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Integrated community supports (ICS) is a new waiver/245D license service as of 2021 under the “waiver reimagine” initiative in Minnesota.

What are integrated community supports?

Integrated Community Supports (ICS) are a 245D licensed service for adults 18+ on the BI, CAC, CAID or DD waivers. Providers provide support (e.g. supervision, cuing, and assistance) and training for adults (18+) in a provider-controlled, multifamily housing building (integrated community supports setting). Providers may deliver up to 24 hours of service support in a day. In a way, Integrated Community Supports (ICS) are similar to other “group home” programs.

ICS is not covered if it is delivered in a setting that is licensed or registered under Minn. Stat. Chapter 144D or Minn. Stat. Chapter 144G to deliver customized living or assisted living services and/or is licensed under Minn. Stat. Chapter 245A or Minn. Stat. Chapter 245D to deliver adult foster care, child foster care, community residential services or family residential services.

ICS provides support and/or training in four community living service areas: (1) community participation, (2) health and safety, and wellness, (3) household management, and (4) adaptive skills.

Community participation may include community mobility and pedestrian safety (e.g., safely getting in and around the community); community resource use and access; community safety and awareness; informal support system and network development; interpersonal communications skills; leisure, recreation and socialization planning; and skill-building to meet transportation needs.

Health safety and wellness may include collaboration with the person to arrange health care (e.g., physical, mental, chemical), meaningful activities, social services, meetings and appointments; cueing, guidance, supervision, training or instructional support to complete self-care activities; health services support; help for the person to activate and build resiliency factors; and support for the person to design and meet individualized strategies to reach their health, safety and wellness goals.

Household management may include cueing, guidance, supervision, training or instructional support to complete routine household care and maintenance; household safety knowledge and skills; tenancy support and advocacy; training, assistance, support and/or guidance (with budgeting and assistance to manage money, cooking, meal-planning and nutrition, healthy lifestyle skills and practices, household chores, including minor household maintenance activities, personal-needs purchasing.

Adaptive skills may include crisis prevention skills; implementation of positive support strategies; problem-solving; sensory/motor development involved in acquiring functional skills; support strategies for self-sufficiency; support and training to increase positive behavior, resulting in reduction or elimination of challenging behavior.

What is an Integrated community supports setting?

An integrated community supports setting is a multi-family housing building (tri-plex, four plex, apartment building, etc.) where the service provider has direct or indirect control of the person’s living unit and has an approved setting capacity report.

An integrated community supports setting Is considered a provider-controlled HCBS setting (must comply with all requirements for HCBS settings in 42 CFR 441.301(c)) and it does not meet the requirements of a person’s own home, community residential program or family residential program.

A living unit is a self-contained residential living unit with living, sleeping, eating, cooking and bathroom areas.

A multifamily housing building will have multiple living units.

When a single provider leases or owns more than one living setting located on the same or adjoining property, the lead agency can only authorize services in one of the settings.

Setting capacity report

A setting capacity report is required to be submitted to DHS by the provider indicating:

the location of the setting;
how many units are in the building
how many units will be occupied by someone receiving ICS.

Before an integrated community supports provider can deliver services, they must submit a Setting Capacity Report, DHS-8062 to DHS for each integrated community supports setting, as required by Minn. Stat. Chapter 245D. Only one HCBS provider may deliver integrated community supports in the approved setting. To submit a setting capacity report, email the completed DHS-8062 form to hcbs.settings@state.mn.us.

Setting capacity limits

Integrated community support settings must comply with the federal HCBS settings rule, therefore there is a limit to the number of units in a building where ICS can be provided.

Integrated community supports may be provided in:

All of the living units in an integrated community supports setting of three or four unit;
Less than 25 percent of the living units of an integrated community supports setting of five or more units; or
A setting with a site-specific review approved by the commissioner where 25 percent or more of the units of an integrated community supports setting are occupied by people who receive integrated community supports funded under BI, CAC, CADI and DD waivers

Site specific review

A site specific review is required for:

a setting where 25% or more of the units are occupied by someone who receives ICS, and;
housing that is developed, funded, or designated specifically for people with disabilities to receive HCBS.

The site specific review is required in order to ensure the setting does not isolate or create stigma for people living there.

Information the provider submits to DHS for the site-specific review must include, but is not limited to:

Setting-specific provider community integration plan that includes strategies to reduce the potential effects of isolation
Policies and practices that demonstrate staff training and monitoring of the community integration plan
Documentation of the community living service category supports and training offered at the setting
Documentation of how the provider ensures people are given informed choice to receive HCBS from providers who are not the integrated community support provider who controls the setting
Description of provider’s continuous quality improvement process, including measures to demonstrate a person’s experience over time
Identification of any specialized care the provider will deliver and/or populations the provider will serve at the setting
Input from the lead agency and community where the setting is located, including local perspectives of the setting, with supporting information or strategies to address potential concerns.

DHS will not approve the site-specific review if the information submitted does not:

Demonstrate that the setting meets the HCBS setting rule characteristics
Demonstrate that the setting does not have the effects of isolation
Identify a plan to monitor and remediate people’s ongoing experience at the setting
Ensure people in the setting have choice to receive HCBS from providers who are not the integrated community support provider controlling the setting.

