Integrated Community Supports (ICS) marks a recent addition to waiver/245D license services, introduced in 2021 as part of Minnesota’s forward-thinking “waiver reimagine” initiative.
Understanding Integrated Community Supports (ICS)
Integrated Community Supports (ICS) stands as a licensed 245D service, offering vital support and training to adults within a provider-controlled, multifamily housing setting—a concept akin to the traditional “group home” programs. With the flexibility to provide up to 24 hours of service support daily, ICS focuses on fostering a holistic and inclusive living environment.
However, it’s important to note that ICS is not applicable in settings licensed under Minn. Stat. Chapter 144D or Minn. Stat. Chapter 144G for customized living or assisted living services, or licensed under Minn. Stat. Chapter 245A or Minn. Stat. Chapter 245D for adult or child foster care, community residential, or family residential services.
ICS offers assistance and/or instruction across four essential community living service domains: (1) community participation, (2) health, safety, and wellness, (3) household management, and (4) adaptive skills.
Community Participation
- Facilitating community mobility and pedestrian safety
- Supporting community resource use and access
- Enhancing awareness of community safety
- Building informal support systems and networks
- Developing interpersonal communication skills
- Planning leisure, recreation, and socialization activities
- Skill-building to meet transportation needs
Health, Safety, and Wellness
This category covers many services, including:
- Collaborating with individuals to coordinate health care, spanning physical, mental, and chemical aspects, as well as facilitating meaningful activities, social services, and managing meetings and appointments.
- Providing cueing, guidance, supervision, training, or instructional support to ensure the successful completion of self-care activities, emphasizing a personalized approach.
- Offering health services support in accordance with Minn. Stat. §245D.05, adhering to defined standards.
- Assisting individuals in activating and cultivating resiliency factors, incorporating strategies such as whole health action management.
- Delivering support tailored to the individual, enabling them to design and implement personalized strategies to attain their health, safety, and wellness objectives.
Household Management
This category covers many services, including:
- Assisting with routine household care and maintenance
- Instilling knowledge and skills for household safety
- Providing tenancy support and advocacy
- Offering guidance on budgeting and money management
- Supporting cooking, meal-planning, and nutrition
- Assisting with healthy lifestyle skills and practices
Adaptive Skills
This category covers many services, including:
- Implementing positive support strategies
- Enhancing crisis prevention skills
- Fostering problem-solving abilities
- Facilitating sensory/motor development for functional skills
- Providing strategies for self-sufficiency
- Conducting support and training for positive behavior development
In essence, Integrated Community Supports (ICS) is a forward-looking service model, catering to diverse needs and aspirations, ensuring individuals attain their health, safety, and wellness goals within an integrated community setting.
What Is An Integrated Community Supports Setting?
An Integrated Community Supports Setting refers to a multi-family housing building, such as a tri-plex, four-plex, or apartment building, where the service provider exercises direct or indirect control over the individual’s living unit. This setting must have an approved setting capacity report.
This setting is categorized as a provider-controlled Home and Community-Based Services (HCBS) setting and must adhere to all requirements outlined in 42 CFR 441.301(c). It does not qualify as a person’s own home, community residential program, or family residential program.
A living unit, in this context, is a self-contained residential space encompassing living, sleeping, eating, cooking, and bathroom areas. In a multifamily housing building, there are multiple such living units.
However, if a single provider owns or leases more than one living setting on the same or adjoining property, the lead agency can only authorize services in one of these settings.
Setting Capacity Report
Before an Integrated Community Supports provider can commence delivering services, they are obligated to submit a Setting Capacity Report (DHS-8062) to the Department of Human Services (DHS) for each Integrated Community Supports setting, as mandated by Minn. Stat. Chapter 245D. Only one HCBS provider is permitted to offer Integrated Community Supports in the approved setting. The completed DHS-8062 form should be emailed to hcbs.settings@state.mn.us.
