Minnesota Depar tment of Human Ser vices
Of fice of Inspector General
Licensing Division
Nov 19 and Dec 4, 2013
COUNTY LICENSING
FUNCTIONS UNDER 245D
LEARNING OBJECTIVES
 Understand the following about 245D home and community based services (HCBS)
 Implementation of 245D
 245D services & settings
 245D license types
 Foster care homes & community residential settings
 Resources – information & contacts
Nov 19 & Dec 4, 2013
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IMPLEMENTATION
Nov 19 & Dec 4, 2013
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SCOPE & APPLICABILIT Y
Scope
 The 245D HCBS Standards govern the provision of home and
community -based services to persons with disabilities and people
age 65 and older.
Applicability
 Applies 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.
Nov 19 & Dec 4, 2013
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245D IMPLEMENTATION; PHASE 1
 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
Nov 19 & Dec 4, 2013
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245D IMPLEMENTATION; PHASE 2
 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 245B DD services standards will be repealed Dec. 31 , 2013,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 ef fective 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
Nov 19 & Dec 4, 2013
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SERVICES & SETTINGS
Nov 19 & Dec 4, 2013
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SETTINGS
Person’s home
 This is a person’s own home or the person’s family home
Community -based setting
 This 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 setting
 This is a licensed program location or facility controlled by a
license holder
Nov 19 & Dec 4, 2013
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BASIC SUPPORT SERVICES
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
Nov 19 & Dec 4, 2013
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INTENSIVE 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
Nov 19 & Dec 4, 2013
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INTERVENTION 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
Nov 19 & Dec 4, 2013
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IN-HOME 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 staf f
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RESIDENTIAL SUPPORTS & 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
 Supported living services
 Residential services provided in an ICF/DD
Nov 19 & Dec 4, 2013
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DAY AND EMPLOYMENT 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
Nov 19 & Dec 4, 2013
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WAIVER SERVICES NOT LICENSED UNDER 245D
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Adult Day Care
Assistive Technology
Caregiver Living Expenses
Caregiver Training and
Education
Case Management
Chore Ser vice
Consumer Directed Community
Suppor ts
Customized Living Ser vices
Environmental Accessibility
Adaptations
Extended Home Care Ser vices
Extended Home Health Aide
Extended Per sonal Assistant
Nov 19 & Dec 4, 2013
Extended Private Duty Nursing
EW Foster Care Ser vices
Family Training and Counseling
Home Delivered Meals
Housing Access Coordination
ILS Therapies
Per sonal Emergency Response
Residential Care
Specialized Supplies and
Equipment
 Transpor tation
 Transitional Ser vices
 EW/AC Ser vices, except for
Homemaker, Companion &
Respite
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ADDITIONAL DHS LICENSED SERVICES AND
PROGRAMS NOT LICENSED UNDER 245D
 Child care: family - or
centered-based
 Chemical dependency
treatment programs
 Detoxification programs
 Independent living
assistance for youth
 Mental health centers &
clinics
 Mental health residential
treatment for adults
 MN sex offender program
Nov 19 & Dec 4, 2013
 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
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245D LICENSE TYPES
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245D-HCBS PROGRAM LICENSE
 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
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TYPES OF 245D FACILITY LICENSES
 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
Nov 19 & Dec 4, 2013
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ADULT MENTAL HEALTH CERTIFICATION
245D.33
 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
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245D-CRS STANDARDS
 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.
Nov 19 & Dec 4, 2013
 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.
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245D.21 FACILIT Y LICENSURE REQUIREMENTS
AND APPLICATION PROCESS.
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.
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245D.22 FACILIT Y SANITATION AND HEALTH
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.
Nov 19 & Dec 4, 2013
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245D.23 COMMUNIT Y RESIDENTIAL SETTINGS;
SATELLITE LICENSURE REQUIREMENTS AND
APPLICATION PROCESS
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
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245D.24 COMMUNIT Y RESIDENTIAL SETTINGS;
PHYSICAL PLANT AND ENVIRONMENT
 Subdivision 1 . Occupancy
 Subd. 2. Common area requirements
 Subd. 3. Bedrooms
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245D.25 COMMUNIT Y RESIDENTIAL
SETTINGS; FOOD AND WATER
 Subdivision 1 . Water
 Subd. 2. Food
 Subd. 3. Food safety
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245D.26 COMMUNIT Y RESIDENTIAL
SETTINGS; SANITATION AND HEALTH
 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
Nov 19 & Dec 4, 2013
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FOSTER CARE HOMES &
COMMUNITY RESIDENTIAL
SETTINGS
Nov 19 & Dec 4, 2013
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FOSTER CARE HOMES & COMMUNIT Y
RESIDENTIAL SETTINGS
245D services that may be provided in a child or adult foster
care home or a community residential setting include:
 Supported living services
 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.
Nov 19 & Dec 4, 2013
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COUNT Y LICENSING AUTHORIT Y FOR 245D
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 .
