The commissioner waived certain requirements for face-to-face visits for seniors and people with disabilities who receive long-term services and supports. For people who receive home and community-based services under Medical Assistance, this means that assessments for needs may be done by phone or online connection, and that case managers may conduct phone or online visits. The affected programs are Alternative Care (AC), Brain Injury (BI) Waiver, Community Alternative Care (CAC) Waiver, Community Access for Disability Inclusion (CADI) Waiver, Developmental Disabilities (DD) Waiver, Elderly Waiver (EW), Essential Community Supports (ECS) and Federal OBRA Level II evaluations. Personal care assistance (PCA) programs include assessments but do not require case management. This change also applies to people served under Rule 185 case management who choose not to waive the annual reassessment. These actions will protect people who receive services and case managers during the pandemic. The department will request CMS approval for any necessary authority related to this requirement.
Affected statutes and rules:
The commissioner waived requirements temporarily for face-to-face visits for Minnesotans on Medical Assistance who receive certain targeted case management services. This means case managers may conduct targeted case management visits by phone or the internet with adults who receive services or their legal guardians and with children who receive services and their parents or legal guardians. The affected programs include:
Assessors must record the time spent with the person completing the assessment interview regardless of the method (i.e., in-person or interactive audio/video telecommunication).
Assessors will record the time in the disposition tab for the person’s assessment. The assessor should record the assessment time regardless of the final disposition (e.g. abandoned).
Yes, the person has the option to move funds that were previously allocated for day or employment support into the Personal Assistance category to pay workers when the person needs support/care at home. CDCS participants should follow their lead agency protocol for changing their current support plan.
Yes, the lead agency may approve additional hours up to the 40 hours per week limit. As a reminder, parents of minors may only be paid to provide waiver services the participant has been assessed to need and may not be paid for activities a spouse or parent of a minor would ordinarily perform or be responsible to perform.
Yes. There is no current CDCS policy or waiver plan language that stipulates or limits the time of day a parent may be paid to provide waiver services to his or her child.
Yes, work schedules of workers may be changed to accommodate needs of participants while services are being provided in their homes.
DHS does not have any language in the waiver plans or in CDCS policy regarding overtime for workers. Additional hours (including OT) must be paid within the CDCS participant’s current budget allocation.
If a lead agency completes a remote assessment/evaluation, lead agencies must:
What is important for people (particularly health and safety) is at the forefront of our minds during this crisis, but we need to continue to consider and balance that with what is important to a person (things in life that help a person to be satisfied, content, comforted, fulfilled and happy).The two are not in opposition to each other. Usually, there is a link between them. We want to continue to ensure that people who use services have a life where they have control and have the quality of life that they define. Our obligation to meet both needs does not change during times of uncertainty.
Insisting someone do something important for them without balancing or linking with what is important to them will create a negative and power-over relationship. Exercising power over another person creates a tense dynamic and perpetuates the harmful perception that people with disabilities are not equal, autonomous individuals. Over time, this creates toxic environments for the people who use services and supports. To exercise power over another person can diminish any therapeutic relationship.
We need to continue to listen to people’s words and observe their actions, and then find a way to help people get what they request. We may feel rushed to come up with ways to help people be safe, but we must also develop creative and innovative ways to contribute to their quality of life.
Here are some examples of creative solutions:
The time spent understanding the seeming conflict between “important for” and “important to” and working with the person to develop solutions is a vital part of supporting someone. This is especially true during times of uncertainty and stress. If you want support and technical assistance to work through complex situations, please contact us at email@example.com.
DHS does not consider restructuring a person’s community engagement opportunities in an effort to comply with the governor’s orders and the Centers for Disease Control and Prevention (CDC) guidance to be a rights restriction.
The governor’s directions to stay at home places limitations on everyone in the state. It instructs all of us to maintain physical distance between people and limit our interaction with the community. This has complicated the role of 245D-licensed providers, who are required to facilitate the community engagement of people with disabilities who receive services. Under 245D, the rights related to accessing the community and engaging in chosen activities do not allow people who receive services to do things that would otherwise be illegal or prohibited.