Setting Capacity Limits
Integrated Community Support settings must align with the federal HCBS settings rule, imposing limitations on the number of units within a building where ICS can be provided. These limits are as follows:
- Integrated Community Supports may be offered in all living units in a setting with three or four units.
- In a setting with five or more units, Integrated Community Supports can be provided in less than 25 percent of the living units.
- An exception is made for settings with a site-specific review approved by the commissioner, where 25 percent or more of the units are occupied by individuals receiving Integrated Community Supports funded under BI, CAC, CADI, and DD waivers.
Site-Specific Review Guidelines
What is a Site-Specific Review?
A site-specific review is mandatory under the following circumstances:
- When 25% or more of the units in a setting are occupied by individuals receiving Integrated Community Supports (ICS).
- For housing explicitly developed, funded, or designated to cater to individuals with disabilities receiving Home and Community-Based Services (HCBS).
The primary aim of the site-specific review is to ensure that the setting neither isolates nor stigmatizes the individuals residing there.
Key Information for Site-Specific Review Submission
The provider must submit comprehensive information to the Department of Human Services (DHS) for the site-specific review, including, but not limited to:
- A setting-specific provider community integration plan outlining strategies to mitigate potential isolation effects.
- Policies and practices demonstrating staff training and monitoring of the community integration plan.
- Documentation of community living service category supports and training offered at the setting.
- Procedures to guarantee individuals have an informed choice to receive HCBS from providers other than the Integrated Community Support provider controlling the setting.
- Description of the provider’s continuous quality improvement process, including measures reflecting individuals’ experiences over time.
- Identification of any specialized care the provider will deliver and/or populations they will serve at the setting.
- Input from the lead agency and the local community where the setting is located, encompassing local perspectives and supporting information or strategies to address potential concerns
DHS will only approve the site-specific review if the submitted information:
- Demonstrates that the setting aligns with HCBS setting rule characteristics.
- Proves that the setting avoids the effects of isolation.
- Identifies a plan to monitor and address individuals’ ongoing experiences at the setting.
- Ensures individuals in the setting have the choice to receive HCBS from providers other than the Integrated Community Support provider controlling the setting.
If a site-specific review is deemed necessary based on the setting capacity report, DHS will reach out to the provider to collect the required information.
Billing for Integrated Community Supports
For information on how much to bill for Integrated Community Supports, refer to the DHS rate framework, specifically the ICS spreadsheet. Input your staffing and resident numbers to determine your specific rate per day. You can find the rate framework at [2022 Disability waiver rate-setting frameworks / Minnesota Department of Human Services](https://mn.gov/dhs/partners-and-providers/policies-procedures/reports-rates/rates/disability-rates).
Choice in Provider
When an individual decides to receive Integrated Community Supports (ICS), their choice extends beyond selecting the ICS service provider; it encompasses choosing both the provider and the specific integrated community supports setting, guided by the approved setting capacity report.
Living in an integrated community supports setting doesn’t obligate an individual to receive ICS. They have the autonomy to opt for alternative services from a provider of their choosing, such as individualized home supports or 24-hour emergency assistance.
Integrated Community Supports Service Limitations
Certain limitations apply to the services available to individuals receiving integrated community supports. Specifically, a person benefiting from integrated community supports cannot concurrently receive:
- Community residential services
- Family residential services
- Customized living (including 24-hour)
- 24-hour emergency assistance
- Individualized home supports
- Night supervision
- Respite
- Caregiver living expenses
In situations where multiple individuals reside in a single living unit within an ICS setting, the ICS provider must refrain from directing or facilitating who will and will not occupy the unit. Instead, each individual should have the freedom to choose their living arrangement, following rental guidelines or a lease agreement. Documentation should be maintained to confirm that each person, along with their case manager and legal representative (if applicable), is aware of and has chosen the living arrangement.
Integrated Community Supports (ICS) can be provided through remote support. However, it is essential that services delivered through remote support adhere to all the specified requirements to ensure quality and compliance.