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FAMILY ADULT FOSTER CARE HOME
ONE OR MORE RESIDENTS RECEIVE 245D SERVICES
 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
Nov 19 & Dec 4, 2013
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FAMILY ADULT FOSTER CARE LICENSE
LICENSE HOLDERS WITH A 245D -HCBS LICENSE
AFC Exemptions
245D Requirements
a)
9555.61 85 Foster Care
Training, (including VA
maltreatment under
245A .65)
a) 245D.09 Staffing
Standards
b)
9555.6225 Sanitation and
Health
c)
9555.6245 Per sonal
Record of Resident in
Foster Care
b) 245D.05 Health Needs
c) 245D.095 Record
Requirements
d) 245D.04 Service
Recipient Rights
d)
9555.6255 Resident's
Rights
e)
9555.6265 Safeguards for
Cash
Nov 19 & Dec 4, 2013
e) 245D.06 Protections,
subd. 4. Funds and
property
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CORPORATE ADULT FOSTER CARE HOME
NOT ALL RESIDENTS RECEIVE 245D SERVICES
 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
Nov 19 & Dec 4, 2013
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CHILD FOSTER CARE HOME
ONE OR MORE 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 245DHCBS 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
Nov 19 & Dec 4, 2013
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COMMUNIT Y RESIDENTIAL SETTING (CRS)
ALL 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
Nov 19 & Dec 4, 2013
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245D-CRS LICENSING
FUNCTIONS
Nov 19 & Dec 4, 2013
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CONVERSION FROM AFC TO CRS
 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
Nov 19 & Dec 4, 2013
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CRS LICENSE TERMS AND CHANGE OF TERMS
 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
Nov 19 & Dec 4, 2013
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CRS LICENSE APPLICATION
 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.]
Nov 19 & Dec 4, 2013
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CRS LICENSE RENEWAL
 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
Nov 19 & Dec 4, 2013
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CRS LICENSING ACTIONS
 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
Nov 19 & Dec 4, 2013
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BACKGROUND STUDIES
 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
Nov 19 & Dec 4, 2013
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FINES
 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.
Nov 19 & Dec 4, 2013
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CRS VARIANCES
 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
Nov 19 & Dec 4, 2013
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ALTERNATE OVERNIGHT SUPERVISION
 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 ef fect 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.
Nov 19 & Dec 4, 2013
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ALTERNATE OVERNIGHT SUPERVISION, CONT’D
 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
Nov 19 & Dec 4, 2013
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ADULT MENTAL HEALTH CERTIFICATION
 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
Nov 19 & Dec 4, 2013
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ADULT MENTAL HEALTH CERTIFICATION,
CONT’D
 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
Nov 19 & Dec 4, 2013
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LICENSING MORATORIUM
 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.
Nov 19 & Dec 4, 2013
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COUNTY & DHS
PARTNERSHIP
Nov 19 & Dec 4, 2013
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CONNECTIONS & PARTNERSHIPS
 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
Nov 19 & Dec 4, 2013
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ONGOING COMMUNICATION
 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.
Nov 19 & Dec 4, 2013
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STATUS OF 245D APPLICATION PROCESS
 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 ef fective Jan. 1;
providers are responsible for timely submission of the application
Nov 19 & Dec 4, 2013
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RELATED REQUIREMENTS
 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
Nov 19 & Dec 4, 2013
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CLARIFICATION OF 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
Nov 19 & Dec 4, 2013
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ACTION NEEDED NOW
 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.
Nov 19 & Dec 4, 2013
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INFORMATION &
RESOURCES
Nov 19 & Dec 4, 2013
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DHS ONLINE 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
Nov 19 & Dec 4, 2013
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MORE DHS ONLINE RESSOURCES
 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
Nov 19 & Dec 4, 2013
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CHANGES TO LICENSING FORMS
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
Nov 19 & Dec 4, 2013
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MHCP PROVIDER CALL CENTER
For questions about fee -for-ser vice 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 1 2:00 to 1 2:45
p.m.)
 Email:
dhs.healthcare-providers@state.mn.us
 Voice: (651) 431 -2700 or 1-800-366-5411
 TT Y: 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 .
Nov 19 & Dec 4, 2013
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HCBS LICENSING UNIT CONTACTS
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 DHS.245Dlicensehelp@state.mn.us.
Other DHS Licensing Questions:
 Licensing Division general information line (651) 431 -6500
Nov 19 & Dec 4, 2013
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FAMILY SYSTEMS UNIT CONTACTS
 E-mail at: dhs.familysystemstechassistance@state.mn.us
 Call (651) 431-6500, press 4, then press 5
Nov 19 & Dec 4, 2013
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QUESTIONS?
Nov 19 & Dec 4, 2013
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THANK YOU!
Nov 19 & Dec 4, 2013
County Licensing Functions Under 245D
Re m e m b e r to
visit the online
r e s o u rc e s o f te n
to o b t a i n
u p d a te d
information
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