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County Licensing Functions Under 245D

County Licensing Functions Under 245D. Minnesota Department of Human Services Office of Inspector General Licensing Division Nov 19 and Dec 4, 2013. Learning objectives. Understand the following about 245D home and community-based services (HCBS) Implementation of 245D

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County Licensing Functions Under 245D

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  1. County Licensing Functions Under 245D Minnesota Department of Human Services Office of Inspector General Licensing Division Nov 19 and Dec 4, 2013

  2. 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 County Licensing Functions Under 245D

  3. Implementation County Licensing Functions Under 245D

  4. Scope & Applicability 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. County Licensing Functions Under 245D

  5. 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 County Licensing Functions Under 245D

  6. 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the 2013 Minnesota Legislature • 245D license application process begins July 2013 • 245B DD services standards will be repealed Dec. 31, 2013, these services will be licensed under 245D • 245D becomes effective Jan. 1, 2014 • Technical assistance visits with providers new to DHS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 County Licensing Functions Under 245D

  7. Services & Settings County Licensing Functions Under 245D

  8. 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 County Licensing Functions Under 245D

  9. 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 County Licensing Functions Under 245D

  10. 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 County Licensing Functions Under 245D

  11. 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 County Licensing Functions Under 245D

  12. 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 staff County Licensing Functions Under 245D

  13. 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 County Licensing Functions Under 245D

  14. 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 County Licensing Functions Under 245D

  15. Waiver services not licensed under 245D • 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 County Licensing Functions Under 245D

  16. 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 • 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 County Licensing Functions Under 245D

  17. 245D License Types County Licensing Functions Under 245D

  18. 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 County Licensing Functions Under 245D

  19. 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 County Licensing Functions Under 245D

  20. 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 County Licensing Functions Under 245D

  21. 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. • 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. County Licensing Functions Under 245D

  22. 245D.21 Facility 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. County Licensing Functions Under 245D

  23. 245D.22 Facility 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. County Licensing Functions Under 245D

  24. 245D.23 Community 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 County Licensing Functions Under 245D

  25. 245D.24 Community Residential Settings; Physical Plant and Environment • Subdivision 1. Occupancy • Subd. 2. Common area requirements • Subd. 3. Bedrooms County Licensing Functions Under 245D

  26. 245D.25 Community Residential Settings; Food and Water • Subdivision 1. Water • Subd. 2. Food • Subd. 3. Food safety County Licensing Functions Under 245D

  27. 245D.26 Community 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 County Licensing Functions Under 245D

  28. Foster care Homes &Community Residential Settings County Licensing Functions Under 245D

  29. 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: • 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. County Licensing Functions Under 245D

  30. County licensing authority 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. County Licensing Functions Under 245D

  31. Family adult foster care homeone 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 County Licensing Functions Under 245D

  32. Family adult foster care licenselicense holders with a 245D-HCBS license AFC Exemptions 245D Requirements 245D.09 Staffing Standards 245D.05 Health Needs 245D.095 Record Requirements 245D.04 Service Recipient Rights 245D.06 Protections, subd. 4. Funds and property • 9555.6185 Foster Care Training, (including VA maltreatment under 245A.65) • 9555.6225 Sanitation and Health • 9555.6245 Personal Record of Resident in Foster Care • 9555.6255 Resident's Rights • 9555.6265 Safeguards for Cash County Licensing Functions Under 245D

  33. Corporate adult foster care homeNot 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 County Licensing Functions Under 245D

  34. Child foster care homeone 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 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 County Licensing Functions Under 245D

  35. Community 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 • Allresidents 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 County Licensing Functions Under 245D

  36. 245D-CRS Licensing Functions County Licensing Functions Under 245D

  37. 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 County Licensing Functions Under 245D

  38. 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 County Licensing Functions Under 245D

  39. 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.] County Licensing Functions Under 245D

  40. 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 County Licensing Functions Under 245D

  41. 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 County Licensing Functions Under 245D

  42. 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 County Licensing Functions Under 245D

  43. 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. County Licensing Functions Under 245D

  44. 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 County Licensing Functions Under 245D

  45. 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 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. County Licensing Functions Under 245D

  46. 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 County Licensing Functions Under 245D

  47. 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 County Licensing Functions Under 245D

  48. 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 County Licensing Functions Under 245D

  49. 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. County Licensing Functions Under 245D

  50. County & DHS Partnership County Licensing Functions Under 245D

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