While the governor’s order might mean that people may not engage with the community in the ways they usually do, providers should work to find new ways to help people access their community, within the limitations of the order. For example, the provider could arrange video meetings with friends and family. How and why it is important to maintain physical distance from others may be a new skill that providers are working to help people do and understand. If a person is struggling with this, we recommend finding alternatives that people might enjoy. For example, if a person typically greets people with a hug, they could create a new greeting that they find fun, but that doesn’t include physical contact. Providers should also help the people they serve understand the need to maintain physical distance between people.
People are still able to take walks, grocery shop, go to work if their workplace is open, visit with friends/family members/neighbors while practicing physical distancing and access venues that are currently open – within the guidelines in the governor’s order.
To help people make informed choices about staying home and maintaining physical distance, we suggest you have conversations with them about the importance of following the guidelines and the dangers of COVID-19. Fact sheets from the CDC or the Minnesota Department of Health (MDH) might help you with this. It can be helpful to relate the guidelines to a value that is important to them.
To learn more about ways to talk about COVID with the people you serve, consider the following links:
In general, no. People are free to come to and go from their homes. DHS does not consider people leaving their own homes without staff’s agreement to meet imminent risk — even at this time – unless other factors are also present.
DHS typically considers physically detaining someone as the use of manual restraint. DHS does not allow the emergency use of manual restraint except when there is imminent risk of harm to someone and that intervention is the least restrictive option.
Providers should attempt to find ways for the person to leave the house and enter their community safely. People may continue to take walks, grocery shop, go to their jobs (if open) and access venues that are currently open – within the guidelines the governor’s order. In these situations, help people to understand the importance of maintaining physical distance and other kinds of risk management (e.g, not touching surfaces that might be contaminated, frequent hand-washing, not touching one’s face, covering coughs, wearing a mask) and how to practice these when in the community. Here are some ideas about how you might do this:
Consult with a licensed health professional for guidance, including recommendations on whether or not the person needs to be tested or quarantined.
We recommend that you have a conversation with each of the people you serve in advance about how they would like to protect themselves if there is an exposure in their home. Some people may choose to stay in their room if another person in the home is infected.
No, DHS does not consider quarantine at home when recommended by the person’s health care provider to be seclusion under statute 245D. There is a difference between prohibited seclusion and a quarantine ordered by a licensed health care professional to curb the spread of an infectious disease.
We acknowledge quarantining a person might present significant challenges. We ask everyone to do their best to continue providing necessary care for the people who access their services. Providers should make every attempt to quarantine people with suspected or confirmed COVID-19 diagnoses safely, when recommended by a licensed health care professional, and to mitigate exposure to staff and other residents. The default approach should not be isolating all residents in their bedrooms without the presence of COVID-19 symptoms. Under these circumstances, people and providers may take the following precautions provided by the CDC and MDH:
For more mitigation strategies, visit the MDH Coronavirus Disease 2019 webpage.
A PSTP is required if your staff implements the emergency use of manual restraint three times in 90 days or four times in 180 days (See Minn. R. 9544.0070). An FBA is required when a PSTP is developed and afterward when a written intervention is developed or modified to change a target behavior.
That said, even though the situation might not meet the conditions for an FBA, if you are working with someone who is engaging in interfering behavior, you might want to consider conducting an FBA to help understand the best way to address the issues. You can find suggestions on conducting FBAs in the Guidelines for Positive Supports in DHS-Licensed Settings (PDF).
You may also email firstname.lastname@example.org or call the 245D help desk at 651-431-6624 with questions.
The governor’s orders do not waive the person-centered planning requirements of 245D or the Positive Supports Rule. During these uncertain times, you might need to engage the person frequently to re-evaluate their identified positive support strategies, individual services and supports preferences, daily needs and activities, and the accomplishment of goals. The following are additional resources to support you and the person with these evaluations:
During the shelter-in-place order, families are encouraged not to visit someone in a home or take their loved ones out of the home for any non-essential outings. We recommend you help people find alternative ways to connect with friends, family, schools and other service providers whenever possible. That said, please remember that many 245D-licensed residential facilities are congregate residential settings; they are also people’s homes. Providers need to consider their actions from both perspectives and respect the rights of people who live there.