If a site-specific review is required for a setting based on the setting capacity report, DHS will contact the provider to obtain the required information.

How much to bill for integrated community supports

The DHS rate framework can be found here, and navigate to the ICS spreadsheet and input your specific staffing and resident numbers to learn your rate per day = 2022 Disability waiver rate-setting frameworks / Minnesota Department of Human Services (mn.gov)

Choice in Provider

Only the provider with the approved setting capacity report can deliver When a person chooses to receive integrated community supports, they are choosing both their ICS service provider and where they live integrated community supports in that setting.

A person who lives in an integrated community supports setting does not have to receive ICS. They can receive other services that meet their needs from a different provider of their choosing (e.g. individualized home supports, 24 hour emergency supports.

Integrated Community Supports Service Limitations

There are limitations on the services that can be delivered when someone receives integrated community supports. A person who receives integrated community supports cannot also receive: community residential services, family residential services, customized living (including 24 hr), 24 hour emergency assistance, individualized home supports, night supervision, respite, caregiver living expenses.

If more than one person resides in a single living unit of an ICS setting, the ICS provider must not direct or facilitate who will and will not live in the unit; allow each person to choose who lives in the unit with them, as allowed by rental guidelines or a lease agreement; and maintain documentation that each person, their case manager and their legal representative (if applicable) are aware of and have chosen the living arrangement.

ICS can be delivered through remote support. Services delivered through remote support must meet all the requirements listed here though.

How to provide integrated community supports

Integrated community supports is an intensive service that is licensed under Minnesota Statutes, Chapter 245D. The service requires both the 245D/waiver license, and the ICS setting capacity report process to be completed.

Frequently Asked Questions

Services

Is ICS replacing another service?

No. ICS is a new service for people on the BI and CADI waivers as of January 2021, and it will be available for people on the CAC and DD waivers in 2023, or upon federal approval.

Why is DHS adding a new service?

DHS introduced ICS to fill identified gaps in services for certain living settings and further promote independent living. This new service is designed to be similar to a supported apartment setting for adults age 18 and older. For information about the history and creation of ICS, see Minnesota’s Home and Community-Based Services Rule Statewide Transition Plan (PDF).

What services are duplicative of ICS?

If a person receives ICS, they cannot receive the following waiver services:

24-hour emergency assistance
Caregiver living expenses
Community residential services
Customized living (including 24-hour customized living)
Family residential services
Individualized home supports (without training, with training and with family training)
Night supervision services
Respite.

Is there a limit to the amount and type of support a person can receive in an ICS setting?

The amount of services authorized depends on the person-centered support plan, developed by the case manager to meet the person’s specific assessed areas of need. ICS can be delivered up to 24 hours per day in the person’s living unit or in the community.

All service delivery hours are awake and must provide training or support in at least one of the community living service categories.

Who can provide ICS?

For provider standards and qualifications, see CBSM – ICS.

If a person currently receives customized living, do they have to transition to ICS?

No. A person receiving customized living is not required to transition to ICS if the setting continues to be licensed as an assisted living setting. If the setting transitions to an ICS setting, a person must either transition to ICS or move to an assisted living setting to continue receiving customized living. For information about how to transition from a customized living setting to an ICS setting, see CBSM – ICS transition plans.

Where can ICS be provided?

ICS is provided in an ICS setting. An ICS setting is a multi-family housing building of three or more units (e.g., apartment building) in which the provider has direct or indirect control over the person’s living unit. A provider has direct or indirect control over a person’s living unit when the provider either:

Owns, operates or leases the living unit.
Has direct or indirect financial interest in the property or housing, including a financial relationship with the property owner.

Can a service provider offer both ICS and individualized home supports in the same building?

No. A single service provider cannot provide both ICS and individualized home supports in a single setting. A provider that controls the ICS setting can only provide ICS in that setting. Other service providers can provide other services (e.g., individualized home supports with training) in the ICS setting.

Does ICS have shared staffing?

No. All hours authorized for ICS are provided directly to the person, one to one. For more information about staffing, see the rates section of this page.

How does ICS allow a person to more be integrated into their community if the provider still controls where they live?

ICS adds another option to the continuum of living arrangements available to people. The person’s living space in an ICS setting includes their own sleeping, bathing, cooking and living area (e.g., apartment unit).

The person has autonomy in their living unit. Although the person lives in a provider-controlled setting, the setting requirements ensure the service provided increases the person’s community integration, independence and options to live in their chosen community. For more information, see CBSM – ICS.

Setting Requirements

Setting Characteristics

Can a provider deliver ICS in a duplex or a single family home?

No. ICS settings are multi-family housing buildings with three or more living units. Duplexes and single family homes are not included in the ICS policy.

What is a living unit?

For the definition of a living unit, see CBSM – ICS.

Can a living unit have more than one bedroom?

