Integrated Community Supports (ICS)

Integrated Community Supports (ICS)

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.

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.

At this time Holt Law offers the ICS it starts with the setting capacity report, and the 245D license. We do the 245D license. See ww.djholtlaw.com/pricing for current pricing packages.

***This process may change due to factors outside our control.

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