Providers need to support health and safety, while balancing a person’s freedom of choice. People who receive 245D-licensed services have the right to see the people they want to see and to come and go freely from their homes within the limits of the governor’s orders. Providers should help people to understand their options, their risks and alternative ways of having what is important to them so they can make informed decisions. You should discuss the risks, the stay-at-home order, MDH guidelines and any established household decisions about visitors with each resident, their family and friends and all staff. It is important to have these in writing so that there is common understanding and consistency in how people are treated. Limiting visitors in the home does not require individual rights restrictions during the governor’s stay-at-home order.
If a person chooses to leave the house for a visit or another activity where they are exposed to other people, staff should talk with the resident before the visit or activity about the risk of exposure, the need for social distancing during the visit, and what additional steps will need to be taken when the person returns to ensure other residents and staff are safe. It is important to educate both residents and staff who are leaving the home about ways to further reduce the risk of disease transmission when they return to the home.
As noted in the guidance for residential and non-residential settings (PDF), the CDC and MDH recommend that residences restrict all visitors and non-essential health care personnel in the home, except for special circumstances. MDH Guidance for Visiting People in their Homes (PDF) includes “care of others” as one of the allowed activities if there is no other way to provide that service. The guidance lists things to take into consideration before deciding to visit a person in their home.
We encourage providers to have discussions with the people who live in the home to come up with mutually-agreed upon norms for:
Measures to consider in developing agreements about people coming and going from the house:
In general, no. Residential settings are the person’s home and each person is still entitled to due process. Physical distancing and/or isolation should be the primary response in this situation. Consult with the person’s licensed health professional before determining whether to take actions such as quarantine.
Since COVID-19 could develop within 14 days of an exposure, there is a 14-day window of potential for transmitting the virus after any activity where exposure can’t be ruled out.
These are some examples of ways the person who may have been exposed can reduce the risk of transmission:
Failure to follow physical distancing guidelines or Executive Order 20-20 requirements, alone, is not grounds for suspending or terminating a person’s services. All suspensions or terminations must still meet one of the permitted reasons in Minn. Stat. §245D.10. Due process requirements in 245D.10 give a person the right to a 60-day notice period before terminating their services. Consider that after 60 days have passed the health risk might also have passed, meaning that a suspension or termination because of the potential health risk a person might pose to others will no longer be a valid reason to terminate services. If you have concerns about the person’s conduct putting the safety of others at risk, you should convene a team meeting (person and their advocates, provider, case manager and health care provider), to talk through the issues and find solutions to prevent the need for terminating services.
As an alternative to service termination or suspension because of the medical risk of someone in the home, consider the use of crisis respite. A person is eligible to receive crisis respite services when caregivers and service providers are not able to provide necessary intervention and protection of the person or others who live with that person. Crisis respite services allow the person to avoid institutional placement. Crisis respite may be provided in-home or out-of-home. License hotels are an approved setting on all of the disability waivers. For more information on the use of crisis respite, speak with the person’s case manager and/or visit the Crisis Respite page in the Community-Based Services Manual (CBSM).
We would again remind you that people may still take walks, grocery shop and access venues that are currently open – within the guidelines of the governor’s order. Terminating or suspending someone’s services solely for doing something everyone is able to do under the order is not permitted.
Executive Order 20-14 (PDF) places limitations on evictions and lease terminations under Minn. Stat. §504B. 245D residential providers are required to hold leases (or legally-binding agreements that have the same protections as leases) with the people they serve in residential sites, in accordance with the home and community-based settings rule. For more information, read Minnesota’s Home and Community-Based Services Rule Statewide Transition Plan (PDF). These leases and agreements create a landlord-tenant relationship that is covered under Minnesota’s landlord/tenant laws. These service providers should review their obligations as landlords under Executive Order 20-14.
There is a distinction between terminating services and terminating leases. While providers may terminate services, under proper circumstances, in accordance with 245D.10, lease terminations are subject to the limitations of Executive Order 20-14.
Consider that if a provider terminates services, the person’s team, including the current provider and case manager, will have to find a new service provider to deliver the person’s needed services in the residence for the duration of the peacetime emergency.