Yes. However, when more than one person lives in a single living unit of an ICS setting, the ICS provider cannot direct or facilitate who will and will not live in the unit. The provider must allow each person to choose who lives with them, as allowed by rental guidelines and choice-of-roommate requirements under the HCBS settings rule. Neither the person nor their roommate is required to receive ICS or any other HCBS service. For more information, see the secondary information – roommates section on CBSM – ICS.

Provider Control

Are there additional lease requirements for an ICS provider that rents living units in a building they do not own?

Yes. If the provider rents the living unit(s) for the purpose of delivering ICS, the provider must be able to demonstrate through documentation that they have the authority granted by the property management/owner to sublease the unit(s) to people who will receive ICS from the provider. This means the person will hold a lease with the provider, and the provider will continue to hold a lease with the property management/owner. To comply with the HCBS settings rule, a person receiving services must have a lease that complies with Minn. Stat. Ch. 504B (landlord and tenant law). Subleasing does not refer to situations when the HCBS provider co-signs a lease with the person. For more information, see the secondary information – sublease section on CBSM – ICS.

What is a provider-controlled setting?

A provider-controlled setting is a setting in which the HCBS provider has direct or indirect control over a person’s living unit. This means the provider either:

Owns, operates or leases the living unit.
Has direct or indirect financial interest in the property or housing, including a financial relationship with the property owner.

ICS settings are provider-controlled settings. They do not meet the requirements for a person’s own home, community residential program or family residential program.

What happens if a person living in an ICS setting decides they want to stop receiving ICS services? Can they continue to reside in their living unit?

If a person decides to terminate ICS services with the provider who controls the setting, the person has the right to continue living in the unit according to their lease agreement.

The person cannot receive ICS services from another provider who does not control the setting. However, the person can choose to receive other services from a provider who does not control the setting.

Can there be more than one ICS provider in one ICS setting?

No. Only one HCBS provider may deliver ICS in an approved ICS setting.

Rates

Is ICS a Disability Waiver Rate System (DWRS) framework service?

Yes. ICS uses a residential rate methodology specifically for the service that uses a “base plus” model. For more information, see RMS User Manual – Residential fields for ICS.

What is a “base plus” model?

The base rate is a standard amount calculated as eight hours of available staffing per day, divided among the number of approved units in the setting, per the setting capacity report.

The base rate allows for the intermittent and unplanned staffing needs of the people who live in the setting. It allows for flexible administration of program operations to have available staffing for all the people who receive ICS in the setting. The base rate is not shared staffing.

The “plus” in the methodology is the number of individual, awake one-to-one hours the person needs per day to support their assessed needs, as allowed within ICS covered services.

Example: A person lives in an ICS setting with five provider-controlled living units. The person’s rate is calculated as the standard amount for the base, divided by five, plus one-to-one hours to meet their assessed needs.

For more information, see RMS Manual – Quick reference guide on staffing hours for ICS.

Does the base rate mean the ICS provider must have staff on site for exactly eight hours per day, seven days per week?

A staff person is not required to work on site at the ICS setting outside of each person’s one-to-one hours. Each setting may be set up differently using the base rate, depending on the needs of the people who live and receive services there. However, each setting must have a plan in place for a person to access staff on-site to meet unplanned and intermittent support needs.

Housing Supports

Are ICS settings eligible for Housing Support?

Yes. The lead agency manages Housing Support for ICS settings. The ICS provider should work with the local lead agency if they have questions about Housing Support applications. For more information, see DHS – Housing Support.

Staffing

Are staff required to be on site 24 hours per day?

The staffing planned for an ICS setting must align to the support needs of the people served in the setting. The base rate allows for unplanned, intermittent needs and access to staffing availability in the setting to meet the needs of the people receiving ICS.

Enrollment

Does an ICS provider need a separate National Provider Index (NPI) number for each ICS setting?

Yes. The ICS provider enrolls each ICS setting separately. Each setting has its own NPI number associated with the program’s enrollment record.

Health Needs

How is nursing handled through ICS?

Nursing service hours are not calculated as part of the DWRS framework for ICS. ICS is a 245D-licensed service. The ICS provider is responsible to meet a person’s health service needs in the support plan, consistent with the person’s health needs.

If a person receiving ICS is assessed to need nursing services, they may receive skilled nursing visits or home care nursing from a qualified home care provider. For policy information about those services, see CBSM – Skilled nursing visit and CBSM – Home care nursing.

The qualified home care provider can be the same provider that delivers ICS, if the person chooses to receive nursing services from them.

Can an ICS provider administer medications as part of ICS?

Yes. ICS is an intensive service licensed under 245D, so the licensed provider is required to have a safe medication assistance and administration policy, per Minn. Stat. §245D.11, subd 2, par. 3.

Unlicensed staff working for a 245D-licensed provider can administer medications with the appropriate training. The medication administration training curriculum must be developed by a registered nurse or appropriate licensed health care professional. Providers must follow their internal safe medication assistance and administration policy. Minn. Stat. §245D.09, subd. 4a lists the training requirements for medication administration (paragraph d).

For questions about medication administration and medical equipment requirements under 245D, contact the 245D help desk at 651-431-6624.

Integrated Community Supports Packages

We offer a variety of ICS packages for providers looking to add this to their 245D license. To learn more about our package options, click the button below!

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