of three years of supervisory level experience in a program providing direct support services to persons with disabilities or persons age 65 or older.

In addition, the owner or managerial official for your organization must complete the required HCBS Waiver and AC Provider Training 101 and competency test and also pass a NETstudy Background check.

Certain services require additional qualifications which are specific to the service provided (such as a residential setting) and are not included.

What is the license application process?

1) Complete the 245D pre-application worksheet.

2) Prepare the policies and procedures identified in the pre-application worksheet by using these sample templates:

• Drug and Alcohol Prohibition Policy
• Emergency use of Manual Restraint Allowed Policy
• Emergency use of Manual Restraint Not Allowed Policy
• Grievance Policy
• Temporary Service Suspension Policy
• Service Termination Policy
• Vulnerable Adults Maltreatment Reporting and Internal Review Policy
• Maltreatment of Minors Reporting and Internal Review Policy.

3) Prepare the other documents identified in the pre-application worksheet by using these sample templates:

• Notarized Signature form
• Worker’s Compensation Insurance Verification form
• Designated Coordinator and Designated Manager Verification Form

4) 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.

5) Pay the nonrefundable $500 application fee. 

6) 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. 

7) DHS 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.

8) 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.

9) All 245D license holders are required to understand and implement Statutes 245A, 245C and 245D prior to providing services. 

10) 245A.03, subdivision 7, prevents any new community residential setting licenses for people receiving services under chapter 245D due to a licensing moratorium.

Background Studies

After your application is submitted, your Authorized Agent will receive an email from 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. If you need any additional assistance with background studies, visit the DHS Background Studies page. 

Who qualifies as your clients – HCBS Eligibility Criteria

Minnesota residents with disabilities or chronic illnesses who need certain levels of care may qualify for the Minnesota HCBS waiver programs.

These programs are available to persons who choose to reside in the community and meet the eligibility criteria.

1. Alternative Care (AC) for people over age 65 years who are at risk of nursing home placement (DHS Aging and Adult Services Division administers the AC program)
2. Brain Injury (BI) Waiver for people with a traumatic, acquired or degenerative brain injury who require the level of care provided in a nursing facility that provides specialized services for persons with BI, or who require the level of care provided in a neurobehavioral hospital
3. Community Alternative Care (CAC) Waiver for chronically ill and medically fragile people who require the level of care provided in a hospital
4. Community Alternatives for Disabled Individuals (CADI) Waiver for people with disabilities who require the level of care provided in a nursing facility
5. Developmental Disability (DD) Waiver for persons with developmental disabilities or a related condition who require the level of care provided in an Intermediate Care Facility for Persons with Persons with Developmental Disabilities (ICF/DD).
6. Elderly Waiver (EW) for people over the age of 65 years who require the level of care provided in a nursing facility and choose to reside in the community (DHS Aging and Adult Services Division administers the EW program)

Rates/Reimbursement for Services:

• Adult Companion Services / S5135 / 15 mins / $2.92
• Homemaker, Assistance with personal cares, Cleaning, Home Management / S5130 / 15 mins / $5.04
• Individual Community Living Support / H2015 / 15 mins / $6.18

View this link for more info.

Resources

245D Frequently used Forms in practice – download here.

245D Waiver Providers must complete Cost Reporting – more information here.

Forms for Long Term services and supports LTSS – here.

Disability Services Division (DHS) Training Archive

Rates/Reimbursement for Services:

Basic Services

Individual Community Living Support / H2015 / 15 minutes / $6.18
24 Hour Emergency Assistance (Maximum rate not published)
Adult Companion Services / S5135 / 15 minutes / $2.92
Homemaker / S5130 / 15 mins / $5.04
Night Supervision (Maximum rate not published)
Respite Care / S5150 / 15 minutes / $6.07