State Assisted Living Policy: 1998. Minnesota



Elderly housing with services. MS § 144D.01 et seq.

Home care licensure: MS 114A.43 to 144A.48.

Minnesota rule, Chapter 4468 et seq.

General Approach

The Housing with Services Registration Act was effective in August 1996. It requires registration for all facilities providing housing and services to elderly persons. Services are provided through licensed home care provider agencies. Draft rules for these agencies were released in February 1998 and were not expected to be final until the fall of 1998. The Housing with Services agency may obtain such a license or contract with a licensed agency.

The state covers assisted living through its state funded Alternative Care (AC) program and the Medicaid Home and Community Based Services Waiver program. The Alternative Care Program serves nursing home eligible residents whose income exceeds Medicaid eligibility levels but who would spend down to Medicaid levels within six months if admitted to a nursing home. The HCBS waiver covers aged and disabled Medicaid recipients who meet the nursing home criteria.


Housing with services establishment means "an establishment providing sleeping accommodations to one or more adult residents, at least 80% of which are 55 years of age or older, and offering or providing for a fee, one or more regularly scheduled health-related services and two or more regularly scheduled supportive services, whether offered or provided directly or by another entity arranged for by the establishment."

The state's Medicaid waiver defines assisted living services as "up to 24-hour oversight and supervision, supportive services, home care aide tasks and individualized home management tasks provided to residents of a residential center living in their own units/apartments with a full kitchen and bathroom. A full kitchen includes a conventional stove with an oven, refrigerator, food preparation counter space and a kitchen utensil storage compartment.

Unit Requirements

Housing with services No requirements stated. Must meet appropriate building and fire codes for the structure.

Medicaid Assisted living policies under the waiver require full apartments with kitchens.

Tenant Policy

Housing with services The statute requires written contracts between the facilities and tenants that describe the registration status, terms, a description of services to be provided directly or through other arrangements, fee schedules and a description of the process through which the contract may be modified, amended or terminated, complaint procedures, retention policies and other items.

Medicaid waiver Participants for the AC and Medicaid waiver programs must be screened by the county preadmission screening team and must meet the nursing home level of care criteria. Most residents fall into case mix categories A through D (see table).


Assisted living home care providers must deliver at least one of the following and may deliver nursing services, delegated nursing services, other services performed by unlicensed personnel or central storage of medications.

Home care rules define health related services as professional nursing services or home health aide tasks such as administration of medication, routine delegated medical, nursing or assigned therapy procedures, assisting with body positioning or transfers of people who are not ambulatory, feeding clients who are at risk of choking, assistance with bowel and bladder control, devises and training programs, assistance with therapeutic or passive range of motion exercises, providing skin care and providing services to maintain hygiene during episodes of illness. Home care aide tasks include preparing modified diets, medication reminders, household chores in the presence of sophisticated medical equipment or when care requires prevention of exposure to infectious or contagious disease and assisting with ADLs for ambulatory clients with no serious acute illness.

The Medicaid regulations allow the provision of assisted living services which include home care aide and home management tasks provided to clients of a residential center within living units and provided by management or by providers under contract with the center. Home care aide tasks are differentiated from home health aide and include assisting with dressing, oral hygiene, hair care, grooming and bathing, if the client is ambulatory and has no serious illness or infectious disease, preparing modified diets, medication reminders, household chores in the presence of technically sophisticated medical equipment or episodes of acute illness of infectious disease.

The Medicaid waiver defines services as "supportive services include socialization (when socialization is part of the plan of care, has specific goals and outcomes established and is not diversional or recreational in nature), assisting clients in setting up meetings and appointments, and providing transportation (when provided by the residential center only). Individuals receiving assisted living services will not receive both homemaking and personal care and assisted living services. Individualized means that services are chosen and designed specifically for each resident's needs, rather than provided or offered to all residents regardless of their illness, disabilities or physical conditions. Under the AC and Waiver programs, residents may also receive home health and skilled nursing which are reimbursed separately from the payment for assisted living services.


Rates for services are negotiated between the client and the provider with limits based on the client's case mix classification. Service rates under the state funded AC program cannot exceed the state's Medicaid share of the average monthly nursing home payment. The client pays for room and board (raw food costs only - meal preparation is covered as a service). The cost of services in addition to assisted living services may not exceed 75% of the average nursing home payment for the case mix classification.