The commissioner suspended or modified specific routine enforcements by DHS Licensing so that clients can continue receiving services during the COVID-19 pandemic, including:
The Licensing Division will continue to respond to critical incidents involving high risk of harm to clients or allegations of abuse or neglect and will prioritize on-site visits as needed on a case-by-case basis. Inspections for pre-licensure and change of premises will continue on a case-by-case basis.
The commissioner also took actions to increase flexibility for providers:
These waivers will be in effect until May 1, 2020, and affect Minnesota Statutes, chapters 245A and 245H.
No, you do not need to recalculate the person’s rate even if there are other people in the home whose rates are being recalculated because of employment/day program COVID-19 closures.
Yes, when a person returns to a day/employment program, the person’s residential rate will need to be recalculated by the lead agency to account for the person no longer needing the additional staffing hours. In other words, the shared staffing hours will be reduced in the residential rate calculation.
The rate may be recalculated using individual staffing hours instead of shared only if the person will receive individual staffing hours as defined below.
Individual: Direct care staff brought in solely to provide support as a one-to-one interaction specific to an individual client’s needs.
Yes, DHS is aware that changes due to COVID-19 might affect waiver budgets. Lead agency waiver budgets should not prevent authorizations consistent with this guidance.
Yes, if a rate is currently banded, this will occur. Lead agencies should not manually band the rate.
No. Rate exceptions are intended to cover extraordinary costs for people with exceptional needs that cannot be met under the disability waiver rate system. While providers might experience additional costs during this time related to worker hazard pay, mandated facility closures or supply costs, these are not costs directly attributable to a person's service needs in relation to the exception process. Legislative action would be required to support these additional costs within the current authority.
The respite community emergency or disaster policy applies to COVID-19 situations in which a person must be relocated. A licensed and qualified provider may provide out-of-home respite to meet the needs of the person who receives waiver services.
If out-of-home respite is necessary, the provider and lead agency must agree on an appropriate rate based on the person’s support needs (daily respite is a market rate).
If there is a need to relocate a person on BI, CAC, CADI or DD waivers to ensure the person’s health and safety during a community emergency or disaster, the provider or lead agency should contact the applicable DSD regional resource specialist (RRS). The RRS will help the provider and lead agency to implement the respite community emergency or disaster policy.
NOTE: Include “COVID-Emergency Disaster Respite” in the subject of your email.
In response to the CDC public health strategies to reduce community transmission of COVID-19, DHS modified the following limitations of the respite service:
As of April 29, 2020, the commissioner temporarily expanded remote support (real-time, two-way communication) as a service delivery option to several waiver services through phone or other interactive technology available to the person. The commissioner approved remote support to be provided to people who live in a single-family home or apartment where the person who receives services or their family owns or rents, and maintains control over the individual unit as demonstrated by a lease agreement.
For more information and operational guidance, please see Bulletin #20-48-01, Temporary expansion of remote support for home and community-based services (HCBS) waivers (PDF).
Visit the Remote support service functions webpage to find out more about remote delivery of specific services.
The U.S. Department of Health and Human Services website offers the most recent information about the types of technology applications that may be used in accordance with HIPAA requirements. This guidance may be found in the Telehealth Remote Communications during the COVID-19 Nationwide Public Health Emergency.
Under this notice:
Temporary expansion of remote support is separate from the existing authority on billable indirect time. Providers may continue to bill indirect time for services based on existing policy. The Rate Management System (RMS) quick reference guide on billable indirect time contains information about billable indirect support activities.
Regardless of service, staff who provide services remotely should check in with people on a regular basis to assess physical health and emotional well-being during the COVID-19 emergency. Here are some guiding questions to assist with conversations:
It is important to consider the impact that COVID-19 has had on everyone’s daily routine and the importance of staying connected and active during a mandated stay-at-home order. Opportunities for wellness help people to maintain a sense of balance and control, especially in times of great uncertainty. Helping a person to think about these opportunities will be beneficial during this difficult time.
Share information with the person about resources that can be found on the Disability HUB MN.
Below is a list of the current waiver services that may be used to pay for support technology. Support technology includes both assistive technology and remote support/supervision, as well as the human expertise to assess a person’s needs, design solutions, complete installation, provide training and support its use.
