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Home- and Community-Based Services (HCBS) let people live and receive support in their homes and communities rather than institutions. At the federal level, the HCBS Settings Rule requires person-centered planning, community integration, dignity, privacy, and individual choice for anyone receiving Medicaid HCBS. States enforce those principles through their own licensing frameworks. This post focuses on Minnesota’s 245D standards and practical steps providers can take to stay compliant.
Minnesota DHS licenses HCBS under Chapter 245D, which lays out provider duties across service recipient rights, protection standards, service planning and delivery, incident reporting, documentation, and staff training/roles. DHS also publishes sample policies and self-monitoring checklists you can adopt and tailor.
1. Service Recipient Rights (give, explain, document)
You must provide and explain 245D rights and maintain documentation of orientation; rights include participation in planning, receiving services aligned to preferences, privacy, and freedom from maltreatment and prohibited procedures.
2. Person-Centered Planning (PCP) & Timelines
Services must be person-centered and delivered per the support plan/addendum. For intensive services, the service plan must be completed within 10 working days after the initial planning meeting and reflect outcomes and supports.
3. Protection Standards & Restrictive Procedures
Emergency use of manual restraint (EUMR) is tightly limited: it must be the least restrictive intervention, used only to prevent imminent harm, and must end when the threat ends—paired with required documentation/review.
4. Maltreatment Policies & Reporting
License holders serving vulnerable adults must establish and enforce written maltreatment reporting policies and orient staff. Mandated reporters must report “immediately” (as soon as possible, not more than 24 hours) to MAARC or internally per policy.
5. Staffing, Training, and Roles
Providers must ensure staff are competent for their roles and that Designated Manager/Designated Coordinator responsibilities—program oversight, staff supervision, plan implementation—are clearly assigned and met, with orientation and ongoing training tracked.
Minnesota Department of Human Services
6. Incident Reporting & Internal Review
Have written procedures for incident reporting and internal reviews; DHS provides sample forms you can adapt. Ensure your policy covers what to report, when, to whom, and how you analyze trends and implement corrective actions.
7. Documentation & Recordkeeping
Maintain complete, current records: service plans/addenda, rights orientation, maltreatment reporting orientation, progress reports, complaints/grievances, and authorizations when handling funds—organized and retrievable for licensors.
Monthly
Audit a small sample of files (clients + staff). Verify rights orientation, PCP timeliness, incident follow-through, and progress notes. Use DHS self-monitoring checklists to standardize your review.
Check incident log for patterns; complete internal reviews and corrective actions.
Quarterly
Refresh staff training trackers; confirm required orientations/refreshers are completed and role-appropriate.
Re-review EUMR logs (if any) to ensure use/conditions and de-escalation requirements are met.
Hold a program evaluation huddle led by your Designated Manager/Coordinator; document decisions and follow-ups.
Minnesota Department of Human Services
Annually
Policy tune-up against the current 245D sections (rights, PCP, protection standards).
Late service plan/addendum after the planning meeting → build an automated reminder for the “within 10 working days” deadline.
Missing rights orientation documentation → add a required “rights given/explained” checkbox + signature in your intake packet.
Unclear EUMR process → add a one-page quick-reference: conditions, least-restrictive standard, stop criteria, and documentation steps.
Maltreatment reporting delays → post your policy flowchart at staff stations with MAARC hotline info and the “immediately (≤24 hours)” definition.
The HCBS Settings Rule expects real community integration and person-led planning—think having visitors, controlling resources, privacy (including lockable doors where applicable), and daily choices over routines—so your 245D practices should always map back to these federal expectations.
□ Rights provided/explained & documented at intake; annual re-orientation scheduled.
□ Person-centered plans/addenda current; intensive services plans done ≤10 working days after initial planning meeting.
□ Maltreatment policy posted; staff trained; reporting “immediately” (≤24 hours) to MAARC understood.
□ EUMR protocol limited to imminent harm; documentation/review procedure tested.
□ Designated roles (DM/DC) assigned; training trackers current; competency verified.
□ Incident log & internal review process active; trends analyzed; corrective actions tracked.
□ Records complete: rights, maltreatment orientation, plans, progress notes, grievances, fund authorizations