Under the HCBS waiver, rates for assisted living services are also capped at the state share of the average nursing home payment and the total costs, including skilled nursing and home health aide in addition to assisted living services, cannot exceed 100% of the average cost for the client's case mix classification. For room and board, the SSI and state supplement payment in 1998 is $667 and the resident retains a personal needs allowance of $54 a month. Residents whose income exceeds the SSI and state supplement level must "spend down" to the Medicaid Medically Needy level of $420 a month. To allow spend down beneficiaries to meet the room and board allowance, all costs below $667 are considered as a "remedial care cost" and are therefore eligible expenses for meeting spend down requirements.

The statewide maximum FY 98 service rates assisted living services for elderly recipients ranged from $684 a month to $1595 a month depending upon the case mix classification. Rates in a particular county could be higher or lower than the averages. In addition to the assisted living rates, the waiver has caps for all waiver services including assisted living. The Alternative Care Program rates for all services including assisted living ranged from $1072 to $200 a month. Medicaid waiver maximum costs ranged from $1429 to $333 a month depending upon the case mix classification. These rates are effective from October 1, 1997 to July 1, 1998 (see table). Approximately 92.6% of the Elderly Waiver participants fall into categories A through E.

The state is implementing the 300% Medicaid eligibility option for waiver participants. The maintenance level will remain at $667 and all excess income will be applied to the cost of waiver services. The state will also revise the payment rates for services.


The assisted living home care provider rules allow medication administration. Staff administering medications must be instructed by a registered nurse, the instructions must be written and the person must demonstrate competence in following the instructions.


The Department of Health's standards for home care services licenses do not apply to the building itself. Housing with services providers may not accept anyone for whom services cannot be provided and must staff to meet the needs of clients/residents.


Staff Orientation and training are required based on the tasks performed by the worker.

Training requirements are specified for staff performing home care aide tasks, home management tasks and delegated nursing tasks. Each person who applies for a license, provides direct care, supervision of direct care or manages services for a licensee must receive an orientation to home care requirements covering: an overview of the statute and regulations, handling of emergencies, reporting abuse/neglect, home care bill of rights, handling and reporting of complaints and services of the ombudsman.

Training and a competency evaluation are required for unlicensed people who perform assisted living home care tasks. The curriculum includes: an overview of the Minnesota statutes; recognition and handling of emergencies and use of emergency services; reporting the maltreatment of vulnerable adults; home care bill of rights; handling of complaints; services of the ombudsman; observation, reporting and documentation of client status and of the care or services provided; basic infection control; maintenance of a clean, safe and health environment; communication skills; basic elements of body functioning and changes in body function that must be reported to an appropriate health care professional; and the physical, emotional and developmental needs of clients.

Staff who provide medication administration and active assistance with medications must complete the above training program, pass a competency test and be instructed by a registered nurse in the procedures to administer the medications to each client/residents. The instruction is specific to each resident.

Staff providing home management tasks (housekeeping, meal preparation and shopping) must receive training on the bill of rights and orientation on the aging process and the needs and concerns of elderly and disabled persons.

Background Check

A license may be denied or suspended for conviction of any of 15 types of crimes listed in the regulations. Each employee with direct contact with clients must sign a statement disclosing convictions of all crimes, except minor traffic violations. Employees may be required to sign a release statement authorizing local authorities to provide the commissioner a history of criminal convictions.


Housing with Services buildings must pay a registration fee of $35 per address.

  Case Mix     Assisted  
Total Rates for all Services2 Description
A $684 $1072 $1429 Up to 3 ADL dependencies3
B $771 $1209 $1612 3 ADLs + behavior
C $871 $1356 $1820 3 ADLs + special nursing care
D $962 $1507 $2010 4-6 ADLs
E $1055 $1654 $2205 4-6 ADLs + behavior
F $1061 $1663 $2217 4-6 ADLs + special nursing care
G $1140 $1786 $2382 7-8 ADLs
H $1289 $2020 $2693 7-8 ADLs + behavior
I $1341 $2102 $2803 7-8 ADLs + needs total or partial help eating (observation for choking, tube or IV feeding and inappropriate behavior)
J $1423 $2320 $2974 7-8 ADLs + total help eating (as above) or severe neuro-muscular diagnosis or behavior problems
K $1595 $2500 $3333 7-8 ADLs + special nursing
  1. The maximum rate limits vary by region of the state but cannot exceed the maximum statewide limits.
  2. Rates include assisted living and all other waiver services which the residence is responsible for providing or arranging.
  3. ADLs include bathing, dressing, grooming, eating, bed mobility, transferring, walking and toileting.


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