Assistive technology includes a wide variety of tools or equipment (which can be high-tech or low-tech) with the primary purpose to help someone to do things for themselves that they would need a direct support professional either to do or provide assistance.
Remote support/supervision includes a variety of technologies to help a direct support professional supervise and/or support someone who needs this type of assistance, without having to be physically present.
Review the service pages below in the Community-Based Services Manual (CBSM) to understand better how you may use them separately and together when support planning:
Sometimes the same piece of equipment may be funded under more than one of the above services; it all depends on how or why it is being used. For example, a medication dispenser could be considered assistive technology if it is being used by someone who is using the dispenser so they can administer their own medications more independently. If, however, the medication dispenser is set to alert a caregiver when the person is late in taking medications so the caregiver can ensure the person receives their medication, it would be considered monitoring technology. Therefore, you always want to consider the purpose of the technology/what need it is addressing.
Waiver funding should only be used when no other funding is available. Below are additional technology resources that may meet someone’s support technology needs. While it might be a little confusing to figure out which service funds what, remember that most support technology can be funded through a waiver, state plan or other source.
State plan covers durable medical equipment (DME). Equipment must:
Durable medical equipment examples:
A relative may be paid to provide services, if they are not a spouse or parent of a minor (related by blood, marriage or adoption) with the exception of consumer-directed community supports (CDCS) services.
Paid relatives must meet all of the following criteria:
If a relative is younger than 18, you must follow child labor laws. More information can be found on the Minnesota Department of Labor website..
There are certain services that require a 245D license. A relative might not have to have a license for some services. For more information, see CBSM – Exclusions from Chapter 245D licensure.
Out-of-home respite may be provided in the following settings if the provider meets the provider standards and qualifications to provide respite:
Any decisions about a person's staffing ratios should be based on an individual assessment and consultation with the person and their team, including but not limited to the case manager and legal representative as applicable. The team should make the determination about what scenario would be best for the person, and to develop any alternatives necessary to protect the health and safety of everyone involved. Alternative options may include the temporary use of intervention services such as crisis respite, positive behavior supports or specialist services.
Staff and people who receive services should take everyday preventive actions to prevent the spread of respiratory illnesses. Actions include staying home when sick; appropriately covering coughs and sneezes; cleaning and then disinfecting frequently touched surfaces; and washing hands often with soap and water.
If you are concerned about your health or the health of people you care for, contact the Minnesota Department of Health COVID-19 hot line at 651-201-3920 or 1-800-657-3903 (between the hours of 7 a.m. and 7 p.m.).
The Centers for Disease Control and Prevention (CDC) has several resources related to protecting yourself and how to care for someone who is sick:
In addition to CDC guidance and resources, the Minnesota Department of Health also has several resources related to protecting yourself and caring for someone who is sick:
The Minnesota Department of Administration is leading a state team that is collaborating with public and private sector partners to obtain and distribute personal protective equipment to prevent the spread of COVID-19. For more information, see the Critical Care Supplies webpage.
Yes, there are several services available that may support grocery and supply delivery. These services include:
Certified Metro Mobility customers may now order groceries and household essentials online from a store that has online shopping and local pick up. Metro Mobility will pick up their orders and deliver to their homes. For more information, visit the Metro Council website.
Yes, homemaker and chore services are existing waiver services available to assist people, or their primary caregivers, to maintain clean, sanitary and safe environments.
To learn more about these services, please view the service pages in the Community-Based Services Manual (CBSM):
The Respite Community Emergency or Disaster policy applies to COVID-19 situations in which a person needs to be relocated. A licensed and qualified provider may provide out-of-home respite to meet the needs of the person receiving waiver services.
If out-of-home respite is necessary, the provider and lead agency must agree on an appropriate rate based on the person’s support needs (daily respite is a market rate).
Refer to the eligible settings for delivery of out-of-home respite.
The federally approved waiver plans also grant the commissioner authority to waive other limitations on the respite service, as necessary, in order to ensure that necessary expenditures related to protecting the health and safety of participants are reimbursed.
In response to the CDC public health strategies to reduce community transmission of COVID-19, DHS is temporarily waiving the following limitations of the respite service:
Yes, DHS has implemented a new out-of-state travel policy. The revised policy removed the 30-day timeline for temporary travel within the United States. The recently amended waiver plan language states that for out-of-state travel a person must:
DHS is developing policy options for scenarios that exceed current 30-day limits. Guidance will be available soon NOT to exit people from the waiver during the state of emergency unless the person has died, moved out of state or wishes to exit voluntarily. Please refrain from taking action until the guidance is available.
This will also apply when there is a level of care change or when case management is the only service a person receives.
In response to the CDC public health strategies to reduce community transmission of COVID-19, DHS is allowing waivers to remain open temporarily when the person is both:
The lead agency must document in the person’s support plan why there are no additional waiver services authorized related to COVID-19.
The DWRS – Quick Reference Guide on Billable Indirect Time policy page outlines the requirements for billable indirect time and lists eligible services. All other indirect time is accounted for in the program plan support component of the rate frameworks.
Direct contact is face-to-face time. Direct contact may include alternative methods of service delivery when defined specifically within the service policy. This includes the remote support COVID-19 guidance.
Indirect service provision is in preparation for direct contact service provision, and cannot be billed for if there is no ultimate intention of providing a direct service, even remotely. Providing a service remotely does not make it indirect time.
For detailed information about the HCBS settings rule, please visit the DHS HCBS settings transition plan page. See below for more information about specific requirements.
People with disabilities have a right to information that explains COVID-19 and identifies the gravity of the COVID-19 pandemic in order to make informed choices about how and where to spend their days and access the community as ordered. See the Person-Centered, Informed Choice and Transition protocol webpage for more information. Review stay-at-home guidance daily, providing educational materials in plain language. For the latest COVID-19 information from the state of Minnesota, see the #StayHomeMN Frequently Asked Questions webpage.
Ensure people understand which activities are allowed while practicing social distancing in public spaces:
Resources for people:
CMS has provided direction to waive the HCBS settings requirement temporarily to allow a person to have visitors at any time. Providers may limit visitors to support the health and safety of the people who live at the setting.
Please note, an HCBS Rights Modification Support Plan Attachment, DHS-7176H (PDF), is not needed for settings that implement restrictions on visitors during the COVID-19 pandemic (national public health emergency or state peaceful state of emergency).
Because CMS waived the right to allow a person to have visitors at any time, the direction to not complete a rights modification support plan if visitors are limited remains the same during both social distancing periods and the stay-at-home period.
Gov. Walz issued Executive Order 20-14 (PDF) to suspend eviction proceedings during the COVID-19 peacetime emergency to help provide housing stability at a time of financial uncertainty. The HCBS Rule requires that all provider-owned and -controlled residential settings have a lease or other legally enforceable agreement. This applies to community residential settings, customized living and foster care.
In addition, all 245D intensive support services require a 60-day service termination notice, in writing, with appeal rights. A person should not lose his or her residence without a 60-day notice. A person who is noncompliant with social distancing and mitigation recommendations cannot be suspended from services as there is not an imminent risk of physical harm to self or others.
People with disabilities have a right to information that explains COVID-19 and identifies the gravity of the COVID-19 pandemic in order to make informed choices about how and where to spend their days and access the community as allowed under emergency orders. See the Person-Centered, Informed Choice and Transition protocol webpage for more information. Review stay-at-home guidance daily, which provides educational materials in plain language. For the latest COVID-19 information from the state of Minnesota, see the #StayHomeMN Frequently Asked Questions webpage.
These changes can affect people with disabilities in different ways. These changes might be difficult to understand or adapt to. It can be scary to experience all of these changes so suddenly. But, there are things you can do to make it less frightening. There are things you can do to protect yourself. There are things you can do to protect other people. Everyone has a part to play.
Ensure people understand which activities are allowed while practicing social distancing in public spaces:
The COVID-19 (coronavirus disease 2019) pandemic has quickly changed how people:
Things can change quickly and be different day to day. Here are some things that you can expect to be a little different for a while:
Everyone has an important part to play. Here are some things you can do to help out right now: